Care Partners Grantee Directory MAY 2016
TABLE OF CONTENTS Depression in Late-Life Initiative... 1 The Care Partners Project... 1 Partnerships... 1 The Sites... 2 Family Health Centers of San Diego, Downtown Family Health Center at Connections & Serving Seniors... 3 El Sol Neighborhood Educational Center & SAC Health System... 5 Sonoma County Human Services Department, Adult & Aging Services Division & Petaluma Health Center... 7 LifeLong Over 60 Health Center & St. Mary s Center... 10 Institute on Aging & UCSF Housecalls and Center for Geriatric Care... 12 VA McClellan Outpatient Clinic... 14 USC-Eisner Family Medicine Center at California Hospital, Eisner Pediatric and Family Medical Center & St. Barnabas Senior Services... 16
DEPRESSION IN LATE-LIFE INITIATIVE Despite recent advances, older adults suffering with depression often do not seek or receive effective treatment. Older adults at particularly high risk for not receiving effective depression care include minorities, older men, and those with multiple medical problems, less formal education, and/or lower socioeconomic status. Closing gaps in care to improve access to effective depression treatment is important and timely. One of the most promising approaches to improving the reach, and effectiveness of late-life depression care, is through the systematic involvement of community-based organizations (CBOs), family, and primary care clinics that work with older adults. These community-engaged partnerships have tremendous potential to improve access to care, engagement in treatment, the patient care experience, and quality of care for depressed older adults. THE CARE PARTNERS PROJECT Archstone Foundation, through its Depression in Late-Life Initiative, seeks to support innovative approaches to treating depression in older adults through community-engaged partnerships. The applicants proposed effective partnerships that build on, and learn from, the strengths each organization brings to the team, to better understand, reach, and treat late-life depression. Together, partners will implement evidence-based Collaborative Care for late-life depression. Innovations in care, funded through this Initiative, will explore Collaborative Care models that can be applied in other communities to improve late-life depression reach, engagement, and treatment across California, and across the country. PARTNERSHIPS These partnerships will work together to deliver Collaborative Care for depression: Community-Based Organization (CBO) and Primary Care Clinic: This intervention will build on the strengths of the CBO and primary care clinic to determine an appropriate sharing of tasks involved in Collaborative Care for late-life depression. Tasks may be offered through the CBO, while others may be offered at the primary care clinic. The broad goal is to improve access and quality of care for older adults suffering from depression in the community. Primary Care Clinic and Family: The Primary Care Clinic Family intervention will feature innovative ways to systematically involve family members to strengthen the delivery of primary care-based depression treatment. These interventions will engage family members as partners, together with older adults suffering from depression, and primary care providers, to deliver Collaborative Care. The overall goal of this partnership is to promote a family-centered approach that will enhance access, and quality of care, for older adults suffering with depression, particularly those who are more difficult to engage in treatment. CBO, Primary Care Clinic, and Family: This intervention will feature innovative ways to systematically involve primary care, CBOs and family members to strengthen the delivery of depression treatment. 1
THE SITES The following sites were selected to participate in the Care Partners project on June 9, 2015. Funding to these sites began July 1, 2015 and continues to June 30, 2017. Grantee Partner Organization Community-Based Organization (CBO) and Primary Care Clinic: Family Health Centers of San Diego El Sol Neighborhood Community Center Sonoma County Human Services Department LifeLong Medical Center Institute on Aging Serving Seniors SAC Health System Petaluma Health Center St. Mary s Center UCSF Housecalls and Center for Geriatric Care Program Primary Care Clinic and Family: VA McClellan Outpatient Clinic N/A CBO, Primary Care Clinic, and Family: USC Department of Family Medicine Eisner Pediatrics and Family Medicine and St. Barnabas Senior Center 2
Family Health Centers of San Diego, Downtown Family Health Center at Connections & Serving Seniors Partnership Type: CBO and Primary Care Clinic The Primary Care Clinic: Downtown Family Health Center at Connections (DTFHC) Downtown Family Health Center at Connections (DTFHC) resides in the heart of downtown San Diego home to many of San Diego s lowest-income seniors and is co-located within a multi-service residential community designed to help homeless individuals move into permanent housing. The Community-Based Organization: Serving Seniors Serving Seniors is an independent non-profit organization focused on improving the health and wellbeing of San Diego s low-income seniors through the provision of essential services such as food, healthcare, housing, and social services. The Innovation Our partnership with Serving Seniors will allow DTFHC to create a medical neighborhood to enhance primary and mental healthcare for downtown seniors with depression. (Administration) From left: Steven Ritter, Myra Buby, Margarita Velosa, Dennis Dearie, Parwin Tahir, Nora Cole 3
Project Leadership and Primary Contacts Myra Buby, LCSW, DTFHC Title: Associate Director of Mental Health CP Role: Project Lead (Primary Contact Person PCC) Email: myrab@fhcsd.org Phone: (619) 876-4441 Nora Cole, MFT, DTFHC Title: Director of Mental Health Email: norac@fhcsd.org Phone: (619) 515-2318 Parwin Tahir, MSW, Serving Seniors Title: Social Service Case Manager (Primary Contact Person CBO) Email: parwin.tahir@servingseniors.org Phone: (619) 487-0725 Mary Mazyck, RN, BSN, Serving Seniors Title: Vice President of Programs & Services Email: mary.mazyck@servingseniors.org Phone: (619) 487-0617 Eileen Evans, DTFHC Title: Clinic Director CP Role: Clinic Oversight Email: eileene@fhcsd.org Phone: (619) 906-4675 Maureen Piwowarski, Serving Seniors Title: Chief Operating Officer CP Role: Organization Liaison & Oversight Email: maureen.piwowarski@servingseniors.org Phone: (619) 235-6538 Other Team Members Dennis Dearie, MFT, Serving Seniors Title: Director of Supportive Services Email: dennis.dearie@servingseniors.org Phone: (619) 487-0613 Paul Hazelbaker, DO, DTFHC Title: Primary Care Provider CP Role: PCP Champion Email: hazelbakerp@fhcsd.org Phone: (619) 876-4441 Joe Sepulveda, MD, DTFHC Title: Psychiatrist CP Role: Psychiatric Consultant Email: joes@fhcsd.org Phone: (619) 515-2355 x3341 Evaluation Lead Myra Buby, LCSW (see above) 4
El Sol Neighborhood Educational Center & SAC Health System Partnership Type: CBO and Primary Care Clinic The Primary Care Clinic: SAC Health System SAC Health System is a Federally Qualified Health Center. Teaching Health Center Graduate Medical Education programs provide primary care, behavioral health, dental, well woman, pediatric, family medicine and community resources to the residents of the Inland Empire. The Community-Based Organization: El Sol Neighborhood Educational Center Founded in 1991, El Sol serves the educational needs of San Bernardino and Riverside community members. Utilizing the Community Health Worker model, El Sol provides an array of culturally and linguistically competent community-based services, focused on promoting and maintaining the wellbeing of vulnerable communities. The Innovation Through their Community Health Worker program and by providing a strong link between SAC Health System, the community-based health center, and the patient, El Sol will provide an innovative approach in improving health outcomes for individuals at-risk for or suffering from depression in the Inland Empire region. From left: Oscar Bustillos, Amelia Zepeda, Tom Bazemore, Irma Abaunza. Monica Fuentes, Adriana Gomez 5
Project Leadership and Primary Contacts Amelia Zepeda, El Sol Title: Program Coordinator CP Role: Project Lead (Primary Contact Person CBO) Email: ameliazepeda@elsolnec.org Phone: (909) 682-4201 Tom Bazemore, MSW, SACHS Title: Manager, Special Projects & Family Resource Center Supervisor Email: tbazemore@sachealthsystem.org Phone: (909) 382-7174 Adriana Gomez, MSW, SACHS Title: Community Resource Specialist (Primary Contact Person PCC) Email: aggomez@sachealthsystem.org Phone: (909) 382-7175 Alex Fajardo, El Sol Title: Executive Director Email: alexfajardo@elsolnec.org Phone: (909) 884-3735 Angelica Alvarez, El Sol Title: Director of Programs Supervisor Email: angelicaalvarez@elsolnec.org Phone: (909) 884-3735 Maryellen Westerberg, PhD, SACHS Title: Director of Research, Special Projects & Behavioral Health Email: mwesterberg@sachealthsystem.org Phone: (909) 382-7131 Other Team Members Irma Abaunza, El Sol Title: Community Health Worker Email: irmaabaunza@elsolnec.org Phone: (909) 884-3735 Monica Fuentes, El Sol Title: Community Health Worker Email: monicafuentes@elsolnec.org Phone: (909) 884-3735 Brenda Boyle, NP, SACHS Title: Psychiatric Nurse Practitioner CP Role: Psychiatric Consultant Email: bboyle@llu.edu Phone: (909) 382-7135 Jason Lohr, MD, SACHS Title: Director of Clinical Operations CP Role: PCP Champion Email: JLLohr@sachealthsystem.org Phone: (909) 382-7180 Evaluation Lead Sharlene Gozalians CP Role: Evaluation Lead Email: sharlene.a.gozalians@gmail.com 6
Sonoma County Human Services Department, Adult & Aging Services Division & Petaluma Health Center Partnership Type: CBO and Primary Care Clinic The Primary Care Clinic: Petaluma Health Center Petaluma Health Center is the principal safety net health care provider in southern Sonoma County. It serves approximately 23,000 patients a year (mostly low-income), with services ranging from primary care to mental health treatment and even dentistry for children. The Community-Based Organization: Adult & Aging Services Division (A&A) The Sonoma County Human Services Department, Adult & Aging Services Division (A&A) serves as the county safety net provider of senior services. The Division provides protective services, in-home care assessment, and case management services to older adults and people with disabilities throughout Sonoma County. The Innovation A&A will embed a social worker with responsibility for home visits and care coordination into the clinic treatment team at Petaluma Health Center. The assessment and care plan developed by this home visiting care coordinator will help inform the treatment team and ensure that the patient s community needs are considered when developing a plan to treat his/her depression. From left: Anne Percival, Todd Finnemore, Diane Camurat, Vicki Rivera 7
Project Leadership and Primary Contacts Jenay Cottrell, A&A Title: Program Planning & Evaluation Analyst CP Role: Project Lead (Primary Contact Person CBO) Email: jcottrell@schsd.org Phone: (707) 565-5738 Nurit Licht, MD, Petaluma Title: Chief Medical Officer Email: nuritl@phealthcenter.org Phone: (707) 266-4372 Suzanne Cochrane, Petaluma Title: Project Manager CP Role: Primary Contact Person PCC Email: scochrane@phealthcenter.org Phone: (707) 559-7500 x1847 Anne Percival, MA, MFT, A&A Title: Social Service Supervisor II Supervisor Email: aperciva@schsd.org Phone: (707) 565-5986 Todd Finnemore, PsyD, Petaluma Title: Mental Health Director Email: toddf@phealthcenter.org Phone: (415) 225-0548 Pedro Toledo, Petaluma Title: Chief Administrative Officer Email: pedrot@phealthcenter.org Phone: (707) 559-7708 Gary Fontenot, A&A Title: Section Manager Email: gfonteno@schsd.org Phone: (707) 565-5931 Other Team Members Diane Camurat, MA, A&A Title: Case Manager Email: dcamurat@schsd.org Phone: (707) 565-5977 Vicki Rivera, LCSW, Petaluma Title: LCSW Email: vrivera@phealthcenter.org Phone: (707) 559-7500 Philippe Edouard, MD, Petaluma Title: Internal Medicine Physician CP Role: PCP Champion Email: pedouard@phealthcenter.org Phone: (707) 559-7500 Olga Robles, Petaluma Title: Mental Health Medical Assistant CP Role: BH Team Manager Email: Olgar@phealthcenter.org Phone: 707-835-4230 8
Ken Weinstock, MD, Petaluma Title: Psychiatrist CP Role: Psychiatric Consultant Email: kenw@phealthcenter.org Phone: (707) 559-7500 Evaluation Lead Jenay Cottrell (see above) 9
LifeLong Over 60 Health Center & St. Mary s Center Partnership Type: CBO and Primary Care Clinic The Primary Care Clinic: LifeLong Over 60 Health Center The LifeLong Over 60 Health Center is a leader in the delivery of integrated health and social services for the elderly. The Community-Based Organization: St. Mary s Center St. Mary s Center is a community of hope, justice and healing, serving at-risk elders and preschoolers in the heart of Oakland. The Innovation LifeLong and St. Mary s Center will both identify older adults with depression, jointly offer a range of clinical and non-clinical services when depression is identified, and track outcomes so nobody falls through the cracks. From left: Karla Salazar, Jesse Merjil, Eva Lumas, Alexis Bradley, Jennifer Elton 10
Project Leadership and Primary Contacts Steven Hardy, LifeLong Title: Center Director CP Role: Interim Project Lead, Organizational Liaison and Oversight Email: shardy@lifelongmedical.org Carol Johnson, St. Mary s Title: Executive Director Email: cjohnson@stmaryscenter.org Phone: (510) 923-9600 x223 Karla Salazar, BA, St. Mary s Title: Director of Resources for the Third Age CP Role: Project Lead & Care Manager (Primary Contact Person CBO) Email: ksalazar@stmaryscenter.org Phone: (510) 923-9600 x235 Other Team Members Sr. Eva Lumas, D.Min., St. Mary s Title: Community Projects Coordinator Email: elumas@stmaryscenter.org Phone: (510) 923-9600 x214 Jesse Merjil, LCSW, LifeLong Title: Clinical Social Worker Email: jmerjil@lifelongmedical.org Phone: (510) 428-4543 Alexis Bradley, BA, LifeLong Title: Community Health Worker Email: abradley@lifelongmedical.org Phone: (510) 428-4541 Megan O Brien, PMHNP, LifeLong Title: Psychiatric Nurse Practitioner CP Role: Psychiatric Consultant Email: mobrien@lifelongmedical.org Phone: (510) 981-4100 Jennifer Elton, NP, LifeLong Title: Nurse Practitioner CP Role: PCP Champion Email: jelton@lifelongmedical.org Phone: (510) 428-4511 Evaluation Lead Steven Hardy (see above) 11
Institute on Aging & UCSF Housecalls and Center for Geriatric Care Partnership Type: CBO and Primary Care Clinic The Primary Care Clinic: UCSF Housecalls and Center for Geriatric Care UCSF Housecalls and Center for Geriatric Care serve San Francisco s homebound elders who are in need of home-based primary care, and who face difficulty in regularly receiving clinic-based services. The Community-Based Organization: Institute on Aging The Institute on Aging (IOA) has a long history of creating innovative mental health services for seniors and adults with disabilities, including the integration of behavioral health screening in existing IOA care management programs, a 24-hour suicide prevention and intervention hotline called the Friendship Line, home-based psychotherapy, and a psychology training program. The Innovation With UCSF s primary care providers and IOA s mental health clinicians having extensive experience in providing home-based services, this collaboration is an innovative model for serving isolated, homebound older adults struggling with depression. From left: Alyson Madigan, Clare Farrington, Carolyn Stead, Marisa Guardado, Meredith Greene 12
Project Leadership and Primary Contacts Carolyn Stead, PsyD, IOA Title: Director of Psychological & Counseling Services CP Role: Project Lead (Primary Contact Person) Email: cstead@ioaging.org Phone: (415) 750-4186 Clare Farrington, BS, IOA Title: Program Coordinator CP Role: Project Coordinator (Primary Contact Person) Email: cfarrington@ioaging.org Phone: (415) 750-4124 Meredith Greene, MD, UCSF Title: Associate Medical Director & PCP Champion Email: meredith.greene@ucsf.edu Phone: (415) 502-3626 Other Team Members Karyn Skultety, PhD, IOA Title: Vice President of Health Services CP Role: Grant Oversight Email: kskultety@ioaging.org Phone: (415) 750-4104 Helen Kao, MD, UCSF Title: Medical Director CP Role: PCP Champion Email: helen.kao@ucsf.edu Phone: (415) 601-7195 David Shoup, MA, IOA Title: Pre-Doctoral Intern Email: dshoup@ioaging.org Phone: (415) 379-2637 Alexis Armenakis, MD, UCSF Title: Assistant Clinical Professor of Psychiatry CP Role: Psychiatric Consultant Email: alexis.armenakis@ucsf.edu Phone: (415) 476-7551 Cami Allard, IOA Title: Psychology Trainee Email: callard@ioaging.org Phone: (415) 379-3246 Marisa Guardado, LCSW, UCSF Title: Clinical Social Worker Email: Marisa.Guardado@ucsf.edu Phone: (415) 502-3322 Evaluation Lead Clare Farrington, BS (see above) 13
VA McClellan Outpatient Clinic Partnership Type: Primary Care Clinic and Family The Primary Care Clinic: McClellan Outpatient Clinic McClellan is a VA outpatient clinic in the Sacramento area that serves over 9000 veterans, the majority of whom are age 65 and above, that is developing integrated mental health and primary care services for veterans. The Innovation The key innovation of the McClellan site is to engage family members in older veterans depression care, including task-sharing related to psychoeducation, self-management (i.e. adherence, symptom monitoring), behavioral activation, and participation in primary care visits. From left: Thuc-Nhi Nguyen, Angela Araneta, Brian Dahmen, Ladson Hinton, Jane Addagatla 14
Project Leadership and Primary Contacts Ladson Hinton, MD, McClellan & UC Davis Title: Psychiatrist CP Role: Project Lead & Co-Investigator Email: lwhinton@ucdavis.edu Phone: (916) 734-3485 Brian Dahmen, PhD, McClellan Title: Mental Health Clinic Manager Email: brian.dahmen@va.gov Phone: (916) 561-7731 Thuc-Nhi Nguyen, PhD, McClellan & UC Davis Title: Project Manager CP Role: Project Lead Email: tminguyen@ucdavis.edu Phone: (916) 734-7530 Other Team Members Angela Araneta, PsyD, McClellan Title: Behavioral Health Clinician Email: Angela.Araneta@va.gov Phone: (916) 561-7552 Jane Addagatla, MD, McClellan Title: Primary Care Provider CP Role: PCP Champion Email: jane.addagatla@va.gov Phone: (916) 561-7407 Chad Murdock, MD, McClellan Title: Psychiatrist CP Role: Psychiatric Consultant Email: Chad.Murdock@va.gov Phone: (916) 561-7574 Evaluation Leads Ladson Hinton, MD (see above) Thuc-Nhi Nguyen (see above) 15
USC-Eisner Family Medicine Center at California Hospital, Eisner Pediatric and Family Medical Center & St. Barnabas Senior Services Partnership Type: CBO, Primary Care Clinic, and Family The Primary Care Clinics: USC-Eisner Family Medicine Center at California Hospital & Eisner Pediatric and Family Medical Center Located in Downtown Los Angeles, Eisner Pediatric and Family Medical Center is a Federally Qualified Health Center dedicated to providing comprehensive, high-quality healthcare for all ages. USC-Eisner Family Medicine Center at California Hospital, also an FQHC, is the primary residency clinic for the California Hospital/USC Family Medicine Residency Program, and a medical home within the Eisner system for patients of all ages. The Community-Based Organization: St. Barnabas Senior Services (SBSS) St. Barnabas Senior Services (SBSS) is a dynamic non-profit senior service agency dedicated to ensuring that older adults have the right to age with dignity by providing comprehensive and innovative programs that promote healthy aging, prolong independence, and enhance the well-being of more than 18,000 older adults each year. The Innovation Our innovation will be to coordinate between the two primary care sites and SBSS for training friends or family members to be Caregivers who will participate in evaluating, treating and advocating for their older adult with depression. Top left: Camilo Zaks, Jose Luevano, Maria De Leon, Bottom left: Ana Rosas, Eveline Zamora, Cristina Sandoval, Sandra Avila 16
Project Leadership and Primary Contacts Camilo Zaks, MD, USC Title: FMC, Medical Director CP Role: Project Lead Email: zaks@usc.edu Phone: (213) 741-1106 Jen Talbot, MACM, USC Title: Program Manager CP Role: Primary Contact Person PCC Email: jencinas@usc.edu Phone: (213) 741-1106 John Kotick, JD, SBSS Title: Vice President of Programs & Services (Primary Contact Person CBO) Email: JKotick@sbssla.org Phone: (213) 388-4444 x235 Gail Myers, Eisner Title: Director, Mental Health Email: gmyers@pedcenter.org Phone: (213) 746-5582 x3444 Other Team Members Sandra Avila, MD, USC Title: Assistant Medical Director CP Role: PCP Champion and Co- Investigator Email: sandra.avila@med.usc.edu Phone: (213) 741-1106 Ana Rosas, Eisner Title: Case Manager Adult Department Email: arosas@pedcenter.org Phone: (213) 747-5542 Maria De Leon, SBSS Title: Case Manager (on leave) Email: MDeLeon@sbssla.org Phone: (213) 388-4444 Adriana Cardenas, SBSS Title: Social Work Intern CP Role: Interim Care Manager Email: acardenas@sbssla.org Phone: (213) 388-4444 Yadira Ramirez-Flores, LCSW, Eisner Title: Therapist Email: yramirez@pedcenter.org Phone: (213) 746-5582 x3244 Dave Baron, DO, MSEd, USC Title: Interim Chair, Dept. of Psychiatry and Behavioral Sciences CP Role: Psychiatric Consultant Email: Dave.Baron@med.usc.edu Phone: (213) 741-1106 Jose Luevano, LCSW, Eisner Title: Mental Health Program Coordinator Email: jluevano@pedcenter.org Phone: (213) 747-5542 Eveline Zamora, Eisner Title: Case Manager Email: ezamora@pedcenter.org Phone: (213) 747-5542 17
Gordon Gibb, SBSS Title: Senior Director, Social Services and Transportation CP Role: Organizational Liaison and Oversight Email: GGibb@sbssla.org Phone: (213) 388-4444 Evaluation Lead Bonnie Olsen, PhD, USC Title: Professor of Clinical Family Medicine, Vice Chair of Academic Affairs CP Role: Evaluation Lead Email: Bonnie.Olsen@med.usc.edu Phone: (626) 457-6610 18