This month, Washington State took a big step forward despite considerable uncertainty about the future of health care in the U.S. Governor Jay Inslee and the Washington State Health Care Authority announced that Washington will receive up to $1.1 billion in incentives from the Centers for Medicare and Medicaid Services (CMS) to launch a five-year demonstration to achieve better care, better health, and better value. One of the primary goals of this effort is to address physical and behavioral health needs in one system through an integrated network of providers, offering better coordinated care for patients and more seamless access to effective behavioral health services in the communities where we live. This will advance the state’s Healthier Washington Initiative to bring together the financing and delivery of physical and behavioral health services. New Accountable Communities of Health (ACH) are being charged with selecting evidence-based approaches for integrating behavioral health into primary care. Our department will be working closely with the state to help accomplish this goal over the next few years.
Several of our faculty and staff – including Anna Ratzliff, MD, PhD, Ian Bennett, MD, Patrick Raue, PhD, John Kern, MD, Anne Shields, MHA, RN and others – are involved in supporting this effort through the creation of a Practice Transformation Support Hub that will offer training, coaching and tools to help accelerate the uptake of effective care models, support progress toward value-based payment systems, and strengthen clinical practice through integrating effective care for mental health and substance use problems.
In addition to working toward better mental health care in Washington State, we are also setting our sites on improving mental health on a global scale through an ongoing search for a Director of Global Mental Health. This will be a joint faculty appointment in the departments of Psychiatry and Behavioral Sciences and Global Health. We have developed an excellent list of candidates for this new position and we hope to announce a new program director sometime this spring. Here at UW, we have a lot to offer in terms of effective mental health care, but we also have a lot to learn from colleagues around the world about how we can address the enormous unmet need for better mental health care in both high and low resource settings.
Last month, for example, I had the privilege of traveling to Cuba with UW President Ana Mari Caucé on the first U.S. commercial flight between the U.S. West Coast and Cuba. Less than 100 miles from the United States, the Cuban health care system achieves remarkable successes in health such as life expectancy and infant mortality rates that rival those in the United States at a fraction of the cost of our own health care system.
Let me conclude on a personal note. These are challenging times for our patients and for many of us, with uncertainty about where we are headed in the U.S. health care system. I came to this country as an immigrant because I saw its capacity to make the world a better place and the enormous potential that lies in our diversity. Let’s listen to each other and work together to do our part in making the world a better place. I wish you all a happy and healthy New Year!
Jürgen
New Faculty Welcome to our newest faculty member, clinical psychologist Patrick Raue, PhD. Dr. Raue comes to us from Weill Cornell Medical College, Department of Psychiatry where he spent the last eighteen years as a faculty member. He has conducted extensive research at Cornell’s Institute of Geriatric Psychiatry on multiple aspects of late life depression, including patient preferences and shared decision-making approaches for depression, the effectiveness of psychotherapy among older adults, and suicidal ideation. Dr. Raue has expertise in psychiatric diagnoses and clinical assessment as well as in developing partnerships and conducting research in medical and community settings. He received his BA in Psychology from Catholic University of America and his MA and PhD degrees in Clinical Psychology from the State University of New York at Stony Brook.
Dr. Raue will develop and lead implementation and training programs in Problem Solving Treatment (PST) as well as other evidence-based behavioral health interventions working with faculty and staff in the AIMS Center and other parts of the department. He recently secured an NIMH-funded R34 to test the feasibility and acceptable of a simplified volunteer-delivered Behavioral Activation intervention for depressed senior center clients. Please join us in welcoming Dr. Raue to the West Coast! His email address is praue@uw.edu.
John Kern, MD, joined the department in November, 2016 to help train psychiatric consultants working on integrated care teams and to help with curriculum development for integrated care trainings as part of a nationwide training program we have developed in partnership with the American Psychiatric Association. Before coming to the UW, Dr. Kern was the Chief Medical Officer at Regional Mental Health Center in Merrillville, IN where he practiced for more than 25 years. Over the last 10 years, he has developed and supervised several collaborative care programs including an IMPACT-model behavioral health in primary care program and a Primary and Behavioral Health Care Integration (PBHCI) grant providing primary care for a seriously mentally ill population. He has also developed and served as Chief Medical Officer of a new Federally Qualified Health Center, working toward a completely integrated health system.
Dr. Kern helped author the recently-published American Psychiatric Press textbook on integrated care for psychiatrists as well as a SAMHSA-sponsored curriculum for training psychiatrists in integrated care, has written widely on integrated care (e.g. Psychiatric News integrated care column), and teaches and consults frequently on the integration of care. We’re thrilled to have John join our department! His email address is jkern2@uw.edu.
Writers Among Us: Two New Books Hit the Shelves A new book by Mark Sullivan, MD, PhD, focuses on the bioethics of chronic illness care and the importance of promoting patient autonomy and action. The Patient as Agent of Health and Health Care, published by Oxford University Press, provides a new theory of the patient as the primary agent of health and health care and argues that health care reform must take place at deeper level than has been considered to date. Described as a “clear, thoughtful, detailed, remarkable guide,” The Patient as Agent argues that truly patient-centered care requires a sense of patient-centered health that is perceived by the patient and defined in terms of the patient’s vital goals. If we get health wrong, Dr. Sullivan warns, we will surely get health care wrong. Learn more at http://www.markdsullivan.org/.
In Student Stress at the Transition to Middle School, Ann Vander Stoep, PhD, and Kelly Thompson, MSW, provide teachers, counselors, and administrators with a complete package for implementing the "Emotional Health Checkup," a program designed to identify and help middle school students who are in need of additional emotional support. Published by W. W. Norton & Company, Inc., the book makes a powerful contribution to the field of school mental health by addressing a critical transition in life for adolescents. This “must-read for school personnel” explains how to carry out classroom screening to detect if a student's stress has shifted from a manageable level to an unhealthy "distress" level and how to follow up with distressed students to create a support plan to address needs for academic, social, or emotional support. The book also describes how a school decides if the Emotional Health Checkup is a good fit for their school and how to get the school on board to implement the program.
Accepting Nominations for the Wayne J. Katon Outstanding Mentor Award
The Wayne J. Katon Outstanding Mentor Award acknowledges the time, dedication, and attention UW Psychiatry faculty members devote to fostering the career development and academic success of colleagues and trainees in the areas of mental health research, clinical practice and education. Through this award, the Department of Psychiatry and Behavioral Sciences honors and celebrates the valuable efforts of UW Psychiatry faculty members who embody Dr. Katon’s spirit of mentoring. One faculty member is selected each year. You can submit your nominations at https://catalyst.uw.edu/collectit/dropbox/rreicher/39704
Please contact Rachel Reichert (rreicher@uw.edu) for details about the nomination and the selection process. Nominations will be accepted February 1, 2017 through March 31, 2017.
Jennifer Villatte Named to ITHS KL2 Program Jennifer Villatte, PhD, is one of three early-career investigators to receive the ITHS KL2 Multidisciplinary Clinical Research Career Development Program. Dr. Villatte’s research is aimed at developing smart technologies that improve the quality and accessibility of evidence-based behavioral health interventions in routine care, as well as identifying factors that influence mHealth engagement and effectiveness.
For her KL2, Dr. Villatte seeks to develop an implementation support tool that helps providers deliver effective, efficient interventions that enhance patients’ mental and behavioral health. The tool will leverage innovations in artificial intelligence and signal processing to provide real-time, automated assessment of patient-provider interactions. It will also draw on human-centered design principles to deliver personalized, performance-based feedback and coaching in Cognitive and Behavioral Therapy (CBT) interventions.
Project STEP Looks at Effect of Marijuana on PTSD Treatment A substantial number of people develop posttraumatic stress disorder (PTSD) following trauma exposure, and many also use marijuana to help manage their symptoms. The co-occurrence of PTSD and marijuana use in trauma survivors is predictive of poorer outcomes and increased drop out from PTSD treatment. A new study led by Michele Bedard-Gilligan, PhD, is evaluating if and how marijuana use effects the treatment of PTSD by examining the relationship between marijuana and fear extinction in individuals with pathological fear as a result of trauma exposure.
Project STEP (Short Term Exposure for PTSD), funded by a National Institute on Drug Abuse (NIDA) R34 Treatment Development Grant, will explore whether an adapted short form of PTSD exposure treatment shows initial efficacy and feasibility (e.g., reduced drop out) for individuals with co-occurring PTSD and marijuana use, and will test the link between basic fear and recovery processes by looking at an extinction task as a predictor of treatment response for individuals with and without marijuana use.
This research is significant in its potential to identify a predictor of treatment response, to test an underlying mechanism of recovery in individuals with PTSD and co-occurring marijuana use, and to test feasibility of a novel intervention for a difficult to treat population. Co-investigators include Rick Ries, MD, Cynthia Stappenbeck, PhD, Nephi Stella, PhD, and Lori Zoellner, PhD (UW Department of Psychology).
Suicide Short Intervention Program Starts at VA Puget Sound Mark Reger, PhD, at VA Puget Sound Health Care System is the site-PI of a recently funded 5-year muti-site, randomized controlled trial of the Attempted Suicide Short Intervention program for Veterans (ASSIP-V). ASSIP is a brief patient-centered treatment that was found to reduce risk for a reattempt by 80% over two years in Swiss suicide attempters. Its innovation lies in its use of a video recording of the suicide narrative for use in the therapeutic process. Dr. Reger is collaborating with Peter Britton at the VA’s Suicide Prevention Center of Excellence.
Quarterly Research Report
In the second quarter of FY 2017, our department was awarded 17 grants totaling approximately $1.5 million. This only includes competing grants and supplements processed through OSP for which we have received funding notice and does not include grants or contracts processed through the SoM, SCH or VA Puget Sound. We are working to incorporate all of our external funding in a quarterly report which we will include in the department newsletter. Awarded grants (October 1- December 31, 2016).
“Reach Vet” Comes to VA Puget Sound, Identifies High-Risk Vets
VA is moving forward with some innovations in predictive medicine. You may have heard some of these buzz words before; precision medicine, predictive modeling, predictive analytics, or calculated risk scores based on regression analysis. VA is enhancing its use of public health models to proactively identify and mitigate risks in our Veteran population.
The push toward predictive medicine (some say, the wave of the future) came out of the national office for suicide prevention. Clearly, everyone has a strong desire to decrease suicides among the Veteran population. The national suicide prevention team worked closely with VA information technology to develop a program that predicts those at the highest risk for a number of negative outcomes, including suicide. The program uses VA’s treasure trove of data (mostly from the Computerized Patient Record System, or CPRS) to identify Veteran’s at the highest risk.
When they examined the top 0.1% of Veterans in the highest risk stratum, they found 30% on the list had been identified as high risk secondary to clinical indicators. For instance, the Veteran had a high risk flag for suicide, were already in a high intensity program, were identified as needing higher intensity care, or were high utilizers of care. Seventy-percent of the 0.1% were not clinically identified as high risk, but were statistically identified high risk. This 70% are of concern as they may be floating under our radar and may fall through the cracks. It is common that Veterans who die by suicide are Veterans with whom we are not very familiar - Veterans that were not clinically showing high risk, but were very vulnerable.
The program not only identified high risk of suicide attempt and suicide, it also identified Veterans at high risk for accidental overdose, other causes of mortality (e.g., accidents and injury), involvement with violence (victim or perpetrator), and admissions.
The new VA program called Reach Vet has been created to give us a systematic way to identify these Veteran’s and consider ways to enhance care. We will be using this new program here at VA Puget Sound and it was recently launched across the Country. We will be sharing more information with you as it comes in. We look forward to presenting you with more information and the concrete tools to utilize the program in the coming months.
Please note: this article first appeared in the January edition of the Mental Health Service Newsletter, VA Puget Sound and was written by Mary Lou McClure, RN
Markman and Piel Named Outstanding Junior Clinician Teachers Each year, our department honors an outstanding junior faculty member in our Clinician Teacher faculty pathway. We are delighted to announce that there are two recipients of this award this year, Jesse Markman, MD, MBA, and Jennifer Piel, MD, JD.
Jesse Markman is an irrepressible and exemplary educator. During his psychiatry residency, he co-developed a curriculum for first year residents about how to teach medical students, developed a one-day curriculum for senior residents on how to teach junior residents, and was instrumental in developing the residency’s Teaching Scholar Career Enrichment Pathway. On the faculty, he is Associate Residency Director at the Seattle VA, Director of Outpatient Mental Health there, and has designed and is piloting a Mentor Development Program for senior faculty across our department. His scholarly work focuses on psychiatric education at all levels, from medical students to faculty development.
Jennifer Piel is a stellar teacher and scholar in forensic psychiatry. After residency here and a Forensic Psychiatry fellowship at Case Western, she joined our faculty at the Seattle VA where she is Associate Residency Director, directs the Disruptive Behavior Evaluation Clinic, and provides a forensic psychiatry rotation for residents that includes mock trial experience. She also teaches UW undergraduate, graduate, and law students. She has an impressive publication record and has won the national American Academy of Psychiatry and the Law’s Young Investigator Award twice. She is also leading our department’s state-funded project designing a model forensic mental health teaching service for Western State Hospital.
The award will be presented at the department’s Graduation ceremony in June. Congratulations, Jesse and Jennifer!
Child & Adolescent Psychiatry, Psychosomatic Medicine Match Results
Our Child and Adolescent Psychiatry and Psychosomatic Medicine fellowships had highly successful Match days on January 4. This year, we were fortunate to recruit a number of truly outstanding candidates from our own residency program and from all around the country.
Marla Shu, DO, MPH – New York Institute of Technology/College of Osteopathic Medicine
Psychology Internship and Psychiatry Residency Recruitment Updates
The Psychology Internship had a successful Open House on January 4. The program received 214 applications for the 2017-2018 year. There are 3 tracks and there will be 14 slots for next year (3 adult, 4 child, 7 behavioral medicine/neuropsychology). The program invited 95 applicants to the open house. 77 applicants attended and those unable to attend interviewed by phone/skype. Thank you to everyone who has participated in this recruitment effort! We are looking forward to the Psychology Internship Match Day on February 17.
The Psychiatry Residency had 1,351 total applicants this year, with 604 of these from US allopathic medical schools and 164 from osteopathic medical schools. The program scheduled interview days for 131 applicants, including applicants for the Seattle Track, Idaho Track, and Psychiatry Residency Research Program. Interview days conclude on January 24 and Match Day will be March 17. Thank you to everyone who has participated in every part of this process, from interviewing applicants to inspiring students to come our way!
Jennifer Piel Selected as Legal Digest Editor Jennifer Piel, MD, is the new Editor of the Legal Digest section of the Journal of the American Academy of Psychiatry and the Law. The quarterly publication serves as a forum for the exchange of ideas at the interface of psychiatry and the legal system. Dr. Piel, based at VA Puget Sound, will manage all aspects of the Legal Digest section that highlights recent legal cases and their application to psychiatrists, forensic evaluators, and patients with mental health needs.
University of Washington
Department of Psychiatry and Behavioral Sciences
1959 NE Pacific Street, Box 356560
Seattle, WA 98195
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Dear friends and colleagues,
Welcome to our newest faculty member, clinical psychologist Patrick Raue, PhD. Dr. Raue comes to us from Weill Cornell Medical College, Department of Psychiatry where he spent the last eighteen years as a faculty member. He has conducted extensive research at Cornell’s Institute of Geriatric Psychiatry on multiple aspects of late life depression, including patient preferences and shared decision-making approaches for depression, the effectiveness of psychotherapy among older adults, and suicidal ideation. Dr. Raue has expertise in psychiatric diagnoses and clinical assessment as well as in developing partnerships and conducting research in medical and community settings. He received his BA in Psychology from Catholic University of America and his MA and PhD degrees in Clinical Psychology from the State University of New York at Stony Brook.
John Kern, MD, joined the department in November, 2016 to help train psychiatric consultants working on integrated care teams and to help with curriculum development for integrated care trainings as part of a nationwide training program we have developed in partnership with the American Psychiatric Association. Before coming to the UW, Dr. Kern was the Chief Medical Officer at Regional Mental Health Center in Merrillville, IN where he practiced for more than 25 years. Over the last 10 years, he has developed and supervised several collaborative care programs including an IMPACT-model behavioral health in primary care program and a Primary and Behavioral Health Care Integration (PBHCI) grant providing primary care for a seriously mentally ill population. He has also developed and served as Chief Medical Officer of a new Federally Qualified Health Center, working toward a completely integrated health system.
A new book by Mark Sullivan, MD, PhD, focuses on the bioethics of chronic illness care and the importance of promoting patient autonomy and action. 
In 
Jennifer Villatte, PhD, is one of three early-career investigators to receive the ITHS KL2 Multidisciplinary Clinical Research Career Development Program. Dr. Villatte’s research is aimed at developing smart technologies that improve the quality and accessibility of evidence-based behavioral health interventions in routine care, as well as identifying factors that influence mHealth engagement and effectiveness.
A substantial number of people develop posttraumatic stress disorder (PTSD) following trauma exposure, and many also use marijuana to help manage their symptoms. The co-occurrence of PTSD and marijuana use in trauma survivors is predictive of poorer outcomes and increased drop out from PTSD treatment. A new study led by Michele Bedard-Gilligan, PhD, is evaluating if and how marijuana use effects the treatment of PTSD by examining the relationship between marijuana and fear extinction in individuals with pathological fear as a result of trauma exposure.
Each year, our department honors an outstanding junior faculty member in our Clinician Teacher faculty pathway. We are delighted to announce that there are two recipients of this award this year, Jesse Markman, MD, MBA, and Jennifer Piel, MD, JD.
Jennifer Piel is a stellar teacher and scholar in forensic psychiatry. After residency here and a Forensic Psychiatry fellowship at Case Western, she joined our faculty at the Seattle VA where she is Associate Residency Director, directs the Disruptive Behavior Evaluation Clinic, and provides a forensic psychiatry rotation for residents that includes mock trial experience. She also teaches UW undergraduate, graduate, and law students. She has an impressive publication record and has won the national American Academy of Psychiatry and the Law’s Young Investigator Award twice. She is also leading our department’s state-funded project designing a model forensic mental health teaching service for Western State Hospital.