Valley Health...2018/03/01  · considering straightening your teeth, we will discuss what you want to accomplish in our initial consultation, and make sure you are an Invisalign candidate,”

Pediatric Center of Excellence

Spring, 2015

Dental braces have a new lookthese days. In fact, the modernones are practically invisible.One of those modern teeth-

straightening devices is calledInvisalign. Dr. Joshua

Bratt, managing dentistat CHSLV’s DentalClinic, began offeringthem this year.

Invisalign uses a custom-made series ofaligners created for each individual mouth.The aligners are made of smooth, comfortable, clear resin. They simply slideover your teeth and gradually and gentlyshift them into place, based on the exactmovements your dentist plans for you.There are no metal brackets to attach andno wires to tighten. You just pop in a newset of aligners approximately every twoweeks, until your treatment is complete. Ittakes an average of 13 to 18 months untilcompletion, depending on the amount of movement required. Invisaligns are available for teens and adults.

Continued on page 3

This year’s addition of Appleseed Pediatrics to CHSLV’s medical grouphas inspired us to take our pediatriccare to the next level. We are calling itthe Pediatric Center of Excellence. Itwill be housed in the new medical facility we are planning to build nextto Morrisville Family Health Care.

Our vision for the Pediatric Center of Excellence is that of an all-encompassing child wellness center.Appleseed Pediatrics will be located atthe Pediatric Center of Excellence,and there may be space for pediatricspecialists to see young patients in anoutreach situation. Because our otherservices will be located in the samebuilding, children (and their parents)

will be able to see their primary careprovider, behavior health and wellnessspecialist, and have access to a pharmacy, all in a familiar and convenient setting.

In addition, we will also provide on-site lactation services. A long-rangegoal is to include on-site childcare for employees. Other state-fundedchildren’s services may be located here as well.

We look forward to offering state-of-the-art quality care at an affordableprice to the children of the LamoilleValley area. The Pediatric Center ofExcellence will be there for ourneighbors and for all their children.

The“clear” way to

straighter teeth

Valley Health

Dr. Clea James, a physician at Stowe Family Practice, is an international traveler. It’s in her blood. Her father wasBritish, her mother was American, andJames was born in Paraguay. She’s traveled to and worked in many differentcountries, most recently Ireland.

Dr. James, and her husband, RichardJames, MD, who works in urgent care,wanted to work abroad in their respectivefields. They chose Ireland because it is one of only five countries that allowsAmerican physicians to apply for a licensewithout attending school in that country.It’s not an easy process, with reams of paperwork to fill out, and it took the couple two years to obtain their licenses.In 2012, they packed up their three children and moved to Dublin for two years.

Ireland is part of the Eurozone, a monetary union of 19 European Unionmember states that have adopted the euroas their common currency. “It was wonderful working in the Eurozone.Every day I’d see people of six or sevendifferent nationalities, all speaking differentlanguages. I saw patients from Europe,Latin America, and Asia, and I learned different approaches to medical care andthe way they did things in other countries,” Clea James says.

James worked primarily in urgent care.“The Irish medical system covers emergency and catastrophic situations.The Irish don’t have to pay for those services, but they do have to pay for routine visits and exams,” she notes.“Working in urgent care, it was amazing

the amount of injuries that came in. Theydo a lot of outdoor sports and people getinjured a lot. I saw many lacerations andbroken bones.”

The James family rented a row house inDublin and had a car, but rarely used it.They biked everywhere and used thetram, because that’s what everyone did.“Dublin is such a multicultural city—theater, parks, music, dance, art—it’s everywhere. My kids took Irish danceclasses and performed at McCarthy’s onSt. Patrick’s Day this year.”

They enrolled their children, then ages 11,9, and 4, in the public school system. Language was not a barrier, since the primary language is English, but kids haveto learn Irish in school as well. All signageis in both languages, and most citizens arefluent in English and Irish.

James has high praise for Dublin’s schoolsystem and lifestyle. “Their schools aremuch more demanding and the kids startschool at age four. So my youngest startedschool when we were in Ireland,” she says.“People of all ages are really happy. Theirlife is much less stressful, they eat dinner

together as a family, and they don’t workon weekends. Everyone gets out andabout. Every restaurant and bar is jam-packed at night.”

James also observed much less obesity, especially among children. “There wasonly one overweight child in all three ofmy kids’ classes,” she notes. “It made merealize that in the U.S. we do a lot of carefor the ‘worried well.’ Here, I really try tohelp people see ways to change theirlifestyles so they experience less stress.”

Ever since she can remember, Jameswanted to be a doctor. “At age six, at theschool bus stop, a woman asked me what I wanted to be when I grew up. I said adoctor. The woman said I would have tobe a nurse, only men are doctors. I toldher I would be a doctor.” Set on a careerpath at an early age, James later attendedBrown University and majored in politicalhealth. She went to medical school atUniversity of California, San Francisco.After receiving her medical degree sheworked for a year in China.

In 2003, James and her family moved toStowe, where she worked at Stowe FamilyPractice. In 2009 she went to FletcherAllen, and then in 2012 to Ireland. Whenshe returned, she came back to StoweFamily Practice. “I understand the value of working in a community where youreally get to know your patients. But I alsoappreciate the benefits of a wide variety of experiences. It brings a different perspective to my practice. It helps to have both in a system, to help make wise decisions as the landscape of health care changes.”

IRELANDTwo Years as a Doctor in

2

“If you are a candidate for Invisalign wecan treat you here at the CommunityDental Clinic, you don’t have to go to anorthodontist,” says Bratt, who receivedhis Invisalign training while in dentalschool at Boston University GoldmanSchool of Dental Medicine. “If you areconsidering straightening your teeth, wewill discuss what you want to accomplishin our initial consultation, and make sureyou are an Invisalign candidate,” he adds.If you are, Bratt makes a bite impression,x-rays, and photos, and sends them to Invisalign. Together they devise a treatment plan.

“After the process is complete, patientsusually require a retainer for the rest oftheir lives. All teeth move with time, butorthodontically moved teeth will shiftfaster than normal movement if not retained,” Bratt explains.

Invisaligns must be worn a minimum of22 hours a day. You remove them to eat,and before putting them back on youmust brush and floss. Every time. Nocheating. So it takes a very dedicated andcommitted individual to embark on theInvisalign process. But it’s worth it. You’ll achieve a great smile with little interference in your daily life, and thebest part about the whole process is thatmost people won't even know you'restraightening your teeth.

For more information about Invisaligncall the Community Dental Clinic at802-888-7585 and schedule an appointment with Dr. Bratt to discussyour options.

Substance abuse is the mostcommon disorder that occurs in adults withmental illness. Individualswith both substanceuse and mental healthdisorders are at increased risk for hospitalization, violence, incarceration, homelessness,serious infections, and relapse.In the past, the high risk of thesenegative outcomes was due to clinicalbarriers such as separate providers noteducated in dual-diagnosis treatment,conflicting provider messages, misdiagnosis of substance use disorders,and separate and sequential treatmentfor substance use and mental healthwith fragmented care. These barrierscreated treatment programs that werelargely ineffective.

Over the last 20 years, research hasidentified effective, evidenced-basedtreatments that seamlessly treat both disorders, resulting in improved outcomes, and the term “dual-diagnosis” emerged to describe diagnosis and treatment of people withmental illness and substance abuse. TheBehavioral Health and Wellness Center(BHWC) at Community Health Services of Lamoille Valley provides evidenced-based, current treatment for dual-diagnosis. Services include psychiatric evaluation, individual and group psychotherapy, and casemanagement for children, adolescents.and adults. BHWC’s team includes apsychiatrist, nurse practitioners, a psychologist, and multiple therapists and substance abuse counselors. Coordinating care with primary careproviders, BHWC’s mental health andsubstance abuse team provides comprehensive care for individualsstruggling with dual-diagnosis.

The 2013 National Survey on Substance Use and Mental Health bythe Substance Abuse and Mental Health

Service Administration(SAMHSA) reports thatin 2013, 18.5 percentof adult Americans hada diagnosable mentalhealth illness (MHI),and 8.5 percent had

a substance use disorder (SUD).

Among those diagnosedwith SUD, 37.8 percent had adual-diagnosis of a MHI.

Among those diagnosed with MHI,17.5 percent had a dual-diagnosis ofSUD. This dual-diagnosis incidence isfar above the baseline for the general population, highlighting the need fordual-diagnosis treatment. At BHWC,dual-diagnosis services simultaneouslyintegrate treatment of both SUD andMHI at the clinical level. One clinician,or team of clinicians, provides care toindividuals for simultaneous treatmentof both disorders, providing patient carethat is continuous and coordinated.

With multiple sites throughout Lamoille Valley, a coordinated team ofspecialty providers, and the support ofthese grants, BHWC can provide comprehensive services to individualsstruggling with substance abuse and/ormental health disorders. Utilizing current, evidenced-based practices,BHWC practitioners can treat physicaland mental health needs across all stagesof addiction recovery.

If you or someone you know couldbenefit from treatment of dual-diagnosissubstance use and mental health issues,contact any provider at the BehavioralHealth and Wellness Center. They arethere to provide you with the care you need.

For more information or to find resources, log on to the SubstanceAbuse and Mental Health Administrationwebsite: www.samhsa.gov and the Behavioral Health and Wellness Center:www.chslv.org/behavioral.html.

Dual-DiagnosisThe “clear” way to straighter teeth. Continued from front page

Support for individuals with substance abuse and mental health illness

by Alexander Johnston, PMHNP

3

CHSLV’s In-House Health & Fitness Challenges

Several CHSLV employees at variouswork places have been participating in motivational health and fitness challenges. One is the Biggest Winner,which helps individuals reach nutritional and body weight goals; the other is Fitbit, a bracelet that tracksyour activity, weight, exercise, andcaloric intake.

Stowe Family Practice receptionistKate-Lynn Pal had the idea for TheBiggest Winner weight and nutritionmanagement challenge. It’s a knock-offof the TV show, The Biggest Loser, butPal’s version has a more positive spin.

Pal was a “float” receptionist forCHSLV for two years. Now she’s a full-time receptionist at Stowe FamilyPractice. As far as she knows, she is theonly employee who has spent time inevery CHSLV office. “I became awarethat in every office, regardless of age,sex, or physical size, staff members havetheir own personal weight and healthconcerns,” she says. “At Stowe FamilyPractice I have become comfortabletalking about my own personal nutritional needs and weight-loss goals.I met with SFP Nutritionist Kate Myerson, and we discovered the bestway for me to help myself is by helpingothers. So I decided to set up theBiggest Winner as a team-based weight-loss challenge.”

The Biggest Winner was based on losing a percentage of your bodyweight, rather than counting the actual pounds lost.The person who lost the highest percentage wasthe Biggest Winner. One participant’s goal was not tolose weight, but to gain it, so her system was set up differently. The eight-week challenge began in mid-January and went through mid-March. Participants met once a

week as a group on Friday mornings totalk about individual successes and set-backs. Myerson was there to helpwith nutritional questions and to givesuggestions on how to make better dietary choices. “It was a weekly weigh-in and support group,” Pal says.“For some people, life would get in theway, and it was very helpful to have thiskind of support to help keep each otheron track.”

Everyone who took part in the BiggestWinner was happy with their progress,whether big or small, and though thefirst one is over, Pal has a vision to doanother Biggest Winner in the future.This time she would like it to includeall the CHSLV offices, with each officeforming its own team. “We might evenadd a financial incentive to help keep people motivated. We could have a winning team as well as overall winners,” Pal says.

Fitbit is the other in-house fitness challenge. It’s a wristwatch-sized wireless device that tracks an individual’s activities, including thenumber of steps he or she takes in a day. It syncs wirelessly and automaticallyto a Smartphone or computer.

Community Health Team ManagerCorey Perpall was one of the peoplewho discovered Fitbit. “We were at aneClinicalWorks conference and a vendor was selling the Fitbit wristbandand software,” she says. “A few of uspurchased them and started wearingthem to work. Then other people gotthem and we became engaged infriendly competition. It makes for goodmorale in the office.”

Seven staff members at Stowe FamilyPractice are linked together as Fitbit“friends,” so they can set up a challenge,invite others to join the challenge, andwatch each other’s progress. “It’s verymotivating. If you are close to your goalat the end of the day, you might go theextra steps just to achieve it,” says

Perpall. “It really puts things into perspective and motivates you to be

more active.”

When it comes to reaching fitness goals, counting steps, nutritional education, and losing weight are just the beginning. Group supportwithin a workplace can bejust the ticket to help you

stay motivated, and see howsmall steps make a big impact

on your life.

4

Jennifer Browe and theCommunity Health Pharmacy

Community Health Pharmacy is primarily a mail-order pharmacy located in Colchester, where walk-insare welcome. But why drive all theway to Colchester when you can haveyour drugs conveniently deliveredright to your mailbox? When you call in for a prescription renewal, the person who is filling that prescriptions, answering any questionsyou may have, and making sure youare getting the best price possible isJennifer Browe, PharmD.

Browe is the managing pharmacist at Community Health Pharmacy. She is the go-to person for all your questions about any of the prescription drugs you are or will betaking. She works with one otherpharmacist who is part time, and astaff of pharmacy technicians who arealso knowledgeable and well-versed inpharmaceuticals.

Community Health Pharmacy iswholly Vermont-owned and operated.Its owners are several FQHCs inNorthwest Vermont, includingCHSLV. Only patients whose prescriptions are written by medicalproviders within this group can receive their prescriptions from Community Health Pharmacy.

“We operate the pharmacy with thetraditional Vermont philosophy ofhelping out the best way we can,” saysBrowe, a native Vermonter who grewup in Shaftsbury, a small town insouth/central Vermont. “Shaftsburywas a great place to grow up. Smalltowns are irreplaceable,” she says.

Browe received her undergraduate degree at Castleton State College,where she majored in microbiology. “I knew I wanted to do somethingmedically related, maybe pharmaceuticalresearch or pharmacy work,” she says.After graduating from Castleton

Browe decided to pursue pharmacologyand attended Albany College of Pharmacy, earning her doctorate in2002. She now lives in Fairfax. Priorto joining Community Health Pharmacy she was a pharmacist at the P&C pharmacy in Essex.

“I really enjoy the group of people I work with,” Browe says. “We get along really well. It’s easy to come towork everyday and it’s a good placeto work.”

Community Health Pharmacy is federally funded so that patients haveaccess to affordable medication. They accept most major insurance

plans, including Medicaid, MedicarePart D, and commercial insurances.

Discounted medications are availablefor patients with no insurance, andthey offer competitive pricing whenyou pay with cash. The pharmacystocks all of the common medicationsand can order specialty medicationsfor delivery the next business day. Amodest selection of over-the-countermeds, including cough and cold, firstaid, vitamins, and digestive aids areavailable as well.

More information is available at communityhealthpharmacy.org, or call 888-669-9017.

5

CHCLV’s Behavioral Health & WellnessCenter provides help for people withmental illnesses of all types. They recentlyhired Psychiatric Nurse Practitioner Jessica Terrien, who will be seeing herown panel of patents at the BehavioralHealth & Wellness Center in Morrisvilleand Stowe Family Practice in Stowe.

Terrien grew up in Huntington, Vermont,attended Mount Mansfield Union HighSchool, and received her undergraduatedegree at St. Michael’s College in 2004.“At one point I was interested in becoming a doctor,” Terrien says. “At St. Mike’s I studied psychology and reallyliked it. After working for a few years Idecided psychiatric nursing might be a better fit for me. I found out about the University of Vermont’s Masters Entry Program in Nursing and returned to school to get my degree inpsychiatric nursing.”

In 2012 Terrien received her master’s degree as a psychiatric and mental health nurse practitioner. She moved to Washington State for a job at a community health center, where sheworked with undocumented workers,

the homeless, people with substance issues, and others in an integrated behavioral health program. Then she came to upstate NY, where she worked in primary care, providing medicationmanagement for adults, adolescents, andchildren in an outpatient communityhealth setting.

But Terrien missed Vermont. A friend who worked at CHSLV’s BehavioralHealth & Wellness Center was leaving and suggested Terrien apply for the position. Terrien jumped at the possibilityof returning to her home state. She applied and was accepted for the positionof psychiatric nurse practitioner. She nowlives in Stowe.

Terrien has a special interest in workingwith people who suffer from mood disorders such as bipolar, anxiety, and depression, as well as substance issues,grief, significant life changes, and chronicmedical conditions. “With chronic medical conditions, such as chronic pain

and diabetes, if you can treat the moodcomponent, we find that the patient’soverall health often improves,” she explains. “People with chronic conditionswho require frequent and specialized careoften have a mental health component. If we can get them the mental health support they need, it’s beneficial to them, their families, and the community as a whole.”

Usually the first visit with a new patient isa “meet and greet,” where Terrien gets toknow the patient and his or her history. “I let them drive the conversation and tellme at their own pace what is going on. Ittakes a lot of courage for someone tocome in and talk to me about a situationthat is affecting his or her life, and I have alot of respect for that,” she adds.

Psychiatric Nurse Practitioner Jessica Terrien is seeing patients at Stowe FamilyPractice on Mondays, Tuesdays, andWednesday afternoons. In Morrisville she is seeing patients at the BehavioralHealth & Wellness Center on Wednesdaymornings and Fridays. To schedule an appointment call the Behavioral Health & Wellness Center at 802-888-8320.

Meet Jessica Terrien,

our newPsychiatric

Nurse Practitioner

6

Pediatric well-care check-upsPediatric well-care check-ups are an important part of raising a healthy, vibrantchild. These check-ups often include immunizations, but that’s just one part of a complete wellness plan. Routine visitsare an opportunity for health care supervision to monitor your child’sgrowth, development, and social and emotional wellness.

There are a number of medical reasons forroutine check-ups during childhood. If apediatrician can catch abnormal growthand development early, there’s a betterchance of finding a reason for the change.Often this leads to early diagnosis and intervention for diseases, potentially preventing damage caused by a late diagnosis. Well-care check-ups also ensureappropriate screening for common anduncommon childhood ailments.

These visits are an ideal time for you andyour pediatrician to discuss your child’sdaily habits and how they may affect hisor her health. Nutrition and physical activity are very important topics to discuss, as are dental health, toileting, andbehavior. It’s often helpful for parents towrite questions down prior to a scheduled

health supervision visit to ensure thatthese questions are addressed. Raisingconcerns that are important to you is thebest way to help your doctor know youand your child, so that you can form astrong partnership.

Pediatricians can often help parents anticipate upcoming changes that are related to a child’s normal growth and development. Whether a child is approaching a growth spurt or there areextra measures that you can take to keep your child safe, pediatricians can prepare parents for common periods ofchange and adjustment in their child’sgrowth stages.

In adolescence, regular health supervisionis especially important. Adolescents are developing independence and forminghabits that will continue for a lifetime.This phase of life is a period of exploration and identity development.Regular health care provides an opportunity for adolescents to discusstheir choices, questions, and concernswith a trusted and experienced professional, and learn about the impact of these choices on their health.

Throughout childhood, health supervisionvisits are well timed to coincide with routine immunizations. Routine immunizations protect a child from serious diseases, including sepsis, meningitis, and cancer. If you have questions or concerns about vaccines, it’s a good idea to schedule a separate visitwith your doctor to discuss them. Many parents use well-care visits forscheduled immunizations, however, immunizations are just one small part of the overall well-care picture—yourchild’s overall health and wellness are thecomplete picture.

Health supervision visitsare recommended at 2 to 3 days of age, before 1 month of age,and at 2 months, 4 months, 6 months, 9 months, 12 months, 15 months,18 months, 24 months, 30 months, 3 years, 4 years, 5 years, and yearlythroughout childhood and adolescence.

If you have questions about well-care visits or your child, please don’t hesitate tocall Appleseed Pediatrics at 802-888-7337.

7

Administration: P.O. Box 749, 66 Morrisville Plaza, Morrisville, VT 05661Phone: (802) 851-8608 CHSLV.org

Nichole Bailey, LPN, practice coordinator(Stowe Family Practice) and Carol Kapusta,front desk coordinator (Morrisville FamilyHealth Care), receive their Helpdesk certifications from President and CEO Kevin Kelley.

BillingDarcy Bohannon (2)Casey Hayden

AdministrationCorey Perpall

Community Health TeamJean Audet

CHSLV Spirit Award RecipientsTracey Chauvin (2)Tracy PatoineJulie Chase (2)Erica Brown

Tammie LowellKathryn WolfeSusan Zumberge

Helpdesk Certification Community Health Services of Lamoille Valley is pleased to announcethat two of their practice managers have recently completed training andreceived the Helpdesk certification for their eClinical software program, an electronic patient health record-keeping system.

Carol Kapusta, front office coordinatorfor Morrisville Family Health Care, andNichole Bailey, practice coordinator forStowe Family Practice, received theirHelpdesk certification after a weeklongintensive training in Massachusetts.

Carol Kapusta joined the front desk staff at Morrisville Family Health carein 1997 and was promoted to front office coordinator in 2006. NicholeBailey, LPN, joined the nursing staff atStowe Family Practice in 2007, and waspromoted to practice coordinator in

2014. Their new Helpdesk certification,as well as their many years of collectiveexperience with CHSLV’s electronicpatient health record-keeping system,enhances their skills and ability to support their practice medical teamsand staff in providing the highest qualityhealth care to their patients.

Community HealthServices of LamoilleValley congratulatesCarol and Nichole ontheir achievement, as they exemplifythe practices’commitment to the overallhealth and well-being oftheir patients.

Recognition for going above & beyond in supporting the CHSLV mission