Psychiatric Mental Health Nurse Practitioners (PMHNPs) hold professional licenses as registered nurses AND advanced practice mental health clinicians. PMHNPs are Master's level clinicians with training and expertise in treating psychiatric/substance abuse disorders through diagnosis and prescription of psychiatric medication, if appropriate, to individuals across the lifespan. PMHNP's work with clients on developing tailored psychiatric medication plans and providing ongoing prescription management and monitoring.

Psychiatric Nurse Practitioners can work in hospitals, psychiatric facilities, outpatient clinics, substance abuse programs and residential care facilities. In the state of Massachusetts PMHNPs are independently licensed to provide psychiatric care without the supervision of another healthcare provider. Newly licensed clinicians require the collaboration of an established psychiatric provider (Psychiatric Nurse Practitioner, Doctor of Nursing Practice in Psychiatry, or Psychiatrist) for the first 2 years of practice.

At Three Rivers Mental Health we focus on psychiatric medication management with a lesser focus on psychotherapy but have therapists that provide this service. We recommend that all clients receiving medication for treatment of mental health disorders work with a licensed therapist on a regular basis in conjunction with taking medication.

Prior to the start of and COVID-19 pandemic all psychopharmacology and medication management appointments were conducted in-person.

As of now we can offer telehealth appointments in between in-person sessions however this may change again in the future.

For all other clients who are NOT taking controlled substances we are able to offer a combination of both in-person and virtual visits (although it is preferred to do the initial appointment in person if at all possible).

To conduct Telehealth appointments our providers are using Optimantra for all virtual visits. We've found that both clients and providers are pleased with the accessibility Telehealth offers.

*Please note that your provider may request to see you in-person for select visits or as determined by the provider. Although Telehealth has been a great platform to connect mental health providers with clients during the pandemic there are certain assessments that require in-person visits.

During your initial appointment you will meet with a Psychiatric Nurse Practitioner or social worker who will gather information about your past psychiatric history as well as what symptoms you or your child are experiencing currently, bringing you to treatment. The clinician will also leave appropriate time to answer any questions you may have regarding diagnosis, treatment options, medication therapy etc.

At the end of the appointment the prescriber or therapist will collaborate with you to create treatment goals and if appropriate recommend next steps (medication or weekly or bi weekly therapy).

At the start of treatment your provider will meet with you on a weekly or monthly basis to monitor your symptoms and evaluate you for any possible side effects of medication.

All clients are encouraged to reach out in between appointments if they wish to been seen earlier than their scheduled appointment. Our admin team will help you connect with your provider for an earlier appointment. We do try to limit discussion between appointments as much as possible. Please try to limit email interactions as much as possible as they are not HIPPA compliant.

Psychiatric Nurse Practitioners provide diagnoses and can prescribe medications. Therapists can diagnose and provide therapy (CBT/MI/talk therapy). Therapists can be licensed as LCSW (Licensed Certified Social Worker), LICSW (Licensed Independent Social Worker), LMHC (Licensed Mental Health Counselor), or PsyD (Doctor of Psychology).

Visits are tailored to a clients needs. Most therapists meet with patients weekly or biweekly. You can discuss this at your first appointment.

We do not accept monthly therapy appointments as this is not in the clients best interest and does not support best care.

We accept the following insurances:

• Oxford

• Aetna

• United/UMR

• Mass General Brigham

• Oscar Health

• Harvard Pilgrim

• Tufts *** commercial plans only***

• Optum

• All ways

• Blue Cross Blue Shield

We do not accept MassHealth or any affiliated plans. We have limited appointments available for Medicare patients with Nina Abelowitz and Elizabeth Morrison

Be sure to contact your insurance provider to request more specific information about your plan's reimbursement rate, deductible, and mental health coverage.

When checking with your provider, they may ask you which codes will be billed in order to provide you the rate of reimbursement. Below is a list of the most common codes that we may use:

• Initial evaluation: 99204/99205/ 90791

• Psychotherapy with medication management: 99213 or 99214 (depending on medication complexity) + 90836

• Psychotherapy: 90834/ 90833/ 90837

For therapy visits, the first visit is an initial evaluation. It is around 50 minutes long. Significant time is spent getting to know the client, going over intake forms and reviewing goals. Goals for therapy may take several visits to form and are made collaboratively. Subsequent visits are 45-50 minutes long and may occur weekly or bi-weekly.

For medication visits, we take the following steps to ensure a comprehensive evaluation.

1. The first session: Initial Psychiatric Evaluation

Your first appointment will include a comprehensive review of your mental, physical, social and biological health history, all of which help build a narrative and map out an effective treatment plan. We appreciate that you took the time to fill out our extensive intake and we will review this during our visit. During this visit, we’ll spend time learning about you, hearing your story, and asking you a few questions. We’ll learn about the important people in your life, your habits and routines, and what you’d like help with. Along with this, we’ll have an initial discussion of your goals which will help tailor recommendations made specifically for you.

*Please note medications are not guaranteed to be prescribed in the initial evaluation, but are discussed in detail during the Treatment Planning visit

Duration: 50-75 minutes

2. Second session: Treatment Planning

Developing an effective treatment plan provides us a “blueprint” of how to best approach your individual concerns. During this appointment we’ll talk about if you’ve tried medication, what your experience was like as well as what worked and what didn’t work.

We’ll talk about the different treatment options that are available, including any recommended psychiatric medication, nutritional supplements and other modalities. Mental health treatment is a process, rather than a destination. Treatment includes an ongoing conversation and in-depth exploration of your symptoms and how it relates to diagnostics. This allows us to design a treatment plan that is tailored to your individual needs.

At Three Rivers Mental Health, we aim to develop a treatment plan that addresses not only how we can help manage the symptoms, but to find the root of their cause, so that eventually, you may not need medication or may need less of it in the future.

Duration: 25-50 mins

3. Follow ups: Created to allow us time to discuss how your treatment is going, response to treatment, including medication and supplements, review medical changes/updates, discuss recent emotional changes and any concerns from the parent/guardian. Appointments will be scheduled based on the clinical necessity and be discussed with you after each appointment we have together.

Medication refills should be taken care of during an appointment. To ensure that you do not run out of medication, please ask your prescriber during your visit for sufficient medication to last until the following appointment.

Prescribers will respond to refill requests that occur outside of an appointment within 72 hours of refill requests. Appropriate requests include current medication that are not controlled substances. They do not include medications that have been discontinued. Please contact your prescriber directly for refills as our practice often does not receive refill requests that occur at the pharmacy.

If for some reason your pharmacist is unable to fill a prescription, please speak with the pharmacy to clarify the issue before contacting your prescriber.

If you need a prescription outside an appointment time, please use our “Prescription refill” tab under “about” on our main page.

If you are experiencing a medical or psychiatric emergency please call 988 or proceed to the nearest emergency room. Please note that we do NOT provide 24/7 care and that messages and calls after hours will be returned during normal business hours.

Stimulants are controlled substances and therefore ought to be treated as such. Please understand that all patients taking these medications are affected by national shortages. Since prescribers have no control over pharmacy supplies and they are controlled substances, the patient is responsible for working toward a resolution to supply issues with his or her pharmacy. Our protocol for these issues is as follows:

1. If the prescribed stimulant is not in supply, you may ask your prescriber to provide you an additional prescription to another pharmacy. Patients are responsible for determining where the medication is to be sent. We advise that you talk to your pharmacist and/or call pharmacies since your prescriber may not be able to send multiple prescriptions.

2. If the prescribed medication is not in supply at any local pharmacy and you need an alternate medication to be prescribed, you will be required to schedule an appointment with your prescriber unless other arrangements were previously made. Please email your prescriber to schedule an appointment.

**In select cases the prescriber may be willing to prescribe an alternate dose of the same stimulant medication. For this to occur, patients will need to know the precise dose of medication that is available. If multiple medication doses are needed, your prescriber will likely require an appointment.

If you must cancel or reschedule an appointment, we require 24 business hour notice (weekends not included). If your appointment is on a Monday or Tuesday, the cancellation must be made by the same hour on the preceding Friday. PLEASE DON’T CANCEL VIA EMAIL. Appointments that are missed (this includes late cancellations and no-shows) will be billed at a rate of $100 for therapy appointments, $150 for medication follow up and $200 for initial medication consults.

If it is more than 24 business hours before an appointment, you can reschedule your appointment by contacting our office at 857-229-2852