Miranda Hennes MN, ARNP, PMHNP-BC will be starting her 5th year serving children and adolescents at Excelsior Wellness Center as a psychiatric mental health nurse practitioner. Prior to this she worked at Washington State University (WSU), College of Nursing for 4 years as an adjunct professor and prior to this a Teaching Assistant. Her undergraduate work includes oncology/med/surg, in-home health and Electroconvulsive therapy for the treatment of severe mental health conditions.

Ms. Hennes received her Master’s degree at WSU. She is a Center of Excellence, meaning she has been trained to diagnose and refer clients with Autistic Spectrum Disorders (ASD) to Applied behavioral analysis (ABA). She has also achieved her Medication Assisted Intervention (MAT) waiver for the purposes of opioid use disorder treatment.

Ms. Hennes is participating in the UW Community Based Integrated Care Fellowship and hopes to gain insight into how best to utilize/collaborate services for children and adolescents with ASD. Sometimes people with ASD have agitation which leads to poor ways of communicating through disruptive behavior. The treatment of choice for this is ABA therapy but the waiting lists are months long. The Spokane area is undeserved for this need. The practice improvement plans she will work toward includes a vision of a Spokane Autism Center similar to the pioneers at Seattle’s Autism Center.

In 5 years, Ms. Hennes hopes to see Collaborative Care as the norm instead of a concept providers have to re-route services through due to reimbursement demands.

Greg Hudson, DNP, ARNP works as a PMHNP in the Tacoma area. He is currently practicing at Greater Lakes Mental Healthcare in Lakewood, WA, working with both adults and children in an outpatient community mental health setting. Additionally, he is working with Hope Sparks, a counseling agency for children and families in Tacoma, to establish a collaborative medical practice.

Mr. Hudson was led to the collaborative care fellowship after witnessing the gaps in service and challenges that his clients experience when transferring to primary care. He is especially interested in developing a model of care that provides more collaborative support for primary care providers to care for psychiatric patients. He is looking forward to collaborating and building relationships with the UW faculty and providers throughout the state.

Greater Lakes struggles with the push to transition stable clients out to primary care that is not equipped to handle their needs. A common topic of discussion amongst his coworkers surrounds those in the community who are “recycled” back to Greater Lakes after crisis or hospitalization due to lack of community services. In Pierce County, the opening of a new psychiatric hospital Wellfound (a 120 bed joint-venture between CHI and Multicare) is sure to change the landscape of psychiatric care in the South sound. While more psychiatric beds are welcome, the people that fill those beds will need quality psychiatric care after discharge.

Mr. Hudson is enrolling in the collaborative care fellowship to help prepare for these changes and promote systems of integrated and collaborative care in the community.  

Mr. Hudson hopes that his participation in this program will help him to understand and implement a model of care where psychiatric specialists can provide support and consultation to primary care providers. He hopes that he can be a “leader from the front lines”, working with clients, providers, and the systems that manage them to close existing gaps and best utilize available resources. He hopes that in the future psychiatric care is more accessible and less stigmatizing for those in need and collaborative care is the norm rather than the exception.

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.