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. 

Kristin Bernhart, MD is a consulting Child and Adolescent Psychiatrist at Allegro Pediatrics, a multi-site pediatrics practice on the Seattle Eastside. Her role includes direct patient care of pediatric patients referred by Allegro pediatricians for diagnostic clarification and treatment recommendations. She provides consultation to the pediatricians about the psychiatry and behavioral health care of their patients. She is also involved in the development of Allegro Pediatrics’ behavioral health program, with the goal of building a program that can better support Allegro pediatricians and reach a larger population of patients needing care.

Dr. Bernhart believes integrated care offers an approach that can broaden the impact of psychiatric and behavioral health care for many patients and families who might not otherwise be able to access needed care. The percent of pediatric patients experiencing psychiatry and behavioral health concerns is high, and growing, while the opportunity for treatment from clinicians with the experience, training, and expertise has not kept pace. Primary care pediatricians continue to be first line in identifying and treating many children and adolescents in need of such care. She believes families and their pediatricians can benefit from the added support provided by care managers and psychiatrist consultants in the integrated care model.

Allegro Pediatrics includes close to 100 pediatricians and cares for close to 100,000 pediatric patients in its practice. Dr. Bernhart’s hope is that by participating in the UW Community-Based Integrated Care Fellowship she will be able to help build an integrated behavioral health program at Allegro in order to broaden the reach of psychiatry and behavioral health care for their patients.

Five years from now, Dr. Bernhart hopes that the integrated care model will build traction in pediatrics to support the increasing numbers of children and adolescents in need of psychiatry and behavioral health care in our area.

Keyna Graham-Heine, DNP, ARNP-PMHNP-BC, provides care as a Psychiatric-Mental Health Nurse Practitioner at Valley Cities Behavioral Health in King County, WA. She primarily provides psychiatric evaluations and medication management across the lifespan, working with a team consisting of clinician (counselor or therapist) and care coordinator.

Dr. Graham-Heine worked as a registered nurse for over 10 years in community health settings, including a Federally Qualified Health Center (FQHC), and the perspective on the needs of both primary care and behavioral health practitioners has led to an interest in integrated care. She hopes to learn integrated care frameworks and gain expertise to support primary care providers and improve client outcomes. Telemedicine, perinatal mental health, substance use treatment, and pediatric mental health treatment are all content areas of particular interest. University of Washington’s Community-Based Integrated Care Fellowship will provide additional support in honing interdisciplinary practice skills which Dr. Graham-Heine can apply in her current practice setting, where psychiatric providers consult at a local FQHC.

She previously had an opportunity to participate in UW’s interdisciplinary Leadership Education in Adolescent Health Fellowship, during which her leadership project topic pertained to increasing uptake of the Partnership Access Line in Pierce County to support primary care providers in providing behavioral health care and ultimately improve pediatric behavioral health outcomes. Through this project she found that primary care providers in Pierce County provide a great deal of behavioral health care and want more support and collaboration with their psychiatric colleagues in doing so. She wants to be well-prepared to provide this interdisciplinary support as a psychiatric specialist. As integrated care rolls out in her home community of Pierce County, where there are limited psychiatric resources, these skills will enable her to provide this type of support in her own community in the future.

Dr. Graham-Heine hopes that in 5 years Collaborative Care/integrated care will be an option for services in every community and for every client.