Darcy Sander, ARNP began her nursing career in 1989 in Seattle, WA. She was employed in a community hospital childbirth center where she held positions in post-partum, labor and delivery, special nursery and post-discharge follow up care. Following a move to Eastern Washington she began working with WA state Medicaid population providing perinatal support services with the program Maternity Support Services. Ms. Sander entered a Master’s program in Psychiatric Mental Health Nursing after seeing a real need for perinatal mental health services. Upon graduation from Washington State University with a Masters of Nursing-Adult Psychiatric Mental Health Nursing, Ms. Sander became employed in a community mental health clinic in Eastern WA. She has been a psychiatric provider for crisis respite, PACT and outpatient services. She has enjoyed meeting mental health needs of both acute and chronic mental health conditions. Ms. Sander maintains a special interest in the perinatal population and completed a post-graduate certificate in infant mental health from the University of Washington in 2015. She has recently attended the Postpartum Support International Annual Conference in Portland and is participating in the perinatal ECHO program at the University of Washington. She plans to sit for certification in perinatal mental health created by Postpartum Support International.

There is a significant shortage of psychiatric providers in Washington and the nation. Ms. Sander is looking forward to participating in the Collaborative Care/Integrated Care fellowship to improve access to services for mental health for clients presenting to medical clinics, and for medical care from mental health clinics. Ms. Sander is particularly interested in increasing access for the perinatal client. She wants to gain expertise in consultative strategies to meet the needs of prenatal care providers ensuring evidence based psychiatric care for clients. Darcy’s hope is that participation in this fellowship will ultimately increase access to care, and ultimately increase awareness and treatment of perinatal disorders and infant mental health in Grant County and beyond.

A vision for Collaborative Care/Integrated Care 5 years from now would include regular communication between medical, psychiatric, and substance use disorders service providers while including clients in decisions and goals of care. Interagency agreements would be commonplace and fluid evolving to meet biopsychosocial changes of providers and clients. Care will include care provided across the lifespan and extending into child care centers, schools, and long term care facilities.

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. 

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.

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.

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.

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.

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.