Meet Bre Chamoff
Dr. Bre Chamoff, DNP, PMHNP-BC, CPNP
Bre..like the cheese. (she/her)
Pediatric Psychiatric Nurse Practitioner
IMPORTANT QUESTIONS FOR MY PATIENTS
Feel free to come to our session with your answer:
1. If you could be any instrument, what would you be?
2. If you could only listen to one band for the rest of your life, who would you pick?
3. What is your LEAST favorite color?
4. What do you think the best show of all time is, and why do you think its Game of Thrones? (or Moana for my littles)
5. What is your favorite memory of all time?
Bre (like the cheese) Chamoff (She/Her) is triple board certified in pediatric primary care, pediatric critical care, and psychiatric mental health. She has been a nurse practitioner for nearly a decade working in various pediatric settings. She is passionate about care for kids, adolescents, and young adults.
Her prescribing philosophy is meds are not first line, unless they absolutely need to be. The team effort between provider and patient is to get that spark back, let your beams shine bright, and use all options to get there. She commonly says her “drug of choice” is human connection, and this certainly bodes well for fostering a team approach with her patients to make a plan that suits them.
Bre has worked in pediatric GI specializing in illnesses such as irritable bowel syndrome (IBS) and functional constipation and how those are experienced both physically and emotionally. She has a particular interest in brain-gut connections and the impact on mental health and behavior. She was also one of the first 2 nurse practitioners who started the pediatric trauma program at Queens Medical Center in Hawaii. She has since spent much of her time working inpatient at Flagstaff Medical Center on general pediatrics and in the pediatric ICU. She has a blunt and comical (mostly when appropriate) approach, because life is hard and no one gets out alive.
Bre currently resides in Flagstaff, AZ. In her free time, you can find Bre Snowboarding , traveling to live music to any number of bands including Tool, Gojira, Daughter, Carina Round, Rainbow Kitten Surprise, System of a Down, Elton John, Bon Iver, Puscifer, Primus or Tim McGraw (to name an eclectic few), reading books galore, or begging her friends to play board games with her. She has a ’73 VW bus named Clementine (who sometimes starts and sometimes does not start, but Clementine’s charm is not dependent on her reliability, or the lack thereof) and a 6 yo Bengal named Ananda, who runs the show entirely.
As you’ll note in Bre’s Q&A she is verbose and rarely lacking the words (or run on sentences) she needs to overly express her interests and ideas with many caveats and sidebars. She offers both an apology and congratulations for this.
"Diagnosis is not identity, its just a guidepost" - bre
What is your favorite movie: Of all time: Almost Famous; Disney: Emperor’s New Groove
But to be fair my second language is movie quotes; I’d say I’m fluent.
Favorite superhero: I always try to have a more unique one but the truth is, it’s Superman. I love that he’s just unassuming Clark Kent, then off saving folks, then back to glasses wearing, run of the mill Clark Kent. Big fan.
If you could have a superpower, what superpower would you pick: Easy! I ask people this all the time! Teleportation. I could see all my favorite people anytime, travel to all live music, without leaving any carbon detriment, and minimizing travel time. Very efficient.
Favorite bands/singer: Tool without question. But, music is my insides on the outsides. I love music so very deeply. I spend most of my spare time on live music, and traveling to live music. I am not personally musically inclined, but I am a big-time consumer for sure. I have a pretty wide array of likes. Indie. Folk. Bluegrass. Metal. Country. And that is certainly not the end of it. I collect vinyl because I like how it sounds despite its wild inconvenience.
If you had 3 wishes, what would you wish for: Selfishly: (1) the ability to speak all languages fluently (2) to see a new and varied sunset in every place of the world (3) an eidetic memory
(wish 3.5: Limitless quantities of Cinnamon Toast Crunch accompanied by free dental care for life) Broad and esoterically: -that every individual has a true inherent fundamental drive to first understand themselves, then understand others, and only then attempt to altruistically affect change. I read a bumper sticker yesterday that said “everyone is just doing their best….
And that is fucking terrifying” Hearrrrrrd that!
What is your favorite food? Okay, are you asking what is my death row meal? Or what is my favorite day to day food? Because my death row meal is for sure next day spaghetti! don’t give me fresh spaghetti. Make it the day before, let it sit all night, and then microwave it- that’s my last meal! Day to day I have a gnarly sweet tooth. So on second thought back to the 3 wishes I think I’ll just take lifetime dental care. 😏
What are you most passionate about in the mental health field? Access to care for kids and adolescents. Offering a true partnership where the child is considered an active person with meaningful thoughts, feelings, and experiences.
What are some experiences you have had that make you unique? My mental health nursing rotation in undergrad was in a study abroad program in Belfast, Norther Ireland. This was illuminating to see psychiatric care offered in a different and social model.
I have a long strong background in pediatric medicine and that offers a robust amount of experience working with complicated pediatric illnesses.
I went to 9+ schools as a child (not a military brat, just life circumstances) so adapting to change is a superpower I gained at a young age out of necessity. This just means I regard most strangers as “friends I haven’t met yet”.
I went to Ecuador for 3 months to learn Spanish, then System of a Down went on tour so I came back early for a concert. Learning Spanish is still a life goal of mine.
I own a 73 VW bus named Clementine. In an ideal world, she would be my traveling office (she breaks down too much, but I still love her).
What is your philosophy on using medication to treat mental health for kids? I believe medicine, like many other things is a tool. I like to explain it this way: consider depression, anxiety, trauma, aggression, etc as broken glass on the ground. We can clean it up without tools like a broom, or without shoes on, but it’s messier and more difficult that way. Using the right tools is going to make it both easier and safer. Sometimes one shoe is therapy, maybe the other shoe is medicine, and maybe the broom is family dynamics. Medication is rarely the singular fix for anything (except for maybe in diabetes), it’s an adjunct for symptom management. It also can allow for healing to occur. Medication is not always forever, and its not always the right choice. It so situationally based, and more complicated than one blanket approach applies to all. Generally, I’m pretty conservative, but not afraid to consider meds when they are an appropriate tool. I am a firm believer in collaboration with my patients and parents. I won’t give teens a medicine they don’t want. Medicine is not the only option, I’m a big believer that work is often necessary when it comes to caring for our mental health, and that involves the whole family unit, nothing exists in a vacuum. Everyone is unique, sometimes we use all tools all at once, sometimes we try them on differently, it’s about the individual. I’m also a big proponent of natural and holistic remedies, but they are not without potential for harm themselves and I think it necessary to be mindful of risk and benefit of any and all interventions. We have to be mindful of all things that affect our neurochemicals, to include many things we forget to consider like caffeine, sleep, exercise etc.
If a patient is nervous about an evaluation, especially when talking about tough things like trauma or sexual abuse, what would you want them to know? Getting to the deep dark stuff is one of the hardest things we ever do, so before you do it know this is a safe space without judgement. I won’t make any decisions about your care without you, you’re in control here. So, first know you’re not alone. Second, those experiences don’t define you. Sometimes healing is a process in patience; I ask that you be patient with you and all that comes up, and patient with this process as I walk alongside you through it. Sometimes we need to say “not today satan” and table that stuff, which is perfectly fine. Others we jump in, like I said, it’s a process. Most importantly that process isn’t always linear and that’s okay too. There’s a meme somewhere that says something like ‘sometimes life is messy, sometimes life is beautiful, most the time it’s both’. That feels a little too flowery for some of the deep dark shenanigans we go through, but at the end of the days it’s not total crap.
Talk to us about working with divorced families, coparenting or families in turmoil? This can get dang hairy. in initial evals it’s important in my book to set the precedent and expectation. Both parents have to be on board, and while that’s often difficult, I feel good about being firm in support of this model. There’s no room for separate meetings or visits, playing ping pong between warring forces. I’m not generally a proponent of avoiding, or releasing families, solely due to parental conflict because the only person there who suffers is the child who can’t get the care they need. I’m willing to be a force when needed to facilitate the forward motion of care for the child. My initial approach is always attempting to understand the perception of each person, the intention of each and then collectively identify a common goal. If I’m right, and I hope I am, we’re all attempting to achieve what is best for the child. When there is an impasse, I tend to get direct and blunt singularly with parents. It’s important to be factual. This has been really effective historically. If you read this and feel you want to go on this wild ride with me, just know I can be spicy, but it’s in an effort to achieve a common goal.
Do you have any personal experiences regarding mental health you are open to sharing? I am an open book but find the specifics to be more beneficially shared contextually. I wouldn’t want to wallop the world with my history on a website, but I’ve been through some doozies. My own “colorful” experiences if you will. It makes me feel really comfortable talking about legitimately anything. I often tell my patients there’s a slim chance I haven’t discussed anything you’re able to bring to the table, so hit me with it and let’s dive in. I also have an interest in non-traditional medicines, including the use of entheogens for further treatment and exploration of mental health disorders in future practice.
You've worked in pediatric acute care for years. Talk to us about the overlap of physical and mental health for kids. Physical and mental health aren’t entirely separate, and while our medical model and approach treats it that way, they are deeply integrated. It has been astounding to see how many kids are left untreated regarding mental health for an enumerate number of reasons. We live in an unprecedented time and continue to attempt to apply historical solutions to it. While that’s not fully unexpected as we have to go with what we know, we also have to ask ourselves how much of the mental health disparity that we see in adults could be mitigated if approached in childhood. On the other hand, I’m not a fan of pathologizing childhood behavior to made them more compliant to a world that expects them not to be kids: an approach at balance is the key (cliches are true for a reason). I think my experience with complex medical illnesses is going to translate well in terms of my ability to communicate and combine holistic care with both pediatric patients and parents. I also have a keen eye to ferret out medical and mental health causes separately and in conjunction.
Do you have experience in working with non-binary and trans kids? Yes definitely! In fact, I originally chose endocrine as my area of specialty focus. So I started meeting with pediatric patients interested in delaying puberty at the onset of my career as a student NP. This was in 2013. Since then, I have encountered a wide array of patients across the spectrum of trans, non-binary, questioning, and more. I am a big proponent of self-expression and exploration. I am a big fan of helping my patients feel seen and actualized and sometimes that includes bridging the conversation with loved ones and being a support in that time.
What are your thoughts on screen time and social media for kids and teens? I think a blanket statement here isn’t going to work. Like anything else, no absolute is the answer. I think when we fully restrict social media children/teens experience a sense of isolation, with full unabridged free reign they can experience any number of things including grooming or bullying, and can be the victim or perpetrator of such. I think with anything, active presence and engagement from the caregiver with mutually agreed upon structure and boundaries is going to be a solid approach. Too much of anything isn’t great. The stimulation of imagination to aid in the progression of developmental stages is best served with varied experiences, they cannot all be garnered from a screen. That is not to even touch on the secondary medical difficulties such as sedentary lifestyle leading to obesity and insulin resistance, and visual decline. With all of that in mind, never in my life have I said to a patient “okay 2 hours of screen time a day” and that happened. So instead, I ask families, would it be possible, once per day, when you go to watch TV, or look at the tablet or phone, you set a timer and do anything else that’s not screen related until the timer goes off (ironically said timer is typically on a phone screen, we can’t win them all). That’s a manageable task, and reduces it by a little. Small achievable changes are often the name of the game.
My personal stance on screen time is it isn’t great, would love to decrease it. But my personal stance on going to the gym is that I should be going more, and I’m literally eating cheese its at 10:30 pm while I write this so life is messy and hard, and we have to make the goals achievable and do what we can!