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Discover engaging mental health infographics in Arizona featuring Zerry Ramirez, a dedicated social media manager at Paper Flower Psychiatry. Kevin Baeza With over a decade of experience in the U.S. healthcare industry managing medical billing and claims, Kevin transitioned from an insurance representative to a medical biller across multiple practices and now specializes in mental health. His current responsibilities include insurance verification, copay collection, and growing expertise in mental health billing. Outside of work, he recharges by spending time at the beach or cuddling with his cats. Insurance Verification Co-pay Collection Medical Billing

Paperflower Psychiatry is a holistic and inclusive psychiatric practice specializing in evaluations and medication for children, adolescents, peripartum and adults in Arizona. Telehealth + offices in Tempe, North PHX + Flagstaff. Self booking is available online. Meet The Providers not sure who to pick? take our matching quiz below! Dr. Azuka Okafo, CNM, PMHNP-BC, DNP Specialty : adult mental health, perinatal, teen mental health Vibe : energetic, curious, humorous, sarcastic Location: Mesa, PHX + Telehealth Request an appointment: here Azuka is a board-certified psychiatric mental health nurse practitioner who retired from her life as a certified nurse midwife on the rez to move into providing psych care with us in PHX. We are pumped to have her, and we feel like if you need a provider who is high energy, direct and a lil sarcastic and silly.. she will be great for you. And she def wants to meet your dogs. Learn more Amanda Pursley, MSN, PMHNP-BC (she/her) Specialty : mood, anxiety, ADHD, LGBTQIA+ Vibe : supportive, nonjudgmental, chill, dash of goofy Location: Telehealth & in person rotations in Flagstaff Request an appointment: here Mandy is a board-certified psychiatric mental health nurse practitioner. Mandy loves working with all ages. She is passionate about patient-centered, inclusive care. She values building meaningful connections and aims to make every patient feel heard, supported, and empowered. Learn more Tabitha Arey, MSN, PMHNP-BC (she/her) Specialty : Ketamine, autism, ADHD & neurodivergence, substance use disorders, adoption/foster care, neurological trauma, perinatal Vibe : dark humor, existential, relatable + nerdy Location: Tempe & Telehealth Request an appointment: here Tabitha is a board-certified psychiatric nurse practitioner who has experience working with children, adolescents and adults. She has previous experience in the neuro-ICU working with extensive trauma. She currently offers neurodivergence evaluations & ketamine injections. She is a super psych nerd and will make sure you have the best understanding of medications and pharmacology. You can hear her on our podcast here . Learn more Michaela Tweh, MSN, PMHNP-BC (she/her) Specialty : ADHD, Perinatal, Anxiety, OCD, Neurodivergence Vibe : chill, personable, quirky, nonjudgmental Location: Telehealth & soon to be Tucson Request an appointment: here Michaela is a board-certified psychiatric mental health nurse practitioner with seven years of nursing experience. Michaela promises to appreciate you where you are at while assisting you to where you want to be. We love that she's knowledgeable with a gentle energy. Learn more Andres Kohler (Andy), MSN, PMHNP-BC (he/him) Specialty : Cultural + religious trauma, bipolar, mood, LGBTQ Vibe : cheerful, nerdy, relatable, thorough Location : telehealth Request an appointment : here Also Speaks : Spanish Andres is a psychiatric nurse practitioner. Andy specializes in mood disorders, anxiety and is excited to nerd out and tell you all the facts about the medication you take. He will see all ages and he really likes dogs. We told him his dogs need to be assisting him during evaluations. He also has chickens and likes cats..but we don't think he likes reptiles. Who doesn't want to talk to dogs during a psych eval? Learn more Jane Na, MSN, PMHNP-BC (she/her) Specialty : cultural/religious trauma, BIPOC, LGBTQIA+, ADHD, anxiety, mood Vibe : easy going, personable, nonjudgmental, amiable, casual Location : Tempe, North Phoenix & Telehealth Request an appointment : here Jane is a board certified psychiatric mental health nurse practitioner who has experience in working with ECT, TMS and psychiatric emergencies. She is passionate about delivering compassionate mental health care and being a patient advocate. She's a really chill person, connects well with people of all ages, and genuinely cares. Jane speaks Korean and conversational Spanish. Learn more Tatiana Sanabria, MSN, PMHNP-BC (she/her) Specialty : anxiety, mood, BIPOC + LGBTQIA+ Vibe: calming, kind, structured, intentional, gentle Location : Telehealth Request an appointment : here Tatiana is a board-certified psychiatric nurse practitioner who has experience working with children, adolescents, young adults, and adults. She is passionate about providing care to folks from marginalized communities, particularly those from low-income, BIPOC, and LGBTQIA+ communities. Tatiana has been a staple with our practice for years, and has consistently offered excellent care. Learn more Allison Stuart, MSN, PMHNP-BC, PMH-C (she/her) perinatal mental health certified Specialty : Functional medicine + supplements, bariatric patients, perinatal care, IVF, anxiety, mood Vibe: quick-witted, nurturing, collaborative, swiftie (yes, taylor swift) Location : Telehealth Request an appointment : here Ally is a board certified psych NP, specializing in young adults. She is a Health at Every Size practitioner, and has special interests in treating adolescents and adults. She also is passionate about helping women navigate mental health through infertility, pregnancy, and postpartum. She is an OG at Paperflower -- and completing her training with us years ago and is now training future nurse practitioners as an expert! Learn more Elizabeth Odhner, MSN, PMHNP-BC, PMHC (she/her) perinatal mental health certified privacy officer of paperflower psychiatry Specialty : Perinatal, infertility, postpartum, breastfeeding, mood, anxiety Vibe: conversational, relaxed, organic, empathetic Location : Telehealth Request an appointment : here Liz is a board certified and PSI postpartum mental health certified psychiatric nurse practitioner. She has worked in outpatient telehealth from her Skoolie for over the past year -- and we are excited she is finally joining us! She has volunteered for years domestically and internationally. She has worked to promote justice, and will be the perfect person to tell you how much big pharma and capitalism sucks the life out of us. She is passionate about working with the perinatal population. She currently sees all ages. Learn more Dr. Erica Lee, DNP, PMHNP-BC (she/her) Specialty : anxiety, mood, pediatric mental health, sexualized behavior and trauma in children Vibe: energetic, approachable, perceptive Location : North Phoenix & Tempe Request an appointment : here Erica is a board-certified psychiatric nurse practitioner with a heart for seeing children, teens, young adults and families navigating mental health challenges. She utilizes an approach that integrates the entire family into care -- because mental health issues in kids do not exist in isolation. With a background as a nursing professor and a mom, she combines real-life wisdom, clinical expertise, and deep empathy to provide care that’s relatable, inclusive, and grounded in reality. Learn more Dr. Bre Chamoff, DNP, PMHNP-BC, CPNP-BC (she/her) accepting ages 5-15 for waitlist Specialty : Pediatric ADHD, mood + comorbid medical conditions. Vibe: chatty, thorough, fun, sigma Location : Flagstaff & Telehealth Request an appointment : here Bre (LIKE THE CHEESE, of course) is a board certified psych NP -- and she is also board certified in pediatric primary care and acute care! She talks really fast and definitely has a lot to say. She's amazingly brilliant and does great connecting with adults, adolescents and small children. She thinks she is hilarious and sometimes she might be. Bre is an OG here at Paperflower and we hope we can keep her forever. Learn more Melody Martinez, MSN, PMHNP-BC (she/her) Specialty : Perinatal Mental Health, Adoption/Foster Care, Mood, Anxiety Vibe: attentive, encouraging, open-minded Location : Tucson & Telehealth Request an appointment : here Melody Martinez is a board-certified Psychiatric Mental Health Nurse Practitioner (PMHNP-BC) renowned for her compassionate and holistic approach to mental health care. With a background in education and nursing, her expertise encompasses needs of children, adolescents, parents, and adults of all ages. Her empathetic and science-backed approach includes therapy techniques when appropriate, prioritizing personalized care. Learn more Meghan Baker, MSN, PMHNP-BC, PMHC (she/her) perinatal mental health certified Specialty : ADHD, Perinatal & Neurodivergence Vibe: gentle, thorough, non-judgmental, grounded Location : Telehealth Request an appointment : here Meghan is a board certified and PSI postpartum mental health certified psychiatric nurse practitioner. Her background as a Labor & Delivery nurse and educator, along with her personal and professional experiences have cultivated a passion for and expertise in Perinatal/Peripartum and Child and Adolescent psychiatric care. Beyond being a psychiatric nurse practitioner, Meghan is a mom who strongly understands the impact of neurodivergence on the family unit. Learn more ¡Conéctame con un proveedor! Quiz ¡Conéctame con un proveedor!

Looking to precept PMHNP students in Phoenix, Arizona? Learn about our precepting program for aspiring mental health nurse practitioners on our site. Estudiantes del PMHNP Precepto con nosotros ¿Es usted un estudiante de PMHNP que busca una pasantía? Recibimos docenas de solicitudes cada semana y entendemos que es difícil conseguir una rotación. A pesar de nuestro amor por el aprendizaje, tenemos cupos muy limitados disponibles cada año. Debido a los límites, buscamos estudiantes que se adapten mejor a nuestros valores y expectativas de práctica. Somos una práctica radicalmente liberal. Diseñé mi práctica para reconocer que la atención médica es política. Si no estás en este lado del espectro político o no te interesa la política, este no es el puesto de rotación para ti. Se espera que conozcas el contenido en profundidad. Se espera que realices evaluaciones y seguimientos después de un día de observación. Somos prácticos. Se evaluará tu disposición a aprender antes, durante y después de las sesiones clínicas. Se espera que busques información y leas libros/artículos para ampliar tus conocimientos. Se espera que te presentes y te apasione lo que estás aprendiendo. Se espera que comprendas los determinantes sociales de la salud, las disparidades en la salud y el efecto que tiene el racismo en la psiquiatría. Si cree que esto es una buena opción, envíe una carta de presentación y un currículum (muy) personalizados a maria@paperflowerpsychiatry.com . No acepto cartas de presentación genéricas. Hábleme de sus pasiones por la salud pública, la reducción de las disparidades en materia de salud, el activismo y el trabajo voluntario. Aplicar

Learn about Paperflower Psychiatry's policies on medication refills, no-show fees, service policies, discharge criteria, and payment requirements. Ensure a smooth experience by understanding our guidelines on appointments, insurance, and medication handling. Policies Want to check in on some important policies on refills, attendance to appointments and all that stuff? We'll break it down. Refill Policy We require an appointment on file to complete your refill. We will send you enough pills to get to that appointment. If you have a balance on your account, you must set up a payment plan with a working credit card on file prior to receiving your refills. If you cancel or choose to not attend after receiving your refill without rescheduling, you will no longer receive refills until you are able to attend an appointment. If you have not completed labs as ordered, you may be denied a refill at your provider's discretion. If after a controlled prescription is filled, it is reported to be lost, accidentally disposed of, or in any other means not accessible prior to the follow-up appointment, refills will not be provided. If you have not been seen by a provider in the requested time frame for follow up (one month, two months or three months), we cannot send your refill We charge $10 for processing same-day urgent refill requests, and $15 for same-day requests on weekends + holidays. Refill requests take up to 72 business hours to complete. Please request in advance. example: requests made on a Friday will be completed by Tuesday example: requests made on a Friday will be completed by Wednesday if Monday is a holiday No Show Policy A "no show" constitutes as not attending your appointment, cancelling your appointment under 24 hours prior to your appointment time (even emergencies...sorry :-(), attending your appointment while driving or coming to your appointment 10+ minutes late. A no show fee for an evaluation is $120 if rescheduled and attended, or $300 if choosing to not reschedule A no show fee for a follow up is $120, even if on a sliding scale No show fees will be automatically charged to your card the same day as missing your appointment Refills and future appointments will not be made unless the no show fee is paid or put on a payment plan with timely payments made Service Policies In order to maintain your evaluation, paperwork must be completed 24 hours before your appointment or your appointment will be cancelled. Support team and billing messages (voicemails, texts and emails) will be answered within 72 hours. Medical record requests will be handled within 30 days of written request. You agree that we will not participate in any court cases that include our presence without a prior agreement and signed contract with the agency and your provider at $350+/hour. We do not do emergency or crisis care. These situations require calls to CRISIS or 911. Parents or guardians are required to be present for the duration of their child's appointment unless otherwise arranged in writing; otherwise this will be cancelled and subject to a "no show" fee. The child is required to be present for their appointment unless otherwise arranged in writing; otherwise this will be cancelled and subject to a "no show" fee. If you have not been seen in 8+ months, we require a full new evaluation. Medication Policies After your provider sends a medication, you are required to call the pharmacy to troubleshoot any insurance, quantity, or other concerns prior to contacting us. DO NOT DEPEND ON YOUR PHARMACY APP TO TELL YOU IF WE SENT A MEDICATION - more often than not, we sent it! Call your pharmacy if it says the medication isn't ready (it probably has nothing to do with us). Medications other than psychiatric medications will not be provided by us. Medications that require blood work such as mood stabilizers are not guaranteed to be filled unless blood work has been completed. Medications can only be sent to pharmacies in the state of Arizona unless your provider holds an alternative state license. We will not prescribe psychiatric medications if you choose to have two psychiatric providers - this is not a safe arrangement You may be requested to sign a "controlled substances" policy if prescribed a stimulant or other controlled medication. Prior authorization requests can take 5-7 business days to complete. We will not prescribe benzo's (xanax, ativan, etc) unless it is (1) for a short term situation such as a flight/funeral/etc (2) you come in already taking one and create an agreement with your provider to taper from it We will not prescribe or continue your non-psychiatric medications (antibiotics, thyroid meds, etc) Discharge Policy Grounds for discharge includes: Refusal to work with our support team or any disrespectful, racist, vulgar language toward our support team. Choosing to have another provider fill or change your psychiatric medications without first notifying your Paperflower provider (it's not safe!) Dishonesty in regards to, selling or misusing medication prescribed Failing to show up (or a "no show") 3+ times for your appointments Refusal to create a payment plan for balances due Refusal to maintain a credit card on file (it's just how our system needs to flow with as many appointments daily we have..) Refusal to follow up as recommended by your provider Disrespect, harassment or vulgar language towards your provider Dishonesty in regards to custody situations or legal matters A patient outside of our expertise or scope of practice ---- In cases of discharge, we will send three referral sources for a new provider and a 90 day supply of medication if the medication is noted by provider to be safe to refill. Policy on fees/insurance We are a fee-for-service company, and do charge fees for paperwork, medical record requests and time outside of appointments. Updated fees can be found on services page. These fees will be charged to the card on file. If you have paperwork, it will be charged before paperwork is filled out or processed. We require everyone to have a working credit/debit card on file in order to keep your appointment. You are required to have a credit card on file even if you have an HSA/FSA card on file. You can write to have the HSA charged first. If there is not money loaded prior to your appointment and other arrangements are not made, the credit card will be charged. All fees/copays/deductibles are collected 24 hours prior to your appointment. If your payment does not go through prior to the appointment and you have not made other arrangements with support (to update card, a day you get paid, payment plan etc), your appointment will be canceled. If you do not have updated insurance information within 24 hours of your appointment, that visit may be charged as a self pay rate. For medications to be sent or paperwork to be completed, if there is a balance on the account, we require a payment plan in place with a down payment. Refunds are not issued in any circumstance if the service has already taken place. A sliding scale is arranged with a single provider. If you chose care with another provider, you may be subject to the full fee unless otherwise arranged. Please contact support if you have questions on this. If you need us to change the card we charged payment on, and did not let us know 24 hours before your appointment, a 6% processing fee is added to your charge. This is because Stripe charges us to refund/rerun it :) ps -- No we aren't money hungry and yes we want you to have services, we just are all trying to make a living doing this..if you weren't getting paid when you went to work, would you still go? Notice of Privacy Practices: Revised April 15, 2025 I. Covered Entity Duties and Key Terms Paperflower Psychiatry, LLC is a Covered Entity as defined under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), including its amendments under the HITECH Act. We are required by law to maintain the privacy of your protected health information (PHI), provide you with this Notice of our legal duties and privacy practices, and notify you in the event of a breach of unsecured PHI. Key Terms: PHI (Protected Health Information): Any health-related information that identifies you. Provider: Any licensed mental health professional under the employment or contract of Paperflower Psychiatry. Treatment, Payment, and Health Care Operations (TPO): Treatment: Coordination or management of your care. Payment: Billing or reimbursement activities. Health Care Operations: Administrative functions like quality improvement, internal training, audits, or business oversight. Use: Refers to activities within Paperflower Psychiatry (e.g., analyzing or storing PHI). Disclosure: Refers to sharing PHI outside our organization (e.g., with another provider or third-party service). II. Telehealth, AI, and International Data Use Paperflower Psychiatry uses telehealth platforms, artificial intelligence (AI)-supported tools, and international Virtual Medical Assistants (VMAs) for certain operational, billing, scheduling, and support tasks. Telehealth: We use secure HIPAA-compliant platforms for virtual care. Your information may be transmitted electronically for diagnosis, treatment, or consultation purposes. AI Tools: Limited AI-based systems may be used for scheduling, transcription assistance, or internal data review, but do not make clinical decisions or access your full PHI without oversight. 4/15/25, 10:55 PM Form Questions https://cylinder-perch-4ktn.squarespace.com/config/scheduling/forms.php?action=edit&id=2369461 1/3 International Staff: Our administrative and billing support team includes VMAs based in the Philippines. All such staff are bound by strict Business Associate Agreements (BAAs), HIPAA regulations, and applicable Philippine data privacy laws. Safeguards: All electronic PHI (ePHI) is handled through encrypted platforms. Passwords, device access, and data backups are strictly monitored and logged. III. Uses and Disclosures Requiring Authorization Your provider may only release your PHI for purposes not covered by TPO with your written authorization. You may revoke your authorization at any time in writing, except when: Your provider has already acted in reliance on it, or The authorization was a condition of insurance coverage. IV. Uses and Disclosures Without Consent or Authorization Your provider may disclose PHI without prior authorization in the following legally mandated or safety- related situations: Child or Vulnerable Adult Abuse Judicial or Administrative Proceedings Serious Threat to Health or Safety Worker’s Compensation Appointment Reminders or Treatment Alternatives For a full list of disclosures permitted without consent, contact our Privacy Officer. V. Your Rights As a patient, you have the right to: Request Restrictions on disclosures (though we may not be able to comply). Receive Confidential Communications at an alternative location. Inspect and Copy your mental health and billing records. Request Amendment of incorrect or incomplete information. Receive an Accounting of Disclosures. Revoke Authorizations (as noted above). Obtain a Paper Copy of this notice, even if received electronically. 4/15/25, 10:55 PM Form Questions https://cylinder-perch-4ktn.squarespace.com/config/scheduling/forms.php?action=edit&id=2369461 2/3 VI. Complaints If you believe your privacy rights have been violated, you may: Contact Our Privacy Officer: Elizabeth Odhner, PMHNP Email: liz@paperflowerpsychiatry.com You may request a formal complaint form at any time. All complaints will be reviewed and investigated within 60 days. File a Complaint with HHS: Visit: www.hhs.gov/ocr/privacy/hipaa/complaints You will not be retaliated against for filing a complaint. VII. Changes to Privacy Practices This notice is effective as of May 5, 2023 and was revised on April 15, 2025. Paperflower Psychiatry, LLC reserves the right to revise this notice at any time. If we do, the revised version will apply to all current and past PHI and will be posted on our website Ketamine Policies -- coming soon

Ouroboros at Paperflower Psychiatry offers expert-led cannabis and integration services tailored for neurodivergent adults, first-time users, and those seeking expert support. Whether you're exploring cannabis for wellness, preparing for your first retreat, or unpacking a transformative experience, we offer education, mindfulness integration, and wellness planning in a safe, affirming environment. Based in Arizona, serving clients virtually and in person. Welcome to Ouroboros Paperflower Psychiatry is proud to collaborate with Ouroboros Integration & Education Services. We offer coaching, education, and integration support for anyone interested in making intentional, informed choices around cannabis, CBD, ketamine, psychedelics, and other non-ordinary experiences. Our services include preparation, harm-reduction education, lifestyle balance coaching, and post-experience integration. Whether you’re exploring for wellness, creativity, or personal growth, we provide a grounded, evidence-informed approach that centers safety, intention, and care. From microdosing guidance to festival safety, from mindfulness practices to retreat planning, our goal is to help you navigate your journey with clarity and confidence. The name Ouroboros reflects the ongoing cycle of transformation. Your path is your own. We’re here to support it with knowledge, safety, and respect. About Services & Pricing Schedule now Anchor 1 Our Story John Greeley Wellness Guide I’m John Greeley, a certified life coach with over 15 years of experience supporting people through periods of transition, growth, and deep inner work utilizing consciousness altering compounds and techniques. My path into this work was shaped by a lifelong fascination with human consciousness and a personal belief that healing and transformation are not linear — they are cyclical, layered, and deeply individual. I created this practice because I saw a gap: people were having powerful experiences with psychedelics, cannabis, and other altered states — sometimes legally, sometimes underground — but often with little to no support before or after. These experiences can be profound, but without proper preparation or integration, their potential is often lost, or worse, becomes confusing or destabilizing. My role isn’t to facilitate or promote substance use — it’s to support people who are choosing these paths to do so with mindfulness, safety, and clarity. Whether someone is exploring cannabis for anxiety, preparing for a legal psychedelic retreat, navigating ketamine-assisted therapy, or working to change a difficult relationship with cannabis, I’m here to help create space for honest reflection, practical tools, and lasting insight. I bring a harm reduction lens to everything I do, meaning I honor your autonomy and meet you exactly where you are — without judgment, dogma, or an agenda. My work integrates elements of mindfulness, somatic awareness, behavioral psychology, and emotional resilience. I also have a particular interest in supporting clients through cannabis use disorder and conscious cannabis practices, as I’ve seen both the benefits and the complexities of this plant in real lives. At my core, I believe that every altered state — whether expansive or difficult — has the potential to teach us something. My job is to help you make sense of it, integrate what matters, and move forward with intention. My interest in consciousness has always been more than academic — it's been deeply personal. Over the years, that curiosity led me to explore a variety of altered states through plants, fungi, synthetic compounds, and traditional techniques. One particular experience profoundly reshaped the trajectory of my life. To say it “changed” me would be an understatement — it dismantled long-held beliefs, dissolved certain fears, and initiated a radical shift in how I relate to myself, others, and this ongoing journey we call life. What truly impacted me wasn’t just the experience itself — it was the processing of the experience and integrating the insights and awareness into my day to day life. Months of inner work, reflection, and reorientation taught me that insight means little without the time and tools to embody it. Years later I still reflect on that experience and continue to learn from it. That realization became the foundation for the work I do now: helping others prepare for, navigate, and integrate their own transformational moments with care, safety, and clarity. Services & Fees Anchor 2 Initial 10 minute Phone Consultation: Free 60 minute session: $50 90 minute session: $75 Retreat Vetting: $15 Ketamine Guide Session: $40 (+ travel if applicable) Customizable packages including monthly plans and annual plans available upon consultation. Financial hardship plans also available. Cannabis Coaching Services: Wellness Use Coaching Cannabis and Mental Health Coaching Strain Exploration & Product Matching Cannabis & Neurodivergence Coaching Family & Parenting Support Dispensary Navigation & Confidence Infused Living and Cooking CBD Benefits and Usage Sleep, Pain & Recovery Guidance Creative Expression Coaching Wellness & Lifestyle Coaching Neurodivergence & Substances Coaching Sleep & Recovery Stress & Burnout Mindfulness Integration Coaching Body Awareness Coaching Ketamine Coaching Services: Ketamine Education & Readiness Coaching At-Home Ketamine Coaching Couples Ketamine Integration Coaching Psychedelic Coaching Festival & Rave Safety Coaching Group Trip Preparation Coaching Microdosing & Macrodosing Guidance Retreat Preparation & Integration Coaching Harm Reduction and Education Coaching Family, Youth and Partner Education Safe Partying Coaching Mixing Substances Coaching Professional Development & Community Education Cannabis, Ketamine & Psychedelic Literacy Presentations Is this right for me? You may be a good candidate if you.. You’re neurodivergent and want guidance that honors how you process things. We will keep it factual and not overwhelm you with vague advice or weird terminology. You’re new to cannabis and have no idea what to buy, how to use it, or even how to ask the “right” questions without feeling judged. You’re a burned-out parent who’s curious about alternative ways to reset or reconnect — but you don’t want to walk into a dispensary alone or figure out a vape on your own. You’re psychedelic-curious but not ready to jump in without understanding the why, how, and what-comes-after — or you’ve had an experience and need help making sense of it. You’re going to your first rave or festival and want to feel confident, safe, and intentional instead of overwhelmed or just going with the crowd. You’re considering a legal retreat or therapeutic experience but feel nervous, skeptical, or just plain unsure what to expect (or if you even “belong” there). We meet you where you are with evidence-based information, no judgment, and authentic support. Ouroboros is based in Arizona but operates as a fully remote entity and can serve people nationwide. Please note: Ouroboros Integration and Education Services does not provide medical, psychiatric, or therapeutic diagnosis or treatment. We do not substitute for licensed healthcare providers and will not operate in states in which services are deemed illegal. Schedule now All clients engaging in our services must complete a consent and disclosure form outlining the nature, scope, and limitations of our services. Clients acknowledge that engaging with altered states of consciousness carries personal risks. Participation in our educational or integration services is voluntary and at their own discretion. Ouroboros Integration and Education Services is not liable for outcomes resulting from individual choices. Email John If you have a question, are interested in a collaboration or would like to book Ouroboros for an educational seminar, presentation or workshop, you can contact him directly. John@paperflowerpsychiatry.com Anchor 3

Paperflower Psychiatry is a holistic and inclusive psychiatric practice specializing in evaluations and medication for children, adolescents, peripartum and adults in Arizona. Telehealth + offices in Tempe, North PHX + Flagstaff. Self booking is available online. Meet The Team Founder & CEO Dr. Maria Ingalla, DNP, PMHNP-BC (she/her) Contact: maria@paperflowerpsychiatry.com Maria started the practice back in 2020 and continues to build Paperflower into a cornerstone of progressive mental health care in the state of Arizona. She has built a social media presence in the mental health community with her podcast and TikTok . But most of the time she just has a headache from wrangling her feisty toddlers. Learn more Practice Manager Delfina Honne (she/her) Contact: delfina@paperflowerpsychiatry.com Direct phone: 602-327-3152 Also speaks: Spanish Delfina is our practice manager. She handles administrative duties, patient care, support team tasks, pharmacy calls, refills, and any patient concerns that are escalated. She is a gem of a human that really cares about other people and will make you feel heard. She has years of case management experience and can help connect you with resources if needed. She also handles QB & Tova testing, local networking, along with community events. Learn more Team Lead Rome Gamusaran, RN (he/him) Contact: rome@paperflowerpsychiatry.com Phone: 928-504-4700 Also speaks: Tagalog Rome was our original support team member, and now oversees the entire team in the Philipphines including the billing department and our support team. Learn more Support team Supervisor June Landingin (he/him) Contact: june@paperflowerpsychiatry.com Phone: 928-504-4700 Also speaks: Tagalog June is an incredible resource at Paperflower - handling our prior authorizations. This means he's the guy that makes sure your insurance covers your medications. He also supervises our support team, answers your calls, calls your pharmacy... basically all the things. Learn more Community Liaison Thea Montesclaros (she/her) Contact: thea@paperflowerpsychiatry.com Phone: 928-504-4700 Also speaks: Tagalog Thea is our community liaison. She manages our referral network, ensuring that we have up to date information on practices we work with across Arizona. She is our point of contact if you'd like to work with our clinic. She also handles medical records. Learn more Credentialing & Support Specialist Michelle Aguila (she/her) Contact: credentialing@paperflowerpsychiatry.com Phone: 602-613-0455 Also speaks: Tagalog Michelle works as our credentialing specialist -- this means she maintains all current information and negotiations with insurance companies to ensure that we stay paneled. She also is cross-trained and works in our support team and alongside our billing team. She is a gentle presence so be nice to her if you get her on the phone! Learn more Billing Expert Ken Ramirez (he/him) Contact: ken@paperflowerpsychiatry.com Phone: 602-613-0455 Also speaks: Tagalog Ken works as an expert in accounts receivable, billing reports, claim submission and denials. He is a key fighter against insurance companies to make sure we try to get your healthcare covered, and also to make sure we don't bankrupt because they underpay us. That being said, we really like Ken. Learn more Billing Expert Jed Pambid (he/him) Contact: billing@paperflowerpsychiatry.com Phone: 602-613-0455 Also speaks: Tagalog Jed works as an expert in coding, billing, claim submission and denials. He will be receiving your calls and emails in regards to any concerns with your insurance, denials, etc. Jed says he has a girlfriend but we are not sure we believe if the photos were AI or not. Learn more Billing Expert Donna del Mundo (she/her) Contact: billing@paperflowerpsychiatry.com Phone: 602-613-0455 Also speaks: Tagalog Donna handles patient collections, payment plans, sliding scales and helps manages any concerns with your credit cards or insurance. She works on insurance verification to make sure we aren't getting denied because we weren't covered in the first place. Learn more Social Media Manager Zerry Ramirez (she/her) Contact: socialmedia@paperflowerpsychiatry.com Phone: 928-504-4700 Also speaks: Tagalog Zerry is our incredible social media manager who handles our instagram and facebook accounts, edits our podcast and manages our youtube . She is incredible at graphic design. Learn more Education Development Expert Gillian Ilagan (she/her) Contact: gillian@paperflowerpsychiatry.com Phone: 928-504-4700 Also speaks: Tagalog Gillian is a registered psychologist in the Philipphines and does incredible humanitarian work. She currently makes educational materials for our patients and the general public, and helps us to build courses for professionals. She is really brilliant and incredible and we love her. Learn more Billing Expert Kevin Baeza (he/him) Contact: kevin@paperflowerpsychiatry.com Phone: 602-613-0455 Also speaks: Tagalog Kevin is the guardian angel of our phones, our VOBs, and honestly our sanity. He runs insurance verifications, handles collections with the gentlest firm voice known to mankind, and makes sure patient statements actually get where they need to go. We don’t know how he does it, but we’re convinced he has superpowers. Learn more Support Specialist Charles Dalimos (he/him) Contact: charles@paperflowerpsychiatry.com Phone: 928-504-4700 Also speaks: Tagalog Charles has spent years in healthcare doing… well, basically everything. Customer service? Yes. DME coordination? Yep. Medical receptionist wizardry? Absolutely. If there’s a phone to answer or a patient who needs reassurance, Charles is already halfway there with a smile in his voice. Learn more

Discover Paperflower Psychiatry's mission of providing inclusive, trauma-informed psychiatric care. We specialize in ADHD, mood disorders, neurodivergence, and LGBTQIA+ mental health, offering both in-person and virtual services across Arizona. Learn more about our practice and approach to patient-centered care. On to the story Flor de papel es otro nombre para Boungavillea. Esta es una planta hermosa y de colores brillantes que continúa prosperando en las condiciones más duras del desierto, mostrando un nivel de resiliencia que las personas con traumas y problemas de salud mental a menudo no pueden. mostrar (sin darse cuenta). Paperflower Psychiatry, LLC was launched in October 2020. Maria had been previously working at a community mental health agency and attempted to make negotiations to match the income of her male nurse practitioner coworker. Negotiations went south, human resources and the chief financial officer laughed at her request. She was already distraught at being burnt out from seeing a huge amount of patients in a short period of time. She was tired of being treated poorly by leadership, and not being able to advocate or create quality care for her patients. She was disgusted by case workers and intake specialists who were actively transphobic and homophobic, refusing to use patient's pronouns and chosen names. She was done with being looked at as a cash cow to make money for people who gave no fucks about the patients. At this point, she said "fuck it" and quit on the spot. If places like that could be corrupt as fuck and thrive, what would hold us back from having a practice that could be better? That could provide better quality care. That could OPENLY support the LGBTQIA+ population and fight health disparities. That could only hire on providers who give a fuck. That could put access to care before money. She registered for an LLC, designed her own website and started the practice that very weekend. Since then, we've just been growing. anti-fascist & secular since 2020. we were born in resistance to the current healthcare system prioritizing capitalism. every single person on our team votes for your right to choose, love, exist and be included in our society. we remain opposed to the current administration. we stand against nazis like elon musk who threaten the livelihood of LGBTQIA+ folx, the jewish community and POC. we stand against the system that erases the existence of trans folx. we stand against RFK for villainizing vaccines and life saving medications. we stand against trump for dismantling the system that offers fair education and rights to special needs children, and the ability to advance ourselves for those of us who can't afford higher education. we stand against the system that favors billionaires, leaving the rest of us without adequate resources or healthcare. we will continue to stand in solidarity with you. we have made some support guides for navigating your safety in the administration here.

Meet Dr. Azuka Okafo, CNM, PMHNP-BC, DNP, a compassionate Psychiatric Nurse Practitioner offering telehealth expert care and psychiatric medications. Dr. Azuka Okafo, CNM, PMHNP-BC, DNP I am double boarded as a nurse midwife and a psychiatric nurse practitioner. I have been a practicing nurse midwife for over two decades and decided to add formal psychiatric training to support my passion for holistic women’s healthcare. I have worked in diverse settings including a private practice in suburban Connecticut, urban health in Baltimore, Maryland, and most recently at a tribal hospital in rural Arizona. My training and interests extend beyond reproductive psychiatry and include SMI and pediatric mental health. I grew up in Africa and have a deep appreciation for cultural influences on health. I am also acutely aware of the impact of mental health on overall well-being. My work on the reservation highlighted the need for a bridge between reproductive and mental health care. I earned Postpartum Support International’s Perinatal Mental Health Certification in 2024 while enrolled in my PMNHP training program. My prescribing philosophy is that medications are one of many options available to support clients. Every person’s needs are unique, and I firmly believe in collaborating with clients to create holistic treatment plans. Being a full-scope nurse midwife did not provide me with much free time, but I enjoy catching up with good friends over tea or a meal, taking walks, reading, working out, watching sparring hummingbirds, and meeting neighborhood dogs. I’d say my vibe is energetic, curious, humorous, compassionate, and collaborative — with a dash of sarcasm and low tolerance for nonsense. I take my work seriously but never myself. Perinatal Care Azuka has spent the last chapter of her career on the Rez delivering babies. As a certified nurse midwife, she has a strong understanding of the intersection of complex pregnancies and mental health. Hormones While many psychiatric providers claim they understand the impact of hormones on mental health, Azuka *truly* understands and has the clinical experience to back it. Adolescents She's really good with teenagers, and can definitely have a fun, silly vibe. If you needed a person who was going to bring some spirit into appointments, Azuka's here for it. Q&A What is your favorite music? I don’t have a favorite type per se, because I grew up in a family where we listened to various genres (classical, jazz, folk, reggae, rock, zouk, R&B, Latin, soul, and funk, etc.) I do have a deep appreciation for classical/Spanish guitar music. Favorite superhero? Batman. He became a superhero as a response to his childhood trauma; I appreciate the complexity of his character. If you could have a superpower, what superpower would you pick? I think that it would be cool to control the weather. I’m looking at you, Storm. Tell me about your pets. I lost my beloved German Shepard/Chihuahua mix in 2024. That dog was the quirkiest animal that I didn’t know I needed in my life. I considered myself to be her therapy human, as frequent walks, pets, dietary changes, and love helped her blossom from an anxious dog into a social pup. I became her medication manager in her twilight years when she required two different medications to ease her escalating anxiety. Fun fact about you: I once caught a baby in my soccer uniform—without the cleats. What are some experiences that make you unique? I have been a midwife on both ends of life; at 14 I held my father’s hand as he left this world. What are ways beyond medication that can improve your mental health? Medication is simply a piece of the whole puzzle and often work better when combined with therapy. I am a firm believer that social support, diet, exercise, and sleep are critical to maintaining one’s mental health. I have been sleep deprived for decades…the need for sleep is real! Are medications lifelong? Does a patient who sees you HAVE to be on medication? No, someone who sees me does not have to be on medication. There are some instances, however, where a person may need to be on medication long term because of that individual’s unique circumstances. 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? I would want them to know that their safety is my main concern and the evaluation an information-gathering session so that I can understand their story. We will only talk about the hard things if they are comfortable doing so. Do you have any personal mental health experiences you can share with us? I worked at a hospital on a reservation during the COVID-19 pandemic. We were isolated and scared; the sound of multiple helicopters used to transport critically ill patients was deeply disturbing. I still brought love and levity to patients birthing amidst the chaos while concealing my own anxiety. We were isolated from our friends and families by fear and local curfews. My self-care suffered and led to a devastating injury and burnout. But I’m also a Black woman so…

Meet Delfina, the dedicated practice manager at Paperflower Psychiatry in Arizona, USA. Learn about her role and contributions to our thriving mental health practice. Delfina Honne Prior to taking our offer to help us at Paperflower, Delfina has been well-known for working as the most fantastic case manager for well over a decade at Arizona Children's Association. She knows the AZ mental health system and all of the resources. You'll never meet another person with as huge of a heart and as dedicated to her patients as Delfina! She may have sat in on Maria's first ever day as a prescriber as emotional support :) She means a lot to us here! Delfina also works at another local mental health office as a Spanish interpreter. Delfina lives in Phoenix, Arizona with her husband, her mom and the most amazing Frenchie named Romeo... Romeo may have a passport and be an international star. You'll have to ask her about Romeo! delfina@paperflowerpsychiatry.com Oversees Practice, Patient Concerns & Students QB & Tova Testing Patient Assistance & Community Events

Meghan Baker, PMHNP-BC, offers compassionate psychiatric care with a focus on perinatal mental health, neurodivergence, ADHD, and trauma. Serving children, teens, and adults across Arizona, Meghan provides personalized care throughout pregnancy and beyond. Now accepting new patients. Conoce a Meghan Baker Meghan Baker, MSN, PMHNP-BC, PMH-C Meghan is a board-certified Psychiatric Mental Health Nurse Practitioner. She previously served as a labor and delivery nurse for ten years prior to venturing into psychiatry. She was even a high school teacher for a period of time! Meghan is board certified in perinatal mental health through Postpartum Support International. She is experienced and knowledgable in managing medications throughout pregnancy and postpartum -- and she can further help plan a safe medication regiment prior to planning a pregnancy. Meghan's goal is to provide empathetic and comprehensive care to the entire family unit. She currently sees all ages, but does love working with the child/adolescent population. She is also passionate about providing neurodivergent affirmative care. Meghan currently resides in the Phoenix, AZ area with her spouse and children. She is up to date on watching the Handmaid's Tale, so you can discuss your thoughts about June Osborne and Serena during your evaluation. Perinatal Care Neurodivergence ADHD Autism is often misdiagnosed and misunderstood - Meghan holds a strong understanding of autism across the lifespan. Meghan is an advocate in ensuring that patients are diagnosed correctly with ADHD and have proper accommodations to thrive. With years of labor and delivery nursing alongside a perinatal mental health certification, Meghan is an expert at care throughout pregnancy and postpartum. Q&A What is your favorite movie? ‘Children of Men’ – beautiful, hopeful, tragic, & haunting. …But can I also say TV shows? Succession or Handmaid’s Tale …Or books? ‘The Road’ by Cormac McCarthy or ‘The World to Come’ by Dara Horn Favorite superhero? I had a mad crush on Christopher Reeves’ Superman as a kiddo. But favorite now? Black Widow - I love Russian history, ballet, and confident strong women – so, she fits the bill! Or, oh wait, maybe the 1997-Gwen-Stefani-soundtracked-strong-woman-fighter-pilot Captain Marvel. Okay, both. If you could have a superpower, what superpower would you pick? I would love to have the ability to speak any language. But more in the true ‘superpower’ category - probably teleportation – it would REALLY help with school dropoff & pickup and all the activities (and I could travel and use my language super power!). Favorite bands/singer? My 10-year-old daughter is an incredible musician, so I love her – and recently we’ve been listening to a whole lot of things: Jax, Lady Gaga, Adele, Paramore, & Jack White. But all-time, long-time? Eminem. If you had 3 wishes, what would you wish for? For our incarceration system to be completely overhauled – trauma- focused treatment, vocational training, true reintegration. For endless, bottomless patience – with my kids, my spouse, my laundry, I-10 construction… To have a personal chef plan for, shop for, and cook everything all the time What is your favorite food? A good Monte Cristo sandwich What are you most passionate about in the mental health field? High quality & ACCESSIBLE Perinatal Mental Healthcare.. Accurate screenings and appropriate 1) Autism Spectrum Disorder and 2) ADHD diagnoses in girls and adult women What are some experiences you have had that make you unique? -My original career path was education - I was a high school history teacher. I quickly realized that I didn’t really want to do that forever (really kind of knew even in college – but I much preferred reading, writing, and studying abroad to early morning lab class for my pre-med/physical therapist dreams), so after teaching for 5 years and growing up a little bit, pursued nursing school. -I studied abroad in Russia for a semester in college. -I have been a Labor & Delivery Nurse for the last 10 years and LOVE it. What is your philosophy on using medication to treat mental health? Are medications lifelong? Does a patient who sees you HAVE to be on medication? Psychiatric medications can be life-saving scaffolding in the journey to managing your mental health. Sometimes they are a lifelong; sometimes they are a situation- or life-season- specific – but you are completely in control of that long-term plan and it will always be an ongoing discussion. I am a huge advocate of integrating non-medication tools into your toolbox– self-awareness, routine, practical life changes, sunlight, activity, community, and self-compassion (the list goes on) can be small-but-huge steps to transformation. Sometimes medication can be the step to take in order to be able to build in life management skills. As your provider, I will always make sure you are fully educated about medication choices as well as talking you through non-medication management techniques! 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? You are not at fault for what happened to you. And I believe you. You didn’t deserve it – and there are absolutely no exceptions. You. Didn’t. Deserve. It. And. It. Was. Not. Your. Fault. We can talk about it when and if you are ever ready. Or I can help find the perfect people to help you process it if and when you are ready. There is no pressure or judgement. Do you have any personal experiences regarding mental health you are open to sharing? With each of my pregnancies and children, I struggled with varying degrees of depression, anxiety, OCD, and psychosis. The huge gap in care was mind boggling to me – and started my passion to transform the perinatal mental health field. As an adult I was diagnosed with ADHD and (very recently) Autism Spectrum Disorder – making so many things about my life make so much more sense and transformed my ability to manage life. How do you feel about medical marijuana? Pro - I think it can have fantastic benefits for certain things, but definitely will always talk to you about how it is impacting you and your treatment/management. Tell us about your pets: Moby – our all-white, 11-year-old, chilliest cat on the block. Marlow – our new (5 months old in November) Bernedoodle puppy. So fun and funny and naughty as all get out. What are your thoughts about treating adult ADHD? I think it is tragically underdiagnosed! Undiagnosed neurodivergence is a huge risk factor for depression & anxiety. If you weren’t an always-talking-out-of-turn, always-in-trouble, can’t-stay-in-your-seat, six-year-old white boy, you can’t possibly have ADHD. Right? Sigh. What if you were a people-pleasing rule-following girl who did great in school but put EvErYtHiNg off ‘til the last minute and now, as an adult, CaNnOt manage your laundry or kid-pick up schedules or ever quiet your brain enough to nap? Or you found that drugs or alcohol were the only way to quiet your brain or manage your anxiety? There are so many factors at play with mental health - I will always consider ADHD or ASD diagnostic criteria during an initial evaluation, and will make sure you feel clear on the risks and benefits all of the options – medication and non-medication. Tell us one fun fact about yourself: As a 6th grader, I wrote a musical about the History of Ancient Egypt. I was also the sole cast and audience member.

Paperflower Psychiatry is a holistic and inclusive psychiatric practice specializing in evaluations and medication for children, adolescents, peripartum and adults in Arizona. Telehealth + offices in Tempe, North PHX + Flagstaff. Self booking is available online. The Neurodivergence Evaluations We offer neurodivergence evaluations that assess for ADHD and Autism by expert nurse practitioners. This can be lifechanging and validating for people who've felt broken their entire lives. These are entirely self pay, unfortunately cannot reimbursed via a superbill and do not count as a qualifying diagnosis for DDD benefits (evaluator can be a psychologist or MD only). These evaluations can be booked by emailing support@paperflowerpsychiatry.com About & Pricing Paperwork FAQs Resources & Education About the Neurodivergence Evaluation These evaluations are performed by nurse practitioners who utilize evidence-based scales, a clinical interview and either one of both of the following: ADOS2 & MIFGAS-2. For those having the full evaluation, we also offer a TOVA or QBtest for ADHD. Current patients may have 1-2 appointments, depending on the complexity and their needs. Both receive a full report at the end of the evaluation process, which should help give you some insight into how to move forward in navigating the rest of your life. We offer these for ages 6 into adulthood. The Price These are SELF-PAY ONLY!! THESE ARE NOT COVERED BY INSURANCE AND CAN NOT BE REIMBURSED VIA SUPERBILL (because insurance companies suck, basically). Current patients: $1,200 (express testing) Not existing patients: $1,800 (comprehensive testing) email support@paperflowerpsychiatry.com to book The Benefits The biggest benefit here is giving yourself an answer. We validate self-diagnosis and are certainly not here to gatekeep. But we can take the time to explore your life, your struggles, your history and your current space to give you a definite clinical answer. If you believe you are autistic and just need someone to validate you and have the proof for yourself, this could be it for you. If you are a parent of a child, perhaps this could help open doors to start OT, PT, Speech, get them supports in school, move them into another school.. and just change your parenting techniques. As the owner of the practice, I am a late-diagnosed autistic woman and I have autistic children. Understanding myself better and understanding them has changed everything for me. Neurodivergence Evaluation Forms Neurodivergence Consent Form RBQ2 Sensory Processing Checklist GQ-ASC Autism Quotient Autism Quotient Child CAT-Q EDA-8 (Child) Sensory Problems Assessment Social Communication Questionnaire (Child) Vanderbilt (teacher) Vanderbilt (parent) Wanting to learn more? We've gotchu covered. We've spent some time putting together resources, educational materials + just some other websites that might be worth checking out for your research. Because..you know, as neurodivergents.. we love deep dives and hyperfocusing on topics :) Educational Content: A Self-Help Guide for Recently Diagnosed Autistic Adults POTS & Neurodivergence ADHD & Anhedonia: when motivation ghosts you. A Guide for ADHD Families on the Road Sources of Fatigue in ASD + ADHD When Diagnosis Hurts More than it Helps The TOVA ADHD Test The QB ADHD Test Sensory Therapy Options for your Child A Sensory Guide for Parenting Understanding Sensory Issues Utilizing ChatGPT for ADHD Making Therapy Accessible for Neurodivergent Kids Hacks to Improve Focus & Flow Parenting Tips for Children with ADHD 7 Things That Have Helped Autistic People Why Classic Therapies Often Do not Work for Autistic Kids Managing Hormonal Depression as an Autistic Person Autism & Identity Navigation Mapping the Autistic Survival Spectrum Autism or OCD: A Guide for Parents How to be a Better Friend to an Autistic Person NEUROAFFIRMING THERAPY: Guide for Parents Understanding the Brain/Body Connection in Neurodivergence Resources: Community Resources Compiled by Neurodiverse Counseling The Dysautonomia Project EDS Specialists Recommended Books Unmasking Autism Sincerely Your Autistic Child Neurotribes Anchor 3 FAQs Why are these evaluations so expensive? Realistically, the training materials, the training courses, the overhead of the support staff, the scheduling software, the time to do the appointment, score the scales and write the report is a ton. In order to fairly pay our clinician for their time while still maintaining the overhead.. this is the lowest calculated cost I could do. I hope as we do more, we can ideally lower the price. Why can't they be used for DDD? Because the state of Arizona sucks and doesn't recognize nurse practitioners as competent to evaluate, tbh. We only allow our most highly trained and expert NPs to do these evaluations. But ya know, the state is stupid. Can you do this for me if I live in another state? No, we aren't licensed to evaluate anyone outside of Arizona at this time :( Are there discounts if we pay up front or sliding scale options? This is something you can discuss by emailing support@paperflowerpsychiatry.com What if I don't want my diagnosis on my chart? That's okay! If I want to become a patient at Paperflower after my ASD eval, do I need to do another medication evaluation? Unfortunately, yes. But if you have insurance, we take insurance for all med appointments.

Dr. Bre Chamoff, DNP, PMHNP-BC, specializes in pediatric psychiatric care with a focus on trauma, ADHD, and brain-gut connections. Offering compassionate care to children, adolescents, and young adults across Arizona. Now accepting new patients Dr. Bre Chamoff, DNP, PMHNP-BC, CPNP-BC 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 over 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 8 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 she needs to overly express her interests and ideas with many caveats and sidebars. She offers both an apology and congratulations for this. *only taking ages 5-15 on waitlist basis* Pediatric Mental Health Bre is an expert in pediatric mental health encompassing ADHD, autism, sensory procesing, mood, anxiety, and trauma. Medical With a background in acute pediatric care, Bre is an excellent resource for kids with co-existing medical conditions or gastrointestinal problems. Adolescent Mental Health Teenagers can be hard to connect with -- but they will appreciate Bre's humor and energy and may (well, hopefully) look forward to visits with her. Q&A 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. 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!