Organization Newsletter

May 2019

In this issue...

  1. The Role of the Physical Therapist in Avoiding Chronic Pain
  2. Getting to Know Your Board Member - David Windom
  3. WWAMI AHEC Scholars at the NW Rural Health Conference
  4. 2019 WRHA Award Winners
  5. Welcome New & Returning Sponsor and Organizations!
  6. Opioid Care Education Opportunities
  7. Dr. Carter Received the 2019 MEDEX Outstanding Preceptor Award


Welcome to the
May 2019 issue of the Washington Rural Health Association e-Newsletter.
Inside this issue you will find news and information from the board of directors, members, and community partners from across the state of Washington. 

If you would like to submit your own story, please click here.

The WRHA e-newsletter is a publication of Washington Rural Health Association, a not-for-profit association composed of individual and organization members who share a common interest in rural health. This e-newsletter seeks to disseminate news and information of interest to rural health professionals and stakeholders to help establish a state and national network of rural health care advocates.

WRHA Members

WRHA members include administrators, educators, students, researchers, government agencies and workers, physicians, hospitals, clinics, migrant and community clinics, public health departments, insurers, professional associations and educational institutions. If you are interested in joining or renewing your membership with WRHA click here.


The Role of the Physical Therapist in Avoiding Chronic Pain


Submitted by:  Bobbi Meins
Pacific Rehabilitation
[email protected]

Providing physical therapy for patients whose pain complaints do not resolve over time can be a significant challenge. With our growing knowledge we have new opportunities to educate patients and give them the tools early during treatment to decrease the risk of chronic pain.

Here’s a brief look at recent evidence based findings on pain and central sensitization:

  • Nociceptor inputs can trigger a prolonged but reversible increase in the excitability and synaptic efficacy of neurons in central nociceptive pathways.
  • Central sensitization has been linked with pain sensitivity with patients with fibromyalgia, osteoarthritis, musculoskeletal disorders with generalized pain hypersensitivity, headache, temporomandibular joint disorders, neuropathic pain, and post-surgical pain.
  • Musculoskeletal disorders can also be characterized by a spread of pain sensitivity to deep uninjured tissue; low level peripheral inputs may maintain this. Woolf, CJ. Pain (2011) 152:3. S2-S15. The importance of the role of stress in chronic pain:
  • Stress produces mechanical hyperalgesia in skeletal muscle and a significant decrease in the mechanical threshold of muscle nociceptors.
  • Stress induces an increase in conduction velocity and increases variability in neuronal activity. [Chen, Green & Levine. Neuroscience (2011) 185:6. 166-173.]

We continue to shift our paradigm in application in clinical practice from only the biomedical model to the biopsychosocial model. Key risk indicators during PT evaluation/during the episode of care include:

  • Pain that persists beyond 12 weeks and red flags for serious pathology has been ruled out.
  • Negative findings with diagnostic tests.
  • Pain complaints that appear exaggerated when compared with what would generally be expected for the injury.
  • Patient reports of significant stressors and/or in your clinical judgment the patient appears to be highly stressed.
  • For back pain patients, use of short screening tools such as the 6-item or 9-item STarT Back can be used to identify patients who are at high risk for chronic, disabling back pain.

Treatment tools the physical therapist can incorporate into treatment:

  • Instruction in techniques of diaphragmatic breathing - The stretch receptors in the lungs and airways stimulate the vagus nerve, which in turn reduces heart rate, reduces blood pressure, and has an overall calming effect. This can modulate pain, decrease anxiety, and promote sleep.
  • Patient education about basic anatomy of the nervous system - how the brain and spinal cord process and regulate pain information, central sensitization, differences between acute and chronic pain, and neuroplasticity.
  • Help remove the perception of threat of harm or further injury - A feeling of safety allows the sympathetic nervous system to slow and the vagus response to increase.
  • Reminding the patient of ‘hurt but no harm’ during therapy.
  • Motor imagery - Instruct patients to visualize themselves doing physical activities that they have enjoyed prior to injury. Then progress through a series of non-threatening exercises to build capacity and confidence to return to the former activity.
  • Specific relaxation techniques such as Teach mind-body therapies that reduce chronic pain, include restorative yoga and mindfulness meditation.
The interdisciplinary team at Pacific Rehabilitation Centers can provide therapy care through the spectrum of acute, sub-acute, and chronic phases of injury in conjunction with behavioral health services when warranted. Our psychologists can provide Cognitive Behavioral Therapy as well, as comprehensive evaluation and treatment for depression and anxiety. Our team goal is to enable patients to feel a greater sense of control, reduce their pain intensity, and return to living and functioning at the highest level possible.

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Getting to Know your Board Member!

With each publication, we would like to introduce a member of the WRHA Board of Directors.
This publication we would like to introduce a valuable member of the board, David Windom:


1)   Please tell me your name, where you work, title, your role with WRHA and how long you have been a board member:    
      Dave Windom, Director of Mason County Community Services, and a new member---for a couple of weeks.

2)   How did you first become involved with the Washington Rural Health Association?    
      I’ve been attending the WRHA conferences since 2010 when I took over as director of public health for Ferry, Stevens and Pend Oreille counties

3)   There are several rural health organizations in Washington State. Why did you choose to work with WRHA?    
      WHRA seems to have the broadest reach including hospitals, FQHC’s and clinics but seems underrepresented in public health, which really delves deeply into the 80% of health that’s not clinical.

4)   Why is Rural Health important to you?
      I’ve lived my whole life in rural counties and the rural lifestyle is very important to me. Rural people tend to be short changed sometimes in access and availability of health care and public health. The voice of those who   choose to live in rural Washington needs to be heard.

5)   What has surprised you most about working with Washington Rural Health Association?
      I’ve just started working with the association though I have been involved in panel discussion. I’m surprised how few public health folks are involved.

6)   What is the best part of working with WRHA?
      The ability to network with hospital senior staff and medical people is valuable to my understanding of the whole framework of health in this state and the challenges that different communities have.

7)   What do you see as some of the most challenging issues facing WRHA and Rural Health in our state?
Cost is and will be one of the largest factors facing people. I think the attention has been pulled from those things like obesity and diabetes which are our leading factors for mortality.

8)   What do you wish other people knew about Washington Rural Health Association?
      More people need to know that we’re out here sharing our experiences and knowledge.

9)   If you could change one thing about Washington Rural Health Association what would it be?
I knew to look for the association and the conference, but I think our outreach and PR could be improved.

10) Do you volunteer for any other organizations? Why do you feel it is important to volunteer?    
      I have any number of volunteer groups that I support. I ‘m currently the president of the Washington State Association of Local Public Health Officials (WSALPHO) which consumes a great deal of time, but I’ve done other   exciting work such as cleft palette and lip clinics in India and the Philippines. I don’t think the importance of volunteerism can be over stated. Nowhere else will you find the energy and enthusiasm for problem solving as you do among volunteers.

11) How do you like to spend your time outside of work and volunteering?
     I support my church, garden, and build model airplanes.

12) What might (someone) be surprised to know about you?
     I’m a total math and science geek.

13) What do you think will change about Washington Rural Health Association over the next five years?
I’m hoping we get an influx of younger members.

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WWAMI AHEC Scholars at the NW Rural Health Conference

Submitted by: Stacey Morrison
[email protected]

The WWAMI Area Health Education Center (AHEC) is proud of our two WWAMI AHEC Scholars who presented at the Northwest Rural Health Conference poster session. 

Koichi Tanji, a Naturopathic Medicine student from Bastyr University and Mizuki Johnson, a University of Washington Pharmacy student, formed a team to do their 40 hours a year of community/experiential/clinical learning at the King County Correctional Facility. Having interviewed Dr. Benjamin Sanders, Koichi and Mizuki gained insights into addiction and mental health issues that inmates experience at KCCF.  Their poster illustrates the pathology of opioid addiction, treatment options, and the part that Adverse Childhood Experiences (ACEs) play in the lives of inmates and their health.  POSTER

WWAMI AHEC Scholars is a new two-year HRSA-branded inter-professional didactic and experiential student health professional program designed to educate students about team-based care in rural and underserved communities.  The AHEC Scholars program covers such pertinent topics as cultural humility, behavioral health integration and social determinants of health.  Our student participation in the poster session was generously supported by the Washington Department of Health.  WWAMI AHEC looks forward to our AHEC Scholars students participating yearly in the Northwest Rural Health Conference. 

Questions regarding the AHEC Scholars program can be sent to Stacey Morrison, WWAMI AHEC Program Office Associate Director, at [email protected].

2019 WRHA Award Winners


Submitted by: Deb Watson, WRHA Secretary
[email protected]

Five Washington State healthcare leaders have been recognized for their contributions to Washington’s rural communities by the Washington Rural Health Association.  The awards were presented in March, at the NWRHC awards luncheon.  Awards were presented by the WRHA board members.  

Each year the Washington Rural Health Association recognizes individuals that have made an outstanding contribution of major significance to rural health during the year.  Recipients are nominated by colleagues, industry professionals or by any of our membership at large.  The winners are selected by the WRHA Board of Directors.
The following are the 2019 winners:


Tessa E. Moore
, Medical Student University of Washington, Seattle


Ronald. G. Rehn
, Chief Administrator Officer, Providence Health Care, Stevens County


Denny Lordan, Telemedicine Program Coordinator, Providence Health Care, Spokane


Beionka Moore, Previous Executive Director, Washington Rural Health Association  


Dr. Joe Mattern, Chief Medical Officer, Jefferson Health Care, Port Townsend WA
(Accepting for Dr. Mattern is Hilary Whittington, CFO at Jefferson Healthcare, on the right)

Congratulations to all of this year's award winners!  A BIG thank you to all the people who submitted nominations, as well. 

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Welcome and Thank you to New & Returning Members!

Submitted by: WRHA
[email protected]


Washington Rural Health Association would not be able to carry out its advocacy activities and would not be a success without the generous support you have provided us throughout. We deeply appreciate the willingness with which you have and continue to sponsor the efforts that enable us to continue our mission to help improve health for the people living in rural communities. Which will ultimately make our communities a healthier, happier place to live in. We sincerely hope that this association will be maintained and that you will continue to support us in our future endeavors.
Thank you!




Washington Coverdell Acute Stroke Program - Seattle, WA
Tri-State Memorial Hospital - Clarkston, WA

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 Opioid Care Education Opportunities


Submitted by:  Edward Bilsky
Pacific Northwest University
[email protected]

Opioid and Trauma Informed Care Summit

On June 20-21, 2019, Greater Columbia Accountable Community of Health (GCACH) and Catholic Charities of the Diocese of Yakima, in collaboration with Pacific Northwest University of Health Sciences (PNWU), are hosting a regional summit on Trauma-Informed Care and the Opioid Crisis.  It will be held at PNWU in Yakima, Washington.  The Summit includes five keynote speakers and four tracks that include 30+ speakers from across the region.  The Summit is where solutions are formulated, where stakeholders from federal to family convene, and where change begins.  This gathering is where we will discuss what's working in prevention, implementation, and treatment for Trauma Informed Care and Approaches and the Opioid Crisis.  Four Tracks have been developed so participants can get the information that is relevant for themselves and their patients.

Track 1 - Strategies for Managing Patients with Opioid Use Disorder
Track 2 - Patient, Payment and Stigma
Track 3 - Trauma Informed Care
Track 4 - Innovative Models of Care

Sponsorship Prospectus/Exhibitors

Submitted By:  Ellen Barton
Western Washington Area Health Education
[email protected]

CME webinar on Hepatitis C and Opioid Use Disorder

Rural areas of the USA show signs of an outbreak of an epidemic of Hepatitis C virus (HCV) and HIV infections.  The epidemic appears to be caused by an untreated epidemic of Opioid Use Disorder.  Dr. Judith Tsui presents research on medications to treat these infections and strategies for patient adherence.  Dr. Tsui is an internist who is also board certified in Addiction Medicine through the American Board of Addiction Medicine since 2013.

Statement of Purpose: This presentation will describe the syndemic of opioid use disorder (OUD) and hepatitis C (HCV) and present evidence showing the current gaps in treatment for OUD and hepatitis C among persons who inject drugs.  Based on analysis of current treatment methods and real-world patient living conditions, the presentation will describe research on innovative models of care to improve treatment access and outcomes for persons with OUD and HCV.  The Area Health Education center for Western Washington is pleased to partner with the Northwest Addictions Technology Transfer Center (NWATTC) to present this free opportunity for Continuing Medical Education on Wednesday, June 26, 2019, from noon to 1 pm (PST).

For more information, contact AHECWW at (360) 383-3170 or [email protected].

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 Dr. Carter Received the 2019 MEDEX Outstanding Preceptor Award


Submitted by: Sandra Anderton
Inland Northwest Health Services
[email protected]

Spokane, Wash.- Gregory Carter, MD, MS, Chief Medical Officer at St. Luke's Rehabilitation Institute, the largest free-standing rehabilitation hospital in the region, has been recognized by MEDEX Northwest for his exceptional teaching, mentoring and leadership.

Dr. Carter received the 2019 MEDEX Outstanding Preceptor Award, designed to honor those who demonstrate outstanding achievements in support of physician assistant education, at the MEDEX Alumni Reception & Awards Ceremony on Saturday, April 27.  Dr. Carter has precepted an astonishing 121 MEDEX students since he joined St. Luke's as Chief Medical Officer in 2014 and has hired several graduates. 

"Dr. Carter's passion for mentoring and teaching our future caregivers is to be commended," said Nancy Webster, Hospital Administrator and Chief Operating Officer at St. Luke's.  "Rehabilitation is a team approach and Dr. Carter exemplifies the skills and dedication of working collaboratively."

MEDEX Northwest is the is the second oldest physician assistant education program in the U.S, and the largest civilian program. MEDEX has 250 students across four campuses in Washington State and Alaska, including clinical year students.

About St. Luke's Rehabilitation Institute:

With 10 outpatient locations in the greater Spokane region, St. Luke's Rehabilitation Institute is the largest freestanding medical rehabilitation hospital in the inland northwest.  The highly skilled and specialized staff provides outstanding treatment and rehabilitation of patients, specifically with strokes, spinal cord injuries, orthopedic issues, and traumatic brain injuries.  St. Luke's utilizes technology and innovative solutions to provide holistic care, so their patients can thrive. 

More information in St. Luke's visit:

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