Works in Progress
Sunday, December 16, 2018
Wednesday, November 28, 2018
ACTIVE SHOOT PREP A SAD COMMENTARY
Violence—random,
sudden, illogical, and lethal—has become a fact of life. Years of social and
economic injustice have resulted in large numbers of people who are frustrated
and without hope for the future, people to whom bravado is everything, and
anything that seems the slightest bit threatening—a put-down, a disagreement, a
dirty look—demands immediate retaliation.
As I write these words, this kind of violence almost seems old school to
me.
I’m
not quite sure when my consciousness shifted about the kind of violence we now
all face. I wonder if it was during the six year period beginning in December
1993 when the Long Island Railroad massacre occurred, followed by the Oklahoma
City bombing in April 1995 and then Columbine school shooting in April 1999.
The targets: public transportation, a federal building and a public school.
I
think it was during that period of time when it started to sink in that something
dramatically different was happening that was more than a fluke. I remember
thinking, in one of my more morbid moments, that all Americans were secretly
entered into a daily national lottery that wouldn’t result in fortunes gained
from pooled funds, but instead in body counts delivered at the hands of
deranged strangers.
And
now, as two additional decades have unfolded, churches, synagogues, concert
halls, nightclubs, workplaces and more have been added to the pantheons of mass
murder.
This
past Election Day, during our annual staff development day, I participated in an
Active Shooter Preparedness Training at
North Shore Child and Family Guidance Center. It was presented by police officer
Ken Murray and paramedic Rich Husch from Nassau County Police Department
Homeland Security division. The training was engaging and informative.
Before
1993 I don’t believe I could have imagined participating in such a workshop.
Today it is essential for workplaces, schools and houses of worship.
In
a staff development day just few years earlier, the theme was mindfulness. Mindfulness, originally a Buddhist concept founded centuries
ago, refers to a practice of paying attention and staying in the present,
moment-by-moment, to feelings, thoughts, bodily sensations, and surrounding
environment without being judgmental. Mindfulness is often taught as a
meditative approach to calming or soothing oneself.
After
the active shooter preparedness training I thought about the commonalities and
contrasts of the two, both of which emphasize paying attention to the
environment, one to luxuriate in the richness of what might otherwise pass one
by and the other to be hypervigilant to threats and escape routes.
Mindfulness
is taught for the benefits of stress reduction, improved focus and reduced
emotional reactivity. Active shooter preparedness is taught so that, In the
midst of chaos, anyone can play an integral role in mitigating the impacts of a
potentially deadly incident.
On
reflection, I’m struck by the emotional flexibility required to absorb both
into one’s consciousness, requiring fluidity and many-sidedness. Robert J. Lifton is an American psychiatrist
and author, chiefly known for his studies of the psychological causes and
effects of wars and political violence.
In
a review of Lifton’s book, The Protean
Self: Human Resilience in an Age of Fragmentation, the reviewer sums up the
concept of the protean self by stating that “life is not a straight line.
Instead, it is, and ought to be, experienced as a collage.”
The
sad reality today is that the collage is becoming overcrowded by images of
carnage that more sensible gun regulation can go a long way to changing.
Published in theislandnow.com: https://theislandnow.com/opinions-100/kids-first-preparedness-mindfulness-and-the-protean-self/
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.
EVERY FIGHT NEEDS A VOICE
When tragedy strikes, the grief can be overwhelming. One way
that some people choose to deal with their pain is to try to make something
good come out of a horrible situation. That’s what the parents of Timothy
O’Clair did when their 12-year-old son died by suicide on March 6, 2001 after
mental health benefits provided by their insurance company ran out.
The O’Clair family fought tirelessly for years for New York
State to pass a law requiring health insurance policies to provide access to
timely and affordable mental health care in the same way they cover physical
illness. The legislation, called Timothy’s Law in honor of their son, was
finally signed in December 2006.
Timothy’s Law helped to blaze the trail for a much broader
federal law that passed two years later which requires health insurers to
provide access to mental health care on par with medical and surgical care.
Now, what would you think if I told you that despite these
hard-fought state and federal laws, in New York State national insurance
companies are continuing to prevent children like Timmy O’Clair from accessing
care and that New York State regulators are assisting them in doing so?
This is precisely the case. As health law expert Brian
Hufford stated, “Timothy’s Law appears effective. In 2009, the state
reported an increase of 4.5 million people with plans promising comprehensive
mental health coverage. But that number is almost certainly a mirage.” Hufford
goes on to say that New York’s insurance regulator, the Department of Financial
Services, has a shallow history of enforcement that suggests it lacks the
interest or resources to adequately protect New Yorkers.
One year ago North Shore Child & Family Guidance Center
issued the results of a groundbreaking study known as Project Access, which
surveyed 650 people across Nassau and Suffolk Counties.
The results revealed conditions similar to what the O’Clair
family fought against in the early 2000s and showed that discrimination against
people living with mental illness and substance use disorders persist.
An immediate follow-up to the Project Access study exposed
the reality: the New York State Department of Financial Service is stonewalling
demands to further investigate this civil rights issue.
In a letter to DFS Commissioner Mary Vullo citing the
Project Access study, state Senators Todd Kaminsky and Elaine Phillips
requested a thorough investigation into the persistent problem New Yorkers were
experiencing when trying to access timely and affordable mental health care.
Almost five months later Scott Fischer, executive deputy
superintendent for Insurance, a division of DFS, responded in writing to the
senators.
Fischer wrote: “DFS’s review of the various networks has
confirmed that each of the insurance companies in Long Island exceeds the
standards for mental health and substance use providers, for the purpose of the
commercial products sold outside of the New York State of Health,” the official
health plan marketplace.
In other words, this DFS official is stating that there is
no problem and nothing more to do, which is contrary to the evidence.
Fischer’s response belies the reality that DFS does little
if anything to verify reports from health insurers indicating that they have
adequate networks of providers available to their beneficiaries.
I had the privilege of meeting Timothy O’Clair’s dad Tom at
a National Alliance on Mental Illness event in Albany in October.
Tom was the driving force behind the passage of Timothy’s
Law. We shared a stage in recognition of our mutual efforts to advocate for
effective and enforceable parity laws so insurers do, in fact, cover mental
health care the same way they do physical illness.
We spoke briefly. I told him that although I never met his
son, I keep Timothy close to my heart in the continued fight. He responded,
“Keep doing what you’re doing.”
Although it was only the two of us in this fleeting interchange,
I’m sure that Tom’s entreaty was meant for all people of good will that know
firsthand the devastating impact of untreated mental illness and addiction. We
all must keep fighting so Timothy’s Law is a reality and not just mere words on
paper.
To find out how you can join this effort, contact Andrew
Malekoff at (516) 626-1971, ext. 302, or email
amalekoff@northshorechildguidance.org.
Published in theislandnow.com: https://theislandnow.com/opinions-100/kids-first-every-fight-needs-a-voice/
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
Friday, November 2, 2018
FIGHTING BACK FROM CHILDHOOD SEXUAL ABUSE: KAYLA'S STORY
By Andrew
Malekoff
I recently attended a seminar
led by Dr. Cynthia Kaplan, Director of Trauma Training & Consultation
within the Child and Adolescent Services at McLean Hospital of Boston. Dr.
Kaplan addressed the issue of childhood sexual abuse (CSA). She incorporated
the story of a young woman, Kayla Harrison, a survivor of CSA and a two-time
Olympian Gold medalist in judo for the United States.
Many years ago CSA was only
heard about in whispers as opposed to in depth reports by investigative
journalists. Today, reports on CSA perpetrated by what seem like otherwise
model citizens – religious leaders, coaches, teachers, seem commonplace.
Dr. Kaplan made a strong
point about how we caution children in the strongest terms to “stay away from
strangers,” yet 90 percent of children and adolescents, who are sexually
abused, know their abuser.
Kayla’s book, Fighting Back: What an Olympic Champion’s
Story Can Teach Us about Recognizing and Preventing Child Sexual Abuse - and
Helping Kids Recover, co-authored with Drs. Kaplan and Aguirre,
contains excerpts from Kayla’s personal journal. She wrote about her experiences
throughout the course of her abuse, including about how she was groomed by her
coach.
“By the time I was 9 or 10 I
started traveling with the team to local tournaments. At night when the whole
team would watch movies I would snuggle up next to him. He would put a blanket
over us and then one day things went further and he guided my hand to touch
him.”
About one in 10 children will
be sexually abused before their 18th birthday. The impact of
CSA can be felt by survivors throughout their lifetime. According to Dr.
Kaplan, what complicates the healing is that CSA is not visible, not
transparent. Consequently, survivors may not get the support they need and are
often left to struggle and mourn alone.
When film director Steven
Spielberg created the Shoah Foundation, which strives to capture the testimony
of Holocaust survivors, he discovered that many of them had never told their
stories before. They often avoided doing so because they had a deep sense of
shame and distress which they often believed could or would not be understood
by others. After the filming they reported feeling a sense of relief at
finally having told someone. They finally felt heard.
Being truly heard requires
another person to bear witness. Living with the hurt in silence can
compound traumatic stress and lead to destructive and even fatal behaviors
including drinking, drugging, self-harm and suicide.
Disclosures of CSA require
professional support. When survivors lose their ability to control disclosures,
the emotional impact can be devastating. Even in the best of circumstances,
says Dr. Kaplan, following disclosure individuals often feel more distressed
and have trouble managing emotions. They may begin to lose faith in the world
and can feel re-traumatized by the disclosure experience itself.
It is significantly more
likely that a child will disclose if they know they are likely to be believed
and do not feel blamed and also if they are helped to anticipate the potential
legal repercussions of breaking their silence.
Believing that they will be
protected by the adult they disclose to goes a long way. Particularly when they
are able to maintain at least some control over the disclosure process,
preserve their anonymity to the extent possible and sustain a level of
confidentiality.
Surprising as it may seem,
children also need to feel free to express their concerns about what will
happen to the offender, as it is a complicated relationship with the
victim having mixed feelings that survivors need time to process.
There is hope. As Kayla said,
after many years and support from her new coaches, parents and mental health
professionals, “I began to see my way out of the darkness and towards the light
until I could again see the flame of the Olympic torch shining with my very own
eyes.”
Published in Blank Slate
Media’s TheIslandNow.com, Oct. 23, 2018, link: https://theislandnow.com/opinions-100/kids-first-fighting-back-from-childhood-sexual-abuse-kaylas-story/
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 book Fighting Back can be found
at: https://www.guilford.com/books/Fighting-Back/Harrison-Kaplan-Aguirre/9781462532971
END RAPE CULTURE
by Andrew Malekoff
In the 1980’s I held a part
time job as a psychiatric crisis counselor for an emergency room nearby my home
in Long Beach. I carried a beeper and was on call nights and weekends. I
handled some of the crises over the phone. Many calls required my presence at
either the ER or, in some cases, the police station.
The calls involved people
with thoughts or actions related to suicide; substance use issues; family
conflicts; or people with mental illness experiencing disturbing symptoms such
as hallucinations or delusions.
Sometimes crisis calls were more
benign. They included people seeking advice or referrals, or people who simply
wanted to make human contact in the middle of the night to combat their
loneliness.
A few of the crisis calls
have not escaped my memory. One of them involved a young Black woman who told
me that she had been raped. She said she came to the ER to request an examination.
In the course of my
intervention in the ER I asked the on duty nurse if the woman was given a “rape
kit,” a sexual assault forensic exam to preserve potential DNA evidence and
receive important medical care. The nurse said she had not. When I asked
why not, she gestured with her head towards the chief emergency room physician
and rolled her eyes.
I approached him and asked
him the same question, “Why not?” With no change of expression he said
matter-of-factly, “Because she’s crazy.” I said, “What has that got to do with
it.” He did not respond.
I returned to the woman and
asked her again, “Would you like to be examined?” She nodded yes.
I circled back to the doctor
and said, “If you’re telling me that you are refusing her a “rape kit,” I am
including that in my crisis note which will be read by government officials
that support this hospital. I will state that the patient reported being raped,
requested a rape kit and that you denied her the examination.” He appeared surprised to be challenged and
finally said, “I’ll give her a kit but don’t ever question my authority again.”
As I was following the
proceedings leading up to the most recent Supreme Court nomination and the
protests led by women, I found the term “rape culture” popping up repeatedly on
social media.
Emilie Buchwald, author of Transforming
a Rape Culture describes
rape culture as “a complex of beliefs that encourages male sexual
aggression and supports violence against women. A rape culture condones
physical and emotional terrorism against women as the norm.”
Women Against Violence
Against Women (WAVAW) Rape Crisis Centre in Vancouver, BC, Canada further states that “rather than
viewing the culture of rape as a problem to change, people in a rape culture
think about the persistence of rape as just
the way things are.”
Perhaps the most disturbing
aspect of rape culture is that, to a large extent, it is accepted as inevitable
when, in fact, it is an “expression of values and attitudes that can change.”
Parents can teach their
children not to condone sexual violence in everyday language and reject the
sexual denigration of women and girls. Schools can teach comprehensive sex
education that includes values and attitudes. The justice system can punish rapists
and not their victims.
And, medical personnel who
perform forensic exams can be properly trained.
Published in Blank Slate
Media’s TheIslandNow.com on Oct. 9, 2018, link: https://theislandnow.com/opinions-100/kids-first-end-rape-culture/
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.
BEYOND WORDS: TRAUMA AND THE ARTS
by Andrew Malekoff
Powerful images that depict disturbing events in ways
that literature alone cannot can be illuminating and healing. Following are
three descriptions of different media that capture recent man-made disasters
still very close to the surface for many of us.
The first, Please
Stand By, is an example of cartoon art in the aftermath of 9/11. The
second, The Last Lockdown, is about a
sculpture created after the mass school shooting in Parkland, Florida. Both
illustrate the fear-inducing paralysis of traumatic events. The last, Memorial Rock Garden, describes bereaved
children painting stones to memorialize their deceased dads.
Please Stand By
In the immediate aftermath of the September 11, 2001
terrorist attack on America, several artists joined together to produce a soft
cover book entitled 9/11: Artists Respond. It is a collection of art, sequenced to
showcase the artists’ response to the terror that befell the world.
One nine-frame piece entitled “Please Stand By…”, by
Jeph Loeb and J. Scott Campbell, features a girl of about eight years old
watching cartoons on television. By the third and fourth frames, the image on
the screen changes to a live feed of the Twin Towers ablaze.
As the little girl stands transfixed, stuffed animal
in hand and her face less than 12 inches from the screen, the commentator
announces, “We interrupt this program to take you live…”
The little girl turns away and cries out, “Mommy!”
The next three frames begin with her mother dropping a basket of laundry. Then,
with her face contorted in anguish, she embraces her daughter to shield her
from the unrelenting televised images.
The final frame is a close up of the little girl
asking, “Mommy, when are the cartoons gonna come back on?”
The Last Lockdown
The next image is a haunting statue, as described by
journalist Josh Hafner, of a “small girl cowering beneath an open school desk,
clutching a leg as she gazes into the distance with a look of fear in her
eyes.”
The sculpture was created by Manuel Oliver, an
artist who lost his 17-year-old son Joaquin in the Parkland, Florida, mass
shooting earlier this year. As Oliver said, “It’s too late for us to save
Joaquin from gun violence, but through art my family and I are making sure that
we protect the rest of the kids out there.”
“Talking about the
trauma is rarely if ever enough,” advises noted trauma expert Bessel van der
Kolk. He points to the Holocaust Memorial in Jerusalem and the Vietnam War
Memorial in Washington, D.C., “as good examples of symbols that enable survivors to mourn the dead and
establish the historical and cultural meaning of the traumatic events to remind
survivors of the ongoing potential for communality and sharing.”
Memorial Rock Garden
In 2002 at North Shore Child &
Family Guidance Center, a group of boys and girls who lost fathers in the
attack on the World Trade Center decorated stones to be placed in a memorial
rock garden.
The kids in the bereavement
group sat together around a table covered with newspaper. In front of each of
them was a large smooth oval-shaped stone. They decorated the stones with
unique designs of paint and glitter, each one a personal remembrance of their
fathers.
“Mine is painted
gold,” beamed Mack. “I painted it gold because my dad is like gold to me.” A
heart framed Jenny’s design, “because my dad will always be in my heart.” On
Seth’s stone were two intertwined hands, a small one and a larger one that
showed “me and my dad were best friends.” Victoria painted a fire hat and said,
“My dad is my hero.”
We might do well to
remember that when funding cuts threaten to
decimate arts programs in schools there is more at stake then we might imagine.
The impact of the arts is not measured by standardized tests and its value is
incalculable.
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.
SEEKING HUMANE SOLUTIONS FOR YOUNG REFUGEES
By
Andrew Malekoff
In a recent story in the Albany Times Union, reporter Mallory
Moench paints a different picture about juvenile asylum seekers as compared to
recent stories about caravans purportedly composed of gang members and Middle Eastern
terrorists.
In the report we meet Rosa,
who left El Salvador as a young adolescent after being targeted by a gang intending
to prostitute her. To prevent becoming sexually exploited, she left her parents
and crossed the border. She has been living in the Capital Region of New York
for the past two years.
Rosa, now 17, is undocumented
and is seeking special immigrant juvenile status that would enable her to apply
for a green card which permits a foreign national to live and work permanently
in the U.S.
Rosa understands that she
could be denied and deported. More than 12,500 undocumented young people have
participated in immigration court this year alone. For those without a lawyer,
the odds of deportation are much greater.
According to the Albany Times Union report, “If juveniles
[under the age of 21] have a relative who is a U.S. citizen or green card
holder, they can apply for a family-based petition. If they are victims of
trafficking, domestic violence or another crime they can apply for crime victim
visas. If they’re fleeing persecution like Rosa, they can apply for asylum. If
they’re missing one or more parents they’re eligible for special immigrant
juvenile status.”
Attorney General Jeff
Sessions has taken measures to fast track deportations. Consequently, many
juveniles may be sent back to their homelands—and the dangers and threats that
await them—before legal proceedings are implemented.
Many of the young people
living in New York’s Capital Region, ages 12 to 19, came from El Salvador,
Guatemala, Honduras or Mexico after being confronted with gang violence. The
profile and numbers of refugees on Long Island is similar. It is ironic that with
the incendiary political rhetoric of the day, many asylum seekers have been
labeled gang members, when it is gangs that they are trying to escape from.
Many young migrants endured
trauma in their passage to the U.S. They faced starvation, violence and
abandonment.
There are only two
immigration courts in all of New York. One is located in New York City and the
other is in Buffalo. For many asylum seekers, the cost for transportation to
court hearings prevents them from following through. For example, for those
living in the Capital Region, a bus ride can be as much as $100 and more than
$500 for private transportation. This is especially daunting when they are
living in poverty.
Furthermore, there is a cap
on the number of visas given each year and also each month. This contributes to
inordinate delays in court.
For most of these juveniles
the fear and anxiety of being deported as they await a final legal
determination can be unbearable and impacts their ability to heal from the
traumatic journey to the U.S.
Immigration laws do need to
be enforced as open borders with endless flow of refugees is unsustainable.
The challenge is how to
enforce the law, dial down the divisive and hateful rhetoric, demonstrate
compassion and seek humane solutions for young migrants simply looking to live
without fear. We’ve strayed from that ideal.
I hope we can find our way back.
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.
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