Psychiatric medication management. Brief therapy. MOUD.

Adolescents age 14 and older and adults seeking medication-led behavioral health care, integrated with their primary-care record at this practice. Diagnoses we routinely manage: major depressive disorder; generalized anxiety disorder; panic disorder; post-traumatic stress disorder (medication arm — therapy arm referred); obsessive-compulsive disorder; bipolar II in stable maintenance; ADHD in adults with completed objective evaluation (see § Contraindications); opioid use disorder via SAMHSA-aligned TIP-63 MOUD guidance; alcohol use disorder via naltrexone or acamprosate; and perinatal mood and anxiety disorders co-managed with the patient's obstetric clinician and the resources at MGH Center for Women's Mental Health.^[01]

Brief therapy: 6–12 sessions of cognitive-behavioral therapy or acceptance-and-commitment therapy delivered by Salim Okonkwo, PMHNP-BC and an APA-listed CBT-trained social worker who consults with the practice on Wednesdays. Brief therapy is for situational and uncomplicated presentations; complex trauma, severe personality disorder, eating disorders, and active suicidality are referred (see § Contraindications).

Behavioral health is delivered by Salim Okonkwo, PMHNP-BC as the primary clinician for the BH panel, with co-management for MOUD by Otis Thackeray, MD and prescribing co-coverage by Maren Vanderlyn, MD when Salim is unavailable. The BH panel is currently 312 patients; the waitlist for new evaluations is approximately 11 days as of v2026.04.30 (it has fluctuated from 8 to 23 days over the last twelve months and is published on the cover ticker).

The visit shape: 75 minutes for a new psychiatric evaluation (CCH-003-NE), 30 minutes for follow-up medication management (CCH-003-FM), 50 minutes for a brief-therapy session (CCH-003-BT), and 30 minutes for a MOUD induction or stabilization visit (CCH-003-MO). The Collaborative Care Model — AIMS Center, University of Washington — informs the workflow but we do not bill 99492/99493 ourselves; the integration is operational.^[02]

We use validated symptom measures at every visit (PHQ-9, GAD-7, PCL-5 where indicated, AUDIT-C for alcohol use, CIWA when relevant for inpatient referral). Scores are entered into the chart at the visit and reviewed in the next-visit brief.

Adolescents age 14 and older and adults. Adolescent BH is shared with Helena Rey, FNP-BC when ongoing pediatric primary care is also in place at this practice; consent and confidentiality follow NY Public Health Law § 17.

Insurance: same in-network list as CCH-001. Behavioral-health-specific carve-outs: some plans contract through Carelon Behavioral Health or Optum Behavioral Health rather than through the medical plan; we run the eligibility check at intake. Membership patients pay no copay for in-house BH visits.

• New evaluation (CCH-003-NE) — 75 minutes, scheduled inside 11 business days as of this revision (waitlist on cover).
• Med management follow-up (CCH-003-FM) — 30 minutes, every 4 weeks during initiation/titration, every 8–12 weeks once stable.
• Brief therapy (CCH-003-BT) — 50 minutes, weekly to biweekly for a structured 6–12 session course. We do not provide indefinite weekly therapy.
• MOUD induction (CCH-003-MO-I) — 60 minutes; same-day or next-business-day for established patients with confirmed OUD diagnosis. Home induction is available; office induction is available on Tuesday and Thursday afternoons.
• MOUD maintenance (CCH-003-MO-M) — 30 minutes, weekly to monthly depending on stability per SAMHSA TIP-63.

• Severe / persistent mental illness. Active psychosis, mania, severe self-harm risk, or histories of psychiatric hospitalization within twelve months are referred to a higher level of care: Albany Med Psychiatry, the NY State Psychiatric Institute, or, for short-stay, the inpatient unit at HealthAlliance.
• Eating disorders. Out of scope. Referral to Walden GOALS or The Renfrew Center; medical co-management of stable patients post-program is in scope.
• Adult ADHD without prior evaluation. We will not initiate stimulants for adult ADHD without a structured evaluation. We complete this evaluation in-house using DIVA-5 and validated rating scales when records support a developmental history; otherwise we refer for objective neuropsychological testing.
• Long-term benzodiazepine prescribing. We will continue established benzodiazepine regimens during a tapering plan; we do not initiate long-term benzodiazepine therapy. Bruyère benzodiazepine deprescribing algorithm is our default.

1. Active suicidality requiring imminent intervention — call 988 or present to an Emergency Department; we will then receive you for outpatient follow-up.
2. Active opioid use disorder with active untreated medical instability (sepsis, endocarditis, severe withdrawal) — referral to HealthAlliance ED first; MOUD induction occurs after medical stabilization.
3. Court-ordered treatment plans where we are required to be the sole psychiatric provider for the duration of the order — out of scope; NYS Office of Mental Health contracted clinics manage these.
4. Patients seeking benzodiazepines, stimulants, or controlled-substance prescriptions where the request, not the underlying condition, is the primary purpose of care — declined on initial evaluation.
5. Children younger than age 14 — referred to pediatric mental-health practices; we maintain a list at the front desk.

The new-evaluation visit is 75 minutes and is exclusively psychiatric. You should bring: a list of current medications and supplements; the names and dates of any prior psychiatric medications you have tried (the dose, duration, and reason for stopping each, if you remember); the names and contact details of any current or recent therapist, psychiatrist, or counselor; and the most recent labs you have. We will request prior records on your behalf if you sign the release on the intake form. We do not require records to be in hand before the first visit.

You will leave with a written diagnostic impression, a written medication plan if one is started, and a written safety plan in any case where the suicide-risk screen requires one — using the Stanley-Brown Safety Planning Intervention. The safety plan is yours to keep; a copy is in your chart.

If MOUD is on the table, expect us to ask about the regional Prescription Monitoring Program (NY PMP), to discuss home induction, to discuss naloxone co-prescription (we will write naloxone with every buprenorphine prescription unless you decline), and to be specific about expectations — appointment cadence, urine drug screens (when and why), and the conditions under which we would change the plan.

Insurance: BH copays vary widely; in 2025 Q4 our observed median copay for a follow-up visit was $40 (range $0–$80). Some plans require pre-authorization for stimulant prescriptions; we will run the auth ourselves.

Membership: $95/month adult covers all CCH-001, CCH-003, and CCH-005 visits at our office. There is no separate "behavioral health membership."

MOUD: buprenorphine prescriptions are covered by all in-network plans; cash price for buprenorphine-naloxone (8mg/2mg) is approximately $50/month at Costco Pharmacy at the time of writing. We will write to your preferred pharmacy.

• Long-term individual therapy. See the in-house brief-therapy scope (6–12 sessions) above. For long-term therapy, we refer through the patient's insurance directory or to the Psychology Today directory; we will work with whichever therapist you choose.
• TMS / ketamine / esketamine. Out of scope. MGH Psychiatry — TMS for an overview; Spravato programs at the regional academic centers.
• Inpatient or partial hospital programs. Out of scope; referral is the appropriate path.
• Methadone maintenance. Methadone for OUD is delivered through an OTP per SAMHSA OTP rules. We refer to CommonBond Wellness in Kingston as the closest accredited OTP.

This monograph is owned by Salim Okonkwo, PMHNP-BC and co-authored by Otis Thackeray, MD for the MOUD sections.

v2026.04.30 — supersedes v2026.01.20. Significant changes: § Mechanism updated to reflect the 11-day current waitlist (was 14 in January); § Outcomes 6-month MOUD retention updated to 72% (was 68%); § Cost updated with Q4 copay range. Diff on the errata page.