Tuesday, March 14, 2017


On February 8, 2017, I was invited to participate in a program for parents and their teen and pre-teen children at East Woods School in Oyster Bay. The focus was on raising awareness about the struggles and danger our youth face today in connection with improper and inappropriate use of social media, cyber-bullying and gaming addictions. The program included a viewing of the documentary film Screenagers: Growing Up in the Digital Age, and featured a live panel discussion afterwards. I was one of four panelists.
Before seeing the film, I read some anonymous reviews written by adults and kids.  Many of them sounded like this one: “Spot on Fantastic!” A few others were more critical. For example, a 16-year-old wrote, “It focuses on the downsides of electronics and never positives.” A 12-year-old wrote, “The message of Screenagers is that kids just exist for their parents to boss around and children's opinions don't matter.”
The film was well done and did spend a good deal of time presenting the risks in the digital world. The strength of the film was the interaction it stimulated, a positive step toward reducing isolation and building community.
The audience of kids and adults was asked, “Are you more fearful after having seen the film?” Easily more than half the parents raised their hands. A 13-year-old boy, when asked what he thought, said that he hadn’t realized how the overuse of digital technology impacts the brain and learning.
I shared the insight that, “Most parents are immigrants to the digital world, while our kids are digital natives.” A mom responded by saying that she never thought about it that way, like actual immigration and the misunderstandings it can create between the generations.  Another parent spoke to the analogy by citing the challenge of trying to negotiate traditional and modern values with her kids, and how to preserve their cultural heritage without preventing them from adapting and growing.  
            “The digital world is an evolving landscape that parents have to learn to navigate,” said Kathleen Clark-Pearson, M.D., in a report she co-authored for the American Academy of Pediatrics. 
The digital world is a great place for kids to connect socially, share photos with family, learn and have fun. As “immigrants” to this high-tech arena, parents would do well to immerse themselves in the digital world of their children and learn as much as possible in order to build common ground for communicating effectively with their kids.
            If a child’s job is to explore and a parent’s job is to protect, becoming more knowledgeable and proficient in digital technology is essential for parents to help their children navigate the many risks and dangers of the digital world including online grooming, cyber-bullying, sexting, gaming addiction and sleep deprivation. Of course, adults are also susceptible to risks and, we have to be careful not to fall victim to “distracted parent syndrome,” when we use our own hand-held devices, for example.
            I shared the story of observing a mother and her pre-teen son sitting across from one another at a local diner. She did not get off of her mobile phone the entire time. The boy did not have such a device. He just fidgeted most of the meal. It was so sad. What was he learning from her example?
            Social media and digital technology are here to stay. The benefits far outweigh the dangers, but with the average kid spending 6.5 hours a day looking at screens, it’s imperative that parents learn the ins and outs, growing with their kids as we all get accustomed to this new world.  

Andrew Malekoff is the Executive Director of North Shore Child & Family Guidance Center, which provides comprehensive mental health services for children from birth through 24 and their families. To find out more, visit www.northshorechildguidance.org.



Living or working with teenagers can be unsettling and disorienting even when you think you have it all figured out. Teenagers will spare no time reminding you that, as an adult, you are not a part of their world.

I am reminded of a quip attributed to Mark Twain:  “When I was a boy of 14, my father was so ignorant I could hardly stand to have the old man around. But when I got to be 21, I was astonished at how much the old man had learned in seven years.”

Having worked with countless teenagers for more than forty years, and having raised two of them, I discovered early on that whatever world I occupied outside of their presence with my professional reputation and credentials, these meant little to the kids I worked with or for that matter, to my own kids.

Decades ago I found something that one of my sons, then about 10-years-old, wrote about me in school. The heading on the page was, “My Dad.” Naturally I read on with great anticipation and a swelling sense of self-importance. Underneath the title he wrote, “My dad is 6’1”, bald, wears glasses, and busts my chops. He likes dogs. My dad has brown eyes and brown hair, at least what’s left of it. He’s a social worker.”

The kids I’ve worked and lived with invariably drew their conclusions about me as they got to know me. In turn, I drew my conclusions about them as I got to know them, despite what might be called their credentials, that is - the often-negative labels assigned to them. It is important to recognize the difference between the way in which young people are viewed and classified by others, and their own experiences and perceptions.

Assuming a stance of uncertainty is one way of saying how important it is for us to be open and reflective, to listen intently to the kids we see only then can we think more deeply and see outside the box.

One of my colleagues, Camille Roman, tells a story about growing up in an economically deprived and chaotic family and how desperately she struggled as a teenager to be heard, and how no one was ever listening. During one particularly troubling and heated exchange at a holiday gathering Camille, whose family is from Puerto Rico, recalled, “My face apparently betrayed my fear and confusion to an elderly aunt who was secretly thought to be a witch. Tia Mercedes turned to me with her soft face and wise eyes and whispered, ‘when your tongue is silent only then can you hear.’”

Camille said, “My Tia was telling me that something else was going on here and if I didn’t get caught up in the noise then maybe I could understand and make sense of the chaos and it would be less frightening and I would not feel so powerless.” And so this powerful bit of homespun advice became a life lesson for her in her work as a social worker and, I think, a powerful insight for all of us.


Andrew Malekoff is the Executive Director of North Shore Child & Family Guidance Center, which provides comprehensive mental health services for children from birth through 24 and their families. To find out more, visit www.northshorechildguidance.org.


If you are a sentient being you’re well aware of the alarming degree of divisiveness that has been generated as a result of the presidential campaign. Given the growing incidence of hateful speech and action, there is a desperate need for open dialogue with young people.

I can vividly recall meeting with a therapy group for troubled teens some 25 years ago. They raised the subject of race and racism after having been exposed repeatedly to the videotaped TV footage of the Rodney King beating, which foreshadowed the current era of cell phone videos and body cams.

Rodney King was an African-American man who became widely known after being beaten by Los Angeles police officers after a high-speed car chase on March 3, 1991. A local resident witnessed the beating and videotaped it from his nearby apartment. The officers were tried in court but were found not guilty.

The two minority members of the group spoke about their own fear and “paranoia.” I listened and then told them “just because you’re paranoid doesn’t mean they aren’t out to get you.”
In 1968, psychiatrists William Greir and Price Cobbs noted in their book Black Rage that, for some people, a suspiciousness of one’s environment is necessary for survival.

Indeed, the phenomenon of adaptive paranoia—which recognizes real threats, not imaginary ones—is not at all uncommon to minority groups who have experienced profound prejudice historically and who now, after the brutal 2016 campaign, are more concerned than ever.

Here’s what we know for sure: Reports of hateful intimidation and harassment are on the rise since the election.  According to the Southern Poverty Law Center, there were more than 850 accounts of racism, Islamophobia and xenophobia between November 9 and the morning of November 14. 

Recently, I posed these questions on social media: What is the emotional impact of the trickle-down divisive campaign rhetoric on the nation's children? What signs are you seeing? What can you do? Here are two responses:

“Hispanic students are afraid to go to school because classmates bully them and tell them they are being deported.”

“Immigrant children are terrified! They are afraid their parents are going to be sent away. I think it is important to allow a space for dialogue.”

Now, more than ever, rather than squash discussion on these sensitive matters, we owe it to the young people in our lives to foster open dialogue. Noted family therapist Harry Aponte’s reflection on diversity might serve us well as a guideline. He said,

“Diversity is not about us-versus-them. And neither is it about easy agreement among different cultural, ethnic and racial groups… It is a bold, rich and complex tapestry. It has to do with being different in values, traditions and speech, and the same in human need, suffering and love. It has to do with living in separate neighborhoods, and together in the larger common community of nation. Diversity of culture, ethnicity and race gets its significance and specialness in the context of our universal identification as human beings.”

Although a better understanding and respect for cultural differences is important, we owe it to our children to reach for commonalties experienced across cultures. That is the way we will open new pathways for connection.


Bio: Andrew Malekoff is the Executive Director of North Shore Child & Family Guidance Center, which provides comprehensive mental health services for children from birth through 24 and their families. To find out more, visit www.northshorechildguidance.org or find them on Facebook.


I recently read rock star Bruce Springsteen’s 2016 autobiography Born to Run. I have to admit: I started the book a virtual stranger. Of course I was familiar with Springsteen’s music, but mostly as background. I wasn’t a faithful fan. My only obscure connection is that I attended junior high and high school in South Orange and Maplewood, NJ with his drummer Max Weinberg.

Max and I weren't close friends but, I would say, friendly acquaintances. I remember him telling me one day in the early 1960s that he was going to be playing drums on a UHF television show hosted by John Zacherle. On the night of the broadcast, I set up the UHF antenna on my parent's black-and-white TV and was proud to see someone I personally knew performing on the tube. It was almost as exciting as the build up to the Beatles on Ed Sullivan.

Although I had no intention of reading Springsteen’s book, I decided to pick it up on the recommendation of a friend who knew I worked in the field of children’s mental health. At the same time I read the book, I turned my dial to E Street radio to add a sound track to my reading experience. By listening to the music I thought I could better get to know the author, who wrote extensively about his personal life in his songs.

Born to Run blends many elements of Springsteen’s life, from early family experiences to first steps as a musician to forming a band to becoming a rock star, husband and parent—and much more. But the core of the book is the enduring and troubling impact of his relationship with his father Doug. Near the end of Born to Run, Springsteen reveals a dream in which he is performing on stage. His then deceased father is sitting in the audience. Bruce approaches him in the dream and says: "Look dad...that guy on stage...that's you, that's how I see you." You’ll have to read the book to have a more complete understanding what the dream represents.

As I worked my way through the book and his music, I was struck with the overwhelming feeling that it was written in its entirety in the voice of vulnerable young boy, as opposed to world-renowned rock icon. The boy has been fighting the isolation and loneliness of living with mental illness in the family his whole life and, at the same time, he has been seeking enduring and healthy relationships. And, he found them.

As much as it is a book about rising to music stardom, Born to Run is a story about debilitating depression, mental illness and adverse childhood experiences. But it’s also a story of hope. Springsteen shows that despite his most troubling childhood experiences, resilience and healing are possible. Readers owe him a debt of gratitude, not only for the decades of socially conscious and uplifting music, but for stepping beyond stigma to, in his own words, “show the reader his mind.”

I started the book a stranger; now I'm a fan.


Andrew Malekoff is the Executive Director of North Shore Child & Family Guidance Center, which provides comprehensive mental health services for children from birth through 24 and their families. To find out more, visit www.northshorechildguidance.org.

Thursday, December 29, 2016


Published in The Hill, February 16, 2016
By Andrew Malekoff

The poisoning of an American city: Where is the outrage about the incomprehensible crime against the children and families of Flint?

I have worked for the welfare of children for 45 years, starting as a big brother in New Brunswick, New Jersey when I was an undergraduate at Rutgers College and, after graduating, as a VISTA volunteer in Grand Island, Nebraska.  Then I went on to get my masters in social work at Adelphi, and I’ve worked in the children’s mental health field on Long Island ever since.

I’ve marched, testified before government bodies for social causes including war, police brutality, school shootings, mental health, addictions and funding for human services. I participated in relief efforts after a number of large-scale disasters such as 9/11 and Hurricane Sandy.

In each case, no matter how urgent the need, how disorienting the circumstances or how depressing the situation I’ve always tried to make some sense out of what happened, even in the most incomprehensible of situations such as the Newtown shootings at Sandy Hook Elementary School.

Early on in my work life, someone suggested that if you are passionate about something and wish to be an advocate you must ask yourself these two questions: Why am I awake? And how do I relate to those who are asleep? In an attempt to wake people up, I’ve written a number of opinion pieces for publications like Newsday to better synthesize my own thoughts and feelings and convey messages that might educate and awaken others. In most cases I found colleagues and neighbors who shared my outrage and stood with and by me on issues that concerned me.

But, as I reach my 65th year in a few months, I must say that although I never ranked the private and public horrors that have unfolded in my lifetime, I believe the poisoning of Flint, Michigan to be the most incomprehensible of all. And although there is outrage and protest, I find it subdued in contrast to other tragedies I have witnessed.

The poisoning of an American city and all of its children, mostly racial minorities, is an act born of government bureaucrats’ wish to cut costs and what filmmaker Michael Moore said would have been considered ethnic cleansing by our government leaders if it happened in any other country but our own.

There is news coverage and there is finally some action being taken, but it feels muted to me as compared to Sandy Hook, for example. The residents of an entire American city were poisoned for 19 months. There were warning signs, yet government officials told the citizenry that the water was fine. It wasn’t until researchers pointed to elevated levels of lead in children under five after the switch to a cheaper water supply that any changes were made. After 19 months of poisoning.
We are all too familiar in New York with government corruption. We’ve been treated to a parade of legislators and public officials charged with and convicted of bribery, fraud, conspiracy, racketeering, money laundering, tax evasion and such. But poisoning children? 

If it were my children who were poisoned I can only imagine what I might do. Yet none of the Flint parents are acting on the murderous rage that I think I would feel and expect they may also feel. I guess it is because acting on such impulses would do nothing to help their children. 

Yet, how do you go on knowing that your unborn child, infant, toddler or school-age child with a still-developing brain will be damaged for life with cognitive impairments? How do you go on knowing that their intellectual potential will be significantly limited because government bureaucrats were looking for a shortcut to balance the budget? What can you say to a parent that might offer them some solace?

I can't think of a thing. Can you?

Malekoff is executive director of the nonprofit children’s mental health agency North Shore Child & Family Guidance Center in Roslyn Heights, NY.


Tucked into the heartbreaking story by Newsday about a young women’s lack of access to lifesaving healthcare to treat her addiction (“A daughter lost to heroin,” Editorial, May 15, 2016) is the fact that Bridgette Kurtzke was diagnosed with bipolar disorder as a teenager.

A 2014 study by the U.S. Substance Abuse and Mental Health Services Administration, 7.9 million people had both a mental health disorder and substance use disorder.

Newsday’s editorial stated that Gov. Andrew M. Cuomo has created a task force on opioid addiction that will propose new legislation. The fact is, we already have federal legislation; namely, the Mental Health Parity and Addiction Equity Act and the Obama Patient Protection and Affordable Care Act. Both state that it is illegal to treat diseases of the brain differently than those of any other part of the body.

Before proposing bills, the governor and his task force should know that these laws aren't being adequately enforced in New York, especially as it relates to having an adequate network of services. Insurers must provide enrollees with timely access to a sufficient number of providers included in the benefit contract.

Andrew Malekoff is executive director for the nonprofit children’s mental health agency North Shore Child and Family Guidance Center in Roslyn Heights, NY


What happens when something that affects children’s lives is widespread but hidden in plain sight? What if it is something that creates untold heartache in lives that are already unnecessarily damaged? It should be addressed and corrected. Yet, because it is hidden from our collective consciousness it remains unaddressed, it persists, and this has consequences.

I am referring to the plight of countless middle-class families with children who have mental health and substance abuse problems and who have health insurance but cannot gain access to timely care.

Under a government mandate called network adequacy, commercial health insurers, used by many working, middle-class families, are required by license to offer adequate networks of providers (child psychiatrists, psychotherapists) for families confronting mental health and substance abuse problems. In other words, they are expected, as per their insurance plan, to provide ready access to a provider near where policyholders live. The reality, though, is that too often they do not.

Why? Because commercial health insurers that pay substandard reimbursement rates have too few in-network providers. Their low rates of reimbursement serve as a disincentive for providers, including community-based mental health agencies that should be providing universal access to care, to enroll in their networks. Consequently, many community-based agencies, along with those in private practice, will accept only higher paying Medicaid insurance.

The gap between reimbursement rates for commercial health insurance and Medicaid is vast. In some cases, for example, the rate paid to providers by commercial insurers is half the rate paid by Medicaid. Although a health insurer is expected to help families find an in-network provider, most often they do not. They simply give them a list of names, and few if any of those providers accept the insurance because the rates of reimbursement don’t come close to covering the cost of services. This then frustrates already anxious parents who have had to work up the courage to ask for help.

It is very difficult for a parent to pick up the phone and seek help when their child is suffering from mental illness or addiction. When they are repeatedly turned away by their supposedly in-network providers, who tell them “I no longer accept that insurance,” it is devastating. When a child is denied access to timely care for mental illness or addiction the results can be life-threatening. 

A few weeks ago a mother seeking mental health care for her teenager came to us at North Shore Child & Family Guidance Center and told a familiar story.

"It's very hard. Decent psychiatrists don't take new patients and the rest don't take our insurance. Most of them don't take your insurance," she said. The intake worker asked her how many turned her down before she called us. She said 20.

What needs to be done? The New York State Department of Financial Services, a relatively new state agency formed by Gov. Andrew Cuomo, has regulatory jurisdiction over insurance companies. However, in my experience, their inaction on this issue indicates that they do little, if anything, to monitor network adequacy.

Substandard rates of reimbursement (e.g. the gap between Medicaid and commercial insurance rates) may be considered a violation of the Affordable Care Act’s parity protections, which require health insurance companies to treat annual or lifetime dollar limits for mental health and substance abuse the same as they do medical benefits. If that is the case, the attorney general also has the power to address this matter if DFS will not. But what remedy is there if they do not take action?

The New York State Comptroller’s Office has the primary responsibility to ensure that state agencies such as DFS are using taxpayer money efficiently and effectively. If DFS does not investigate the issue of network adequacy, then they are open to the scrutiny of a state audit as it relates to their effectiveness in the use of taxpayer dollars to properly monitor insurance companies under their jurisdiction.

Although mental health legislation, The Helping Families in Mental Health Crisis Act, has been introduced in Congress, it will do little good if families cannot find a provider. The act will only work when the issue of access to care is monitored and enforced. It’s time for DFS to do its job and launch an investigation of any commercial insurance company suspected of not having an adequate network of providers. It could truly save lives.

Andrew Malekoff is the executive director of the North Shore Child & Family Guidance Center in Roslyn Heights, a nonprofit that provides comprehensive mental health services for children from birth through age 24 and their families. To find out more, visit www.northshorechildguidance.org. - See more at: http://nynmedia.com/news/how-insurers-are-failing-children-with-mental-health-needs#sthash.omFazlzp.dpuf

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