Jacynda Wheeler, DO, currently works at Island Hospital in Anacortes, in their Psychiatry & Behavioral Health Clinic, doing general outpatient psychiatry and working with a broad range of patients. The behavioral health clinic was established to support primary care clinics and providers in the community in providing quality mental health care.

Dr. Wheeler’s involvement in the integrated care track during residency at the University of Washington exposed her to the dynamic work going on at the interface of primary care and psychiatry. She is excited to further her knowledge in this fellowship while working to develop a more formal integrated care program at Island Hospital. She thinks we have an exciting opportunity to further our mission and improve access to mental health care by learning from the expertise and experience that the UW AIMS Center has to offer.

Dr. Wheeler is hopeful that 5 years from today, integrated care will feel more like a standard of care, and something that patients come to expect from their primary care clinics rather than feeling lucky to be part of a new program.

Vernetta Stewart, ARNP works as a psychiatric mental health consultant at Providence Everett Regional Medical Center (team includes two psychiatrists, two psychiatric N.P.s) performing mental health evaluations for patients with various co-morbidities including acute medical conditions, substance use disorders, and of course psychiatric components; prescribing psychotropic medications; advising medical providers; and making recommendations for treatment and disposition.

Ms. Stewart wishes to update her knowledge, including the use of alternative therapies on the most prevalent/effective clinical practices, psycho-pharmacotherapy, tele-psychiatry, and available community resources as well as the economic and political influences governing mental health services, especially with our underprivileged population.

Ms. Stewart’s long nursing career (as a staff RN and ARNP) has largely been centered in acute care settings in the Providence/Swedish systems and to a lesser degree in community mental health clinics. In the latter role, she has collaborated with PCPs, various agency case managers and clinicians, private practice psychiatric nurse practitioners, and of course patients’ families. There is much more to learn, however.

Ms. Stewart trusts participation in this program will facilitate her patients’ wellbeing in receiving the best treatment possible, especially upon being discharged back to the community which includes Everett and the outerlying rural areas.

Simone Hall, ARNP works for Community Health Center of Snohomish County, a federally qualified health center, as a psychiatric ARNP and behavioral health clinical director. She supervises 8 other staff and performs various administrative duties. In her clinical work, she provides psychiatric evaluation, consultation, and medication management for primary care patients. She works with patients that have a variety of mental health conditions and come from diverse backgrounds, most of whom are underserved.

Ms. Hall’s hope is to improve her knowledge base in the deliverance of care to populations served in the integrated care setting and become a more efficient and effective consulting provider for her primary care colleagues. She also hopes to learn more about the implementation of telepsychiatry, especially in a setting where resources may be scarce.

She believes her participation will improve the quality of care that is provided within her organization. With the knowledge that she gains from this fellowship, perhaps her organization will be able to utilize their resources more efficiently so that a greater number of patients can utilize their mental health services.

Five years from now, Ms. Hall’s hope is that Collaborative Care/integrated care is the normative approach for all outpatient settings in Washington state and becomes a model that more states adopt.

Rachael Barry, ARNP  is a psychiatric nurse practitioner for the Multicare Assertive Community Treatment (ACT) team. ACT is a multidisciplinary evidence-based treatment model that provides outreach-based care to clients with severe and persistent mental illness. This work involves seeing clients where they live or where they are at for the moment (shelter, hospital, McDonalds).

Ms. Barry’s interest in this program was sparked by the transdisciplinary nature of the program she works in right now. She sees first-hand how effective it can be when multiple disciplines work together towards the single goal of assisting clients live better lives. Her interest is also spurred on by frustration that she is not more effective in her collaborative efforts with primary care providers.

Ms. Barry’s hope for this program is that she will gain the skills and expertise needed to work more effectively with primary care providers to ensure clients receive the care they need as they become ready to move on from the intensive nature of ACT. She also hopes to gain insight into new and better ways she can leverage her skill set to serve clients.

Ms. Barry believes her participation in this program can positively affect the level of integrated care in her current practice and is excited to find new ways to build on her current practice model and think outside the box for how psychiatric care is delivered.

Ms. Barry hopes that in 5 years collaborative/integrated care will have expanded to the point where clients have meaningful access to psychiatric care before they have reached a crisis point with their symptoms. She also hopes that she will not have to argue for delay of transition to a lower level of care for clients served by her team because there is no one willing to continue prescribing the clients psychiatric medications.

Raghuram B. Bhat, MD, MA, FAPA is a board-certified psychiatrist, with additional board certifications in addiction medicine and geriatric psychiatry, as well as a Fellow of the American Psychiatric Association. He is currently the Medical Director of an addiction treatment center in Southwest Washington. Prior to this, Dr. Bhat held a number of medical leadership roles in WA and NY, including serving as Medical Director of dual diagnosis outpatient clinics, Medical Director of a methadone clinic, and Chief Medical Officer of a community mental health organization. He has taught and mentored medical students, psychiatry residents, and addiction psychiatry fellows, as well as psychiatric nurse practitioners and other psychiatrists. He has been interviewed in both written and television news about his work providing medication-assisted treatment for underserved adults with opioid addiction.

Dr. Bhat believes in providing compassionate, patient-centered, trauma-informed medical and psychological care for clients suffering from addiction, within a team-based approach that utilizes the best available pharmacological and behavioral treatments. He has a special interest in understanding and treating the psychological trauma that often underlies addiction.

Dr. Bhat applied to the Community-Based Integrated Care Fellowship with the hopes of learning how the approach may be applied to help more persons in his community benefit from evidence-based treatments for addiction, perhaps by expanding the team-based approach, successfully used in addiction treatment centers, to a broader team including primary care physicians and other community health providers. In the more distant future, Dr. Bhat is hopeful that such a community-based integrated approach may be further expanded, beyond addiction treatment, to include those for whom psychological trauma may be underlying the course of their general medical conditions.

David Paris, PMHNP-BC received his nurse practitioner degree from the University of Washington. He has worked in inpatient and outpatient psychiatry settings for more than 20 years, and currently works as a Psychiatric Nurse Practitioner for a private nonprofit clinic in Cowlitz County.

Mr. Paris also currently provides telepsychiatry services for crisis patients in Grays Harbor County. His employer is rapidly expanding into other services not robustly available in rural counties, including primary care and substance use disorder treatment. The integration of these services with ongoing mental health services is a primary focus of effort. He has extensive experience implementing and providing remote psychiatry services, including in austere locations. His current interest is the comprehensive management of patients with severe and chronic mental illness.

Renn Polk, ARNP received MSNs from the University of Southern Maine and Norwich University. She completed her psychiatric nurse practitioner residency at the joint Duke University and Durham VA Medical Center program. She is currently in the Doctoral completion program at Gonzaga University. In addition to her academic experience, Ms. Polk is a U.S. Army Veteran and current Army Reservist who will assume command of the 1972nd Combat Operational Stress Control Unit in June 2018.

Ms. Polk chose to pursue the Community-Based Integrated Care Fellowship as she has experienced how the false distinction between medical and mental health care can encumber patient care. She believes that integrated and patient-centered approaches are requisite elements of good health care. As part of her fellowship experience, she hopes to improve her own practice of integrated care and take an active role continuing the adoption of successful integrated care models in the Army and VA health care systems.

Ms. Polk’s clinical interests include moral injury, trauma, and stressor related disorders, and adjustment disorders related to military service and transitions. Her research interests include the identification and treatment of moral injury. She is currently proposing research investigating the intersection of trauma experiences, moral injury, and psychophysiological reactivity.

Howard Welsh, ARNP resides in Forks, WA where he does primary care for local residents, many of whom are loggers, truckers, and fishermen or longtime members of the local tribes engaged in subsistence activities. There is a sizable community of locals working in the forests gathering salal, mushrooms, and recycling cedar for roofing shakes.

There is one grocery store and two hardware stores. There is a Head Start and an elementary and secondary school system. Along Highway 101 there are some restaurants and motels with service workers, cooks, and waitresses. There are a few state and federal employees as well. This makes for a diverse population of patients. 

There are serious alcohol and polysubstance problems and seemingly intractable poverty-driven health problems with every kind of social and mental health problem imaginable. Residents watch the logs being loaded onto trucks and driven to the ports in Port Angeles and Aberdeen-Hoquiam and loaded onto ships headed overseas, where they are milled and processed – work the local residents used to do for decent wages.

In a community like this, Mr. Welsh is expected to do everything, so integration of healthcare is a necessity. According to Mr. Welsh, “The local people just don’t get any mental health care, or any care at all, without the integration of the clinic services wth the local agencies which are bare bones. It is good that an old curmudgeon such as myself is here trying to provide some patient advocacy where it is otherwise lacking.”

Since Mr. Welsh enjoys being a nurse, as well as fishing/ hunting/hiking, he will continue working here until something “forces him into retirement.”

Mr. Welsh appreciates the UW for helping him be a better provider and actually giving him the instruction he needs to keep working effectively in this environment.

Ginny Buccola-Tourney, DNP, ARNP works as a PMHNP, both in a small private practice and in community mental health, both in Pierce County. At the community mental health center where she spends most of her time, she serves as the manager of medical services, providing supervision and administrative support to a team of 5 providers as well as providing direct care to clients. She provides medication management for children, adolescents and adults with a specialty focus in perinatal mental health. She also enjoys providing reflective supervision in infant mental health for our local Nurse Family Partnership nurses and teaching both about perinatal mental health and infant mental health.

Ms. Buccola-Tourney is very interested in a model of care that supports psychiatric specialists serving as consultants to primary care providers. She would like to develop a sustainable model for her clinic to provide consultation to their area primary care providers. She is also hoping to build relationships and learn from other providers throughout the state.

Her clinic has struggled to recruit and retain psychiatric providers, and this will be even more pressing over the next few years as the majority of their provider team is close to retirement. Simultaneously there is a great push to transition more stable clients out of her clinic and back to their primary care providers. This type of transfer is not always successful as there is no current structure for them to provide ongoing consultation or relationship building with our informal community partners. With active collaboration we would be able to expand access for clients to have their psychiatric medications safely and effectively managed.

Ms. Buccola-Tourney has many hopes! She hopes that they have an effective consultation system in place for psychiatric specialists to provide consultation with primary care providers. She hopes that EMR systems are in place to facilitate provider to provider communication. She hopes that psychiatric care is more easily accessible to those who are in need and that they can receive the best quality care quickly and efficiently.