POISONED CHILDREN IN AMERICA

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.

TREATMENT LAWS AREN'T BEING ENFORCED

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

HOW INSURERS ARE FAILING CHILDREN WITH MENTAL HEALTH NEEDS

http://nynmedia.com/news/how-insurers-are-failing-children-with-mental-health-needs

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

(c) 2016 City and State NY, LLC. All rights reserved.

FAMILIES CAN'T AFFORD TO WAIT FOR MENTAL HEALTH SERVICES

L.I. Business News, March 4, 2016 

Access delayed is access denied.

These are words that ring true for thousands of families across Long Island who have been unsuccessful in accessing timely and affordable mental health and addictions care through their health insurer.

How do I know this? From the stories that people tell us at North Shore Child & Family Guidance Center, a 63-year-old children’s mental health agency in Nassau County.

Health insurers are mandated by government to offer panels of providers so that families can find easily accessible, quality care for their loved ones; and not only for physical illnesses. This requirement is known as network adequacy, referring to adequate networks of care.

The problem of access for mental health care, however, is more complex and may begin with a family’s hesitance to ask for help and to reveal that they are living with someone who is suffering from a mental illness. Families coping with mental illness or addiction do not as readily seek help as they might for heart disease, cancer or diabetes. Why? Because of stigma and the shame it generates. When there is a mass shooting for example, and the perpetrator is labeled mentally ill, it casts a shadow on all people with mental illness, despite the fact that mentally ill persons are disproportionately the victims of violence.

In the United States we have chronically failed to treat illnesses above the neck the same as illnesses below the neck. For example, a parent who would not hesitate to reach out for help if their child was in an accident and appeared to have broken an arm, might wait weeks and months, if not longer, to ask for help if it was a mental health or substance abuse problem.

What makes all this so insidious is that once a parent picks up the phone to ask for help, and they are told repeatedly by providers, “I’m sorry I don’t accept that insurance any longer, I only accept cash,” there is a chance they will give up.

When a parent gives up, they risk their child deteriorating further. This is also true for adults with mental illness and increases the odds that they will ultimately need more costly care or confinement; hospitalization or incarceration.

What to do? Gov. Cuomo created the Department of Financial Services, charged with the responsibility to monitor private health insurers to ensure that they have adequate networks of care as a condition of their license. This means they must demonstrate the consistent ability to provide timely access to care for individuals and their families.

Just this week parents who came to the Guidance Center after taking their child to the emergency room, told us that they called no less than 20 different therapists or agencies and were turned down by all of them. Finally they called another hospital that made the referral to us. We turn no one away for inability to pay.

This is an all too familiar story that we hear frequently and that my colleagues from sister agencies tell me as well. You might wonder why this happening.

Private health insurers pay substandard rates of reimbursement for mental health and addictions care, as compared to Medicaid; sometimes 50 percent or less the than the Medicaid rate. Consequently, participating providers bail out because they cannot afford to accept such low rates. The insurers fail to carefully monitor their lists and the state fails to monitor and regulate the insurers.

In the case of delayed care for a child, this represents corporate and state child abuse.

I have reached out repeatedly to the governor, attorney general and numerous state legislators to issue a call to action to demand that DFS do their job. There is sympathy, but no action.

Andrew Malekoff is executive director of North Shore Child & Family Guidance Center in Roslyn Heights.

If you subscribe to Long Island Business News: http://libn.com/2016/03/04/malekoff-li-families-cant-afford-to-wait-for-mental-health-services/

IT'S TIME TO OPEN DIALOGUE WITH YOUNG PEOPLE

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.

WHO'S THROWING THE BABIES INTO THE RIVER

Despite feeling blindsided, most of us now know that we are living in the midst of an unprecedented drug epidemic. According to the U.S. Department of Health and Human Services (HHS), since 1999, the rate of overdose deaths including prescription pain relievers, heroin and synthetic opioids such as fentanyl, nearly quadrupled.

Some of the steps taken to save lives include improving prescribing practices and expanding access to medication-assisted treatment and the use of Naloxone.  

Medication-assisted treatment combines talk therapy and medications such as methadone or buprenorphine to treat opioid addiction. Through affordable, accessible and quality care people can recover and go on to live productive lives.

Naloxone is used to treat a narcotic overdose in an emergency situation by reversing the effects of opioids, including slowed breathing or loss of consciousness.

Notwithstanding the increased attention to lifesaving measures, there is less focus on the devastating impact of addiction on children living in families where a parent is addicted to drugs or alcohol.

Perhaps nothing drove home the reality of America’s opioid problem more than the recent photo taken in Ohio of two overdosed adults spread out in the front of a car, while one of their young grandsons looked on from the back seat.

There are more than 8 million children younger than 18 years of age that are growing up in homes with alcohol and other drug-abusing parents. These young people are likely to become alcohol or drug abusers themselves without intervention.

Parental alcoholism and drug addiction influence the use of alcohol and other drugs in several ways including increased stress and decreased parental monitoring.

Children who grow up with an addicted parent learn to distrust to survive. When unpredictability dominates a child’s life, he or she is likely to be wary, always sensing disappointment lurking nearby.

Children growing up with an addicted parent become uncomfortably accustomed to living with chaos, uncertainty and instability. When a child grows up under these conditions, they learn to guess at what normal is, with no roadmap to assist them.

Denial, secrecy, embarrassment and shame are common experiences of children who live with an addicted parent. Even seeking help outside of the family might in itself be seen as an act of betrayal, a step toward revealing the family secret.

Children who grow up with an addicted parent live with an unspoken, emotionally numbing mandate - don’t talk, don’t trust, don’t feel.

Growing up with an addicted family member leaves one with little hope that things will ever change; unless, we take steps to change it. I am reminded of a parable about the small village on the edge of a river.

One day a villager saw a baby floating down the river. He jumped in the river and saved the baby. The next day he saw two babies floating down the river. He and another villager dived in and saved them. Each day that followed, more babies were found floating down the river. The villagers organized themselves, training teams of swimmers to rescue the babies. They were soon working around the clock.

Although they could not save all the babies, the rescue squad members felt good and were lauded for saving as many babies as they could. However, one day, one of the villagers asked: "Where are all these babies coming from? Why don't we organize a team to head upstream to find out who's throwing the babies into the river in the first place!"

Mobilizing resources to pull babies from the river, while neglecting the one’s left behind makes no sense.

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. 

DOES THE PATH HAVE A HEART

As Election Day 2016 approaches I am wondering how first-time voters, especially young people, are faring. Even when my powers of concentration are sharpest after a full night’s sleep, I cannot fully trust that I can accurately differentiate substance from style, image from authenticity. As I watch and listen, I am reminded that we tend to place great emphasis on intellect, especially language skills and ability to reason and less emphasis on more personal intelligences. 

Howard Gardner, author of Multiple Intelligences, identified key areas that we should look for in leaders that go beyond intellect. They include abilities to understand oneself and others, and to address profound human concerns, especially during times of crisis. These are abilities that we cannot possibly know about through scripted sound bytes and clever marketing.

We know that Donald Trump is a wealthy businessman, gifted salesman, media personality and, by all accounts, a celebrity. We know that Hillary Clinton is a lifelong public servant, former first lady, politician and advocate for many vulnerable groups; and, also a celebrated figure. Both are spouses, parents and grandparents.

We know that both lead candidates are far from perfect. Their character flaws, vulnerabilities and missteps have been revealed repeatedly in what is perhaps the bloodiest presidential campaign in memory. Let’s assume, just for the sake of argument, that the character issue is a wash. Does that make it any easier for young people placing their ballot for the first time? I think not.

We cannot forget about the fear factor - terrorism, homeland security, crime, illegal immigration, gangs, the drug trade - that the candidates and their surrogates aim at fence sitters – the independents that can be swayed one way or the other and whose collective votes can make all the difference. And, of course, there is the economy.

For the last 15 years, the income of the typical American family has been at a standstill, health outcomes for many children are poor, and globalization and technological change have made it most difficult for poorly educated Americans to achieve the peace of mind and self respect that a secure livelihood enables.

So when one checks off character, wades through media deceit and considers the fear factor and economic concerns, first-time voters are left only with faith about what they glean each candidate to really stand for in the areas that are most important to them.

Reverend Theodore Hesburgh, former president of Notre Dame University said, “Voting is a civic sacrament.”

As I consider my final decision about who to vote for, I am reminded of a line by Carlos Castaneda in his book, A Separate Reality: “Anything is one of a million paths. Look at every path closely and deliberately. Try it as many times as you think necessary. Then ask yourself, and yourself alone, one question: Does this path have a heart?”

I offer good wishes to first-time voters who have sacrificed their time and energy to make some sense out of who to support on November 8th. It is the soul searching and the struggling through that make you the true winners on Election Day. 

https://longislandweekly.com/does-the-path-have-a-heart/

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.

PARADE OF BROKEN HEARTS

There were many reflections about the 2001 terrorist attack on America leading up to the 15^th anniversary just a few weeks ago. Following is my reflection on the memorial service at the World Trade Center on October 28, 2001. I attended the service with a group of mental health workers who offered their support for the bereaved.

As I recall, at the end of the service there was a chill in the air as the sun disappeared behind the ruins of the World Trade Center. Renee Fleming, accompanied by the Orchestra of St. Luke’s, sang God Bless America.

Moments earlier I said goodbye to the family I stood beside during the memorial service. They sat in the back row of our section, one of scores of sections filled with thousands of folding chairs, each chair occupied by a grieving family member. I stood with my back against an iron gate so I would not block anyone’s view. The family had lost its father and husband, a decorated firefighter. The widow was a slight woman of Italian descent, probably in her late sixties.

Photos of her husband were pinned to her wool coat, and to the coats of her three children. He was handsome. He had a white moustache and a full head of silvery hair, combed straight back. When the memorial service started an hour earlier one of her sons, an off-duty police officer, asked if I would make sure that no one obstructed his mother’s view. He said, “You can see how short she is.”

The service began with a processional that included His Eminence Edward Cardinal Egan, Archbishop of New York. Then, police officer Daniel Rodriguez of the NYPD sang The Star Spangled Banner. He had become a national presence by appearing in his dress blues and singing the national anthem at Yankee Stadium before the 97^th World Series that pitted the Yankees against the Arizona Diamondbacks.

Everyone was on his or her feet. A massive wall of mourners rose around the tiny figure to my right. When I saw her struggling to climb, I took her arm and helped her up onto a folding chair. I told her that she could grab on to me. “Hold on to my shoulders,” I said. She hesitated. I told her, “Don’t worry you won’t knock me over.”

I could feel her trembling as she removed her right hand from my shoulder and fumbled for a tissue inside her coat pocket. I reached into my pocket and handed her a handkerchief.

When I was picking out my clothes earlier in the morning I had come across several unopened packets of white handkerchiefs. They belonged to my father who died seven years earlier. As I got dressed, I thought that today my father would want somebody who needed it to have one of his handkerchiefs. At first she refused my offer, not wanting to impose. I urged her, “Please, take it. It’s okay.”

Fifteen years later, my father’s handkerchiefs remain tucked into my dresser drawer - a daily reminder of when I joined a parade of broken hearts. Sometimes I close my eyes, think back and try to recall what things felt like before that sunny fall morning at ground zero.

https://longislandweekly.com/parade-broken-hearts/

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. 

A COMMON STRUGGLE

Patrick J. Kennedy is a former member of the U.S. House of Representatives who has struggled with mental illness and addiction for most of his life. He has become a leading force in the passage of the Mental Health Parity and Addiction Equity Act of 2008, a U.S. law that states that it is illegal to treat diseases of the brain differently than those of any other part of the body. The battle ahead is for the law to be enforced in the face of health insurers who stand to profit by denying the full range of coverage for people suffering with mental illness and addictions.

In his 2015 book, A Common Struggle: A Personal Journey Through the Past and Future of Mental Illness and Addiction, Kennedy offers personal reflections on the impact of trauma, addiction and mental illness on the extended Kennedy clan. He talks about the rocky relationship he had with his dad, the late U.S. Senator Edward “Ted” Kennedy and about his mom Joan’s battle with alcoholism.  

At the heart of the memoir are Kennedy’s own revelations about his co-occurring mental illness and prescription drug and alcohol addiction, his path to recovery, and his ascendance to becoming, arguably, the nation’s leading advocate for parity and equity in mental health and addiction care. Kennedy has fought hard to lift the veil of ignorance about mental illness and addiction and to expose the health insurance industry’s tradition of denying and restricting access to care for individuals with brain illness.

Kennedy radiates a fire for eradicating stigma and ending discrimination against people with brain illness. According to One Mind, a nonprofit organization he co-founded, that is dedicated to benefiting all affected by brain illness and injury, “One of the harmful effects of stigma is that it can lead to discrimination. It could be as obvious as someone making a negative remark about your mental illness or as subtle as someone avoiding you because they think you could be unstable, violent or dangerous.”

On their website, One Mind lists some of the ways that these attitudes can be damaging and even dangerous. For example:

·      Reluctance to seek help or treatment due to the labeling

·      Lack of understanding by family, friends, co-workers or others you know

·      Fewer opportunities for work, school or social activities or trouble finding housing

·      Bullying, physical violence or harassment

·      Health insurance that doesn't adequately cover your mental illness treatment

·      The belief that you'll never be able to succeed at certain challenges or that you can't improve your situation

Kennedy rightly frames the inequities that people with mental illness and addictions face as a matter of civil rights.

What he has accomplished, which he freely acknowledges is the result of a collective effort, has already gone a long way to wiping out stigma and increasing people’s access to mental health and addictions care. His goal, he states, is to launch “a new civil rights movement, to finally force medical equality for diseases of the brain.”

Tens of millions of Americans owe Patrick Kennedy a debt of gratitude for leading the way. Now all of us must carry the ball forward by treating children and adults with brain illnesses with dignity; and demanding that government enforce parity and equity for all and put an end to discrimination.

https://longislandweekly.com/a-common-struggle/ 

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.

WHEN ARE THE CARTOONS GONNA COME BACK ON?

Violence—random, sudden, illogical, and lethal—has become a fact of life. Shootings and acts of terror, homegrown and imported, with or without racial or religious overtones, have become gruesome signposts along a seemingly endless path of public and private horrors. They are taking a toll on our children.

No child should have to wake up each day as if he or she was on 24-hour-a-day guard duty. But in the United States this is the reality.

We can no longer think of these as isolated incidents, aberrations or confined to urban settings. Denial, an emotional trap door, is not a viable escape in a world where a sense of imminent threat is ever present.  

In the immediate aftermath of the September 11, 2001 attack, writer Jeph Loeb and artist J. Scott Campbell produced a nine-framed cartoon entitled “Please Stand By,” that featured a very young girl watching cartoons.

By the third and fourth frames, the image on the screen changed to a live feed of the Twin Towers ablaze. As the little girl stood transfixed, stuffed animal in hand, the commentator announced, “We interrupt this program to take you live…,” the little girl turned away and called, “Mommy…” The next three frames began with her mother dropping a basket of laundry. Then, with her face contorted in anguish, she embraced her daughter to shield her from the unrelenting images. The final frame is a close up of the little girl asking, “Mommy, when are the cartoons gonna come back on?”

Among those who are left in the wake of violent acts are the survivors - friends and family members of victims, who live with the emptiness, frustration, and rage of incomprehensible death by violence.

Earlier this month, as the mother of the oldest child of Alton Sterling, the black man fatally shot by Baton Rouge, Louisiana police, expressed sorrow and outrage at his death, Cameron Sterling, 15, the oldest of Sterling’s children wept inconsolably by her side, for the entire world to see and experience his heartbreak.

One day later a St. Paul, Minnesota Montessori school cafeteria supervisor Philando Castile met a similar fate. Just one day after his shooting, five police officers, protecting  hundreds of people in Dallas, Texas, who were peacefully protesting the two shootings, were gunned down and murdered, ambush-style, by a lone shooter who was fueled by racial hatred and bent on misguided revenge. Ten days after the Dallas shootings, three Baton Rouge police officers met a similar fate.

Beyond those left in the direct wake of violence are growing numbers of young people who are fed a regular diet of horrific episodes of violence through graphic media accounts such as the live streaming of a bloodied and gasping Philando Castile, filmed by his girlfriend Diamond Reynolds who wanted the world to join her in bearing witness as he took his last breaths.

In the aftermath of trauma, children (and others) feel fearful, unprotected, hyper-vigilant, and hopeless and on their own; similar to orphans who feel they must take care themselves.

We are living in world gone mad, a place where the rich diversity of colors, shades, languages, orientations, beliefs and rituals should be shared and celebrated rather than drawn as battle lines. The answers do not lie in books of psychology or popular bromides, or in aspiring national leaders who have proven to be untrustworthy.

The answer lies in being mindful - paying attention on purpose, making connections with one another and building a sense of communality.

https://longislandweekly.com/cartoons-gonna-come-back/

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.

THE ADOLESCENT BRAIN AND A GRANDMOTHER'S WISDOM

Once upon a time there was widespread belief that the human brain was fully developed by the time a child reached five or six years old. We know, for example, that the amygdala, the part of the brain that is responsible for instinctual reactions such as fear and aggressive behavior, does fully develop early. However, thanks to new technologies such as magnetic resonance imaging (MRI), neuroscience researchers have discovered that, although 95 percent of the brain’s architecture is formed by the time a child is six-years-old, that there are significant changes that occur around the time of the onset of puberty, between 10 and 13 years of age.

Scientists have discovered that during adolescence there is a rapid increase in the connections between the brain cells and refinement of brain pathways and that these changes are critical for the development of coordinated thought and action. As my colleague Craig Haen put it, “In the teen years, young people are going through a software upgrade, neurologically, in which circuitry is being consolidated, networks are being reorganized, connections are being made stronger and more expedient and unused pathways are wearing away.”

Changes in the brain take place in the context of many other factors including early childhood experiences and environment. Scientists are continuing to look into the development of the brain and the relationship between the changes taking place, behavior, and health.

The stakes are great during the teenage years. There is a perplexing contradiction between adolescents reaching the peak of physical health, strength and mental capability and, at the same time, facing greater risks and hazards than ever before. Parents walk a fine line between supporting their children’s independence and protecting them from harm.

Child and adolescent brain studies affirm that the brain is hard-wired for social interaction and for attaching and bonding with caregivers. Despite all the scientific advances, according to leading brain researcher Jay Giedd, people might be disappointed to know that the “best advice we can give is things that our grandmother could have told us generations ago: to spend loving, quality time with our children.”

Teenagers hunger for significant relationships with adults who care about them. This belief has been validated by social scientist Ellen Galinsky, who interviewed more than a thousand children and found that teens longed for more time with their parents, even when they seemed to be pushing them away. Galinsky concluded , "Even though the public perception is about building bigger and better brains, what the research shows is that it's the relationships, it's the connections, it's the people in children's lives who make the biggest difference.”

If a child’s job is to explore and a parent’s job is to protect, understanding changes in adolescent brain development offers an opportunity to support and create environments that promote positive peer experiences, where teens can safely explore and experiment and avoid behavior that can harm themselves or others.

https://longislandweekly.com/adolescent-brain-grandmothers-wisdom/

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. 

HELPING HAITIAN GIRL FEEL AT HOME

At North Shore Child & Family Guidance Center, the vast majority of our clients are from Nassau County communities, but we recently had the opportunity to work with a young girl who came to Long Island from Haiti.

Thirteen-year old Anabelle traveled to the United States to receive life-saving surgery for an advanced stage of scoliosis at Shriners Hospital for Children in Philadelphia. Her condition was so serious that she would not have survived in Haiti. She was placed with a generous and loving host family that lived in Nassau County—far from home for a frightened and ailing teenager.

After about two weeks in the U.S., Anabelle became very withdrawn and refused to communicate with the family in any way. They weren’t sure how to help Anabelle, who didn’t speak English.  The family was desperate to figure out a way to ease her fears and draw her out.

During this period the host family’s son, a recent college graduate, was working as a volunteer tutor at North Shore Child & Family Guidance Center’s Westbury office, known as the Leeds Place. He shared with his mom the broad scope of the work that we do with a very diverse population. She decided to call the Director of the Leeds Place, Dr. Nellie Taylor-Walthrust, to brainstorm about what could be done to help Anabelle.

The discussion led to a plan that included one of our Haitian Creole-speaking outreach workers, Marmeline Martin, who has extensive experience working with special needs children and in training foster parents.  Nellie asked the host mom if Marmeline  could make a home visit to meet her and Anabelle. She was so happy and said, “Absolutely!” Then she asked, with a look of surprise on her face, “You make home visits?” 

She was assured that we do, and added that seeing Anabelle in the home environment would be better, at least to start, than bringing her to an unfamiliar setting.

Marmeline readily agreed and made her way to the home where she met Anabelle who was sitting in her wheelchair, head bowed, with a somber look on her face.  Marmeline asked if she could speak with  Anabelle alone, and the family agreed it was fine. 

At first, Anabelle would not speak to Marmeline. But in a short period of time, she opened up and revealed feeling homesick and alone, sharing that she wished to see her mother and the rest of her family back in Haiti.  As Marmeline continued to speak to Anabelle in Creole, Anabelle began to brighten up, feeling reassured because she could be understood and feel comfortable enough to express her feelings.  Marmeline asked if it would make her feel better if she came back to visit with her and she nodded in agreement. 

Marmeline then met with the host mom to reassure her that Anabelle wasn’t in need of psychotherapy but was feeling low due to the separation from her family.  She promised that she would continue her visits and that Anabelle was going to be fine.

On the next visit Marmeline brought some Haitian music to listen to that reminded Anabelle of being home.  As the weekly visits continued, Anabelle began to smile and became more engaged with the family. 

We reassured the host mom that she was caring for Anabelle in a loving manner and that what she needed to understand was that Anabelle’s adjustment to a new culture, environment and language was naturally frightening to the teen. 

Cultural competency and the flexibility of home visits are key components of providing community-based mental health care, whether preventive care as in the case of Anabelle, or more intensive treatment for children with serious emotional disturbances.

As Nellie said, reflecting back, “It’s the small things that often make a world of difference.”

https://longislandweekly.com/helping-girl-feel-home/

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. 

"ONE PERSON CAN IGNITE A FIRE THAT CAN LIGHT THE ENTIRE FOREST"

On March 30, 2016 I had the pleasure of meeting a true hero - Dr. Bennet Omalu. He was the keynoter at the Head Injury Association's Awareness Sports Forum at the Hyatt Regency Long Island.

In 2002 Dr. Omalu discovered the presence of degenerative disease in the brain of National Football League (NFL) player Mike Webster. He named the brain disease chronic traumatic encephalopathy, known as CTE. His discovery has proven to be a powerful pebble that has generated waves throughout the troubled waters of youth, college and professional football, as well as other contact sports.

Dr. Omalu was portrayed by Will Smith in the 2015 film Concussion, based on his book of the same name. Prior to that, he was prominently featured in the public affairs television program Frontline and in the book, League of Denial: The NFL, Concussions and the Battle for Truth.

Although the focus of the head injury forum was to raise awareness to protect school-aged athletes from concussions, Dr. Omalu transcended his role as a forensic scientist, inspiring an audience of several hundred people with his deep faith and fortitude.

He began his remarks by recalling that he was born in war-torn Nigeria and describing how he suffered as a child from malnutrition. He revealed that, "Because of the consequences of war, I became a weakling and introvert who was ridiculed."

The turning point in his life came, he remembered, when he realized that "with knowledge you can do all things." This realization ignited what became a lifetime thirst for learning and quest for truth. In fact, he has earned eight degrees and certifications.

Omalu explained that both science and faith seek truth. The role of faith, he said, "is the manifestation of things we do not see," which was the case with Mike Webster and the rest of the world. Dr. Omalu said that it was his deep faith in humanity that led him to wonder about the cause of Webster's destitution, deterioration and death, and, to "speak" to Webster's spirit during the autopsy.

"Whatever happens to the least of us happens to all of us," he told the rapt audience in Hauppauge; and, "what we do for the least of us, we do for all of us." And, so began his spiritual relationship with the deceased Mike Webster.

Omalu has faced enormous obstacles as a scientist. He shared that he was smeared by National Institute of Health which said he was not a reputable doctor. And he was also defamed by the NFL that did all they could to stonewall his discovery and disassociate the notion that repeated blows to the head were the cause of a degenerative brain disease that led to the premature deaths, including suicides, of scores of former players and counting.

Dr. Omalu spoke to the challenge of working in a context of "conformational intelligence" which he explained as when one's "mind conforms to the expectations of society" and not necessarily truth. "How does conformational intelligence hold down a society?" he asked.

Omalu—who portrayed himself as an "outlier," someone who operates outside of the box—concluded his remarks by stating, "One person can ignite a fire that can light the entire forest."

We owe Dr. Omalu a debt of gratitude for his discovery and for his quest for truth, against all odds.

We must demand that those in power in youth, interscholastic and intercollegiate sports protect our children; and we must help our children, from an early age, to think critically and to develop the good sense and courage, without shame, to speak the truth and break the silence.

https://longislandweekly.com/one-person-can-ignite-fire-can-light-entire-forest/

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.

SCHOOLS MUST STOP THE FOCUS ON TEACHING TO THE TEST

Unless you are an academic professional, you may have never heard the term social emotional learning before, but it’s a concept that’s critical to your child’s well-being.

What is social emotional learning? According to the American Institutes for Research, it is “the process through which we learn to recognize and manage emotions, care about others, make good decisions, behave ethically and responsibly, develop positive relationships, and avoid negative behaviors. It is the process through which students enhance their ability to integrate thinking, feeling and behaving in order to achieve important life tasks.”

Recognizing and building on the strengths and assets of children and youth and promoting social and emotional learning are essential to their success both academically and in life. Teens who feel connected are less likely to engage in high-risk behaviors such as self-harming, violence, early sexual activity, disordered eating or suicidal ideation, for example.

Nevertheless, this is a tricky goal to reach in schools where teaching to the test is so prevalent. School officials must reframe their thinking that there is only room for either social emotional learning or academic learning. Either-or thinking must be replaced by a both-and commitment.

Following is a composite account of conversations that I had with school social workers who work in urban, suburban and rural settings.

Ted is one of three social workers in an inner-city middle school where there are more than 1,500 students in grades 6, 7 and 8. The school day runs from 7:50 a.m. to 2:20 p.m. There are six 55-minute periods per day and a 30-minute lunch break. According to Ted, faculty and administrators are consumed with prepping students for standardized testing. Among the responsibilities of the social workers is to schedule and monitor standardized tests for weeks at a time. Ted described this aspect of his job as “crowd control.” 

When I asked him what the biggest obstacle was, he said, “teaching to the test.”

“These days teachers are being evaluated on their students’ test scores and schools are trying to align curricula to the tests, which leaves little flexibility for what can happen in or outside the classroom,” he said. “Teachers are increasingly unwilling to let kids leave class for alternative activities like groups that might address career exploration, grief or anger management—you know, all things that can have a really positive impact on a student’s academic achievement.”

Ted has not given up. He said that we need to educate teachers, administrators, parents and school board members that “kids under stress, kids who were traumatized or living in difficult life situations, need to have social and emotional learning as a part of their school experience. Working with kids in groups is an important part of that learning. The adults in schools need to know that good groups that focus on social emotional learning can positively affect learning and healthy classroom environments.”

One thing that Ted has tried that has gotten some traction is meeting with the teachers themselves in groups.  “I formed a monthly group for teachers who are interested in learning more about working with kids who are depressed or who exhibit self-harming behaviors. But, mostly, teachers ask for help individually, and it is usually crisis-oriented.”

School personnel need to be reminded of what some kids experience on a day-to-day basis and what the impact will be if social emotional learning is taken out of the school equation. Here’s how one 16-year-old student described his troubles.

“I was getting good grades till my mom’s boyfriend moved in and started beating us. That’s when the problems started. Then the school started complaining about my behavior. I was stressed out. I would be sitting in class trying to concentrate but couldn’t. Too many things were running through my head. I’d be sitting there with all of these thoughts that just don’t go away.”

Virtually everyone who works in a school can relate to this and can come up with their own compelling illustrations of kids under chronic stress. Telling their stories is important in demonstrating that standardized test preparation alone will not guarantee academic success or behavioral compliance. It’s time to recognize the crucial nature of social emotional learning in the schools so our children are seen as whole human beings and not testing machines.

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. 

DAVID AND GOLIATH

On January 21, 2016 I received a most unusual award – a David Award – that was described to me as follows:

For each of the past 15 years, every January Networking® magazine has honored eight exceptional men – “Renaissance Men” who have performed generous and unselfish acts for the benefit of us all. The David Awards are named for David, the giant slayer, who represents the Renaissance Ideal Man memorialized by Michelangelo’s famous 16th century statue of David. Each of our honorees has been a true Renaissance man having excelled in business or academics and also accomplished outstanding heroic and humanitarian acts.

I thought that I would make this column a little more personal than usual and share my remarks here.

Having been selected for this honor led me to consider, "If I am David, then who is Goliath in my life?" I can think of many but I’ll share just two with you.

On the same day in late September that Networking Magazine publisher Christine Sheehan delivered the good news to me about this honor, my doctor called with the results of a biopsy and PET scan. She said that my cancer, which had been in remission for five years, transformed into something more aggressive. It was rapidly spreading and required immediate treatment.

In fact, if the David Awards breakfast was held just one week earlier to the day, instead of my sitting on the dais you would have found me seated in a recliner at Sloan Kettering, hooked up to an IV, and receiving what I am hoping will be my last infusion.

I tell you about my personal Goliath not for your sympathy. I tell you because I know I am not alone in this room of more than 500 people. I salute my fellow cancer survivors and family members of those who have battled cancer.

Although my first Goliath is more personal, and now public, my second Goliath is more insidious. It cannot be slayed by science and medicine, and it demands the attention of our hearts, minds and souls.

My second Goliath is stigma – the stigma that brings shame to people with mental illnesses and addictions; the stigma that denies them the sympathy and support that I have received in abundance while battling cancer.

Please understand that no parent would hesitate for even a moment to get help for a child with cancer. However, parents who have a child suffering from a mental illness or addiction wait weeks, months and even years to ask for help. Stigma causes many to hide and retreat, rather than stand and advance.

Stigma has two co-conspirators. They are the government and the health insurance industry. Government neglect and corporate greed represent nothing less than institutional child abuse and neglect that prevent sufferers from choosing and accessing life-saving treatment options. This is a clear denial of civil rights.

Defeating the Goliath stigma is a good start. It requires that we make a collective commitment to treating illnesses above the neck the same as illnesses below the neck.

If my being a David Award winner helps to inspire that, then I will truly feel a worthy recipient. Thank you.

https://longislandweekly.com/david-and-goliath/

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.