Good Sleep and How to Get It

We all know that sleep is important for our health. Unfortunately, sleep can become elusive in times of stress, such as the current COVID-19 crisis. In honor of Sleep Awareness Month, Mosaic behavioral health consultant, Kelly Winter, MS, LMFT drafted this blog to help you get the shut eye you need, now more than ever.

In this article we tackle:

      • How much sleep you need
      • Physical and emotional benefits of sleep
      • Common ailments sleep deprivation puts you at risk for developing
      • Easy tips to improve the quality and quantity of your sleep
      • Other ways to get help
How much sleep you need

The Center for Disease Control and Prevention (CDC) recommends the following amounts of sleep:

Newborn 0-3 months 14-17 hours
Infant 4–12 months 12–16 hours per 24 hours (including naps)
Toddler 1–2 years 11–14 hours per 24 hours (including naps)
Preschool 3–5 years 10–13 hours per 24 hours (including naps)
School Age 6–12 years 9–12 hours per 24 hours
Teen 13–18 years 8–10 hours per 24 hours
Adult 18–60 years 7 or more hours per night
61–64 years 7–9 hours
65 years and older 7–8 hours
Physical and emotional benefits

When we sleep at night, we basically hibernate. Our bodies don’t need to expend energy moving, digesting, coordinating, strategizing, reacting, feeling, etc., and as a result, all of that energy turns inward. Therefore, our time sleeping is spent in four rejuvenating ways; resting, repairing, restoring and resetting.

  • Rest: Active bodily functions rest, therefore all energy goes to automatic processes only and the heart beats less to extend its life
  • Repair: Cell, injury and illness repair
  • Restore: Physical energy levels and proper hormone levels are restored
  • Reset: Bodily processes (e.g., muscle and tissue elasticity) are reset and cells rejuvenate and multiply
  • Rest: Mental activities that work while we are conscious enter a state of rest
  • Repair: Emotional damage both from our daily interactions and from long held wounds are repaired
  • Restore: Mental fatigue limits and distress tolerance are restored
  • Reset: Memory stores, mood levels and regulation capacities are reset
Common ailments associated with sleep deprivation

When we sleep for less than six hours (as 40% of Americans report), we are at higher risk for developing “lifestyle-related” conditions. Here are some common ones we see:

        • Type 2 Diabetes. In the deeper phases of sleep, the body produces hormones to regulate what we lost during the day. One of these hormones is insulin, which regulates blood sugar levels. Lack of enough insulin to regulate the blood sugar can lead to Type 2 diabetes.
        • Hypertension. Hypertension is related to elevated levels of cortisol and adrenaline. Without enough sleep, our body cannot regulate these hormones. If we have too much, our ability to handle stressors goes down and our risk of high blood pressure goes up.
        • Obesity. When we don’t wake refreshed, we rarely feel like exercising. Similarly, we tend to eat the most convenient foods in sight. These factors, combined with an imbalance of necessary hormones, can lead to obesity. has an excellent article on this topic if you’d like to learn more.
        • Depression/Anxiety. The brain is a soup of hormones which regulates our emotions, brain and body activities. Common ones include serotonin, dopamine, and melatonin, just to name a few. When not enough of these are produced or regulated, it throws off the brain’s chemical balance, resulting in depression or anxiety. Consequently, we find it difficult to cope with stress and lack motivation to change.
Improving sleep quantity and quality

Try some of the below tips to improve your sleep. Over time, you’ll likely notice improvement in your mental and physical health, too.

          1. Try to sleep and wake within an hour of the same times each night – even on your days off
          2. Cease electronic use the last 30 minutes before bed
          3. If you can’t get back to sleep within 20 minutes, get up and do something monotonous
          4. Avoid caffeine after noon
          5. Use your bed for sleeping and sex only
          6. Avoid clock watching – this gets your brain stressed about how much sleep you are losing
          7. Try exercise daily – even a 20 minute walk will help
          8. Keep the room dark and cool
          9. Try a weighted blanket, cooling pillow or mattress pad
          10. Establish a regular bedtime routine that includes some form of relaxation
Other ways to get help

If you need extra help, call 541-383-3005 to make an appointment with a Mosaic provider. As a result of COVID-19, many of our providers have gone digital, replacing in person visits with remote sessions. Let’s use these new tools of connection to help improve your sleep.


Media Release: Mosaic Medical Opening First Retail Pharmacy in Prineville Clinic


Contact: Bridget McGinn, Communications Manager

Tel: 541.408.3327; Email:

New pharmacy will increase access and affordability of prescriptions in the region

Prineville, Oregon, Mar. 25, 2020 – Mosaic Medical, a nonprofit community health center, is opening a retail pharmacy on Mar. 30 in its Prineville Clinic at 375 SW Beaver Street. All Mosaic patients and members of the community are welcome to use the Mosaic Pharmacy.

“We are looking forward to helping to provide greater access to an important service in the Prineville community,” said Albert Noyes, PharmD, CDE, BC-ADM and Director of Pharmacy Services for Mosaic. “Being able to fill and receive prescriptions quickly and safely is especially important during a pandemic situation, and we are ready to serve.”

To help slow the spread of COVID-19, the Mosaic Pharmacy will offer curbside pickup of medications and mail delivery of some prescription medications. To learn more about these options please call 5431-323-3865.

Increasing access to pharmacy services in Crook County

Crook County is one of a handful of counties in the western region of the U.S. that have the lowest number of pharmacies per person. Increasing access to pharmacy services promotes the safe use of medications and can improve clinical outcomes for patients. The new Mosaic location will provide Prineville residents with the first centrally-located alternative for filling prescriptions in town.

Mosaic patients benefit from pharmacy location in clinic

Mosaic patients who already visit the Prineville Clinic will benefit from the addition of an on-site pharmacy. As the pharmacy will stay open for an hour after the clinic closes, patients will be able to fill their prescriptions before leaving the building. Because the pharmacy and clinic providers will be sharing the same space, they will be able to collaborate on patient needs more closely. Patients will benefit from better treatment and care plans as a result.

Community members benefit from cost-savings

In addition to increasing access and convenience, the Mosaic pharmacy will help community members who do not have insurance or who have high prescription copays. As a Community Health Center, Mosaic Medical is able to receive medications at lower prices and then pass the savings along to those in need. These discounts can make a significant difference for patients who require medications they otherwise could not afford. Mosaic patients are also able to access sliding scale prices based on their income level.

For community members who are under-employed or under-insured, Mosaic pharmacy will offer a prescription club for a $10 annual fee per household. Club members will pay just $4 for a month’s supply of more than 300 generic medications.

View our Mosaic Pharmacy FAQ here

About Mosaic Medical:

Mosaic Medical is a nonprofit community health center that serves all Central Oregonians, regardless of life circumstances. Through a network of 15 clinics, we offer integrated health services that address each patient’s medical, dental, behavioral health, nutrition and medication needs. Our care is never influenced by how much money our patients make, what language they speak or the status of their insurance coverage. Mosaic Medical provides quality care for all.



Media Release: Mosaic Medical Adapts to Address COVID-19


Contact: Bridget McGinn, Communications Manager

Tel: 541.408.3327; Email:

Patients are encouraged to call with concerns; walk-ins not accepted

Bend, Oregon, Mar. 22, 2020 – In response to the rapidly changing COVID-19 situation, Mosaic Medical is adapting to keep patients and care team members safe.

“In support of the strong public health guidance that we have received to stay home, and to keep social distancing if going out is absolutely needed, we are asking our patients who have not already spoken with us to call us, rather than going to one of our clinics,” said Megan Haase, CEO.

Mosaic moves to minimal staffing model

This coming week the nonprofit community health center is taking further steps to help slow the spread of the coronavirus by moving an additional number of appointments to phone, email—through  MyChart, their patient portal—and video visits with providers. Clinics will be staffed using a minimal staffing model that insures coverage for essential in-person care and allows many employees to work from home.

Temperatures of staff and patients checked outside Mosaic clinics

At all clinics Mosaic is checking temperatures of staff and arriving patients outside the entrance. Staff identified with fever will be sent home, and patients with fever will be isolated as much as possible to protect others from illness, including COVID-19.

Call Center support added and MyChart use encouraged

Mosaic has adapted their staffing model to provide additional Call Center support. Those patients with active MyChart accounts are encouraged to access them for fast and easy communication with their care team. MyChart provides access to medical and immunization records, test results, the ability to manage appointment online and more. The Mosaic MyChart app may be downloaded for Android and Apple devices. Patients may also visit for more information. Patients with urgent needs should call us immediately so that we can connect them with an appropriate care team member.

Visit for FAQs in English and Spanish

Mosaic has posted information for patients about COVID-19 in English and Spanish on our website at The Mosaic Facebook page is also a good resource for patients seekinginformation. Both the website and Facebook page are updated frequently.

About Mosaic Medical:

Mosaic Medical is a nonprofit community health center that serves all Central Oregonians, regardless of life circumstances. Through a network of 15 clinics, we offer integrated health services that address each patient’s medical, dental, behavioral health, nutrition and medication needs. Our care is never influenced by how much money our patients make, what language they speak or the status of their insurance coverage. Mosaic Medical provides quality care for all.



COVID-19 Information for Mosaic Patients and Our Community

Para información en español, presione aquí

Updated Mar. 23, 2020 11:40 a.m.

Mosaic Medical is working with state and local partners to create and manage a response plan for COVID-19, a type of coronavirus, which is a small germ that can spread and cause illness in people.  COVID-19 mostly affects the respiratory system. While most infections are not dangerous, it can cause pneumonia (a serious infection of the lungs) and can be deadly in severe cases. It is highly contagious and is spreading in the United States, including in Oregon.

Information about COVID-19 changes quickly. We will post updates here as they become available.


What are the symptoms of COVID-19?
  • Symptoms include mild to severe respiratory illness with fever, cough, and sometimes difficulty breathing.
  • Older people and people with existing health conditions may be at higher risk for serious illness.
If I have these symptoms, when is it important for me to see my doctor?
  • For most people these symptoms can be managed at home. If you are worried about your symptoms, call us at 541-383-3005. We will have our triage nurses evaluate your symptoms and help you decide on next steps. Please be aware that if you are expecting a return call or an interpreter call from one of our care team members that the phone number they are calling from may not be the main Mosaic line.
  • For more information, view CDC guidelines here.
Is it OK for me to come to Mosaic if I have these symptoms?
  • If you have these symptoms, please call us at 541-383-3005 before coming in. We will talk with you and help you decide on next steps.
  • If you have a scheduled appointment at Mosaic and you develop a cough or fever prior to your visit, please call ahead and let your care team know. This will help ensure that our staff and patients are protected from exposure and can properly care for you.
  • At our Mosaic clinics you will be greeted by a care team member outside of the clinic who will assess you and anyone accompanying you for signs of fever or illness. You may be asked to wait in your car or outside the clinic for a provider to come out to you for further assessment. Following their instructions will help protect you, other patients and our staff.
How can I protect myself?
  • Wash your hands often: Use soap and water and wash for at least 20 seconds. Watch a CDC video of good handwashing practices here.
  • If soap and water are not available, use an alcohol-based hand sanitizer with at least 60% alcohol.
  • Don’t touch your eyes, mouth and nose.
  • Cough or sneeze into your elbow or a tissue and then throw the tissue away.
  • If you’re older or have serious health issues, please take extra caution when in public and consider staying home as much as possible.

COVID-19 reminders

Should I be wearing a mask?
  • If you are not sick: You do not need to wear a facemask.
  • If you are sick: You should wear a facemask when you are around other people (e.g., sharing a room or vehicle) or pets at all times. Please wear a facemask before entering a healthcare provider’s office.
  • When you are caring for others: If the person who is sick is not able to wear a facemask, avoid being in the same room with them. When it’s necessary to be in the room with the ill person, wear a facemask.
Has COVID-19 affected Mosaic’s services?
  • Mosiac implemented modified staffing plans at our clinics system-wide on Monday, Mar. 16. We took this step to align with State directives to support physical distancing to help slow the spread of COVID-19. It also helps our employees adapt to school closures and daycare issues. Our modified staffing model ensures that patients are taken care of and allows many employees to work from home, conducting phone visits with patients as appropriate.
  • We are seeing an increase in the number of calls to our call center, with periods of longer hold times. Thank you for your patience.
  • We ask that if you have activated your MyChart account that you use it as much as possible; and reach out directly to your pharmacy for prescription refills. The MyChart app can be downloaded for Android and Mac devices. Visit for more information and to sign up online.
I understand there’s a test for COVID-19. Can I get this test at Mosaic?
  • As of Monday, Mar. 16 Mosaic is able to do very limited COVID-19 testing with very specific criteria.
  • Walk-in testing is NOT available at Mosaic at this time.
What is Mosaic doing to stop the spread of this virus?
  • Please see above for details on our modified staffing plan to support physical distancing and to help slow the spread of the COVID-19 virus.
  • We are asking patients with coughs and fever to call us before they enter our clinics and asking our care team members who are ill to stay home.
  • If patients with COVID-19 symptoms do enter one of our clinics, we are asking them to wear face masks and are isolating them as soon as possible to stop spread of the virus.
How does seeking treatment for COVID-19 symptoms impact Public Charge Rule?
  • A recent update regarding Public Charge Rule from the U.S. Citizenship and Immigration Services (USCIS) states:  “USCIS encourages all those, including aliens, with symptoms that resemble Coronavirus Disease 2019 (COVID-19) (fever, cough, shortness of breath) to seek necessary medical treatment or preventive services. Such treatment or preventive services will not negatively affect any alien as part of a future Public Charge analysis.”  
  • More information is available at
Where can I find more information?



Hack your Snacks: Eat Right, Bite by Bite

Megann Dastrup and Christa Marney, Mosaic Medical’s registered dietitian nutritionists, offer a fresh take on mid-day snacks in this blog.

Smart snacks to overcome the afternoon slump

Do your energy levels take a dive around 3 p.m. everyday? Do you find yourself craving something sweet or salty around that time? If you answered yes, you might need a snack. Having a mid-day snack is a great way to keep your energy levels up between lunch and dinner.

Unfortunately, typical American snacks are high in calories, fat, sodium or added sugar and often leave you feeling…snackier. However, if you build your snacks around whole foods like fruits and vegetables, nuts and whole grains you can stay fuller longer. Because these foods are typically lower in calories, they are a more satisfying way to keep your energy levels up.

Before you nibble

Check in with your hunger. Are you really hungry or just bored or maybe even thirsty? Make sure you are addressing what your body really needs before reaching for a snack.

Plan ahead for snack success

  • Build Your Own: Make your own snack mix with unsalted nuts and seeds, dried fruit, popcorn (plain), whole grain cereal like cheerios or life.
  • Prep Ahead: Pack grab and go snacks by portioning your snack foods into baggies or containers when you get home from the store or at the beginning of your work week.
  • Keep Portions in Check: Snacks shouldn’t be large, but just enough to tide you over till your next meal. Think 100 – 150 calories.

Get creative

  • Create Combos: Combine food groups for satisfying snacks. Yogurt and berries, cottage cheese and peaches or tomatoes, apple with peanut butter, whole grain crackers with avocado and swiss cheese.
  • Eat Vibrant Veggies: spice up raw vegetables with healthy dips: try hummus, guacamole, salsa, or a homemade greek yogurt dip (see recipes below!).
  • Snack on the go. Bring snacks from home when you’re out. Pack water, trail mix, low sugar granola bars, fruit like apples or bananas or carrot sticks for healthy options.

Homemade greek yogurt dips

Dip and veggies

Greek yogurt dips are a satisfying afternoon snack.

What makes these snack-able dips so handy? It’s because they can be modified to satisfy sweet and savory cravings alike. Start with one cup plain non-fat greek yogurt and choose your add ins:

  • Ranch: 2 tbsp Mrs Dash or ¾ tsp garlic powder, ½ tsp onion powder, ½ tsp dried dill, ¼ tsp kosher salt, ¼ tsp worcestershire, 1/8 tsp cayenne pepper.
  • Taco: 1 tsp onion powder, 1 tsp dried oregano, ½ tsp paprika, 1 tsp cumin, ½ tsp chili powder, salt and pepper to taste.
  • Greek: ¼ cup chopped cucumber, 1 tsp garlic powder, 1 tbsp lemon juice, 1 tbsp olive oil, ½ tsp black pepper, 1 tbsp fresh dill or parsley.
  • Sweet: 2 tbsp honey or maple syrup, ½ tsp cinnamon, ¼ tsp vanilla.
  • Chocolate: 2 tbsp honey, 2 tbsp cocoa powder, ½ tsp vanilla, pinch of cinnamon.

Each ¼ cup serving contains approximately: Calories: 30 –  62, Protein: 6 grams. Carbohydrate: 2 – 10 grams. Note that the sweet dips typically contain more calories and carbohydrates.

March is National Nutrition Month. We hope these tips, adapted from and, help you jump start your health and fitness goals.

Megann Dastrup, MDA, RDN, LD is a registered dietitian nutritionist. She completed her Masters in Dietetics Administration, dietetic internship and undergraduate studies through Utah State University. She is a certified health coach through ACE fitness and has a certificate of training in adult weight management as well as in child and adolescent weight management.

Christa Marney, RDN, LD has always had an appetite for being active and staying healthy. She is a certified intrinsic coach and completed training in adult weight management through the Academy of Nutrition and Dietetics.


The Head and Heart Connection

Mosaic Medical’s Behavioral Health Director, Kimberly Swanson, PhD, clears up misconceptions about the head and heart connection (mental health and heart health) for American Heart Month.

For years, medical providers thought that behaviors were the connection between the head and heart. For example, a person experiencing depression might seek relief from smoking, drinking alcohol or eating high fat foods. This thinking has changed with research showing that there is a physiological connection between heart health and mental health. We now know that the same biological and chemical factors that trigger mental health issues also influence heart disease.

Mental Health and Heart Health

Research shows that common mental health conditions such as depression, anxiety or stress firmly link to heart disease. Stress and depression can also impact blood pressure and heart rate.

Heart Health and Mental Health

Having heart disease or stroke can cause depression and anxiety due to the biological and chemical factors mentioned above.  Some patients may also think that they “should be depressed” after having a heart attack or stroke. However, minimizing sadness or, even worse, dismissing it can worsen both heart health and mental health.

What Should You Do?

Begin by openly discussing how you are feeling both physically and mentally with your Mosaic health care provider.  Your Mosaic health care provider can help connect you to our Behavioral Health Consultants who are experts at both improving your mental health and heart health.

Kimberly Swanson, PhD, is a Licensed Psychologist and Director of Behavioral Health for Mosaic Medical.


Public Charge: Update on the Supreme Court Ruling

Image of Supreme CourtOn Monday, Jan. 27, the U.S. Supreme Court temporarily cleared the new “Public Charge” regulation to go forward nationwide. The new rule will go into effect on Feb. 24 throughout the nation (except for Illinois), even as lawsuits challenging the rule work their way through the court system. The rule will not be retroactive, so no one will be held to the new rule until after Feb. 24. At Mosaic Medical we want to share information about this rule in order to support our immigrant patients, staff and their families.

What is “Public Charge”?

The U.S. Department of Homeland Security (DHS) assesses individuals seeking admission to the U.S. or applying for a green card to determine if they would be a “public charge.” This is defined as an individual “who receives one or more public benefit for more than 12 months . . . within any 36-month period (such that, for instance, receipt of two public benefits in one month counts as two months).”

The expanded rule cleared on Monday broadens the public charge definition. For the first time the definition now includes: non-emergency Medicaid (OHP), “SNAP” (also known as “food stamps”), and Section 8 housing assistance.

Please note these are NOT considered “public charges”:

  • Medicaid (OHP) for kids under 21
  • Medicaid (OHP) for pregnant women, including 60 days post-partum
  • Emergency Medicaid (CAWEM)
  • Oregon’s Cover All Kids program

(see the linked documents below for more exemptions)

Mosaic Medical sliding scale discounts do not count as a public charge. Also, a child’s use of Medicaid (OHP) does not create a public charge issue for the parent of that child. It is only programs used by the person applying for U.S. entry or a green card that are considered. Programs used by children/family members of those applying are NOT considered.

Public Charge Information Sheets

We encourage everyone to review the links below to the Oregon Health Authority fact sheets and FAQs in English and Spanish.

Immigration Legal Resource

To seek advice from an immigration attorney contact Oregon Immigration Resource.


Note: This post will be updated as further information becomes available.

Information provided by: Elaine Knobbs-Seasholtz, Director of Strategy and Development, Mosaic Medical


Winter Well-Being and How to Stay Active

Winter well-being and how to stay active

Photo of the author taken by Warren Cruze. Location: Dolomites of Cortina d’Ampezzo in Italy.

Sharing her thoughts on winter well-being and how to stay active, our guest blogger is Tina Bollman, Behavioral Health Coordinator at Mosaic Medical and Subject Matter Expert for the American Council on Exercise

Baby, it’s Cold Outside!

Many people find that it can be difficult to stay on track with healthy activity goals and New Year resolutions after the holiday festivities end. Coping with winter well-being and how to say active in cold, rainy or snowy weather can be challenging. And, the shorter days can make you feel tired, moody and less likely to be active. It’s all too easy to find reasons to skip a workout today and hope to do better tomorrow. However, while this may feel good in the moment, it can turn into a bad cycle.

The benefits of staying active

Regular exercise not only helps us to maintain a healthy weight but also improves our overall health, with benefits like:

  • Better sleep
  • Improved energy level
  • Lower blood pressure
  • Lower blood cholesterol
  • Reduced risk of heart attack
  • Lower risk of type 2 diabetes
  • Develops stronger bones, muscles and joints
  • Better recovery from illness and periods of bed rest

Exercise affects your mental health

Did you know that being active is also shown to change levels of chemicals in your brain? These changes have positive effects on your mental and emotional health. In fact, finding time to move and be active is practically a “magic bullet” for feeling better, immediately. It’s long been said that if the many benefits of exercise could be put into a pill, it would be prescribed to everyone!

Studies show that exercising:

  • Gets your mind off of worries
  • Improves your mood
  • Relieves stress
  • Improves sleep patterns
  • Reduces tiredness
  • Increases mental alertness and sharper thinking
  • Brings a feeling of success and better self-esteem
  • Helps you feel more relaxed and positive about life

A little exercise is better than none

Even a little bit of activity is better than none. And, this is probably the single most important thing to focus on. Short bouts of exercise, even 5-10 minutes at a time, is very helpful. You do not have to train daily at the gym, run miles and miles, or sweat buckets to become healthier. Thirty minutes of moderate exercise, (like walking, hiking, snowshoeing, skiing, dancing, or cycling) five times a week will get you all of these wonderful health benefits.

Exercising in cold weather has extra benefits

So what about these super wintry conditions? It turns out that doing outdoor activities in cold temperatures brings extra benefits. Here’s why you shouldn’t avoid getting outside in the winter months:

    • Exercising in the cold can burn more calories as your body produces heat
    • There is no heat and humidity to deal with, making you feel more energetic
    • Sunlight exposure improves mood and reduces depression
    • Cold exposure during exercise can boost immunity to colds and flu

And don’t forget those gorgeous rosy cheeks!

Stay safe and have an alternate plan to exercising outside

To stay safe while exercising outside be sure to have an alternate plan in case the weather is just too terrible. To help with that, here are Four Fun and Effective Treadmill Workouts to try, which can easily be modified for your current fitness level.

Those who suffer with asthma should check with their doctor before exercising outside in winter weather as cold air can trigger an asthma attack. And everyone can learn from these tips for Keeping Cold-weather Physical Activity Safe.

The key to winter well-being and staying active is commitment

The key is to commit to some kind of activity – even just a few minutes – on most days of the week. Making a small change today, and repeating it = a new healthy habit. Regardless of the weather, it is possible to develop habits that help your winter well-being and how to stay active. In summary, just keep at it, and the benefits of exercise will begin to change you for the better, mentally and physically!


Tina Bollman is the Behavioral Health Coordinator at Mosaic Medical. She is a Subject Matter Expert for the American Council on Exercise and holds certifications as a Group Fitness Instructor, Personal Trainer and Health Coach.



Mental Health Services Are Closer to Home with Tele-Mental Health

An in-depth look at the innovative work of our Behavioral Health team to reduce barriers to mental health services for our rural patients.

The Need for Mental Health Care

There is no question that a lack of access to proper mental health care is one of Central Oregon’s biggest public health struggles. Every day Mosaic providers acutely feel the impact of poor access to specialty mental health care for our patients. Our patients feel the impact too. So much so that their collective voice has elevated improving timely access to specialty mental health services as a top priority for our state and region to address.

State and National Statistics

According to the U.S. Centers for Disease Control and Prevention, 25% of American adults suffer from a mental illness. Almost half of Americans will experience a mental health issue at some point in their life, or someone close to them (peer or family member) will be impacted with a mental health concern. It is estimated that 15 million American children are in need of specialty mental health services. To further compound matters, of all the 50 states plus the District of Columbia, Oregon ranks 49th in the nation for access to mental health services. And Oregon is one of the states with the highest percentages of mental illness.
Furthermore, Oregon has severe mental health care provider shortages, with no less than one mental health care provider for every 1,000 people. Even Bend is considered a mental health care provider shortage area according to the Health Resources & Service Administration (HRSA).

Mental Health and Physical Health

Individuals with poorly treated or under-treated mental health conditions have greater health issues compared to the general population. For example, individuals with depression are twice as likely to develop type 2 diabetes mellitus. And their risk for stroke and myocardial infarction is three-and five-fold times higher than people without depression. Mental illness in general is associated with an increased risk of hepatitis, tuberculosis, and poor dental health. It has been estimated for individuals who have severe and persistent mental illness (e.g. those with schizophrenia, bipolar disorder) that life expectancy is reduced by at least 10 years as compared to the general population.

Individuals with mental health conditions use a significant number of health care services. For example, nearly 12 million visits made to United States hospital emergency departments in 2007 involved individuals with a mental disorder, substance use disorder, or both. While poor physical outcomes in individuals with mental health issues are related to many factors, fair access to skilled interdisciplinary care both in specialty mental health and medical settings are top contributors.

Innovative Solutions are Needed Now

Innovative solutions are needed to increase access to all forms of specialty mental health care, and they are needed now. Tele-mental health services which include tele-psychiatry is one of the most promising developments to provide patient-centered, affordable, and effective interventions for individuals in need of mental health care.

Mosaic Pilots Tele-Mental Health Visits

In an effort to improve access to mental health care in our rural sites, in June of 2019 Mosaic began a pilot program offering tele-mental health visits for adult patients at our Prineville clinic. Our pilot program includes both traditional specialty tele-mental health visits as well as a consultative model. Traditional tele-mental health visits treat approximately 30% of the population. The consultative model, called Collaborative Care, treats 70% of the population. Collaborative Care is also called consultative psychiatry and is a routine part of advanced primary care practice. If you are interested in learning more, visit the AIMS Center at the University of Washington website.

“In the consultative model, our tele-mental health providers provide our Primary Care Providers (PCPs) and Behavioral Health Consultants (BHCs) with expert advice on how to effectively treat the most common mental health conditions in primary care (e.g. depression),” said Kimberly Swanson, Ph.D. and Mosaic’s Behavioral Health Director. “Our patients in Prineville now have equitable and timely access to skilled interdisciplinary care right within their primary care medical home. We are proud to say we now offer 28 hours of tele-mental health services each week in Prineville.”

Tele-Mental Health Basics

“Tele-mental health generally refers to the delivery of mental health assessment and ongoing care via telecommunication technology,” said Michael Thomas, Mosaic’s Director of Technology and Clinical Informatics. “The patient is checked in at one of our clinics and roomed in a space set up for telemedicine. Staff ensures that the video and audio connection with the tele-mental health provider is established. The provider can be at another Mosaic clinic or any other location with an adequate internet location. The visit proceeds just as if the provider was in the room with the patient. The provider documents in Epic at their location, then notifies the clinic staff that the visit is over and terminates the connection.”

Tele-Mental Health Providers

At Mosaic, our tele-mental health providers include the following:

Care Manager: A licensed clinical social worker. Our Care Manager is different from a Behavioral Health Consultant working in our clinic in that she/he provides a slightly longer and more in-depth behavioral treatment for a variety of health and mental health conditions.

Psychiatric Mental Health Nurse Practitioner: Has completed an advanced nursing degree and specializes in psychiatry. Our Psychiatric Mental Health Nurse Practitioner assesses, diagnoses and treats mental health conditions to help manage symptoms resulting from psychiatric or substance disorders. They are an expert in psychopharmacology and have in-depth experience and knowledge of psychiatric medications and how to prescribe them effectively.

Tele-Mental Health Versus Face-to-Face Visits

Some patients and providers have expressed concern that patients are not getting comparable care via tele-mental health versus conventional face-to-face visits. However, research indicates tele-mental health is just as satisfying, more cost effective, well accepted by patients and equally as impactful as in-person visits. Additionally, there is some emerging evidence that some patients may actually prefer tele-mental health visits to in-person treatment. Learn more: Telepsychiatry Effectiveness and Feasibility

Tele-Mental Health and the Patient

In most cases the process of getting specialty mental health help for a patient changes little about the patient experience. Patients at our Prineville clinic first visit their PCP or BHC to discuss their concerns. The PCP or BHC then creates an internal referral to see one of our tele-mental health providers, and Prineville clinic front desk staff or HIT-Referral staff schedules the patient appointment for tele-mental health. The patient is seen within our Prineville clinic, and they check in for their tele-mental appointment like they would for any other appointment. Any follow- up appointments are conducted in the much the same way.

Patient Privacy

“Though our patients have not voiced concern about privacy while accessing tele-mental health, our telemedicine equipment and network protocols are HIPAA compliant,” said Thomas. “Recently, Mosaic has worked with OCHIN to embed telemedicine within EPIC (our electronic medical record system). This simplifies the entire process by allowing the video visit to launch right from EPIC instead of a separate application. Video awareness within EPIC scheduling functionality becomes much easier. With integrated video during these visits, the availability of a patient for the audio/video link up becomes evident, simplifying communication, and keeping it in the EPIC schedule view.”

The Provider’s Perspective

Our rural providers in Prineville have been supportive and enthusiastic about the addition of telepsychatry services.

“We all have recognized the fact that our community has not had adequate access to mental health care services. Since we started this pilot, the feedback from the providers has been very positive. We’ve all seen positive changes in PHQ9 scores of patients that have been referred to telepsychiatry,” said Diana Burden, Prineville Clinical Medical Director.  “In addition, we’ve had positive anecdotal responses from our patients when they have followed up with us in the clinic.”

Collaboration with our telepsych providers has been very congenial. The initial guidelines that were developed provided a clear foundation for communication, as well as practice policy. The pilot leadership group solicits feedback from the provider group regarding communication between providers, and determines if there are any changes that need to be made with regards to clinic or procedure flow. In addition, Prineville providers have monthly joint meetings to discuss the patients we share with our tele-mental health providers. This ensures that we are meeting the needs of our patients. We also have daily access to the tele-mental health providers if we feel we need to discuss mutual patients with urgent needs more frequently.

“Overall, the provider group in Prineville feels very positive about the addition of our telepsychatry services, and we look forward to our ability to expand to the pediatric population in the future,” said Burden.

The Clinic Perspective

“As with many changes, piloting telepsychiatry seemed daunting to our team in the beginning. There were not only logistical challenges (support staffing, space, etc.), but also doubts about our community’s willingness to engage with the program,” said Laura Pedraza, Prineville Clinic Manager. “Thanks to the thorough preparation that went into implementing the program, these fears were quickly dispelled. To our surprise, patients were willing to give telepsychiatry a chance, and then kept coming back!”

The positive community response assisted our decision to commit to staffing additional time with a Medical Assistant in order to expand program hours. We currently have tele-mental health services available 28 hours each week.

“Thanks to careful provider selection, we have engaged and caring telepsychiatry providers who partner well with our team and patients in the delivery of tele-mental health services,” said Pedraza. “We are happy to say that the telepsychiatry program has now been fully adopted as an extension of our clinic’s services.”

On the Horizon

  • On January 27, 2020, we are excited to expand our Prineville pilot program to include children and adolescents. Crook Kids (School-Based Health Center) will also be able to refer their patients for tele-mental health services.
  • In the spring of 2020 we will expand tele-mental health to our Madras Clinic and Madras High School Based Health Center. We are thrilled that our tele-mental health providers for Madras are also bilingual and bicultural.
  • We are exploring the idea of leveraging technology within Mosaic through “Tele-BHC.” Other Federally Qualified Health Centers (FQHCs) in Oregon have begun using a similar model e.g. Yakima Valley Farm Workers Clinic. Through Tele-BHC we envision being able to cover all six of our School-Based Health Centers 100% of the time as well as improve mental health support and coverage at all Mosaic clinics.

Special thanks to Mosaic’s Behavioral Health team for preparing this overview of our Tele-Mental Health pilot program in Prineville. For article citations and further information please contact Kimberly Swanson, Ph.D. Mosaic’s Director of Behavioral Health at


Mindful Holiday Eating and Drinking

Mindful holiday eating and drinking can help us navigate the season healthfully.

Guest blog post by Kimberly Swanson, Ph.D., Director for Behavioral Health at Mosaic Medical

All of our best intentions and good health habits are put to the ultimate test this time of year, and mindful holiday eating and drinking can help us navigate the season healthfully. During the holiday season there are typically lots of distractions and we are often over-scheduled, rushing around to attend many parties and get-togethers. And of course there are an abundance of yummy treats at every turn. Added to all this, many people have trouble fitting in exercise during this busy time of year. It is not easy to stay on track with our health through the holidays, and before you know it we have overindulged and packed on some unwanted pounds. To help you enjoy the holiday season fully we have gathered together a few tips to help you celebrate while maintaining your health. Practicing mindful holiday eating and drinking can help to lessen the stress of the season.

Alcohol Guidelines

Alcohol and celebration can often go hand in hand. It is not unreasonable to have alcohol in your life, but alcohol has a lot of hidden calories (e.g. one pint of beer has as much calories as a sugar coated doughnut!) and can really impact your health.

Some key questions to consider for mindful drinking include:

1) Are you relying on it?

2) Are you or is someone close to you concerned about your drinking?

The Center for Disease Control (CDC) recommends that adult men have no more than two servings of alcohol in one sitting and adult women have no more than one serving in one sitting. Pregnant women are advised to avoid alcohol altogether. To limit alcohol consumption, try to alternate drinking alcohol with glasses of sparkling water.

Mindful Eating

Most of us eat because food is in front of us, whether or not we are truly hungry. And celebrations often have most, if not all of our favorite foods! Using the five “S’s” of mindful eating can help you enjoy all your holiday favorites while maintaining your health:

    1. Sit down: Studies show people eat 5% more when they stand and eat.
    2. Savor: Take a moment to really see the food in front of you, and to smell the aromas.
    3. Slowly Chew: Let the flavors rest on your tongue before taking the next bite.
    4. Stay in the moment: When we are socially engaged we cannot truly focus on what we are eating and drinking. Research shows us that when other people are indulging around us, we tend to indulge more too.  Put your fork down between bites of food while eating.
    5. Smile: Holiday meals and celebrations are the perfect time to give thanks for the abundance in our lives and for the people and efforts that went into providing the meal.

Holiday Hosting

If you are hosting for the holidays, below are some helpful tips to invest in both celebration and health:

    1. Include healthy food choices on your menu such as vegetables, fruits and lean meats.
    2. Baking, broiling and barbequing are healthy ways to prepare foods versus frying or adding fat and grease.
    3. Avoid sampling foods more than necessary while preparing – the calories can add up fast!
    4. Avoid grazing by putting food away after the meal is over.
    5. Give guests left over dishes to take home with them.

Being a Healthy Guest

If you are a guest at someone else’s home over the holidays, here are more helpful tips:

    1. Don’t skip meals beforehand in preparation for overindulging.
    2. Keep plate sizes and portion sizes small.
    3. Skip dressings, butter and gravy.
    4. Drink mostly water and limit alcoholic beverages.
    5. Plan some form of exercise before or after eating.

Need Support?

If you find you need help staying on track this holiday season with mindful holiday eating and drinking, or you find that the indulgences added up, never fear, we are here to help you get on track and stay on track! The first step is reaching out to your Mosaic provider. Your Mosaic Medical provider can direct you to several community and Mosaic resources:

  • Walk with Ease
  • Nutrition Kitchen
  • Eat for Life – a 4 months program for Type II Diabetes
  • Living Well with Chronic Medical Conditions
  • Mindfulness Group
  • Are you or a loved one concerned about your drinking? Talk to your Mosaic provider today.  We care about you and are here to help.

Not a Mosaic patient? Give us a call at 541-383-3005 and we can help you join the Mosaic Medical family.

Kimberly Swanson, Ph.D., is a Licensed Clinical Psychologist working full time as the Director for Behavioral Health at Mosaic Medical where she oversees both the Primary Care Integrated Behavioral Health team and embedded Substance Use Team (Transitions).  Dr. Swanson completed a yearlong leadership fellowship 2015-2016 in health care transformation through the Oregon Health Authority. Dr. Swanson presently chairs the regional Pain Standards Task Force (PSTF) for the Central Oregon Health Council. She was awarded the 2017 Deschutes County Health Hero award for the positive public health impact of PSTF. Dr. Swanson also currently serves on the Leadership Group for the Central Oregon Suicide Prevention Alliance and is a new Advisory Board Member for the Central Oregon chapter for the National Alliance for the Mentally Ill.