Laura Katers, PA-C, MCHS, MS began her medical career in 2013 as a primary care provider in community medicine where the lack of mental health care access was so glaring she earned additional training and CME to better screen, diagnose and treat anxiety and depression disorders during the influx of new patients at the start of the Affordable Care Act. Nearly 50% of her patients hadn’t seen a medical provider in over 5 years. At the time, she also developed an interest in pain management as pain medicine is such a complex, nuanced and misunderstood phenomenon, and so many patients were suffering and forgoing care because of stigma or fear. Or, on the flipside, were mired in addiction.

In 2016 Ms. Katers began work as part of an interdisciplinary complex pain team at the University of Washington Medical Center and teaches courses in behavioral medicine with UW MEDEX Northwest. 

Ms. Katers’s interest in integrated care stems back to before PA school, when she worked as an addiction counselor and detox supervisor in Denver, CO. It was here that she saw the true failings of society, the people who fell through the cracks due to untreated mental illness, poverty, addiction, and for some, just plain bad luck. She was trained in substance abuse treatment and counseling and by way of a collaborative approach to care (at the time between local ERs, law enforcement, social workers, mental health, and primary care) she recognized a medical degree would allow her to become a stronger patient advocate. The drive to optimistically increase access to mental health care, patient by patient, is at the underbelly of her clinical interests and goes back to witnessing very dire situations rooted in trauma and addiction, but from which people did blossom with the right support and follow up.

Ms. Katers is interested in finding new solutions to integrating mental health care access not only in the community but also in the hospital, where for some this is the one point of contact to offer aid or intervene. Given that co-occurring psychiatric and substance use disorders can often be linked with pain, she hopes to build networks and collaborations with other community members to increase follow up for patients once they are discharged and to decrease the burden on primary care providers (who may have no mental health training).

Additionally, her team is in the process of establishing a perioperative pain clinic at UWMC where she hopes to share the trainings of the fellowship not only with other providers and staff, but also with patients. She is personally interested in pain psychology, telemedicine, and non-pharmacological approaches to pain management and in developing grants to bring these tools to the community.

Lastly, as an educator, she is interested in opportunity to develop mental health training for frontline providers, including creating affordable CME in primary care, and/or curriculum development with increased focus on behavioral medicine during student training. 

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.

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.