SHIELD CHILDREN FROM VIOLENCE, SUPPORT CHILDREN'S MENTAL HEALTH

http://blog.timesunion.com/opinion/shield-children-from-violence/31303/

Albany Times Union, December 10, 2014

Now we learn that Adam Lanza did not get the help that was needed and that might have prevented his murderous rampage (“Chances to help were lost as killer evolved,” Nov. 23).

Think about it: After the Sandy Hook shootings, there was not one parent who was able to escape the tyranny of imagining his or her child being murdered in the neighborhood school. How many more children will be taken from us before lawmakers devote the same energy and resources it takes to launch their re-election campaigns to safeguarding our children?

New York state has ensured easy access to mental health care for Medicaid recipients and neglected the needs of underinsured middle-class families.

The gun lobby is formidable and well-heeled. Children, on the other hand, don’t have a voice until they are in the ground. Children are killed, grieving parents become tireless advocates and laws are passed in their children’s names. Timothy’s Law (mental health parity), Megan’s Law (making information available to the public regarding registered sex offenders) and Katie’s Law (making aggravated vehicular homicide a crime) come to mind.

We need our lawmakers, elected and appointed officials, to wake up. Our children are suffering and dying; families are struggling and desperate. Our leaders can support the constitutional right to bear arms while taking steps to prevent gun violence and providing adequate funding for community-based mental health centers to support the emotional well-being of all of our children.

Andrew Malekoff

Executive director, North Shore Child and Family Guidance Center, Roslyn Heights

TESTIMONY ON GOVERNOR PATERSON'S PROPOSED BUDGET CUTS TO HUMAN SERVICES

New York State Hearing on Governor Paterson’s Proposed Budget Cuts
Brookhaven Town Hall Auditorium
Farmingville, New York
Testimony by Andrew Malekoff, Executive Director / CEO
North Shore Child and Family Guidance Center
480 Old Westbury Road
Roslyn Heights, New York 11577

Representing the Long Island Coalition of Behavioral Health Providers, Inc.
400 Garden City Plaza – Suite 202
Garden City, NY 11530

October 27, 2009
Good afternoon senators. My name is Andrew Malekoff and I am the executive director and CEO for North Shore Child and Family Guidance Center in Roslyn Heights, New York. I am here representing the Long Island Coalition of Behavioral Health Providers.

More low income and middle-class families than ever before are in need of low cost, high quality community-based mental health care. Yet, the New York State Office of Mental Health is implementing a plan for these critical services that will result in a system of community care where only those children and families with Medicaid “fee for service” insurance coverage will be assured ongoing access to care. At the same time, Governor Paterson has proposed cutting local assistance dollars for behavioral health services.

The erosion of local assistance funding in conjunction with the march towards clinic reform is the perfect storm for the destruction of children’s community-based mental health services on Long Island. There will be no real cost savings left in the wake of this storm; only the incalculable cost of young lives being lost and set adrift, and families being splintered and destroyed.

For more than half a century North Shore Child and Family Guidance Center has been a proud provider of community-based mental health services on Long Island. The lethal mix of clinic reform and decades of diminished local assistance dollars portends a mental health delivery system that will no longer assure access to mental health care for children regardless of their parents’ ability to pay.

A once proud community-based mental health care system that was “for one and for all” is being systematically deconstructed into a depleted “Medicaid-only, others need not apply” delivery system.

New York State has a statutory responsibility to make sure that its most vulnerable citizens, our children, get care regardless of their families’ economic status. Instead, what we are getting is institutionalized classism that cuts the middle class and working poor out of the behavioral health equation.

Many children with what seems like ample health insurance coverage will no longer receive behavioral healthcare services from community clinics as a result of the lack of parity between government (Medicaid) rates and rates paid by commercial insurers for behavioral health care. And, despite rhetoric to the contrary, the new Federal Mental Health Parity Act will not help. Offering unlimited clinic visits at substandard rates is not parity, but rather a barrier that denies access to the middle class and working poor. Commercial insurers that cannot demonstrate an adequacy of network for behavioral health care should have their licenses revoked by the State Department of Insurance.

Community clinics have always been a mainstay in addressing the needs of children and adolescents with serious emotional disturbances and their families. Private psychotherapists and counselors, with rare exception, cannot and afford to offer the labor intensive work necessary to properly serve families that are struggling with serious emotional disturbances.

We call on New York State, in conjunction with local government, to restore and enhance rather than slash local assistance funding – a partnership between local and state government, the local community and client-consumer. Action must to be taken now to reverse the course of clinic reform and to preserve local assistance funding before it is too late.

Thank you, senators, for holding this hearing and for giving me the opportunity to testify before the committee.

Andrew Malekoff is executive director and chief executive officer for North Shore Child and Family Guidance Center, Roslyn Heights, New York email: amalekoff@northshorechildguidance.org

IT'S NOT REFORM WHEN IT HURTS THE MIDDLE CLASS AND WORKING POOR

It's not reform when it hurts the poor

By ANDREW MALEKOFF

First published in print: Monday, July 27, 2009, Albany Times Union

More low- and middle-income families than ever are in need of low-cost, high-quality community-based mental health care. Yet, the state Office of Mental Health, along with the state Health Department, is aggressively pursuing a "reform" plan that will assure continued access to care only to children and families with Medicaid fee-for-service insurance coverage. This will leave a significant number of children and adults in the lurch.

This clinic reform plan sets up a mental health service delivery system that will no longer assure access to care for children, regardless of their parents' ability to pay.

This represents a dramatic departure from New York's statutory responsibility to make sure our most vulnerable citizens -- our children -- get care, regardless of their family's economic status.

Clinic reform signals movement away from a universal model of care to one that will discriminate against underinsured middle-class and working-poor families. Because of the lack of parity between higher rates paid by government and those paid by commercial insurers, many children with what seems like adequate health insurance coverage will no longer receive behavioral health care services from community clinics.

Community clinics are the last bastion in addressing the needs of children and adolescents with serious emotional disturbances. Private psychotherapists, with rare exception, will not provide the labor-intensive work necessary to properly serve children and families struggling with serious emotional disturbances.

One step forward would be for the Health Department to pressure commercial Medicaid managed-care carriers to increase their rates to match Medicaid rates. A second step would be to do the same with commercial insurers.

As community-based clinics void contracts with underpaying commercial insurers, as they are sure to do, families will be denied service if they are unable to pay the full cost. Commercial carriers that cannot demonstrate an "adequacy of network" can and should have their licenses revoked.

Consumers must be educated about these issues so that they can join the fight now and later, when denied services because their carrier cannot offer them an adequate network of care.

Last but not least, the Office of Mental Health must restore and enhance local assistance funding, also known as deficit financing -- a partnership between local and state government, the local community and client-consumer -- for specialty children's outpatient mental health clinics that serve a significant proportion of non-Medicaid fee for service clients. If implemented in its current design, the clinic restructuring plan will guarantee only narrowly-defined treatment for those with Medicaid fee-for-service eligibility. Clinic reform is certain to increase the marginalized role of middle-class and working-poor families in society.

Action must to be taken now to modify the course of clinic reform, before it is too late.

Andrew Malekoff is executive director of the North Shore Child and Family Guidance Center in Roslyn Heights and a member of the state Office of Mental Health group developing the New York State Children's Plan.

HELLO DALAI

HELLO DALAI

by Andrew Malekoff

“Giving money and power to government is like giving whiskey and car keys to teenage boys.” – P.J. O’Rourke

The Dalai Lama and the New York State Senate

On May 9, 2009 Nobel Peace Prize laureate the Dalai Lama offered an invocation for the New York State Senate, calling for compassion during tough times. The 73-year old spiritual leader of Tibet spoke from the chamber floor about honesty and transparency and told the Senators and spectators about his deep respect for American values. “This house,” he said, “I think demonstrates the American democratic system.” Ya think?

Just one month later, as we are now painfully aware, a failed legislative coup paralyzed the system that the Dalai Lama praised in the house that he sanctified. Since that time the State Senate deconstructed into a child’s game of “Who gets to hold the gavel.”

Teaching our children about conflict resolution

What can we learn from the senate stalemate fiasco that will help our children when they are in conflict with their peers? According to Marjorie Kostelnik, Dean of College of Education & Human Sciences at the University of Nebraska, in our zeal to reach a compromise, a child might be denied their legitimate right to maintain possession of a desired object. When this occurs, she advises, “the focus should shift to helping the child who wants the object to generate appropriate strategies, such as asking, trading or bargaining to achieve their goal.”

Of course, sometimes our first response to the fuss is to say: “OK kids, who started it?’ or ‘How many times have I told you not to quarrel?” Children typically respond by denial or finger pointing. Of course, neither of these responses leads to constructive problem solving.

Kostelnik says, “It is better to approach the conflict saying: ‘You both seem very upset’ or ‘It looks like both of you want the [gavel] at the same time.’ These statements focus on the problem that exists between the children rather than giving sole responsibility to either child.” Boy oh boy, our New York State Senators sure have given us a lot to think about.

Perhaps the most important goal in conflict resolution is not so much the outcome of a situation as the enhanced ability to handle conflicts on a more mature level. In healthy conflict resolution there are some basic rules of conduct that we can teach our children. No name calling, staying with the topic at hand, no dredging up the past, keeping an open mind, and listening to other points of view. This means no filibustering or talking over one another.

These tips are especially important, living in an era of violence –random, sudden, illogical, and lethal – where anything that seems the slightest bit threatening – a put down, a disagreement, a dirty look – demands immediate retaliation. We need to help our children to peaceably resolve conflicts. It is ironic that the Dalai Lama, a man that advocates for peaceful solutions based upon tolerance and mutual respect, spoke before the Senate just weeks before the mess in Albany.

The Dalai Lama and the Beatles

To digress a bit, when I was a freshman in college in 1969, the Beatles were at their pinnacle. A rumor went around that Paul McCartney died. Word spread like wildfire that there were hidden messages about this on their album covers and in the lyrics of their songs. One neat trick, back in the day, was to play their songs backwards for clues. I did this with the song “Revolution Number 9.” I was sure that when I spun the vinyl disc counterclockwise that I heard the words, “turn me on dead man, turn me on dead man.” This was so freaky that it gave me goose bumps. Of course, the whole thing turned out to be nothing but a clever hoax.

For some reason, this episode in my life recently popped to mind and led me to get hold of the audio of the Dalai Lama’s address to the New York State Senate. Something told me to play it backwards. When I did, I could swear that I heard two words repeated over and over again – term limits, term limits, term limits.

Andrew Malekoff (copyright, July 2009)