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Radical Rosewood: Building a Clinical System to Identify and Address Social Determinants of Health

The presenters will examine Rosewood's process for screening and identifying barriers and social determinants. They will use specific cases to highlight clinic workflows, care coordination, and patient navigation services, and how team-cased care helps patients and families overcome barriers and achieve their health and wellness goals.

Leadership and staff from Rosewood will talk about their journey to transform what had been a traditional model of care into a patient-centered, team-based model that addresses all aspects of health and well-being with a focus on social determinants of health.

Michelle Lehr O'Connell, MPA has more than fifteen years of experience working with community health centers around administration and operations, capacity building, practice transformation, staff leadership and development, program development and fundraising. Michelle is deeply committee to promoting shared learning and responsibility through engagement and collegial environments.

She currently serves as the Clinic Director for Rosewood Family Health center, a federally qualified health center and patient centered medical home that is part of the Yakima Valley Farm Workers Clinic. At Rosewood, she is responsible for ensuring access to care, the provision of competent and culturally sensitive care, and responsiveness to community need. She leads a site-based leadership team to foster collaboration between staff and improve efficiency of service delivery.

Beth Briggs, PsyD, earned her doctorate from Antioch University New England. She completes a predoctoral internship at Cherokee Health Systems and a postdoctoral fellowship at Edith Nourse Rogers VAMC/University of Massachusetts Medical Center. Her areas of interest include providing mental health care for underserved populations in primary care settings, health behavior change in chronic health conditions, and interdisciplinary education. She has worked in a variety of settings including federally qualified health centers, community mental health centers, academic health, and a VAMC.

Dr. Briggs is currently a Behavioral Health Consultant at Rosewood Family Health Center, a federally qualified health center and level four patient centered medical home that is part of Yakima Valley Farm Workers Clinic. She provides on demand assessment and intervention for a diverse population across the lifespan. She also offers consultation to primary care providers and contributes to initiatives to improve access to care and improve health outcomes.

Josie Riggall, MPH, RD, earned her Master of Public Health degree from the University of Wisconsin-Madison and completed her Dietetic Internship at Oregon State University. Josie currently serves a Primary Care Dietitian at Rosewood Family Health Center. She sees patients who come to the clinic for primary care and are interested in learning more about healthy eating and nutrition. Her practice uses a motivational interviewing approach to help patients modify behaviors and meet their wellness goals. Josie is bilingual in Spanish. She is a member of the Academy of Nutrition and Dietetics. In her free time, she enjoys hiking, biking, gardening, cooking, and spending time with her family.

Katie Occhinipinti, RN, BSN, received her first Bachelor's degree in psychology from the University of Oregon and went on to pursue her Bachelor's degree in nursing from Oregon Health and Science University. Katelyn has five years of experience working in a variety of community health settings, serving diverse patient populations. Community health nursing is Katelyn's passion, and she is committees to providing holistic, patient-centered care to underserved and vulnerable populations.

Katelyn joined Yakima Valley Farm Workers Clinic at Rosewood Family Health Center and is currently working as the Community Health Services intake registered nurse. In this position Katelyn works with all new patients to establish care, and helps facilitate interdisciplinary coordination for medically and socially complex patients.


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