MaryAnne Murray, DNP, EdD, FNP-BC, PMHNP-BC, CARN-AP has lived in Western Washington since she was a small child. Twenty years ago she left the big city and has lived in a series of rural communities. When she landed on the Long Beach Peninsula eight years ago, she found her place of joy. She is self-employed in a small private practice, plus she contract her services to a residential substance use disorder treatment program where she performs a psychiatric evaluation and medication management for each client. She also does some teaching, including precepting PMHNP students.

She has undergone training in MindBody Medicine and believes that health care needs to address the needs of the whole person. Integrated care is one way to accomplish this, and this fellowship offers a model which can work effectively while leveraging the skills of a psychiatric prescriber as a consultant to assist primary care providers in helping patients achieve their goals. She hopes to do this for her hometown and other communities in her rural county. She hopes to collaborate with two primary care physicians and a cast of ancillary-skilled individuals to create an integrated care clinic which likely will serve individuals from their town as well as 0communities up to 50 miles away.

In 2026, she expects that integrative care will be the model that people demand. She predicts that unless a person has a longstanding relationship with a particular primary care provider, he or she will reject primary care options which fail to include the whole-person focus. By that time, the other primary care clinics in her rural county will have adopted our model, or ask her or her team to show them how they have accomplished it. She hopes that by 2026, her team will be able to provide this care in a cost-effective manner with appropriate reimbursement which will allow them to pay their team reasonably well, offer the best healthcare place to work, and provide the most comprehensive healthcare services in the county.

Mariana Sant’Anna Neeway, DNP is a psychiatric mental health nurse practitioner at the Kadlec Behavioral Health Clinic in Richland. Kadlec Medical Center (and its many clinics) is the largest health care provider in the Tri-Cities area. Dr. Neeway works in outpatient medication management for patients across the lifespan dealing with psychiatric and mental health disorders. She works in an underserved area with a diverse population, both ethnically and socioeconomically. She hopes that the Community-Based Integrated Care Fellowship helps her and her team better develop and utilize their integrated care practice. She is also interested in telepsychiatry as a possibility for some of their patient appointments. 

Jennifer Purses, DO, is board certified in general psychiatry and child and adolescent psychiatry. She has been providing direct psychiatric consultative coverage in the acute care setting at Mary Bridge Children’s (a regional tertiary care children’s hospital) since August 2013 and has served as the Medical Director of Consultation & Liaison Psychiatry there since April 2016. More recently, her role is evolving to better strengthen outpatient primary care settings through providing support to co-located psychiatric nurse practitioners and through exploring novel models of care delivery to better address challenges of access to mental health services for pediatric primary care populations.

Dr. Purses has become very interested in the Collaborative Care Model and how this model may be adapted for children, adolescents, and families. She hopes that participating in this fellowship program will provide the skills and knowledge to establish a concrete plan moving toward better integration in pediatric primary care settings in the Mary Bridge Children’s Hospital & Health Network and across the Pacific Northwest. Learning what is needed to implement an integrated care model into our primary care settings is imperative to overcome barriers to care, particularly access. Educating and empowering primary care settings to care for basic mental health needs of children and families provides the opportunity to unburden specialty providers, allowing them to focus on higher acuity, more severe mental health needs, resulting in improved access to services for everyone.

Dr. Purses hopes that 5 years from now, Mary Bridge will have implemented a robust and successful Collaborative Care Model that allows families to receive care for basic mental health services in settings with which they are familiar and comfortable, thereby reducing barriers to care. She hopes that the roll-out of this novel model of care delivery will result in more children receiving the care they need, pediatricians feeling better equipped and increasingly competent at caring for the whole patient, and better integration of patient & family-centered care within primary (and perhaps even specialty) care

Debra Rice, ARNP, PMHNP is a Psychiatric Mental Health Nurse Practitioner (PMHNP), who currently provides outpatient psychiatric care at Catholic Charities in Richland and Yakima. This is a shared position involving a short commute and a diverse clientele. Debra has worked as a psychiatric provider for five years in both inpatient and outpatient settings. Prior to becoming a provider, she taught nursing and worked for twelve years at Eastern State Hospital as a psychiatric nurse. Her varied work background provided a rich landscape of psychiatric experiences that highlights the importance of collaboration in providing holistic care.

Ms. Rice believes that collaborative care is critical to the environment of psychiatric care, where many of the clients are disenfranchised and economically impoverished. These financial limitations affect the ability of psychiatric clients to access medical care; it also impacts their ability to effectively navigate complex communication contexts once they are engaged with the clinical setting. These factors make collaboration, and advocacy critical for preventative health care. Ms. Rice hopes to expand her ability to meet the many and varied needs of psychiatric clients through the collaborative/integrative care program.

Recently the premier Cardiac Center in the Yakima Valley, Astria Regional Medical Center, closed its doors. This closure has further impacted the lack of healthcare access in the Yakima Valley. Modalities like telemedicine are imperative to provide this area with the health care so important to meet the needs of the Valley. The Yakima Valley is also home to the Yakama Nation, a federally recognized tribe whose homeland covers 130,000 acres in southwestern Washington. The suicide rates among Native Americans is three times that of the national rate. As a provider in the Yakima Valley, Ms. Rice hopes her participation in this program will aid her in establishing new ways of expanding outreach to this rural community.

Ms. Rice is hoping that the collaborative/integrative care model becomes the standard of care within the next five years. She is confident that the use of this model will aid in providing holistic care to the Yakima Valley. 

Darcy Sander, ARNP began her nursing career in 1989 in Seattle, WA. She was employed in a community hospital childbirth center where she held positions in post-partum, labor and delivery, special nursery and post-discharge follow up care. Following a move to Eastern Washington she began working with WA state Medicaid population providing perinatal support services with the program Maternity Support Services. Ms. Sander entered a Master’s program in Psychiatric Mental Health Nursing after seeing a real need for perinatal mental health services. Upon graduation from Washington State University with a Masters of Nursing-Adult Psychiatric Mental Health Nursing, Ms. Sander became employed in a community mental health clinic in Eastern WA. She has been a psychiatric provider for crisis respite, PACT and outpatient services. She has enjoyed meeting mental health needs of both acute and chronic mental health conditions. Ms. Sander maintains a special interest in the perinatal population and completed a post-graduate certificate in infant mental health from the University of Washington in 2015. She has recently attended the Postpartum Support International Annual Conference in Portland and is participating in the perinatal ECHO program at the University of Washington. She plans to sit for certification in perinatal mental health created by Postpartum Support International.

There is a significant shortage of psychiatric providers in Washington and the nation. Ms. Sander is looking forward to participating in the Collaborative Care/Integrated Care fellowship to improve access to services for mental health for clients presenting to medical clinics, and for medical care from mental health clinics. Ms. Sander is particularly interested in increasing access for the perinatal client. She wants to gain expertise in consultative strategies to meet the needs of prenatal care providers ensuring evidence based psychiatric care for clients. Darcy’s hope is that participation in this fellowship will ultimately increase access to care, and ultimately increase awareness and treatment of perinatal disorders and infant mental health in Grant County and beyond.

A vision for Collaborative Care/Integrated Care 5 years from now would include regular communication between medical, psychiatric, and substance use disorders service providers while including clients in decisions and goals of care. Interagency agreements would be commonplace and fluid evolving to meet biopsychosocial changes of providers and clients. Care will include care provided across the lifespan and extending into child care centers, schools, and long term care facilities.

Claire Thurman-Moore, MSN, ARNP works as a PMHNP in Bellingham, WA. She is currently practicing at PeaceHealth St. Joseph Medical Center’s inpatient psychiatric unit. In the spring of 2020, she will be transitioning part-time to the integrated behavioral health program at PeaceHealth Medical Groups’ primary care clinic.

Like so many communities nationwide, Whatcom County does not have enough licensed psychiatric providers to meet the mental health needs of its community. Ms. Thurman-Moore has witnessed the impact of this shortage first hand. She frequently treats patients who have tried to seek timely psychiatric care in order to prevent hospitalization only to be turned away by psychiatrists or PMHNPs with full practices or months long waitlists. She also frequently refers psychiatrically complicated patients to their primary care providers for support after hospitalization, hoping that the PCP’s busy practices can adequately address these patients’ complex needs. 

PeaceHealth’s integrated behavioral health program attempts to fill this gap by directly supporting primary care clinicians as they provide timely, high-quality mental health care. Ms. Thurman-Moore has come to believe that this program and others like it are the best way to leverage scarce psychiatric resources in order to more efficiently and creatively care for individuals with mental illness in our communities. 

In participating in this fellowship, she hopes to solidify her skills as a psychiatric consultant as well as to identify and address specific needs within PeaceHealth’s existing integrated behavioral health program. In particular, she plans to work with her colleagues to develop a registry of patients with active mental illness to prevent folks from “falling through the cracks.”  She hopes that, as PeaceHealth’s integrated behavioral health program grows, it can serve as a model for other primary care clinics in the county and that, within five years, integrated behavioral health will be standard practice throughout the healthcare system. 

Paul Grekin, MD attended University of Michigan School of Medicine and completed psychiatry residency and community psychiatry fellowship at the University of Washington. He began work at Evergreen Treatment Services, an opioid treatment program that now has clinics in Seattle, Renton and Olympia, providing psychiatric care to patients with opioid use disorder who were unable to obtain that care elsewhere. He was subsequently promoted to medical director, overseeing the opioid treatment provided by a team of advanced practice nurses and physician assistants, as well as supervising the managers of each clinic’s dispensaries. During his career he has also served as medical director at Seattle Counseling Service for Sexual Minorities and provided psychiatric care and consultation at Pike Market Medical Clinic.

Patients with opioid use disorder have a high incidence of co-morbid psychiatric and medical problems for which they often have difficulty receiving adequate care due to stigma, distrust, poor organization and lack of resources. They are high users of acute medical systems, including emergency departments and hospitals. Providing primary medical and psychiatric services on site at the opioid treatment program, where the patients are already attending and feel a level of trust, should improve the patient utilization of needed care. However, experience suggests that even co-locating services does not overcome the barriers for many patients. Dr. Grekin envisions using the collaborative care model to facilitate the provision of integrated care by providers with whom the patients already have a trusting relationship. Dr. Grekin is participating in the fellowship to develop the knowledge and skills to implement integrated care using the Collaborative Care model at Evergreen Treatment Services and sees this as a potential model for other opioid treatment programs to pursue.

Angela Hamel, ARNP, PMHNP-BC will be starting her 3rd year serving patients of all ages at Kadlec Behavioral Health Clinic. She is also working at Washington State University as an adjunct professor teaching nurse practitioner students specializing in psychiatry. Prior to becoming a nurse practitioner she was an acute care nurse for over five years.

Mrs. Hamel received her Master’s degree at Gonzaga University. She is currently completing her Doctorate in nursing practice at Chatham University. Mrs. Hamel 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.

Mrs. Hamel has been collaborating with primary care providers in her current organization by making recommendations for patients with mild to moderate symptoms of mental illness. She is hoping to improve this program by participating in the UW Community-Based Integrated Care Fellowship. She is particularly interested in utilizing collaborative care to reach more individuals with mental illness and learn how to incorporate telepsychiatry into her practice to help patients in underserved areas.

Leslie Hite, ARNP, PMHNP-BC is a Psychiatric Mental Health Nurse Practitioner at Mid-Valley Clinic, a rural health clinic in Omak, WA (Okanogan County). She provides mental healthcare services for individuals across the lifespan and works collaboratively with primary care providers, specialty healthcare providers, chronic care managers, and community support services to provide a “team-based” approach to health. Ms. Hite also takes referrals from healthcare providers all over Okanogan County to meet the mental health needs of Okanogan County.   

Ms. Hite is interested in collaborative and integrated healthcare because she believes that a “team-based” approach has always been the best healthcare approach. She enjoys working together with an individual’s primary care provider and including other specialty providers and community resources to provide the best opportunity for health and wellbeing. Through this fellowship, she hopes to gain knowledge, new resources, and new ideas in providing integrated healthcare. 

Ms. Hite chose to pursue this fellowship to develop knowledge and skill in providing integrated healthcare that she plans to share with the healthcare providers and staff that she works together with which will increase the health of individuals across the clinic, community, and county.

In 5 years, she hopes to see that all healthcare providers are practicing collaborative or integrated healthcare everywhere. In Okanogan County, she hopes to see a positive trend in healthcare statistics or community health scores because of practicing integrated healthcare. 

Po Karczewski, ARNP is a contract prescriber, Psychiatric ARNP, currently providing medication management, assessment, and motivational interviewing for an inpatient drug and alcohol treatment facility, a child and adolescent clinic which has not offered medication management previously, and a clinic serving HIV positive clients.  He has always been an advocate for the importance of therapy, good nutrition, physical health, healing environments and psychiatric medication being used in conjunction with each other, along with emphasizing the cautious and judicious use of psychiatric medication. 

Mr. Karczewski hopes to develop a better understanding of how to be an effective voice for integrated care in his community in Pierce County, and to be able to work with the other Fellowship graduates in his area. Some efforts in this area in the past have resulted in sub-standard care, and it is important to have an effective model for integration.

He hopes to see Collaborative Care/integrated care be the standard of practice/organization. He thinks that the sharing of information systems with rigorous history and current status charting is likely to be more effective than attempts at partial co-location of services.