Our Standards
How We Design Care to Reduce Preventable Risk
Many practices promise “safe, high-quality, personalized care.” Few explain what that means in real clinical systems. We do.
Rappore was built by former clinical leaders at Columbia to deliver compassionate, evidence-based care that is never rushed or volume-driven. We are clinician-led. Treatment decisions are guided by clinical judgment and research, with senior oversight for complex cases. Our clinicians are employed by Rappore—not hired per visit from a gig-style marketplace—which supports continuity, supervision, and accountability.
We provide online psychiatry and therapy for adults in New York, New Jersey, and Connecticut, with particular depth in women’s mental health. Hormonal and reproductive transitions can change diagnosis, risk, and medication safety. The standards below apply to every patient, with additional safeguards when clinically relevant.
Below are Rappore’s Seven Safety Protocols we use across therapy, medication management, and combined care — followed by Seven Questions you can use to evaluate any provider, including us.
1) Pre-Treatment Clinical Evaluation Gate
Why it matters:
A brief screening questionnaire is not a clinical evaluation. Early diagnostic and prescribing decisions shape the trajectory of care. Early errors compound.
How we handle it:
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A licensed prescriber conducts a full clinical evaluation before any medication decision.
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The first visit is framed as diagnostic clarification and shared decision-making — not a default commitment to prescribe.
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We review psychiatric history, prior medication trials (including tolerability), safety concerns, medical contributors, and reproductive factors when relevant.
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Hormonal and reproductive variables are treated as active clinical considerations, not background context.
2) Telehealth Appropriateness and Scope Boundaries
Why it matters:
Not every condition can be safely managed via telehealth. Safety requires clarity before treatment begins.
How we handle it:
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We screen for acuity or conditions that exceed telehealth scope and discuss referral options when indicated.
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Scope boundaries are defined early so there are no mid-treatment surprises.
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Escalation pathways are considered from the first visit.
3) Controlled-Substance Safeguards
Why it matters:
Controlled substances may be appropriate, but they require added structure and oversight due to safety and dependency risks.
How we handle it:
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We document a tailored risk–benefit discussion, including reproductive considerations when relevant.
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Intended duration and discontinuation planning are defined at the outset.
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We use a structured consent framework to ensure consistency across clinicians.
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When clinically reasonable, we prioritize non-controlled and non-medication alternatives first.
4) Dose Guardrails and Supervisory Escalation
Why it matters:
Dose escalation can help — or harm. The difference lies in structure and oversight.
How we handle it:
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We maintain internal dose-range guidance for commonly prescribed medications.
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Plans outside typical ranges require documented rationale and supervisory review.
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Visits are structured for assessment and monitoring — not “refill-only” care.
5) Measurement-Based Monitoring on a Defined Schedule
Why it matters:
Without structured measurement, treatment decisions rely on memory and impression. Both are unreliable.
How we handle it:
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We use validated tools including the PHQ-9 (depression) and GAD-7 (anxiety) at baseline and defined follow-up intervals.
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We use our Mental Health Fingerprint® — a structured assessment grounded in functional domains often undertreated in standard care.
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We track functioning and quality of life over time, not just symptom counts.
6) Structured Re-Evaluation When Treatment Stalls
Why it matters:
Continuing ineffective treatment wastes months. When care isn’t working, the answer is re-evaluation — not inertia.
How we handle it:
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Before major pivots, we reassess diagnostic fit, including overlap and comorbidity.
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We review medical contributors such as thyroid dysfunction, sleep disorders, medication side effects, and hormonal changes when relevant.
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We assess adherence and tolerability.
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We evaluate new stressors or sleep disruption.
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We consider iatrogenic effects from prior changes.
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Treatment adjustments follow a documented pathway: optimization, change, augmentation, therapy shift, or referral — with rationale recorded.
7) Between-Visit Safety Monitoring and Escalation
Why it matters:
Risk often increases between appointments. Safety systems must extend beyond the session.
How we handle it:
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We monitor for red-flag indicators including suicidality, self-harm risk, acute destabilization, and medication-related emergencies.
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Clinically significant worsening is reviewed by the treating clinician, with supervisory involvement when indicated.
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We maintain a pathway to higher levels of care when telehealth is no longer sufficient.
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We provide 988 Suicide & Crisis Lifeline information to all patients.
Safety Protocol
Protocols matter only if they are enforced. Publishing them publicly is one form of accountability. Internally, we reinforce these standards through structured documentation, supervision, and routine case review.
Seven Questions
Important Questions Worth Asking Any Provider - Including Us
1. Who performs the initial medication evaluation, what does it include, and how long does it take?
2. How do you determine who is appropriate for telehealth care?
3. How do you measure progress, and how often?
4. What happens at a defined timepoint if treatment isn’t working?
5. How are controlled substances managed, including consent and discontinuation planning?
6. What happens if symptoms worsen between visits?
7. How are clinicians supervised, and how are standards enforced?