Five of the most essential elements are:

1. Collaborative care is the cornerstone of the IMPACT model and functions in two main ways:

• The patient's primary care physician works with a care manager to develop and implement a treatment plan (medications and/or brief, evidence-based psychotherapy)
  
• Care manager and primary care provider consult with psychiatrist to change treatment plans if patients do not improve

2. Depression Care Manager:

This may be a nurse, social worker or psychologist and may be supported by a medical assistant or other paraprofessional. The care manager:

• Educates the patient about depression
  
• Supports antidepressant therapy prescribed by the patient's primary care provider if appropriate
  
• Coaches patients in behavioral activation and pleasant events scheduling
  
• Offer a brief (six-eight session) course of counseling, such as Problem-Solving Treatment in Primary Care
  
• Monitors depression symptoms for treatment response
  
• Completes a relapse prevention plan with each patient who has improved

3. Designated Psychiatrist:

• Consults to the care manager and primary care physician on the care of patients who do not respond to treatments as expected

4. Outcome measurement:

• IMPACT care managers measure depressive symptoms at the start of a patient's treatment and regularly thereafter. We recommend the PHQ-9 as an effective measurement tool, however, there are other effective tools.

5. Stepped care:

• Treatment adjusted based on clinical outcomes and according to an evidence-based algorithm
• Aim for a 50 percent reduction in symptoms within 10-12 weeks
• If patient is not significantly improved at 10-12 weeks after the start of a treatment plan, change the plan. The change can be an increase in medication dosage, a change to a different medication, addition of psychotherapy, a combination of medication and psychotherapy, or other treatments suggested by the team psychiatrist.