A psychiatric nurse practitioner is a registered nurse who has pursued additional graduate education and training, both in general health and in the field of psychiatry. In Washington State, psychiatric psychiatric nurse practitioners have “independent practice”, meaning they practice with full autonomy, in much the way that psychiatrists do - they are licensed to evaluate and diagnose mental health conditions as well as treat them, prescribing medications and offering therapy. However, nurse practitioners and physicians have different education and training - in spite of serving in similar roles in Washington State, some patients may need or prefer the approach of one type of provider over the other.

Both Erin and Malia currently see adults ages 18 and over only at this time. Erin and Malia are both passionate about providing services for individuals across the gender spectrum, and this includes a commitment to ensuring access to psychiatric care during the perinatal period.

It is our belief that certain psychiatric disorders require more extensive support and resources than we can currently provide as an association of private practitioners.

If you are seeking treatment for a substance use disorder, it is possible you will be recommended to complete an inpatient detoxification as well as additional care outside of your visits at Sequoia.

At this time we are not established to provide care to individuals with active psychotic disorders, high lethality risk, or a recent psychiatric hospitalization unless additional care is already established.

We are not currently providing assessments for Autism, but we both have extensive experience working with this population, and welcome patients with a prior diagnosis, formal or otherwise.

Initial 90-minute session includes a review of your health and psychiatric history, medical conditions, current symptoms and mood as well as your goals with treatment and reasons for seeking services. You will be expected to complete our intake packet 48 hours prior to your scheduled visit. If your intake packet is not completed, Sequoia may need to cancel your intake visit. While medication may be prescribed at initial visit, we may also require more time and assessment before being able to safely recommend and prescribe a medication.

Please note: these visits often include deeply personal questions about your life and history. We encourage you to come to the intake during a time when you can reasonably rest or decompress afterwards. Part of the reason we have embarked on this journey to collaborate is our shared belief that care should be both thorough and trauma-informed; patients should feel in control. As a result, both practitioners welcome patient requests to take a break from the interview questions or discuss specific topics at a later visit.

Yes - sometimes, and some types of therapy. Psychiatric nurse practitioners are licensed to provide therapy as part of their board-certification. However, our training is limited compared to a master’s or doctorally prepared LMHC, PsyD, LICSW, etc. Malia and Erin both have training and experience providing therapy utilizing cognitive-behavioral, motivational interviewing, and interpersonal supportive frameworks. At any time during treatment, we may recommend you seek therapy externally in order to ensure your care needs are appropriately met.

Yes. We follow the recommendations of experts in the ADHD field for this assessment. In addition to the initial psychiatric evaluation, we use screening tools, and an evidence-based structured diagnostic interview that can take up to 5 hours (over separate appointments) to complete, as well as review of collateral information from family or friends. We may require additional medical information to evaluate for underlying medical conditions that can contribute to symptoms. In order to initiate treatment, we may require medical clearance from your primary care provider.

Yes, sometimes. These medications have their place in our field, and while they have risks, can be life-saving tools. Controlled substances will not be prescribed at a first visit, and will require an in-person visit for new patients. If you are taking a controlled medication, please be aware that a release of information may be necessary for us to coordinate care with your primary care provider, and we may require more frequent visits, or additional monitoring (such as blood pressure and heart rates, labs, etc.) We have a set of controlled substance policies that will be provided to you at the time a prescription is initiated.

No. We recommend seeking care from a provider who specializes in these evaluations.

Sequoia Integrative Psychiatry consists of Erin Delsol and Malia Alexander who operate as an association of two independent Professional Limited Liability Corporations (PLLC). We have registered a DBA as Sequoia Integrative Psychiatry and we share health records, patient and prescription information in compliance with Washington state and federal HIPAA standards. We occasionally provide consultation for one another and for our patients, and in some circumstances we may also refill medications on behalf of the other provider. As a patient, you can expect that you will see your primary provider for most visits unless your provider has made arrangements with you ahead of time to see the other provider due to a planned absence or for consultation.

We’re glad you asked! Sequoias thrive in the Cascadia region of the Western United States, where Erin and Malia are from and where we ground ourselves in community. The word sequoia is a latin derived from the indigenous Cherokee name Sequoya for these trees. Sequoias are adaptive, strong trees that have evolved to not only survive fires, but require them for growth and survival. We like this symbolism for the resilience of the human psyche in the face of life’s inevitable challenges.

In addition to receiving a copy on intake, you can find the full document here.