first appeared in Crosscut on January 6, 2020 /  by Emily McCarty

A small team in southeast Washington is leading the charge in telepsychiatry

In tiny Dayton in southeastern Washington, the local hospital district has developed an innovative mental health program that has caught the attention of rural hospitals around the state.

The Columbia County Health System previously retained an in-house psychiatrist, but financial realities made continuing that approach impossible. CEO Shane McGuire didn’t want to give up, so he began the search for solutions.


Wayne Pollard teleconferences with Dr. Matthew D. Iles-Shih M.D., M.P.H. at the Columbia County Health System Clinic in Dayton, Washington December 19, 2019. (Rajah Bose for Crosscut)

Last July, McGuire found an opportunity to work with the University of Washington’s psychiatry program and its Advancing Integrated Mental Health Center (AIMS). The center’s primary focus is creating collaborative care models between primary care providers and their mental health care counterparts.

Dayton’s model weaves behavioral health care directly into primary care appointments. In Dayton, a mental health screening that indicates the patient would benefit from specialty care prompts a referral right away.

McGuire says the program extends beyond the AIMS model, because the UW psychiatrists not only support the medical staff, but also work directly with patients.

“They were willing to think outside the box for us,” he says. “I don’t think they really have a name for what they’re doing here yet.”


Rural Washington has struggled with behavioral health care solutions, with most citing problems in recruitment, retention and the high financial burden of providing specialty services. These hospital districts must be creative in building programs robust enough to meet basic mental health care needs, especially as Gov. Jay Inslee prepares to fully integrate behavioral health in the new year.

The 2019-2021 state operating budget provides $350.5 million to improve the mental health system, with over $35 million dedicated to community services and beds. Close to $120 million in the capital-construction budget was set aside for community-based beds to keep patients in their communities instead of being sent to Western or Eastern State Hospital.

Two bills making their way through the state Legislature would further change telemedicine for rural communities. Currently in committee is Senate Bill 5385, which seeks to pay out telehealth services at the same rate as in-person care. Senate Bill 5387, which took effect last July, allows the remote telehealth physician to access the patient’s local health records.

For now, each district is expected to find mental health solutions that will work best for them with the resources they have.

A Dayton city flag flies in front of the Columbia County courthouse
Columbia County is the third-least populous county in the state, yet hosts one of the most robust behavioral health programs in rural communities. (Rajah Bose for Crosscut)

“I think there’s 14 rural hospitals in the state that are operating in the red, year after year, working in their communities,” McGuire says. “We’re safety net organizations for our communities. We don’t turn people away.”

Rural communities are taking a variety of approaches toward mental health. Some, like Three Rivers Hospital in Brewster, provide crisis services only in the emergency room through the county health department. Newport Hospital, an hour north of Spokane, has a visiting psychiatrist once or twice a month. Cascade Medical in Leavenworth is looking at using pharmacists for more specialized prescribing assistance. Many towns have started building their mental health programs only within the past two years, starting with a few social workers, a dedicated nurse or a clinical psychologist.

But even in rural hospital districts with existing behavioral health care, psychiatrists are uncommon. Those services are usually provided by monthly visits from a visiting psychiatrist or, in more recent years, utilizing telemedicine services with psychiatrists in other cities using video conferencing.

Patients in Dayton do just that. They have access to top-tier psychiatric services from UW using Zoom, an encrypted video conferencing platform that meets federal HIPAA privacy regulations.

“You’ve got some of the best psychiatrists in the nation working in guiding the care of our patients … which is really an amazing overlap,” McGuire says.

Leading the charge is Dr. Matt Iles-Shih, an adult psychiatry and addiction specialist from the University of Washington’s Medical Center. His team initially started working in outpatient care, but this fall they rolled out inpatient services to the hospital with two additional attending psychiatrists who dedicate two hours a day.

Iles-Shih does one-on-one telemedicine for every new patient’s first appointment to start them on their course of treatment, prescribing psychotropic medication as needed or managing their current doses. About three months later, the patients will have a follow-up. If they have ongoing issues that need more treatment, repeat telehealth appointments can be made.

He also works directly with the doctors and social workers, providing curbside consultations to answer questions and provide clarification. He says this model not only benefits the patients, but allows the doctors to grow in their knowledge as well, strengthening the team across the board.

“Just through the process of clinical support that we’re doing through the program, there’s an upscaling and a sense that the PCP [primary care physician], she’s just absorbing a lot and actually changing their practice,” Iles-Shih says. “It’s not like you’re just reliant on someone else in another city, but this is an opportunity to really build up your own skills and capacities as an individual clinician.”

For outpatient needs, he communicates directly with one of Columbia County’s two social workers, Wayne Pollard and Tasha Willoughby.

Tasha Willoughby talks to high schoolers in front of a chalkboard
Social worker Tasha Willoughby talks about social work to Dayton High School students, where she or Pollard staff open office hours every Monday. (Rajah Bose for Crosscut)

On Thursday mornings, Iles-Shih video conferences with Pollard about four to eight patients. Iles-Shih will enter notes into the shared electronic database, which the patient’s primary doctors can access during regular appointments.

Physicians at Columbia County screen their patients every year for depression and anxiety. Those already in the newly created behavioral health program are rescreened with every visit. Depression and anxiety are the main diagnoses, but post-traumatic stress and bipolar disorders follow closely behind, Pollard says.

Pollard has been Columbia County Health System’s clinical social worker for the past two years. When he started, there was no program; McGuire created an entirely new system from the ground up.

The first half a year was clunky, Pollard says, but they saw the number of clients grow substantially. They hired their second social worker, Willoughby, to help handle the ever-growing caseload. Pollard averages about 60 clients, while Willoughby sees upwards of 90.

In crisis situations, where mental health services are needed as soon as possible, Pollard says the team can get patients in front of a UW specialist within two hours. This kind of expedited service from a psychiatrist is almost unheard of in rural health systems, he says.

There are no face-to-face psychiatrists in the area, Pollard says, and while the Tri-Cities offers such services, patients may have to wait up to a year to see one.

“It’s unusual that I could see somebody last week and tell her, ‘There’s a spot to see Dr. Matt next week. Let’s get you in front of him,’ ” he says. “That just doesn’t happen anywhere. People are blown away that they’re in front of this super specialist psychiatrist within a week or two.”

Both social workers are also certified in EMDR, or eye movement desensitization and reprocessing, commonly used to treat trauma.

“We are offering a specialty care here, which is very hard to find anywhere, much less than little Dayton, to have some EMDR therapists dealing with psychological trauma [and] PTSD symptoms,” Pollard says.

The wraparound care patients receive doesn’t stop at counseling, psychiatry and primary care services. The team also includes Paul Ihle, another social worker at Columbia County. He helps clients in everything from insurance complications to housing, but Dayton has him fill a unique need with mobile outreach, which provides transportation assistance for appointments.

About half of Ihle’s clients need transportation because of their mental health, and people were missing appointments because they lacked transportation, Ihle says. So the hospital licensed him to drive a hospital van, including for referrals outside of the community. They’ve brought patients from as far away as UW Medical Center in Seattle and Moscow, Idaho.

“The state provides People for People services, but it has a very rigid criteria for qualifying,” he says. “Some people are successful meeting that criteria, but there’s always circumstances that set up insurmountable hurdles to being successful and it tends to hit most profoundly the sick and the disabled and the poor.”

McGuire has also expanded into the local high school, down the road from the hospital. Pollard or Willoughby spends every Monday at the school with an open-door policy for students to talk about everything from standard “high school drama” to drug use and problems at home, Pollard says. They work with students over 13 years old. so the students can access services without needing parental permission, allowing students to drop in during school hours.

CEO Shane McGuire stands outside the Dayton clinic

CEO Shane McGuire has lived in Dayton for 16 years and been at Columbia County Health for almost 10 of those. He says they don’t turn people away and their services are unique: people come from as far as Walla Walla. (Rajah Bose for Crosscut)

“We are surprised at the amount of kids coming to see us already,” Pollard says. “We just started at the beginning of the year and easily there’s five or six kids popping in every day, which is pretty significant with being brand new there.”

McGuire wants to make sure the services are available to Columbia County’s whole network of services, so the staff also visits the nursing home attached to the hospital. Therapy is more difficult with cognitive issues, Pollard says, but they attend monthly psychotropic meetings where Iles-Shih is present via video conferencing.

This comprehensive behavioral health care all stems from McGuire, Pollard says. He made an effort to build a program, starting at square one.

“He’s wanting to do much more than the minimum of what’s required in any community. … He has a heart to see people get better,” Pollard says. “He gets the support from the board and a small community here who just want … people feeling as good as they can, instead of shoving this under the carpet like we’ve done for hundreds of years.”


Number 7/45:

America’s Most Beautiful Hills

Where: The Palouse

Why We Love It:
Located in Idaho, Washington, and Oregon, the Palouse is a lush area that features rolling hills. According to The Seven Wonders of Washington State website, “The hills were formed over tens of thousands of years from wind blown dust and silt, called ‘loess.'”

most beautiful places america palouse

Getty Images

First appeared on Washington Department of Commerce website on Dec. 17, 2019.

OLYMPIA, WA – Expanding on the success of its original economic gardening program, the Washington Department of Commerce has developed Thrive!, a new program to help second-stage companies increase revenues and position for growth.

Based on the Edward Lowe Foundation’s System for Integrated Growth (SiG) framework, Thrive! connects chief executive officers to subject matter experts who provide them with data, analytics, best practices and strategies that are typically only available to larger corporations. This actionable information can be used to overcome roadblocks related to human resources, finances, operations, marketing, sales, international trade and other business issues.

“Since its introduction three years ago, Commerce’s second-stage program has helped 39 businesses across the state find innovative ways to increase growth and revenue,” said Lisa Brown, Commerce director. “Where the original program focused solely on external issues, Thrive! examines internal and external roadblocks to growth, since one can often affect the other.”

Research shows that historically, companies that have completed a second-stage program like Thrive! experience a 15% to 30% increase in revenue.

The ideal candidate for Thrive! is a company that’s been in operation in Washington for at least two years, has between six and 99 employees, achieved $1 to $25 million in annual revenue and has demonstrated an appetite and aptitude to handle additional growth.

To help offset the $4,275 cost of the program, Commerce contributes $1,275 to pay for the initial needs assessment call with the team leader as well as a strengths-weaknesses-opportunities-threats (SWOT) analysis call with a team of experts assigned to address identified business issues. Based on these calls and the resulting work plan, the CEO can move into the research phase of Thrive!, which entails up to 33 hours of professional research time. Thrive! is conducted entirely by phone and a secure online portal created especially for each participating company. Thrive! requires approximately eight to 12 hours of the CEO’s time over the course of four to eight weeks.

More information about Thrive! as well as a link to the application for the program is available at Contact Susan Nielsen at [email protected] for eastern Washington Thrive! opportunities.

First appeared in The Coeur d’Alene Press, December 12, 2019 at 5:00 am | By MIKE PATRICK Staff Writer

COEUR d’ALENE — Same ‘ol-same ‘ol looks pretty sweet.

Speaking to a packed house of 215 business people and community leaders Wednesday, economist Dr. John Mitchell said there’s little reason to expect the nation’s unprecedented 126-month expansion to come to a screeching halt. What we saw in 2019 should look a lot like what we see in 2020, he said.

Dr. John Mitchell delivers his keynote to Coeur d’Alene Chamber of Commerce (Loren Benoit, Coeur d’Alene Press)

In his annual Coeur d’Alene Chamber of Commerce breakfast address at the Best Western Plus Coeur d’Alene Inn, the veteran fiscal forecaster predicted economic growth might slow a bit but continue heading in the right direction.

“The things we traditionally worry about at the moment are not happening,” he said.

Sure, there’s some uncertainty with impeachment proceedings, Mitchell acknowledged. Angst ebbs and flows with international trade and tariff talk, too.

It’s always possible the market could see a big dip, or threats emerge to upend the tax system or the medical system. And of course, Mitchell had to raise the specter of a black swan event — some disaster that nobody sees until after it’s already happened — no matter how unlikely.

“I worry about… people’s willingness to take chances and invest,” he conceded. “That’s a threat.”

But having covered the big scary stuff, Mitchell’s forecast had a calming effect.

“The things that preceded many other recessions don’t seem to be there,” he said.

Nationally, Mitchell pointed to GDP slowing slightly next year but strong employment and low inflation propelling a steady course.

Close to home, Mitchell unwrapped a Christmas package of economic positivity.

He cited Idaho’s 2.1 percent population growth as No. 1 in the nation, tied with Nevada.

Idaho’s job growth for the year through October was a sturdy 2 percent, good for eighth in a nation where all 50 states showed job growth in 2019. Mitchell charted Kootenai County job growth for three years, from October 2016 through October 2019, and tallied 8.4 percent growth, with construction and leisure/hospitality leading the way.

The local housing picture is especially bright — if you’re looking at the value of your property rather than your tax bill, anyway. According to Mitchell’s research, the Coeur d’Alene metro area had the fourth highest housing appreciation rate in the country as of the year’s third quarter. Chico, Calif., rising from the ashes of the Paradise Fire, led the way with a 14.25 percent appreciation rate. Boise (11.81) was second, followed by Idaho Falls (11.33) and Coeur d’Alene (10.85). Demonstrating the growth power of the Northwest, Spokane was fifth in the nation (9.36).

Growth is also visible throughout Kootenai County, as building permits attest. Mitchell said residential building permits are up 11.5 percent year over year.

“The forces that have been driving the county would seem to be intact,” he said, pointing to confident employed consumers, an aging population in the higher cost areas, the many attributes of the region, and simply rising with the tide of continued national economic expansion.

He’s got some numbers to back that all up. Looking at 2010 through 2018, Mitchell showed a positive population change in Kootenai County. Making babies was responsible for 3,822 new faces, while net migration brought in 19,111 during that period, he said. That added up to a 16.6 percent increase, well ahead of Idaho’s strong 11.9 percent population growth.

Growth is evident not just in bodies but bank accounts. According to Mitchell’s research, Kootenai County residents’ personal income was up 7 percent last year. He noted that the big uptick isn’t all from hard-working employees getting raises or better-paying jobs, either: dividends, interest, rents and transfer payments are boosting the bankroll of retirees.

“Old people save a lot,” he said.

Worries over deficit spending haven’t slowed the overall economy, and the dreaded “R” word has somehow been held at bay. Mitchell called “recession headlines very common in 2019,” but said the warnings are often a reflection of political rather than economic interests.

“I always have in the back of my mind, ‘What’s the person’s agenda?’” he said. “The recession just keeps getting pushed further and further out.”

With some effort, the economist who has been making similar presentations for 47 years strained to see dark clouds, let alone black swans, on the 2020 horizon. However, all economic expansions end sometime.

“I don’t think it’s going to be in 2020,” Mitchell said, “but it’s out there somewhere.”

The following projects, initiatives, and economic developments are making news in eastern Washington and northern Idaho. This release is distributed by the Inland Northwest Economic Alliance on behalf of its regional partners.


COEUR D’ALENE, Idaho — StanCraft Boat Co. is expanding from manufacturing watercraft to offering aviation services with the addition of a $15 million StanCraft Jet Center at Coeur d’Alene Airport-Pappy Boyington Field. Construction on the new 85,000-square-foot FBO began in August east of Empire Aerospace, and the project is expected to be completed by May 2020. Coeur d’Alene-based Eric Hedlund Design is the architecture firm that designed the structure, and Hayden-based Young Construction Group of Idaho Inc. is the contractor. The 40,000-square-foot Southfield Aviation building will be used as a maintenance facility after the new jet center is built. In addition to refitting jet interiors, StanCraft Jet Center will offer jet refueling, conference rooms, waiting and pilot areas, and a tenant improvement space for offices. Contact Robb Bloem, StanCraft President, for more information.

Dauntless Air, an aerial firefighting company, relocated its aircraft maintenance operations to the Coeur d’Alene airport this year. Dauntless protects people, land and property from the devastation of wildfires through advanced aerial fire suppression tactics in Minnesota, Washington, Alaska, Idaho, North Carolina, California and Oregon. Learn more about the company at or contact Brett L’Esperance, Dauntless CEO.

PULLMAN, WA — Washington State University’s Cosmic Crisp apple will hit the fruit stands on December 1, a project over 20 years in the making. Cosmic Crisp was developed specifically for Washington’s climate and growing conditions. WSU researchers combined the disease-resistant Enterprise with the Honeycrisp, known for its crispness, juicy sweetness, and hint of tartness. There are 12 million trees planted in the state of Washington and this year 450,000 boxes of Cosmic Crisp apples will be available. Washington apple growers will have exclusive rights to the Cosmic Crisp for 10 years. Washington produces 65-75 percent of the nation’s apples, yet this is the first variety that originated from the state. Contact Proprietary Variety Management for more information.

HAYDEN, Idaho — Roller coaster manufacturer, Rocky Mountain Construction (RMC), continues its Six Flags success with the innovative Jersey Devil Coaster at Six Flags Great Adventure in Jackson, New Jersey. Known as a single-rail coaster, riders in one-passenger cars will straddle a 15.5-inch-wide steel, monorail track and navigate a twisted course that will include multiple inversions, climbing 130 feet and hitting a top speed of 58 mph along 3.000 feet of monorail track. RMC has grown to 115 full-time employees and 5 manufacturing facilities, totaling more than 75,000 square feet. See USA Today’s article for more.

DAVENPORT, WA – Washington Department of Commerce, USDA, and Washington State University Medical School hosted a daylong workshop with 100 community leaders and residents from Eastern Washington to address the broadband law approved this year by Washington state lawmakers. A new statewide broadband office will approve and distribute grant and loan funds to local governments, tribes, public, private and nonprofit entities working together to expand broadband. The program has $21.5 million available, including $14.5 million for loans and $7 million for grants. The state will prioritize funding to public-private partnerships, with a focus on underserved areas in the state. Contact Margie at Lincoln County EDC for more information.

MARIES, Idaho — City officials and housing developers, Troy Lozano, are projecting construction of new homes in Ragan’s Addition to begin in early 2020. Lozano purchased 21 lots in the addition and plans to partner with Julian Construction to build single family homes. Updates can be found at

OTHELLO, WA — McCain Foods broke ground on a 170,000-square-foot expansion, a project that will cost $300 million and is scheduled for competition in 2021. The expansion to the frozen potato products line is estimated to bring about 180 new jobs to Othello and is expected to be the biggest manufacturer of frozen potato products in the world. Dale McCarthy, McCain Foods, said Othello’s proximity to West Coast shipping makes it a crucial location for the company. “Othello is very strategic for us.” Adams County officials are working with McCain Foods and the state to develop a recruitment process and support. They plan to conduct a countywide housing needs assessment to confirm housing needs and development solutions.  Email Adams County Economic Development Council for more info.

MOSCOW, Idaho — Northwest River Supplies (NRS) began operations from its new facility on South Blaine Street on November 5. The newly constructed 155,000-square-foot building includes a warehouse, customer service center, corporate offices and a 3,500-square-foot NRS flagship retail store. The $13.5 million project received a tax break from Latah County that exempts 75 percent of the increase in the site’s value from property taxes for five years, ending in 2023. Read more here.

PULLMAN and COLFAX, Wash. — Two Inland Northwest businesses were recognized through the Washington Secretary of State’s Corporations for Communities Award Program. Schweitzer Engineering Laboratories, of Pullman, was recognized for donating and raising funds for local charities and providing money for employees to donate to the charity of their choice. Bunyard Automotive, of Colfax, was honored for repairing vehicles at little to no cost for families in need. Both businesses were awarded the National Association of Secretaries of State Medallion for their efforts in their communities. The full press release is here.

OSBURN, Idaho — The city dedicated the newly completed Shoshone Fire District #1 facility, which was awarded a $500,000.00 block grant earlier this year. The new 10,000-square-foot facility is a significant fire, training, and emergency services upgrade for the region. Contact Silver Valley EDC for more information.

LEWISTON, Idaho — With a start-up $839,809 grant from the National Science Foundation, the Northwest Intermountain Manufacturing (NIMA) Association has created a pilot project to train high school students in fabrication and machining. In partnership with Lewis-Clark State College, the Clearwater Economic Development Association, the University of Idaho and 16 school districts, the program gives students a solid skill set and educational background in manufacturing so they can be ready to start work right after high school for local companies. The first group of students will complete the program in 2020. See Idaho Department of Labor article here.

LIBERTY LAKE, WA — In response to a gap in the city’s flex office market, Liberty Lake Coworking LLC will open Jan. 2 at 23505 E. Appleway. The 4,600-square-foot space will have 11 private offices, six semi-private spaces, and open table space. The space will also feature booths for private calls, two semi-private meeting booths, a podcast and media room, access to high-speed fiber internet, and free parking. More details can be found here.

POST FALLS, Idaho — Construction on Idaho’s fourth state veterans’ home is expected to start next year. The 82,000 square foot project is to be built in Riverbend Commerce Park in Post Falls and will have 64 beds. The home will be built on 7.3 acres donated by the Jacklin Land Co. in Riverbend Commerce Park on Post Falls’ west side. It is adjacent to BioPol Laboratory and Buck Knives. See the full article here.

SPOKANE, WA — The Toolbox manufacturing incubator expanded to 17,000 square feet in a recent move to Logan Neighborhood. Anchored in the space is Vestis, which manufactures specially designed commercial awnings and canopies. The Toolbox continues to serve as collaborative space where established companies and business mentors share expertise, ideas, tools, and equipment with manufacturing startup and entrepreneurs. The Toolbox is overseen by nonprofit Spokane Create. Read full article here.

On December 4, the Edward Lowe Foundation and Washington Department of Commerce will lead businesses through the basics of Thrive!, a new state program that helps second-stages businesses to increase revenue, streamline operations, and expand into new markets. Contact Susan Joseph Nielsen for more information about Thrive!

POST FALLS, Idaho— Northwest Specialty Hospital completed a $4.5 million addition to include an Endoscopy Center and two additional operating rooms. The 15,000-square-foot addition brings to eight the number of operating rooms for patient surgery. The Endoscopy Center, a 8,650-square-foot addition to the hospital, features two procedure rooms, one exam room and eight preoperative and post-anesthesia care unit bays. See company news release for more information.


Inland Northwest Economic Alliance (INEA) is a consortium of fourteen economic development agencies representing fifteen counties in the North Idaho/Eastern Washington region. The collaborative effort is aimed at building economic growth through enhancing the brand recognition of the Inland Northwest and its communities and showcasing its business value.