Ignite: Making Connections that Spark Change (Ignite) seeks to address identified needs in our community resulting from limited access to mental health services, relatively high rates of chronic disease and the broader social determinants of health such as limited income and lack of social or emotional supports that negatively impact overall health and function in the population. Housed in the Mid-State Health Center, Ignite works with clients with depression and diabetes or high blood pressure using care coordination frameworks based on the evidence-based program, the IMPACT model. Using a referral system from primary care providers, behavioral health providers, or self-referral – patients can participate in the program where they will receive 12 weeks of telephone-based monitoring for health indicators for diabetes and hypertension. During the telephone call, the Ignite team member will also use behavioral activation techniques to help treat depression. Following the initial 12-week period, patients select the type of continued follow-up they would like. A nurse case manager oversees the implementation of the program, engages patients and families, and helps to train staff to better accommodate patients and to adapt the IMPACT model to better fit the needs of the community.