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.

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. 

Danielle Waldron, MSN, ARNP is entering her eighth year as a psychiatric nurse practitioner. She works both at Behavioral Health Urgent Care (BHUC) and in a small private practice in Snohomish County. In her clinical work at the BHUC, she assesses patients in crisis and assists those with difficulties accessing psychiatric care in their community. She provides psychiatric evaluation as well as consultation with ER physicians, primary care providers, and case managers, with the goal of assisting with ongoing care recommendations. She encounters a wide range of psychiatric disorders in this setting. In her work in private practice, she provides ongoing medication management and supportive therapy.

While she has some experience collaborating with primary care providers in her current work, she would like to improve her knowledge and skill set through the UW Community Based Integrated Care Fellowship. She is particularly interested in improving care around perinatal mental health and substance use disorders in integrated models. These patients are often seen as too complex for integrated care; however, they often have no other options for care. Her participation in this program will improve how she is able to advocate for integrated care for patient populations who are underserved.

In five years from now she hopes to see Collaborative Care expanded to reach more patients in need of psychiatric care in a timely manner.

Sahciko Oshio, PhD has a private practice mainly focused on women’s care for Japanese speaking women. She has been providing midwifery and women’s healthcare in various settings (private obstetrician’s office, my own private clinic, and hospital-based midwifery practices) in the past 20 years and recently added mental healthcare to the same population. Her main interest is women’s reproductive mental healthcare.

She is a novice as a mental healthcare provider. She hopes to learn from the leaders and fellow participants the arts of mental healthcare. She would like to develop a network of resources she can turn to and send patients to as appropriate for their needs, and in turn, she would like to be a resource for Puget Sound area women’s healthcare providers and birth communities.

Psychiatric mental healthcare can be more effective when paired with the content-specific expertise of specialists in various settings. For example, she is intimately familiar with experiences of infertility treatments, miscarriages and still births. She has supported patients through traumatic birth experiences and knows the reality of having a challenging newborn infant at home. By adding collaborative care provision skills, she can support perinatal/women’s healthcare providers with stronger mental health component.

Mental healthcare will become routine component for midwives and women’s healthcare providers.

Angela Carter, ARNP, PMHNP-BC is currently completing her Doctor of Nursing at Vanderbilt University. She received her Master’s degree at the University of Washington School of Nursing, and her post-MSN at Maryville University. She is in her 2nd year of serving psychiatric patients ages 16 years and above at the Helping Hearts Advanced Psychiatry Clinic, PLLC with various mental health care needs. She was an Adjunct Professor at the Seattle University from 2013-2019. She has advanced skills in telepsychiatry practice and is in interested in incorporating the collaborative care model into current practice.

Justin Bayley, DNP, ARNP is a psychiatric nurse practitioner working in Spokane.  His work as a medical nurse started in 2011.  His work in mental health began in 2014 as a float pool nurse who frequented the psychiatric units in Sacred Heart hospital.  Throughout this experience he saw the necessity of acute care but was frequently frustrated by a lack of outpatient psychiatry services.  After much reflection he decided to go back to school to be part of care that contributed to people staying out of the hospital.

Dr. Bayley started his career as a nurse practitioner in 2021 and currently works as a PHMNP at Excelsior Family Medicine.  Excelsior is a fast-expanding organization whose background is the treatment of children and their families.  Excelsior has continued to grow in its role as a mental health provider with WISe services, a holistic school, primary care, mental health care, and now an inpatient facility specializing in detox, behavioral rehabilitation, day treatment, and young adult residential services transition.

Through participation in the fellowship program, Dr. Bayley hopes to gain methodology and skills to better coordinate services throughout multiple specialties.  He is excited to explore the role of integrated care as it pertains to both primary care services and psychiatric services while incorporating their continuity with WISe services.  In 5 years, he hopes that fluid coordination can allow for effective access to care with prompt, consistent follow-up between primary care, mental health, and WISe programming. 

Tamra Johnson, ARNP, PMHNP-BC is a Psychiatric Mental Health Nurse Practitioner at Woman’s Health Care Center, at UW Medical Center – Roosevelt.  She provides mental healthcare services for individuals ages 13 and older and works collaboratively with the primary care providers, obstetrics and gynecology providers, specialty healthcare providers, and MSWs, to provide a “team-based” approach to wellness.  

Ms. Johnson is interested in collaborative and integrated healthcare because she is passionate about everyone having an opportunity to have access to psychiatric care and believes that collaborative and integrated healthcare is the pathway to achieve this. She appreciates being a part of the primary care, OB/GYN, and specialty care teams, and to be able to provide psychiatric care within the clinic where the patients already feel comfortable and are often well known to their care team.  Through this fellowship, she hopes to gain insight and a greater understanding of how collaborative care can give more patients access to psychiatric care. 

Ms. Johnson chose to participate in this fellowship to increase her knowledge and skill base in providing the collaborative healthcare that she plans to continue to develop and share within the clinic community and eventually, with the community-at-large.  

In 5 years, she hopes to see collaborative care continue to grow in practice and to be more widely accepted and utilized as the standard of care so that everyone that needs psychiatric care can access it. 

Julie Christiansen, ARNP is currently working as a psychiatric consultant in a primary care setting at CHAS Health, a community health organization based in Spokane. She splits her time between an urban clinic in the downtown corridor with a large homeless population in Spokane as well as a small rural community in Deer Park. Her daily panel is a mix of initial intakes, consultations with primary care providers and follow up appointments. One of the most satisfying aspects of the practice is the opportunity to work with complex, treatment resistant patients when they experience an improvement in function. The volume and complexity of patients keeps the day interesting.

Integrated care at CHAS Health has the potential to improve mental health outcomes in the primary care setting. CHAS Health’s Market Street clinic currently has a modified integrated care practice with a strong psychiatric consultant based there. One goal for Ms.Christiansen is becoming better equipped to implement a more integrated approach to psychiatric services at CHAS Health’s downtown and Deer Park clinics. She looks forward to learning skills related to providing psychiatric consultation to primary care providers who are resistant to change from “usual practice”.

Five years from now, she would like to see an established integrated care model at CHAS Health across all clinics, allowing increased access to psychiatry services in the primary care setting.

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.