Danielle Kizer, MD currently works at PeaceHealth St Joseph Medical Center in Bellingham. Her clinical duties include work on the consult/liaison service, attending on the 20 bed, locked, inpatient psychiatric unit, occasional work in the Emergency Department and ½ day a week in the primary care clinics. In addition, Dr. Kizer also has administrative duties as Medical Director for Behavioral Health. 

Dr. Kizer is interested in Collaborative/Integrated Care as she sees it as a creative and effective solution to the shortage of psychiatric providers in the nation. Dr. Kizer sees Collaborative/Integrated Care as a way to provide care to a large population of patients with limited resources, and as a way to provide support to primary care clinicians.

Dr. Kizer hopes to gain improved knowledge regarding implementation and maintenance of Collaborative/ Integrated Care with the hope of applying that knowledge to the newly initiated program at her institution. 

As above, Dr. Kizer has started a small Collaborative/Integrated Care program in her primary care clinics. She hopes to use her knowledge to improve implementation of the program, ongoing care of patients and support of clinicians. 

In 5 years Dr. Kizer hopes that patients and providers see the value of Collaborative/Integrated Care and that it becomes the norm for most primary care clinics. She hopes it will help break down the silos of “medical” and “psychiatric” care and allow all patients access to services.

Erika Rootvik, ARNP is a board certified PMHNP who works in community mental health in Walla Walla, WA.  She performs psychiatric evaluations and medication management for patients across the lifespan, working with outpatient treatment teams that include a registered nurse and a therapist or case manager.  She is also an active participant in the clinical leadership team at her community mental health center.  

Ms. Rootvik has been interested in Collaborative Care/Integrated Care since working with at-risk youth at a school-based health center and realizing how many people “fall through the cracks” in our current healthcare system, struggling to receive adequate services for both mental and physical ailments.  She hopes that through this program she can learn how to better collaborate with medical providers in her community to ensure easy access to appropriate services and improved continuity of care for individuals in her community.   

Ms. Rootvik is pleased that the state has placed great emphasis on providing equal access to mental healthcare services on a payment-based level.  Also, the organization she works for is a mid-adopter for Washington’s Integrated Managed Care, having just transitioned in January 2019.  Despite these initiatives, Ms. Rootvik recognizes that communication between mental health care providers and primary care providers needs to be improved.  She is hoping to develop a quality improvement program that aids in her organization’s collaboration with primary care providers.

Seeing that the need for mental health services is ever-expanding and the shortage of psychiatric providers does not appear to have an end in sight, Ms. Rootvik hopes that over the next few years this issue can be improved via closer collaboration with primary care providers.  She would like to see lower acuity psychiatric patients more easily transferred to medication management under their primary care providers so that mental health providers can continue to meet the demands of more severe cases that require a higher level of care.  

Amber Kostial, MD, has been running a private adult general psychiatry practice in Bellingham since 2016. She opened her practice after working for a year at the local hospital due to observing the need for increased outpatient psychiatric care in the community. She owns her own practice, but shares office space and participates in an office association with two other psychiatrists and 6 psychotherapists, which allows for a community feeling and ample opportunity for consultation and collaboration.

Dr. Kostial’s interest in collaborative care was sparked by her experience participating in integrated care as a psychiatric consultant for PeaceHealth primary care clinics in Bellingham and via telemedicine with Peace Island Medical Center on San Juan Island. She enjoyed being able to collaborate with primary care providers and behavioral health care managers to help optimize mental healthcare for individuals in a timely and efficient way and to help identify individuals in need of more intensive care with a psychiatric prescriber and/or psychotherapist.

Dr. Kostial gained a basic understanding of integrated care systems through her experience and readings at the time, but through participating in the Integrated Care Fellowship she hopes to gain a breadth and depth of knowledge that will allow her to offer psychiatric consultation services to her community in an optimally informed, effective, and evidence-based way. There is a major shortage of psychiatric prescribers in Whatcom County, with no outpatient psychiatric services offered through the hospital, only a couple community mental health agencies serving individuals with Medicaid, and a handful of private practice psychiatrists/ psychiatric prescribers, with only a couple who take Medicare.

By participating in the Integrated Care Fellowship, Dr. Kostial hopes to help expand the reach of behavioral health care to individuals, including those who may never see a psychiatrist or therapist, in her local community. She hopes to share her experience with other local psychiatrists/psychiatric prescribers to get them interested in participating in integrated care also.

Dr. Kostial hopes that integrated care will be a usual component of primary care within the next 5 years. She also wonders if there might be value in the longer term to extending to some nonprimary care settings (e.g. neurology, dermatology, pain clinics, surgery clinics) to reach patients with frequent specialist contacts and complex comorbidities that may be significantly impacted by/have significant impacts on behavioral health.

Daniel Ferber, MD, does clinical work that includes psychiatric assessment and medication management to patients across the age spectrum. An interdisciplinary approach to patient care is integral to his role as a medical provider working in community mental health.

Dr. Ferber’s interest in participating in the collaborative care fellowship evolved from his role as Medical Director of a Community Mental Health Center currently in the process of implementing a Coordinated Care Behavioral Health Center (CCBHC) grant. He hopes that the knowledge gained from his participation in the fellowship will allow him to be a more effective participant in clinical planning at the agencies where he practices. 

Dr. Ferber believesthe relationships developed from his participation in the fellowship will continue to be an invaluable resource as the application of integrated care evolves and impacts his clinical practice. 

Over the next five years , Dr. Ferber envisions coordinated care/integrated care as contributing greatly to improved health outcomes for our patients. Hopefully, the coordination between physical and mental health providers will not be implemented in such a way that it is perceived as an additional burden on our medical providers.