Yehonatan Shilo, MD is a psychiatrist at PeaceHealth St. John Medical Center in Longview, WA. 

He spends ⅔ of his time in outpatient, and ⅓ of his time doing hospital work and consultations in the ED as well as on the medical/surgical floors. 

This is his first job as an attending, after a long international journey in which he was exposed as a student, intern and resident to psychiatric care and primary care in Italy, Israel and now, the USA. 

Dr. Shilo’s interest in collaborative/integrated care has increased since he started practicing in a more rural/underserved area, especially during the COVID 19 pandemic. The limited access to care has made first presentations more clinically severe and has unnecessarily prolonged suffering. 

He hopes to gain tools that will allow him to help more people in an efficient and safe way. 

Dr. Shilo believes that in today’s reality in which psychiatric care is constantly lacking in availability and the prevalence of mental health problems only keeps rising, collaborative/integrated care will become more prevalent and being part of the model will become the reality for a lot of psychiatrists. 

Benjamin Stephens, MD is a 2021 graduate from the University of Virginia General Psychiatry Residency now in private practice in the Charlottesville, Virginia area.  He spends most of his time in direct patient care and hopes to form relationships with local primary care providers to establish his own collaborative care practice.  Dr. Stephens clinical experiences with behavioral health integration in primary care and rural telemedicine to underserved areas of Virginia has driven his interest in the collaborative care model.  He hopes to deliver higher quality care, at lower cost, to more Virginians who need mental health services.  By participating in the Community Based Fellowship Dr. Stephens hopes to bring the best practices in collaborative care back to Central Virginia.  In 5 years he hopes to have his own collaborative care practice and see collaborative care become more common in psychiatry residency training programs in Virginia.

Bianca Reis, DNP, ARNP, PMHNP-BC graduated from the Doctor of Nurse Practice program at the University of Washington in 2020 and has since worked as an outpatient Psychiatric Nurse Practitioner at a Community Health Center treating children through adults. Prior to this, Dr. Reis worked as a Psychiatric Clinical Nurse Specialist at UW-Valley Medical Center, overseeing the treatment of patients on the medical floors hospitalized with a primary or secondary, co-occurring psychiatric condition.

Dr. Reis would like to bring the extraordinary multidisciplinary and collaborative care work and effort she has experienced in the acute care setting to the outpatient setting. Although the collaborative care model is growing in community health, there continues to be systemic barriers to its progress and success. Dr. Reis hopes that this program will provide the tools to address the obstacles so that collaborative and integrated care models can grow and thrive.

Five years from now, she hopes that most of the current barriers to meaningful collaborative/integrated care models are eliminated so that care team members communicate effectively to bring about improved outcomes in our communities. 

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.

Anna Raymaker, DNP, ARNP, PMHNP-BC provides psychiatric services at Columbia Valley Community Health (CVCH), a Federally Qualified Health Center (FQHC), in Chelan, WA. This is the first time that CVCH Chelan has had a psychiatric prescriber on site full-time. Dr. Anna Raymaker provides both ongoing psychiatric treatment to a panel of patients as well as consultative services to the primary care providers (PCPs) at CVCH Chelan.

Dr. Anna Raymaker has worked in healthcare for approximately 10 years, and has explored various settings, specialties, and geographic locations throughout her career. She feels fortunate to have a meandering and nonlinear career, as it has provided her with so many unique and rewarding learning experiences.

CVCH Chelan utilizes an integrated care model, where medical, dental, and behavioral health services are provided under the same roof and in a collaborative way. Dr. Anna Raymaker is new to this model and hopes to further develop the communication and clinical skills necessary for this model of care through the UW Community-Based Integrated Care Fellowship.

Dr. Anna Raymaker hopes that involvement with the UW Community-Based Integrated Care Fellowship will allow her to help facilitate growth of behavioral health services within her agency and her community. For the near future, Dr. Anna Raymaker hopes that integrated care becomes a possible model for all rural communities, as rural healthcare continues have unmet primary care and behavioral health needs. 

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.

Katherine Kirner, ARNP has worked as a primary care provider at a Federally Qualified Health Center in Twisp, WA for the past 12 years. At least an hour from the nearest hospital or referral center, there is a mixture of  primary and emergent/crisis care. Frustrated by the lack of psychiatric resources in the area, she returned to school for certification as a PMHNP a few years ago. Now, she is also working as a psychiatric nurse practitioner at a small private practice. She continues to use her behavioral health expertise within the confines of a traditional primary care appointment.  

By participating in the Community-Based Integrated Care Fellowship Ms. Kirner looks forward to exploring ways to bring those two worlds together. As her organization moves toward integration of behavioral health and primary care, they are challenged by the geographic isolation of each of their clinics and lack of qualified providers. Ms. Kirner hopes to learn about telehealth and other strategies to provide resources for both patients and clinicians, even in the most remote clinics.

In the future, she would like to see behavioral health strategies used for all aspects of health care – from traditional mental health issues to diabetes and IBS. She is encouraged by the efforts of the University of Washington and other organizations to increase accessibility but acknowledges that there is still significant stigma and resistance on the part of patients. She believes that, through integrated care, we can continue to break down those barriers and normalize the experience of seeking help.