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.