In a pilot study, collaborative care also has been found effective in treating low-income Latinas with cancer (Dwight-Johnson et al., 2005).

Three Component Model (3CM) of the MacArthur Initiative on Depression and Primary Care

Based on a review of research findings, the John D. and Catherine T. MacArthur Foundation Initiative on Depression and Primary Care developed a Three Component Model (3CM) in which the primary care clinician, a care manager, and a mental health specialist collaborate with the patient and with each other in providing care. Primary care processes also are reengineered to promote illness self-management, quantitative monitoring of the response to care, and modification of treatment as needed. Care processes include screening and assessment using standardized tools to identify the target population (patients with depression), patient education and engagement in shared decision making, use of a designated case manager to provide telephone support for the depressed patient and periodic feedback to the clinician on the patient’s response to treatment, and formal linkages with mental health specialists (Anonymous, 2004, 2006). A randomized controlled trial of this model in three medical groups and two health plans in the United States involving 60 affiliated primary care practices and 405 patients demonstrated significantly reduced symptoms of depression and increased remission rates compared with usual treatment (Dietrich et al., 2004). 3CM has been recommended as an approach for ensuring comprehensive survivorship care to cancer patients through “shared care” collaborations between specialist and primary care clinicians (Oeffinger and McCabe, 2006).

Project IMPACT Collaborative Care Model

Another model of care for delivering psychosocial health services was developed by a national panel of experts for the Improving Mood—Promoting Access to Collaborative Treatment for Late-Life Depression (IMPACT) project. This model consists of systematic assessment to determine a diagnosis; collaboration among patients and primary care and specialty providers to define the problem, develop a therapeutic alliance, and formulate a personalized treatment plan; follow-up and monitoring of treatment outcomes by a case manager; and use of protocols for the involvement of consultation or greater involvement in care by specialists. In a randomized controlled trial of the IMPACT project at 18 primary care clinics associated with eight health care organizations in five states with ethnically and socioeconomically diverse patients, patients with depression



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