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.

Amber Kostial, MD, has been running a private adult general psychiatry practice in Bellingham since 2016. She opened her practice after working for a year at the local hospital due to observing the need for increased outpatient psychiatric care in the community. She owns her own practice, but shares office space and participates in an office association with two other psychiatrists and 6 psychotherapists, which allows for a community feeling and ample opportunity for consultation and collaboration.

Dr. Kostial’s interest in collaborative care was sparked by her experience participating in integrated care as a psychiatric consultant for PeaceHealth primary care clinics in Bellingham and via telemedicine with Peace Island Medical Center on San Juan Island. She enjoyed being able to collaborate with primary care providers and behavioral health care managers to help optimize mental healthcare for individuals in a timely and efficient way and to help identify individuals in need of more intensive care with a psychiatric prescriber and/or psychotherapist.

Dr. Kostial gained a basic understanding of integrated care systems through her experience and readings at the time, but through participating in the Integrated Care Fellowship she hopes to gain a breadth and depth of knowledge that will allow her to offer psychiatric consultation services to her community in an optimally informed, effective, and evidence-based way. There is a major shortage of psychiatric prescribers in Whatcom County, with no outpatient psychiatric services offered through the hospital, only a couple community mental health agencies serving individuals with Medicaid, and a handful of private practice psychiatrists/ psychiatric prescribers, with only a couple who take Medicare.

By participating in the Integrated Care Fellowship, Dr. Kostial hopes to help expand the reach of behavioral health care to individuals, including those who may never see a psychiatrist or therapist, in her local community. She hopes to share her experience with other local psychiatrists/psychiatric prescribers to get them interested in participating in integrated care also.

Dr. Kostial hopes that integrated care will be a usual component of primary care within the next 5 years. She also wonders if there might be value in the longer term to extending to some nonprimary care settings (e.g. neurology, dermatology, pain clinics, surgery clinics) to reach patients with frequent specialist contacts and complex comorbidities that may be significantly impacted by/have significant impacts on behavioral health.

Daniel Ferber, MD, does clinical work that includes psychiatric assessment and medication management to patients across the age spectrum. An interdisciplinary approach to patient care is integral to his role as a medical provider working in community mental health.

Dr. Ferber’s interest in participating in the collaborative care fellowship evolved from his role as Medical Director of a Community Mental Health Center currently in the process of implementing a Coordinated Care Behavioral Health Center (CCBHC) grant. He hopes that the knowledge gained from his participation in the fellowship will allow him to be a more effective participant in clinical planning at the agencies where he practices. 

Dr. Ferber believesthe relationships developed from his participation in the fellowship will continue to be an invaluable resource as the application of integrated care evolves and impacts his clinical practice. 

Over the next five years , Dr. Ferber envisions coordinated care/integrated care as contributing greatly to improved health outcomes for our patients. Hopefully, the coordination between physical and mental health providers will not be implemented in such a way that it is perceived as an additional burden on our medical providers. 

Vernetta Stewart, ARNP works as a psychiatric mental health consultant at Providence Everett Regional Medical Center (team includes two psychiatrists, two psychiatric N.P.s) performing mental health evaluations for patients with various co-morbidities including acute medical conditions, substance use disorders, and of course psychiatric components; prescribing psychotropic medications; advising medical providers; and making recommendations for treatment and disposition.

Ms. Stewart wishes to update her knowledge, including the use of alternative therapies on the most prevalent/effective clinical practices, psycho-pharmacotherapy, tele-psychiatry, and available community resources as well as the economic and political influences governing mental health services, especially with our underprivileged population.

Ms. Stewart’s long nursing career (as a staff RN and ARNP) has largely been centered in acute care settings in the Providence/Swedish systems and to a lesser degree in community mental health clinics. In the latter role, she has collaborated with PCPs, various agency case managers and clinicians, private practice psychiatric nurse practitioners, and of course patients’ families. There is much more to learn, however.

Ms. Stewart trusts participation in this program will facilitate her patients’ wellbeing in receiving the best treatment possible, especially upon being discharged back to the community which includes Everett and the outerlying rural areas.

Simone Hall, ARNP works for Community Health Center of Snohomish County, a federally qualified health center, as a psychiatric ARNP and behavioral health clinical director. She supervises 8 other staff and performs various administrative duties. In her clinical work, she provides psychiatric evaluation, consultation, and medication management for primary care patients. She works with patients that have a variety of mental health conditions and come from diverse backgrounds, most of whom are underserved.

Ms. Hall’s hope is to improve her knowledge base in the deliverance of care to populations served in the integrated care setting and become a more efficient and effective consulting provider for her primary care colleagues. She also hopes to learn more about the implementation of telepsychiatry, especially in a setting where resources may be scarce.

She believes her participation will improve the quality of care that is provided within her organization. With the knowledge that she gains from this fellowship, perhaps her organization will be able to utilize their resources more efficiently so that a greater number of patients can utilize their mental health services.

Five years from now, Ms. Hall’s hope is that Collaborative Care/integrated care is the normative approach for all outpatient settings in Washington state and becomes a model that more states adopt.

Rachael Barry, ARNP  is a psychiatric nurse practitioner for the Multicare Assertive Community Treatment (ACT) team. ACT is a multidisciplinary evidence-based treatment model that provides outreach-based care to clients with severe and persistent mental illness. This work involves seeing clients where they live or where they are at for the moment (shelter, hospital, McDonalds).

Ms. Barry’s interest in this program was sparked by the transdisciplinary nature of the program she works in right now. She sees first-hand how effective it can be when multiple disciplines work together towards the single goal of assisting clients live better lives. Her interest is also spurred on by frustration that she is not more effective in her collaborative efforts with primary care providers.

Ms. Barry’s hope for this program is that she will gain the skills and expertise needed to work more effectively with primary care providers to ensure clients receive the care they need as they become ready to move on from the intensive nature of ACT. She also hopes to gain insight into new and better ways she can leverage her skill set to serve clients.

Ms. Barry believes her participation in this program can positively affect the level of integrated care in her current practice and is excited to find new ways to build on her current practice model and think outside the box for how psychiatric care is delivered.

Ms. Barry hopes that in 5 years collaborative/integrated care will have expanded to the point where clients have meaningful access to psychiatric care before they have reached a crisis point with their symptoms. She also hopes that she will not have to argue for delay of transition to a lower level of care for clients served by her team because there is no one willing to continue prescribing the clients psychiatric medications.

Raghuram B. Bhat, MD, MA, FAPA is a board-certified psychiatrist, with additional board certifications in addiction medicine and geriatric psychiatry, as well as a Fellow of the American Psychiatric Association. He is currently the Medical Director of an addiction treatment center in Southwest Washington. Prior to this, Dr. Bhat held a number of medical leadership roles in WA and NY, including serving as Medical Director of dual diagnosis outpatient clinics, Medical Director of a methadone clinic, and Chief Medical Officer of a community mental health organization. He has taught and mentored medical students, psychiatry residents, and addiction psychiatry fellows, as well as psychiatric nurse practitioners and other psychiatrists. He has been interviewed in both written and television news about his work providing medication-assisted treatment for underserved adults with opioid addiction.

Dr. Bhat believes in providing compassionate, patient-centered, trauma-informed medical and psychological care for clients suffering from addiction, within a team-based approach that utilizes the best available pharmacological and behavioral treatments. He has a special interest in understanding and treating the psychological trauma that often underlies addiction.

Dr. Bhat applied to the Community-Based Integrated Care Fellowship with the hopes of learning how the approach may be applied to help more persons in his community benefit from evidence-based treatments for addiction, perhaps by expanding the team-based approach, successfully used in addiction treatment centers, to a broader team including primary care physicians and other community health providers. In the more distant future, Dr. Bhat is hopeful that such a community-based integrated approach may be further expanded, beyond addiction treatment, to include those for whom psychological trauma may be underlying the course of their general medical conditions.

David Paris, PMHNP-BC received his nurse practitioner degree from the University of Washington. He has worked in inpatient and outpatient psychiatry settings for more than 20 years, and currently works as a Psychiatric Nurse Practitioner for a private nonprofit clinic in Cowlitz County.

Mr. Paris also currently provides telepsychiatry services for crisis patients in Grays Harbor County. His employer is rapidly expanding into other services not robustly available in rural counties, including primary care and substance use disorder treatment. The integration of these services with ongoing mental health services is a primary focus of effort. He has extensive experience implementing and providing remote psychiatry services, including in austere locations. His current interest is the comprehensive management of patients with severe and chronic mental illness.

Renn Polk, ARNP received MSNs from the University of Southern Maine and Norwich University. She completed her psychiatric nurse practitioner residency at the joint Duke University and Durham VA Medical Center program. She is currently in the Doctoral completion program at Gonzaga University. In addition to her academic experience, Ms. Polk is a U.S. Army Veteran and current Army Reservist who will assume command of the 1972nd Combat Operational Stress Control Unit in June 2018.

Ms. Polk chose to pursue the Community-Based Integrated Care Fellowship as she has experienced how the false distinction between medical and mental health care can encumber patient care. She believes that integrated and patient-centered approaches are requisite elements of good health care. As part of her fellowship experience, she hopes to improve her own practice of integrated care and take an active role continuing the adoption of successful integrated care models in the Army and VA health care systems.

Ms. Polk’s clinical interests include moral injury, trauma, and stressor related disorders, and adjustment disorders related to military service and transitions. Her research interests include the identification and treatment of moral injury. She is currently proposing research investigating the intersection of trauma experiences, moral injury, and psychophysiological reactivity.