Terese Schneider, DNP, ARNP, PMHNP is employed by the VA Puget Sound Health Care System as a psychiatric nurse practitioner at the Bremerton, WA outpatient clinic in primary care mental health integration (PCMHI). Half of her time is dedicated to same day access; the remainder includes referrals from primary care providers for psychiatric medication consultation. Acute, chronic or complex psychiatric cases are typically referred to specialty psychiatry care.
Dr. Schneider has been an advanced practice psychiatric nurse since 2004 at which time she obtained a Master’s Degree and board certification as a Psychiatric Mental Health Clinical Nurse Specialist. She was board certified as a Psychiatric Mental Health Nurse Practitioner in 2005. From 2004 to 2005 she worked for the Hampton Virginia VAMC as a psychiatric prescriber, participated in a tobacco cessation research study and conducted group therapy. Dr. Schneider worked for the Philadelphia, PA VAMC from 2005 to 2006 in the outpatient addiction treatment monitoring ambulatory detox and counselling for substance abuse. From 2006 to 2015 Dr. Schneider served as a psychotherapist for the Horsham, PA VA outpatient clinic where she obtained certification in Cognitive Behavior Therapy for Depression, Cognitive Processing Therapy for PTSD, and Cognitive Behavior Therapy for Insomnia. She also conducted Seeking Safety groups and smoking cessation treatment.
In 2014, Dr. Schneider obtained her Doctor of Nursing Practice degree as a Psychiatric Nurse Practitioner from a prestigious program at Robert Morris University in PA. Dr. Schneider has been employed by the VA Puget Sound Health Care System since January, 2016 as a psychiatric nurse practitioner, having worked in Primary Care Mental Health Integration and in the Addiction Treatment Unit. Prior to becoming an advanced practice psychiatric nurse, Dr. Schneider had worked as a psychiatric RN BSN in various inpatient and outpatient mental health facilities for 15 years.
Dr. Schneider hopes to learn more efficient and effective methods for curbside consultation. She also wants to learn the best evidence-based psychopharmacologic interventions for the psychiatric disorders that she treats. The advantages of PCMHI include allowing the Veteran immediate access to professional behavioral health providers in psychopharmacology and psychotherapy on the same day at the same location. PCMHI also provides expert consultation in behavioral health issues to busy primary care providers, who have varying degrees of familiarity dealing with behavioral health concerns of Veterans.
Dr. Schneider is hopeful that as she gains more knowledge and skill in the PMCHI model, she will be able to encourage the providers to utilize the PCMHI services more consistently with its design. She is hoping that primary care providers would eventually adapt to the model and no longer think of the PCMHI team as a separate specialty mental health clinic. Dr. Schneider is also hopeful that the MH and primary care service lines’ leadership would promote the PCMH model and educate the providers about our model, which has wonderful evidence basis for effectiveness to increase Veterans’ engagement in care and reduce the burden of mental illness on the population.
Dr. Schneider hopes to see Primary Care Mental Health Integration as a service that people become so familiar with that it would be assumed that “we are on site, effective and utilized to the full extent of our expertise.” The VA Puget Sound HCS is talking about having primary care providers obtain waivers to prescribe buprenorphine for opioid use disorder, and having PCMHI prescribers obtain the waivers to support this practice in the primary care setting. She believes this would provide access to an evidence based pharmacologic agent at the front line of patient care for the opioid epidemic. Dr. Schneider believes that it would reduce the mortality and mortality from opioid use disorder. A recent VA webinar presenter pointed out that primary care clinics do have to provide specialty addiction services to do this.