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. 

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.

Danielle Kizer, MD currently works at PeaceHealth St Joseph Medical Center in Bellingham. Her clinical duties include work on the consult/liaison service, attending on the 20 bed, locked, inpatient psychiatric unit, occasional work in the Emergency Department and ½ day a week in the primary care clinics. In addition, Dr. Kizer also has administrative duties as Medical Director for Behavioral Health. 

Dr. Kizer is interested in Collaborative/Integrated Care as she sees it as a creative and effective solution to the shortage of psychiatric providers in the nation. Dr. Kizer sees Collaborative/Integrated Care as a way to provide care to a large population of patients with limited resources, and as a way to provide support to primary care clinicians.

Dr. Kizer hopes to gain improved knowledge regarding implementation and maintenance of Collaborative/ Integrated Care with the hope of applying that knowledge to the newly initiated program at her institution. 

As above, Dr. Kizer has started a small Collaborative/Integrated Care program in her primary care clinics. She hopes to use her knowledge to improve implementation of the program, ongoing care of patients and support of clinicians. 

In 5 years Dr. Kizer hopes that patients and providers see the value of Collaborative/Integrated Care and that it becomes the norm for most primary care clinics. She hopes it will help break down the silos of “medical” and “psychiatric” care and allow all patients access to services.

Erika Rootvik, ARNP is a board certified PMHNP who works in community mental health in Walla Walla, WA.  She performs psychiatric evaluations and medication management for patients across the lifespan, working with outpatient treatment teams that include a registered nurse and a therapist or case manager.  She is also an active participant in the clinical leadership team at her community mental health center.  

Ms. Rootvik has been interested in Collaborative Care/Integrated Care since working with at-risk youth at a school-based health center and realizing how many people “fall through the cracks” in our current healthcare system, struggling to receive adequate services for both mental and physical ailments.  She hopes that through this program she can learn how to better collaborate with medical providers in her community to ensure easy access to appropriate services and improved continuity of care for individuals in her community.   

Ms. Rootvik is pleased that the state has placed great emphasis on providing equal access to mental healthcare services on a payment-based level.  Also, the organization she works for is a mid-adopter for Washington’s Integrated Managed Care, having just transitioned in January 2019.  Despite these initiatives, Ms. Rootvik recognizes that communication between mental health care providers and primary care providers needs to be improved.  She is hoping to develop a quality improvement program that aids in her organization’s collaboration with primary care providers.

Seeing that the need for mental health services is ever-expanding and the shortage of psychiatric providers does not appear to have an end in sight, Ms. Rootvik hopes that over the next few years this issue can be improved via closer collaboration with primary care providers.  She would like to see lower acuity psychiatric patients more easily transferred to medication management under their primary care providers so that mental health providers can continue to meet the demands of more severe cases that require a higher level of care.  

Kate Cousineau, PA  works in private family practice where she is part of a behavioral health team providing comprehensive behavioral health services to internal clinic patients.  Patients are self identified or identified by their primary care providers as needing more intense psychiatric services than they can provide. Ms. Cousineau works with therapists and social workers, as well as local community resources, to provide integrated care to a rural community in the Gorge.

Ms. Cousineau’s interest in collaborative care started when she was a child welfare social worker.  It was apparent to her that the behavioral health system, primary care system, and drug and alcohol system were separate spokes trying to accomplish similar goals; however, due to their lack of communication and disjointed relationship, patients’ care suffered. 

Patients went to jail or became acutely ill because there was no comprehensive clinic for patients to receive care, and they were often lost to follow-up in the confusion.  Patients also had a hard time developing relationships with so many providers and became frustrated with frequent appointments and differing opinions.  She sadly saw patients die on waiting lists for Medication Assisted Treatment when they were active patients at a local behavioral health or primary care clinic.  This led her to believe in the power of good primary care, and to want to create a model that was supportive to primary care providers and sustainable for patients.

Participation in this program will help Ms. Cousineau solidify a model of care within her clinic and community that will be helpful for her primary care colleagues, financially sustainable, and easy for patients to access.  She hopes that patients isolated by the mountains in the Gorge will have access to a level of quality that they could enjoy in a progressive urban area. 

Ms. Cousineau hopes that integrative care will be the standard of care in 5 years, practiced by all primary care for the benefit of all patients.  Her goal is for all patients to be able to access care in a timely manner, and for no patient to ever die on a waiting list again.

Laura Katers, PA-C, MCHS, MS began her medical career in 2013 as a primary care provider in community medicine where the lack of mental health care access was so glaring she earned additional training and CME to better screen, diagnose and treat anxiety and depression disorders during the influx of new patients at the start of the Affordable Care Act. Nearly 50% of her patients hadn’t seen a medical provider in over 5 years. At the time, she also developed an interest in pain management as pain medicine is such a complex, nuanced and misunderstood phenomenon, and so many patients were suffering and forgoing care because of stigma or fear. Or, on the flipside, were mired in addiction.

In 2016 Ms. Katers began work as part of an interdisciplinary complex pain team at the University of Washington Medical Center and teaches courses in behavioral medicine with UW MEDEX Northwest. 

Ms. Katers’s interest in integrated care stems back to before PA school, when she worked as an addiction counselor and detox supervisor in Denver, CO. It was here that she saw the true failings of society, the people who fell through the cracks due to untreated mental illness, poverty, addiction, and for some, just plain bad luck. She was trained in substance abuse treatment and counseling and by way of a collaborative approach to care (at the time between local ERs, law enforcement, social workers, mental health, and primary care) she recognized a medical degree would allow her to become a stronger patient advocate. The drive to optimistically increase access to mental health care, patient by patient, is at the underbelly of her clinical interests and goes back to witnessing very dire situations rooted in trauma and addiction, but from which people did blossom with the right support and follow up.

Ms. Katers is interested in finding new solutions to integrating mental health care access not only in the community but also in the hospital, where for some this is the one point of contact to offer aid or intervene. Given that co-occurring psychiatric and substance use disorders can often be linked with pain, she hopes to build networks and collaborations with other community members to increase follow up for patients once they are discharged and to decrease the burden on primary care providers (who may have no mental health training).

Additionally, her team is in the process of establishing a perioperative pain clinic at UWMC where she hopes to share the trainings of the fellowship not only with other providers and staff, but also with patients. She is personally interested in pain psychology, telemedicine, and non-pharmacological approaches to pain management and in developing grants to bring these tools to the community.

Lastly, as an educator, she is interested in opportunity to develop mental health training for frontline providers, including creating affordable CME in primary care, and/or curriculum development with increased focus on behavioral medicine during student training. 

Miranda Hennes MN, ARNP, PMHNP-BC will be starting her 5th year serving children and adolescents at Excelsior Wellness Center as a psychiatric mental health nurse practitioner. Prior to this she worked at Washington State University (WSU), College of Nursing for 4 years as an adjunct professor and prior to this a Teaching Assistant. Her undergraduate work includes oncology/med/surg, in-home health and Electroconvulsive therapy for the treatment of severe mental health conditions.

Ms. Hennes received her Master’s degree at WSU. She 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.

Ms. Hennes is participating in the UW Community Based Integrated Care Fellowship and hopes to gain insight into how best to utilize/collaborate services for children and adolescents with ASD. Sometimes people with ASD have agitation which leads to poor ways of communicating through disruptive behavior. The treatment of choice for this is ABA therapy but the waiting lists are months long. The Spokane area is undeserved for this need. The practice improvement plans she will work toward includes a vision of a Spokane Autism Center similar to the pioneers at Seattle’s Autism Center.

In 5 years, Ms. Hennes hopes to see Collaborative Care as the norm instead of a concept providers have to re-route services through due to reimbursement demands.

Greg Hudson, DNP, ARNP works as a PMHNP in the Tacoma area. He is currently practicing at Greater Lakes Mental Healthcare in Lakewood, WA, working with both adults and children in an outpatient community mental health setting. Additionally, he is working with Hope Sparks, a counseling agency for children and families in Tacoma, to establish a collaborative medical practice.

Mr. Hudson was led to the collaborative care fellowship after witnessing the gaps in service and challenges that his clients experience when transferring to primary care. He is especially interested in developing a model of care that provides more collaborative support for primary care providers to care for psychiatric patients. He is looking forward to collaborating and building relationships with the UW faculty and providers throughout the state.

Greater Lakes struggles with the push to transition stable clients out to primary care that is not equipped to handle their needs. A common topic of discussion amongst his coworkers surrounds those in the community who are “recycled” back to Greater Lakes after crisis or hospitalization due to lack of community services. In Pierce County, the opening of a new psychiatric hospital Wellfound (a 120 bed joint-venture between CHI and Multicare) is sure to change the landscape of psychiatric care in the South sound. While more psychiatric beds are welcome, the people that fill those beds will need quality psychiatric care after discharge.

Mr. Hudson is enrolling in the collaborative care fellowship to help prepare for these changes and promote systems of integrated and collaborative care in the community.  

Mr. Hudson hopes that his participation in this program will help him to understand and implement a model of care where psychiatric specialists can provide support and consultation to primary care providers. He hopes that he can be a “leader from the front lines”, working with clients, providers, and the systems that manage them to close existing gaps and best utilize available resources. He hopes that in the future psychiatric care is more accessible and less stigmatizing for those in need and collaborative care is the norm rather than the exception.

Terese Schneider, DNP, ARNP, PMHNP is employed by the VA Puget Sound Health Care System as a psychiatric nurse practitioner at the Bremerton, WA outpatient clinic in primary care mental health integration (PCMHI). Half of her time is dedicated to same day access; the remainder includes referrals from primary care providers for psychiatric medication consultation.  Acute, chronic or complex psychiatric cases are typically referred to specialty psychiatry care.

Dr. Schneider has been an advanced practice psychiatric nurse since 2004 at which time she obtained a Master’s Degree and board certification as a Psychiatric Mental Health Clinical Nurse Specialist. She was board certified as a Psychiatric Mental Health Nurse Practitioner in 2005. From 2004 to 2005 she worked for the Hampton Virginia VAMC  as a psychiatric prescriber, participated in a tobacco cessation research study and conducted group therapy. Dr. Schneider worked for the Philadelphia, PA VAMC from 2005 to 2006 in the outpatient addiction treatment monitoring ambulatory detox and counselling for substance abuse. From 2006 to 2015 Dr. Schneider served as a psychotherapist for the Horsham, PA VA outpatient clinic where she obtained  certification in Cognitive Behavior Therapy for Depression, Cognitive Processing Therapy for PTSD, and Cognitive Behavior Therapy for Insomnia. She also conducted Seeking Safety groups and smoking cessation treatment.

In 2014, Dr. Schneider obtained her Doctor of Nursing Practice degree as a  Psychiatric Nurse Practitioner from a prestigious program at Robert Morris University in PA. Dr. Schneider has been employed by the VA Puget Sound Health Care System since January, 2016 as a psychiatric nurse practitioner, having worked in Primary Care Mental Health Integration and in the Addiction Treatment Unit. Prior to becoming an advanced practice psychiatric nurse, Dr. Schneider had worked as a psychiatric RN BSN in various inpatient and outpatient mental health facilities for 15 years. 

Dr. Schneider hopes to learn more efficient and effective methods for curbside consultation. She also wants to learn the best evidence-based psychopharmacologic interventions for the psychiatric disorders that she treats. The advantages of PCMHI include allowing the Veteran immediate access to professional behavioral health providers in psychopharmacology and psychotherapy on the same day at the same location. PCMHI also provides expert consultation in behavioral health issues to busy primary care providers, who have varying degrees of familiarity dealing with behavioral health concerns of Veterans. 

Dr. Schneider is hopeful that as she gains more knowledge and skill in the PMCHI model, she will be able to encourage the providers to utilize the PCMHI services more consistently with its design. She is hoping that primary care providers would eventually adapt to the model and no longer think of the PCMHI team as a separate specialty mental health clinic. Dr. Schneider is also hopeful that the MH and primary care service lines’ leadership would  promote the PCMH model and educate the providers about our model, which has wonderful evidence basis for effectiveness to increase Veterans’ engagement in care and reduce the burden of mental illness on the population. 

Dr. Schneider hopes to see Primary Care Mental Health Integration as a service that people become so familiar with that it would be assumed that “we are on site, effective and utilized to the full extent of our expertise.” The VA Puget Sound HCS is talking about having primary care providers obtain waivers to prescribe buprenorphine for opioid use disorder, and having PCMHI prescribers obtain the waivers to support this practice in the primary care setting. She believes this would provide access to an evidence based pharmacologic agent at the front line of patient care for the opioid epidemic. Dr. Schneider believes that it would reduce the mortality and mortality from opioid use disorder. A recent VA webinar presenter pointed out that primary care clinics do have to provide specialty addiction services to do this.