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.

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.