FAQ

Your initial intake session will extend for 90 minutes. Before your session, you’ll receive consents covering practice policies, as well as forms mandated by law—please note, these requirements are beyond my control. Additionally, you’ll receive a link to your cell phone for completing essential baseline questionnaires. Following your initial session, you might receive additional personalized assessment tools based on your unique situation.  A portal will allow you to view your results and, through occasional retesting, track progress over time. This not only guides treatment plan adjustments but also adds a fun element. It has the additional benefit to providing me insight on your progress and make adjustment, if necessary.

Expected initial follow-up appointments will be 30 to 45 minutes, based on complexity, until stability is achieved. Once stable—denoting no expected changes in treatment plan, medication type, or dose—subsequent appointments will be 30 minutes. For urgent medication refills without dose or medication changes, a 15-minute follow-up can be accommodated.

If your plan involves controlled substances, your initial 90-minute intake session will be followed by 30 to 45-minute follow-ups every 2 weeks until your medication and dose are established. Subsequently, you’ll transition to 30-minute monthly follow-ups for 3 months. If stability persists, you’ll shift to 30-minute follow-ups every 3 months.

The patient portal serves as your central hub for several essential functions. Within the portal, you can complete necessary intake documents and consent forms. It also enables you to check our availability, schedule appointments, and even prepay for upcoming sessions. Additionally, you’ll find a direct link to your telehealth appointment, accessible through your computer or cell phone.

Furthermore, the portal allows you to upload and securely store medical documents. You can manage your medical history, including current medications, supplements, and laboratory findings. Monitoring health vitals like height, weight, and blood pressure is also possible, with the option to visualize these data points if desired.

Another valuable feature is the ability to communicate with your provider through messages, although response times are more casual. As you transition into a client, you’ll gain access to a separate communication platform allowing for direct messaging and texting. This platform also serves as a backup for telehealth sessions so you will want this available in case there are technology issues or for a faster response from the clinic.

Unrelated to this portal, you will receive a private portal offering the convenience of accessing your measures and tracking their changes over time. You will create this portal when you receive a request to complete your intake assessment tools.

These portals are yours and you will enjoy continued access.

ANXIETY: The duration of medication treatment for anxiety varies based on the specific anxiety disorder and the individual’s response to treatment. For Generalized Anxiety Disorder (GAD), treatment with medication may be recommended for several months to a year or longer, depending on the severity of symptoms and response to treatment. Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are commonly prescribed medications for anxiety and may be used for an extended period to manage symptoms effectively. Both you and I will track your anxiety symptoms over time that will allow you to see your progress. The optimal outcome often results from a combination of therapy and medication management. Of course, working with a therapist while receiving medication, has the best outcome.

DEPRESSION: The duration of medication treatment for depression varies depending on the severity of the condition and the individual’s progress. For Major Depressive Disorder (MDD), antidepressant medication is often prescribed for an initial period of 6 to 12 months. However, some individuals may benefit from continuing medication for a more extended period. It’s common for healthcare providers to recommend continuing medication treatment for 6 to 12 months after the individual’s mood stabilizes to prevent relapse. Of course, working with a therapist while receiving medication, has the best outcome.

BIPOLAR AFFECTIVE DISORDER: Bipolar disorder is a chronic condition characterized by episodes of mania or hypomania and periods of depression. It’s managed rather than cured. The duration of medication treatment for bipolar disorder is typically long-term and aims to stabilize mood and prevent relapses. Mood stabilizers are the mainstay of treatment. Medications like lithium, lamotrigine, and antipsychotics (such as olanzapine, quetiapine, or aripiprazole) are commonly prescribed to manage symptoms and stabilize mood swings. For acute episodes of mania or depression, additional medications may be prescribed, such as antipsychotics for mania or antidepressants for depression. However, antidepressants are often used cautiously due to the risk of triggering manic episodes. It’s essential to we work closely to find the right combination of medications and dosages to manage symptoms effectively Medication treatment for bipolar disorder is typically ongoing, as stopping medication prematurely can lead to relapse. However, the exact duration can vary based on individual response and the presence of other factors. Regular follow-up appointments with a healthcare provider are crucial to monitor mood, assess medication effectiveness, and adjust treatment if needed. Remember that while there may not be a cure for bipolar disorder, effective medication management, combined with therapy and lifestyle adjustments, can help individuals lead stable and fulfilling lives. Open communication is vital for maintaining symptom control and preventing relapses. Of course, working with a therapist while receiving medication, has the best outcome.

ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD):

ADHD is a neurodevelopmental disorder characterized by difficulties with attention, hyperactivity, and impulsivity. Medication treatment for ADHD is a key component of managing symptoms, but it doesn’t cure the condition. Stimulant medications (such as methylphenidate and amphetamine-based medications) and non-stimulant medications (like guanfacine ER, clonidine, and to a lesser degree atomoxetine and bupropion) are commonly prescribed to manage ADHD symptoms. The duration of medication treatment for ADHD varies based on individual needs and response to treatment. For many individuals, medication treatment is ongoing to help maintain symptom control and improve daily functioning. Regular follow-up appointments are essential to monitor the effectiveness of the medication, assess for any side effects, and adjust treatment as needed. The decision to continue medication treatment is made collaboratively between the individual, their healthcare provider, and often involves considerations like the individual’s age, symptom severity, response to treatment, and potential need for other interventions like therapy or behavioral interventions. Based on our experience, it is rare individuals diagnosed with ADHD struggle with ADHD alone, there are usually other concurrent mental health struggles. Remember that while medication can significantly help manage ADHD symptoms, it’s often most effective when combined with other strategies, such as behavioral therapy, lifestyle adjustments, and creating supportive environments. An open and ongoing dialogue with a healthcare provider is crucial for finding the right approach and maintaining symptom control. As part of an ongoing assessment, we may request a urine drug screen from time to time.

Yes, our approach involves a comprehensive evaluation through psychological assessment, including a thorough interview and testing tools. Diagnosis can range from straightforward to intricate. Some testing tools may be integrated into the intake process or provided after the initial assessment. The results are promptly shared with you. Additionally, there’s a specific tool, taken at home, lasting about 15 minutes. Its results are forwarded to our office within a few days. This test, not covered by insurance, incurs a $200 fee that’s necessary for a comprehensive evaluation. While it’s a one-time requirement, it’s vital.

For clients who might require medical intervention, particularly stimulants, monitoring your blood pressure, heart rate, and weight at each session is imperative for safety. You can conveniently obtain a blood pressure monitor for around $25 from local and online retailers.

Of note, in this practice, we take a thoughtful and comprehensive approach to assessing and diagnosing ADHD. In addition to a thorough interview and measurement process. When it comes to treatment, with empathetic consideration of your treatment plan, we seek to provide clarity in conveying our philosophy.

If it becomes necessary to prescribe a stimulant medication for ADHD management, we believe in the importance of using long-acting stimulants as a core component. These medications play a vital role in effectively addressing day-long symptoms. In certain cases, we might consider the incorporation of a low dose of short-acting stimulant in addition to the long-acting one, if it proves beneficial for achieving the best outcome.

To be clear our treatment approach does not involve prescribing solely a short-acting stimulant. To illustrate, if someone is currently taking Adderall (not Adderall XR) multiple times daily, our goal when assuming their care would be to identify an appropriate long-acting stimulant.

Ultimately, our focus is on tailoring the treatment approach to provide the most effective and balanced management of ADHD symptoms, while prioritizing your well-being and overall experience.

We provide a comprehensive range of services, carefully tailored to each individual’s unique needs. It’s important to note that, in alignment with best practices, we do not prescribe benzodiazepines for extended periods exceeding two weeks, but realistically, fewer than a couple of days.  However, we do recognize specific situations where a one-time prescription may be appropriate – such as prior to flying or undergoing an MRI.

In cases where a benzodiazepine becomes necessary, it’s essential to emphasize that xanax (alprazolam) is not a part of my prescribed options. My priority is ensuring the utmost safety and well-being of my clients. For those seeking to discontinue benzodiazepine use, I offer personalized taper plans. The duration of this process may vary, spanning a few weeks to potentially over a year, contingent on factors like dose, frequency, and duration of previous treatment.

It’s vital to clarify that we approach benzodiazepine prescriptions with a commitment to gradual reduction. I am here to assist in a safe withdrawal process, focusing on decreasing doses over time. If your aim is to transfer an ongoing, lifelong benzodiazepine prescription, our approach may not align. However, please rest assured that we address anxiety concerns diligently. Together, we will explore alternative options, whether for short-term or long-term use, tailored to your unique needs. Your well-being and safety are paramount in every step of this journey.

A Psychiatric Mental Health Nurse Practitioner (PMHNP) is a specialized mental health care provider operating under rigorous licensing and credentialing standards. They cultivate meaningful therapeutic relationships with individuals facing mental health or substance use challenges, extending support to families as well. By educating patients, families, peers, and communities, PMHNPs emphasize the integral link between overall health and mental well-being, challenging the associated stigma.

PMH-APRNs (Advanced Practice Registered Nurses) assess, diagnose, and treat individuals, families, or groups dealing with intricate psychiatric-mental health issues. Their services span a wide age range, from prenatal to end-of-life care. Some PMHNPs focus on specialized areas like acute care, child and adolescent mental health, gerontology, forensics, substance use disorders, and more. Core responsibilities involve prescribing medications, offering diverse forms of psychotherapy, and delivering clinical supervision. PMH-APRNs can work independently or collaboratively, possibly in self-employment or under an agency, with billing practices varying.

Different mental health practitioners include psychiatrists, physician assistants, social workers, therapists, and psychologists.

PMHNP and other PHM-APRNs hold nursing degrees, which form the foundation of their practice, rooted in the nursing process. Psychiatrists, on the other hand, have earned Medical Degrees and have undergone specialized training during their residency in psychiatry, potentially pursuing further expertise in specific areas. Meanwhile, Physician Assistants are equipped with medical science degrees, grounded in the medical model, which prepares them to practice as Physician Assistants after successfully completing their training and qualifying certification exams. There’s overlap with these and other roles; for instance, psychotherapy is a common thread as is training in psychopharmacology. While PMH-APRNs, Psychiatrists, and Physician Assistants can prescribe, psychologists and social workers cannot. Psychologists excel in psychological testing, whereas the other disciplines do not. All these practitioners can practice independently within state-defined parameters.

A PMHNP plays a vital role in mental health care, applying nursing principles to their practice. They complement other mental health roles, offering distinct contributions to holistic well-being within their licensed scope.

We understand that unexpected situations can arise, affecting your ability to attend appointments. Our late-cancellation and no-show policy is designed to strike a balance between flexibility and accountability.

For established clients, we offer a forgiving approach. The first instance of late cancellation or no-show will not incur any charges; however, we kindly request that you notify the office so we can accommodate others on our waiting list. If a second occurrence takes place, the fee will be reduced to 50% of the standard fee, which amounts to $125. This acknowledges the circumstances while still emphasizing the importance of honoring appointments. Should a third instance arise, the full fee of $250 will be charged, prompting a reevaluation of the appointment commitment.

We appreciate your understanding that this policy is meant to maintain the quality of care for all clients while recognizing that life can be unpredictable.

For new clients, we allocate 90 minutes to ensure a thorough and comprehensive intake process tailored to your needs. While this timeframe can typically accommodate 2 to 3 clients, it is exclusively reserved for your appointment. To secure your scheduled slot, we kindly request that you provide a credit card for appointment confirmation during the booking process.

In the event that you need to cancel or reschedule, we kindly ask for a minimum of 24 hours’ notice. Failure to do so or not attending your intake will result in a charge of $250. We understand that unexpected situations can arise, so to avoid this charge, we recommend notifying our office in advance or postponing the appointment until you have a confirmed date and time. This ensures that both your time and our resources are optimally utilized.

We offer both self-pay options and sliding-scale fees for our services. Currently, we accept Aetna, Cigna, and Optum insurance plans in CA, WA, OR, NV, and NM.

We are diligently working to expand our partnerships with additional insurance providers to better serve you:

In California, we are actively pursuing partnerships with Medicare, Anthem, Carelon, Humana, Oscar Health, and Oxford.

In Washington, we are working to include Humana in our accepted insurance plans.

• Optum-UHC
• Oscar
• UHC
• Oxford
• GEHA
• Aetna
• Meritain
• Nippon
• Cigna