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SUSTAINABILITY Implementation Stories

After the study, the organization-supported changes of 3CM were extended to the usual care practices, as well as to practices that did not participate in the research trial. The responsibility for training these additional clinicians and their practices was transferred from the research team to the participating organizations supporting them and the practices to sustain 3CM over the long term. After three years of follow up, the majority of practices continued to support the model with minimal modification.

Based on these research findings, a number of health plans have subsequently requested and received consultation and assistance with implementing 3CM. The Initiative has provided consultation to Magellan, Beacon Health, Blue Cross Blue Shield of Georgia, and Aetna. In 2006 Aetna’s Chairman’s Initiative was to improve primary care management of depression. Aetna incorporated 3CM’s training manuals and programs into a web-based education process that included care planner support for patients and Aetna consulting psychiatrist support for primary care clinicians treating covered patients with depression.

Subsequently, a variety of other organizations sought assistance from the MacArthur Initiative, as have some individual practices. The New York City Department of Health and Mental Hygiene established a Depression Initiative and chose to include 3CM as part of its effort. To complement public and physician education, consultation and training were provided by the Initiative for a pilot project to screen patients at community-based health centers and to provide 3CM care. The Department of Family Medicine of the University of Miami is working in partnership with community members of the Overtown neighborhood of Miami, historically one of the most impoverished communities. A major goal of this partnership is to improve access to mental health diagnosis and treatment in primary care. To address this goal, 3CM has been adopted and the Initiative has provided training and consultation on its implementation.

To assist the US Army with its plans to improve mental health care options for soldiers returning from service in Iraq and Afghanistan, the Initiative agreed to expand 3CM to address posttraumatic stress disorder and design a pilot project in a large primary care clinic at Ft. Bragg, North Carolina. The feasibility results from this project, “RESPECT-MIL,” have led to an expansion at additional primary care clinics at Ft. Bragg, 15 additional bases, as well as plans to expand RESPECT-MIL to another 17 army bases throughout the world.

To learn about the experiences of several organizations involved with the Three Component Model visit the Resources for Organizations section by clicking here.

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