HELP YOUR KIDS BLOSSOM

Finally, what seemed like the longest, coldest winter in memory is over. I don’t know about you, but I’m grateful to spend time soaking up the sun, walking and biking along the boardwalk in my Long Beach neighborhood.

But during my excursions, it saddens me to see how many young people are isolated and clueless about the beauty of the world surrounding them. Most are staring down at their phones as they text or scroll through their Instagram feeds.  

For other kids, their tech device of choice doesn’t even make it out of the house. It can be a perfect spring day—75 degrees, sunny, not a cloud in the sky—and these youngsters prefer to stay indoors, playing video games or glued to some other form of electronic device.

Make no mistake: Regardless of their protestations otherwise, a number of these children and teens are not only lonely and miserable, but they’re at risk of a host of physical, social and emotional problems.

Here are just a few: We all know that obesity is an epidemic in our culture, and a big reason is that our kids’ addiction to gadgets means they’re not outside running around and playing. Lack of movement plus bags of chips and big gulp sodas equals overweight  youth—who are likely to turn into unhealthy adults.

Socially, when kids spend all their time on Facebook instead of face-to-face with their peers, they feel isolated and alone. Finally, research suggests that kids who don’t spend enough time in nature are prone to anxiety and depression.

What’s a parent to do? There’s no better time of year than now to get out there with your kids and start digging and planting.

Here at North Shore Child & Family Guidance Center, we’ve seen firsthand how children blossom when they “get back to the garden.” At our Roslyn Heights headquarters, groups of children and teens water, seed and weed our organic bed, and they’re filled with pride when they see lettuce, tomatoes, peppers and other vegetables grow. And, since much of the produce they harvest is donated to local food pantries, they experience the pride that comes from helping others.

Through their work in the garden, we saw kids who were shy and insecure develop self-confidence and make new friends. They learned social, leadership and team-building skills. They felt a sense of accomplishment that they had never experienced before.  

Tending the garden and watching it grow enabled them to intensify their sense of wonder and curiosity.

Gardening helps kids connect to the Earth, to each other and, yes, even to their parents. Young children will be in awe as you show them the fruits (and vegetables) of your joint labor. If your teens are reluctant to work with you, that’s OK. Give them some responsibilities of their own, such as watering or weeding; expose them to tools that they can begin to master—and don’t be surprised if they end up sharing some gardening hours with you. By sowing seeds and harvesting bounty, they gain a more visceral sense of how things change over time.

Another plus: Gardeners might not use the terminology, but they achieve a natural state of calm and focus that’s become known as “mindfulness.”

Though people often associate it with meditation, mindfulness doesn’t require hours of prayerful silence or chanting mantras.  Mindfulness at its core is about paying attention—staying in the present, moment by moment—to feelings, thoughts, bodily sensations and the surrounding environment in a judgment-free way.

Mindfulness is an inherent part of the experience of tending to a garden; it gives kids new ground to stand on, both literally and figuratively, embracing their senses of sight, smell, sound, touch and taste. Mindfulness in nature calms the brain, allowing for reflection and healing, and it’s also great for the body, lowering stress, inflammation and blood pressure.

If gardening isn’t up your alley, not to worry. Being outdoors—whether hiking in the woods, riding your bike or swimming at the ocean—restores the spirit, and there’s bound to be an activity your kids will enjoy.

So, whether you are eight or 80 or anywhere in between, take advantage of the beautiful weather and find your bliss. It’s right outside your door.

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. 

CUTTING MENTAL HEALTH SERVICES

Opinion

Newsday, April 17, 2015 

Thank you for exposing the disturbing trend of nonprofit mental health clinic closures on Long Island ["Crisis in the clinics: As demand grows, mental health facilities dwindle on LI," News, April 12]. For mental health providers, this does not come as a surprise.

The state's grand plan is to consolidate services by reducing the number of clinics and restricting access to care to Medicaid recipients only, thereby cutting middle class children and families out of the equation. Consolidation is by design, and is what the state refers to as its "regional centers of excellence" plan.

Some of the ways that clinics stay afloat, beyond fundraising, are to restrict access to care to families with Medicaid insurance, which pays higher rates than commercial insurers; to spend shorter periods of billable time with clients to pack more revenue into a day; and to replace salaried mental health professionals with fee-for-service workers to avoid paying for benefits.

In other words, build a factory that maximizes revenue and minimizes quality care.

I do not feel encouraged by a system that restricts access to care to one population only and dilutes quality care to drive up revenue. This is not excellence, but mediocrity. Long Island children and families deserve better.

Andrew Malekoff, Long Beach

Editor's note: The writer is executive director of the North Shore Child & Family Guidance Center in Roslyn Heights, a nonprofit children's mental health center.

COMMUNITY MENTAL HEALTH WOES

Community mental health woes

 

in Long Island Business News, LIBN.COM - April 17-23, 2015, p. 14

Andrew Malekoff

When Nassau residents decided that speed cameras in school zones were unfair, their outrage got the attention of local politicians. The cameras were gone in record time. And when taxpayers told their representatives to keep gambling off the block, the pols backed down, knowing they were waging a losing bet.

So why are our state leaders closing their ears to the pleas of children and families in desperate need of mental health services?

Across Long Island, the agencies that care for the most vulnerable are dropping like flies, victims of a mentality that stigmatizes psychiatric illness and a short-sighted healthcare system more interested in managing costs than managing care. This year alone, FEGS, a $250 million agency, closed after 80 years. Catholic Charities will close its outpatient mental health clinic in Freeport in May. Previous L.I. victims were South Shore Child Guidance, the Family and Children's Association, Peninsula Counseling Center and Pederson-Krag Center.

The pattern is clear: For decades, big government has cut funding to mental health services across the nation, and the cuts just keep on coming.

Failed state and federal leadership has enabled insurance companies to make it nearly impossible for community-based mental health clinics to survive, unless they reduce the time spent with clients to squeeze in more billable hours; refuse to handle crisis situations that require greater resources; restrict access, taking only patients who have Medicaid, which pays a higher rate than commercial insurers; and/or fire salaried employees and hire per diem staff who have little stake in the agency’s values.

When the “community” is taken out of community-based mental health care, it’s not just semantics. Time-honored practices fall by the wayside. Cultures fall apart. Quality of care crumbles.

Government powerbrokers continue to slash funding for lifesaving programs. Why? Follow the money. Insurance company lobbyists pay them big bucks to turn their backs on those in need.

But politicians also listen when constituents make noise. Isn’t it time we get loud about something as critical as the health and well-being of our children?

 

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

CRISIS IN THE CLINICS by Laura Figueroa

CRISIS IN THE CLINICS…as demand grows, mental health facilities dwindle on Long Island

April 12, 2015 by LAURA FIGUEROA / laura.figueroa@newsday.com

Increasing numbers of nonprofit mental health clinics on Long Island are closing or being sold to other mental health networks, following years of declines in government funding and a growing demand for services.

In the past four years, at least four clinics have closed in Nassau and Suffolk, including one that has closed and one about to close this year, and four clinics have been acquired by other nonprofits.

The closures have prompted several local social service advocates to ramp up fundraising efforts while lobbying for increases in government aid. They say treatment options are dwindling for low- and middle-income patients who earn too much to qualify for Medicaid.

"There is somewhat of a crisis in the system," said Jeffrey Steigman, chief administrative officer of the nonprofit Family Service League, of Huntington, which provides counseling services for children and families.

In February, the league acquired the Huntington clinic of Pederson-Krag, a social service agency founded in 1957. But "it's not just the clinic we took over," Steigman said. Mental health agencies "throughout the state are transferring their licenses or closing clinics because of the financial burden and the deficits that occur. The fiscal model is broken in certain ways," he said.

Currently, there are 18 licensed nonprofit mental health facilities in Nassau and 48 in Suffolk, according to the State Office of Mental Health Services. The clinics provide services, including family counseling and drug rehabilitation, for low- and middle-income residents who cannot afford private care.

More than 10,000 individuals sought treatment at nonprofit clinics in Nassau last year, according to the county's Office of Mental Health, Chemical Dependency, and Developmental Disabilities Services.

Suffolk's Office of Mental Hygiene said it did not have overall figures. But state data show that nearly 4,000 Suffolk adults and 1,200 children enrolled in Medicaid sought mental health services in 2013. In Nassau, there were 3,600 adults and 850 children on Medicaid who received mental health services.

Freeport clinic forced shut

In May, Catholic Charities Outpatient Mental Health Clinic in Freeport, which has treated 550 patients a year, will shutter after more than 50 years in operation. Earlier this year, the 81-year-old nonprofit Federation Employment and Guidance Services, which provided mental health services throughout Long Island, announced it was closing.

The closures came as Peninsula Counseling Center, a Valley Stream nonprofit founded 102 years ago, and three clinics operated by Pederson-Krag were acquired by other nonprofit mental health agencies in recent months, after years of struggling to stay afloat financially.

Laura A. Cassell, CEO of Catholic Charities of the Diocese of Rockville Centre, said the organization decided it no longer could afford to run its Freeport clinic, because of insufficient reimbursement rates and declining government funding to subsidize care. Over the past three years, Catholic Charities had to raise $1.26 million in private donations to keep Freeport open, Cassell said.

"While Catholic Charities is blessed with generous donations to support our ministries, we cannot direct such a large portion to just one service site," Cassell said. "Many other mental health providers were forced to close their doors for the same reason."

"Unfortunately, with no hope of permanent additional funding to match the real costs of providing quality services in the future and increasing unfunded government regulatory mandates, this painful decision had to be made," Cassell said.

In a newsletter to Long Island mental health providers last month, Martha A. Carlin, director of the Long Island field office of the state Office of Mental Health, noted that with the closures and acquisitions, the "beginning of 2015 has been challenging for the Long Island region."

Declining reimbursements

Mental health providers say some of their fiscal strain is due to low reimbursement rates by private insurers.

Under Medicaid, clinics are reimbursed an average $130 per visit for an adult patient and $137 for children, according to state figures.

Commercial insurance providers pay anywhere from 20 percent to 50 percent less, several local mental health providers said. Officials with the New York Health Plan Association, which represents commercial health insurance providers, said they could not provide data on reimbursement rates because each company negotiates rates with clinics.

The incentive to treat higher-paying Medicaid patients means that some clinics are opting to see fewer patients covered by commercial insurance, said Andrew Malekoff, executive director of the North Shore Child and Family Guidance Center in Roslyn Heights, a nonprofit that has about 5,000 clients annually.

Malekoff, who has testified before state lawmakers about the challenges faced by nonprofit mental health providers, said that with fewer clinics accepting privately insured patients, many families who earn too much to qualify for Medicaid are "left with nowhere to turn for affordable community-based outpatient mental health care."

The closure of one nonprofit clinic often causes a ripple effect among the small group of Long Island nonprofit clinics, where phones are "ringing off the hook," with queries from displaced patients looking for affordable care, said Jeffrey Friedman, CEO of Central Nassau Guidance Services in Hicksville.

"As a result of the closures, we've had an influx of people calling us," Friedman said. "I think for us the landscape is changing drastically because the reimbursement from insurance companies is not adequate. We're losing money on that visit."

Leslie Moran, spokeswoman for the New York Health Plan Association, said each provider negotiates reimbursement rates with clinics, aiming to control costs to keep plan rates down for consumers.

"The reality is, in our health care system, affordability is something we have to keep an eye on," Moran said.

In 2012, the nonprofit Family & Children's Association, of Mineola, closed its mental health clinics in Roosevelt and West Hempstead, after years of deficits stemming from services provided to low-income patients.

Jeffrey Reynolds, executive director of the association, said losses at both clinics in 2011 totaled $1.6 million. Keeping them open would have "threatened the livelihood" of other operations, including homeless shelters for seniors and runaways, Reynolds said.

"What happens when you lose these clinics is you're driving people into chemical dependency, ERs or jails," he said.

State taking steps to aid LI

State Office of Mental Health spokesman Ben Rosen, to whom Carlin referred questions, said the agency has "taken several steps to help Long Island's mental health clinics remain fiscally viable." Rosen said $60 million has been allocated over the next three years to fiscally distressed clinics statewide, including seven in Nassau and Suffolk. The clinics, which include the former Pederson-Krag clinics, each were assigned "strategic planners" to improve their finances over the next three years, Rosen said.

The agencies acquiring some of the local facilities say the transition is going as seamlessly as possible.

Herrick Lipton, administrative and financial director of New Horizon Counseling Center, said that since taking over Peninsula, the agency has done repair work at the clinic and installed a flat-screen TV in the waiting room. New Horizon, which also runs clinics in Ozone Park, East Elmhurst and the Rockaways, also is planning to add Saturday service hours at Peninsula, Lipton said.

"Peninsula was losing money, it didn't have the ability to invest in repairs . . . they were in dire straits," Lipton said. "Our goal is to create a sustainable solution for mental health services for Nassau County. In today's environment, many health care providers are struggling to survive."

RESPONDING TO COMMENTARY BY NEW YORK STATE OMH

 

As director of the only specialty children’s mental health agency on Long Island, after reading the New York State OMH Long Island Field Office (LIFO) News from the Field, Winter 2015 edition, I was left with few thoughts. In the cover story, From the Director’s Chair, by LIFO Director Dr. Martha Carlin, she comments on multiple outpatient clinic closings and acquisitions on Long Island.

Dr. Carlin stated that the closures “point to a myriad of difficulties among providers, which impacts on the provision of quality clinical care.” However, nothing was mentioned in her report about the impact of New York State’s Clinic Reform policy, which has been the major contributor in advancing clinic closures, restricting access to care and compromising quality clinical care for New Yorkers in need of community-based care.

Regarding Dr. Carlin’s reference to recent closures of mental health clinics at Peninsula Counseling Center in Nassau and Pederson-Krag in Suffolk, what her commentary did not address is that both of these long-standing and highly-respected organizations were acquired by Queens-based PSCH. Then, after only a few years, PSCH decided to let go of the mental health clinics operated by both of these esteemed organizations.

Consequently, an acquisition by a $100 million organization (PSCH) that was implemented and did not hold, led to a second round of acquisitions. Which begs the questions, what went wrong? and what has been and will be the impact on consumers?

Some of the ways that clinics stay afloat in this environment, beyond fundraising, is to restrict access to care only to consumers with the best insurance rates (Medicaid), to see consumers for shorter periods of billable time in order to pack more revenue into a day, to remove salaried employees to save expenses by eliminating fringe benefits, to not respond to time-consuming and labor-intensive crisis situations, to cut parents and other relevant family members out of the clinical equation, and to curtail consistent clinical supervision and team meetings. In other words: build a factory to maximize revenues and minimize quality care.

In another article, in the March 5, 2015 issue of Crain’s Business Health Plus, it was reported that “Mergers and acquisitions activity among behavioral health nonprofits with budgets under $25 million is expected to increase substantially this year . . . given that the state’s Office of Mental Health has made its desire for consolidation an open secret. From a government perspective, it simplifies the number of contacts and number of relationships that they need to have. The unknown is the impact on program services.”

It seems to me that what is impacting quality clinical care most, are the actions of New York State that have resulted in restricted access to care and the development of a business environment that is least conducive to a community-based, mission-driven clinic. In other words, the focus is on managing cost as opposed to managing care.

Dr. Carlin stated that, “although the challenges continue there are many exciting changes happening within our system which will help better the lives of people we serve.” She cited telepsychiatry, DSRIP (Delivery System Reform Incentive Payment Program) and Managed Medicaid as examples.

I do not feel encouraged by a system that restricts access to care to one population and dilutes quality care to drive up revenue. Long Islanders – children and families – who need quality community-based mental health care deserve better.

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

REMOVING THE STIGMA - We must start treating illnesses above the neck the same as illnesses below the neck?

Anton News, Long Island; Opinion – Andrew Malekoff

February 25 – March 3, 2015 

When we hear that our neighbor’s teenage son has been diagnosed with cancer, or that our colleague’s newborn has a heart defect, we shed some tears—and then we move into action. We bring meals; we offer to take their other kids to soccer games or piano lessons; we raise money so the parents can stay home from work to care for their ailing children.

But when we learn that our daughter’s best friend has been hospitalized for depression, or that a boy on our son’s basketball team has stopped going to school because of severe anxiety, we’re often at a loss as to how to respond.

Here’s a fact that may surprise you: Although more children suffer from psychiatric illness than autism, leukemia, diabetes and AIDS combined, only one of five with an emotional disturbance gets help from a mental health specialist. Moreover, 50 percent of serious mental illness occurs before the age of 14.

People with mental health problems and addictions, along with their families, often suffer in silence, while people with physical health problems evoke the sympathy and support of others. Why do we continue to treat illnesses above the neck differently than illnesses below the neck?

The sad truth is that there’s still a widespread stigma when it comes to mental health. The result? Parents who need help often wait months and even years to make that first phone call. A parent whose child is diagnosed with cancer doesn’t wait to ask for help. Waiting only happens with mental illness and addiction.

Fortunately, more than 60 years after our founding, North Shore Child & Family Guidance Center is still here to fight that stigma and provide help to children in need. Let me share a few of their stories.

We met nine-year-old Joey 14 years ago, a few weeks after his father died in the World Trade Center. We soon discovered that he was calling his dad’s cell phone number every day. As Joey explained, “I call because, what if he is still alive? I don’t want him to be all alone.”

We met seven-year-old Jeremy two years ago. He came to us holding a large flashlight in his tiny hands. He said he needed it in case the lights went out again, like they did after Hurricane Sandy, when Jeremy lost his toys, his home, his daily routine. And, as Joey before him, he lost his belief that the world is a safe place.

While we do respond to headline stories, we more often are called upon to respond to personal dramas and private disasters that are hidden in plain sight.

For example, we met six-year-old Jerome soon after he attempted to jump out a window because, as he said, “Nobody loves me.” Fifteen-year-old Celeste said the reason that she cuts her arms until they bleed is not to take her life, but to lower her blood pressure. And 14-year-old Maria told us that she lives in a house with a revolving door welcoming men who touch her.

Depression, anxiety, fear, child abuse, school refusal, bullying, isolation, drug addiction, domestic violence . . . we receive more than 100 calls a week, and increasing numbers are emergencies.

All across Long Island, mental health agencies are shuttering their doors, or they’ve been acquired by corporate entities with no roots in the community. That’s tragic, because community-based mental health organizations are as essential to the health and well-being of our children as hospitals or schools.

What can you do? First, tell your representatives that you value the mental health organization that serves your community and would like their support to ensure its future. And if you know someone whose child is suffering from a mental health issue, don’t ignore them. Make that phone call. Let them know you care.

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.

More focus, money for mental health

NEWSDAY

December 4, 2014

Immediately after the Dec. 14, 2012, shootings in Newtown, Conn., mental health experts offered tips to speechless parents about how to soothe their children ["Report: Sandy Hook killer enabled," News, Nov. 22]. The advice sounded like this: Be available emotionally, be compassionate, limit media exposure, reassure safety, offer distractions to prevent obsessive worry, monitor for angry outbursts and depression and, if symptoms persist, seek professional help.

I imagine many parents were thinking, instead, "It's a cruel world, evil is everywhere, watch your back, and don't trust anyone."

After the Sandy Hook shootings there was probably not one parent in the United States able to escape the tyranny of imagining his or her child being killed in a neighborhood school. How many more children will be taken before lawmakers devote energy and resources to safeguarding our children?

Take steps to prevent gun violence -- within the constitutional right to bear arms -- and provide adequate funding for community-based mental health centers for the emotional well-being of all of our children.

Andrew Malekoff, Long Beach

Editor's note: The writer is the executive director for the nonprofit North Shore Child and Family Guidance Center in Roslyn Heights.

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

We must start treating illnesses above the neck the same as illnesses below the neck?

PARENTING PLUS column for Anton News, Long Island, NY, February 2015

When we hear that our neighbor’s teenage son has been diagnosed with cancer, or that our colleague’s newborn has a heart defect, we shed some tears—and then we move into action. We bring meals; we offer to take their other kids to soccer games or piano lessons; we raise money so the parents can stay home from work to care for their ailing children.

But when we learn that our daughter’s best friend has been hospitalized for depression, or that a boy on our son’s basketball team has stopped going to school because of severe anxiety, we’re often at a loss as to how to respond.

Here’s a fact that may surprise you:  Although more children suffer from psychiatric illness than autism, leukemia, diabetes and AIDS combined, only one of five with an emotional disturbance gets help from a mental health specialist. Moreover, 50 percent of serious mental illness occurs before the age of 14.

People with mental health problems and addictions, along with their families, often suffer in silence, while people with physical health problems evoke the sympathy and support of others. Why do we continue to treat illnesses above the neck differently than illnesses below the neck?

The sad truth is that there’s still a widespread stigma when it comes to mental health. The result? 

Parents who need help often wait months and even years to make that first phone call. A parent whose child is diagnosed with cancer doesn’t wait to ask for help. Waiting only happens with mental illness and addiction.

Fortunately, more than 60 years after our founding, North Shore Child & Family Guidance Center is still here to fight that stigma and provide help to children in need. Let me share a few of their stories.

We met nine-year-old Joey 14 years ago, a few weeks after his father died in the World Trade Center. We soon discovered that he was calling his dad’s cell phone number every day.  As Joey explained, “I call because, what if he is still alive? I don’t want him to be all alone.”

We met seven-year-old Jeremy two years ago. He came to us holding a large flashlight in his tiny hands. He said he needed it in case the lights went out again, like they did after Hurricane Sandy, when Jeremy lost his toys, his home, his daily routine. And, as Joey before him, he lost his belief that the world is a safe place.

While we do respond to headline stories, we more often are called upon to respond to personal dramas and private disasters that are hidden in plain sight. 

For example, we met six-year-old Jerome soon after he attempted to jump out a window because, as he said, “Nobody loves me.” Fifteen-year-old Celeste said the reason that she cuts her arms until they bleed is not to take her life, but to lower her blood pressure. And 14-year-old Maria told us that she lives in a house with a revolving door welcoming men who touch her.

Depression, anxiety, fear, child abuse, school refusal, bullying, isolation, drug addiction, domestic violence . . . we receive more than 100 calls a week, and increasing numbers are emergencies.

All across Long Island, mental health agencies are shuttering their doors, or they’ve been acquired by corporate entities with no roots in the community. That’s tragic, because community-based mental health organizations are as essential to the health and well-being of our children as hospitals or schools.

What can you do? First, tell your representatives that you value the mental health organization that serves your community and would like their support to ensure its future. And if you know someone whose child is suffering from a mental health issue, don’t ignore them. Make that phone call. Let them know you care.

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. 

MENTAL HEALTH CENTERS IN DECLINE

Mental Health Centers in Decline

LONG ISLAND WEEKLY - MARCH 11-17, 2015

by Andrew Malekoff

So here's the deal folks. Last week it was announced that Catholic Charities is giving up their Freeport mental health clinic. In January, $250 million, 81-year-old FEGS announced it was closing; before that Peninsula Counseling Center (PCC) in Valley Stream and Pederson-Krag Center (PK) in Huntington gave up their mental health clinics. (Actually it is more insidious than that. PSCH, an NYC-based $100 million operation, took over PK and PCC and then dumped their mental health clinics). Before that, South Shore Child Guidance was taken over by the Epilepsy Foundation. And before that, Family and Children's Association let go of their mental health clinics in Roosevelt and West Hempstead. And, there is more to come.

Now, one might ask, "Well, aren't they being picked up by other organizations?” That may be so; but these mental health clinics were tied to reputable organizations with venerable histories and committed local boards of directors. In other words, they were grounded in community-based cultures.

Culture matters when growing an organization! Change the culture and the values follow. Change the values and time-honored practices change too. Managed care becomes managed cost, and vulnerable children and their families are then shortchanged as a factory mentality prevails.

Why is this happening? Because New York State government leadership is neglectful, misguided and lacking in humane leadership. And, because they can get away with it.

The State has systematically stripped funding from well-established, community-based organizations and, in so doing, has restricted access to care to Medicaid recipients only. Meanwhile, private insurance companies pay substandard rates. Consequently, fewer and fewer providers will contract with them, leaving hundreds of thousands of middle class families in NYS with nowhere to turn for affordable, community-based outpatient mental health care for their children.

Government leaders won't address the fact that insurers do not have adequate networks of providers because providers don't like their substandard rates of pay. Why doesn't the government better regulate them? Because the insurance companies' lobbyists pay elected officials big bucks for their silence. Elected officials can apply pressure or ease pressure depending on what best suits them and their campaign treasuries.

Now, back to those that let go of the mental health clinics and those that picked up their business. The only profitable way for the latter to proceed, with few exceptions, if any, is to restrict access to care to clients with the best insurance rates (that's Medicaid); to see clients for shorter amounts of billable time to pack more revenue into a day; to eliminate salaried employees to save expenses by eliminating fringe benefits; to not respond to time-consuming and labor-intensive crisis situations; to cut parents out of the equation; and to eliminate consistent clinical supervision and team meetings that are essential to quality of care. In other words, build a factory to maximize revenues and minimize quality care.

In the end, what you get are fewer and fewer vulnerable children who are able to access the best care and more and more services that slide from a gold standard of care to a bronze standard or worse. This is because New York State plays us for fools. Do you know what they refer to their "transformation" initiative as? CLINIC REFORM and REGIONAL CENTERS OF EXCELLENCE. They deform clinics and call it reform, and they offer mediocrity and call it excellence. Factories and propaganda.

So why are North Shore Child & Family Guidance Center and a few others still standing and providing universal access to care with diverse (including bilingual), salaried employees? Because their boards of directors won't have it any other way. For now, that is. Whether they can continue to weather the scorched earth policy of New York State remains to be seen. Nevertheless, the public deserves to know what our government and the insurance industry are up to. What are they up to? NO GOOD.

Which kids’ lives are at stake? What kinds of issues are they facing? Depression, anxiety, abuse, neglect, trauma, domestic, violence, isolation, school failure, demoralization, bias, bullying, family unrest, learning problems, posttraumatic stress, loss and grief, gang exposure, rape, incest, poverty, dislocation, suicide, homicide, obesity, eating disorders, alcohol and drug addiction, gambling, cutting and burning oneself, immigration (including unaccompanied minors), adjusting to foster care, loneliness, and more.

These are the children that a community-based mental health center sees every day. Lots of them each week, thousands each year. This is what is at stake. This is what is being neglected and eroded by New York State.

What will come of this? More tragedy for more families and, ultimately, more cost to warehouse vulnerable children and youths who will not be able to access preventive care or more intensive outpatient care early on.

How will tragedy manifest itself? Probably not horrifically, like Sandy Hook where the outcry and ocean of tears changed nothing of significance that anyone sees or feels on the ground. It will happen more insidiously and slowly, in drip, drip, drip fashion. That is, unless there is pushback.

Pushback against speed cameras and slot machines brought about change in Nassau County in the snap of the finger. But children's mental health? Nah, nobody's going to stand up for that. Until it is their child who is suffering and can't get quality care. And then, too often, they fight alone. After all, STIGMA rules. And it crushes.

It is more convenient for the masses to pretend that children's mental health problems are the result of bad upbringing or moral failing. Bad government counts on that. Everyone rallies around kids with cancer. But who rallies around kids with mental illness?

You?

You CAN make a difference.

TAKE ACTION AND BE A VOICE FOR VULNERABLE CHILDREN!

Here’s how to help:

· Share this with your friends and colleagues via Facebook, email and other social media

· Write to your local newspaper

· Contact your local, state and federal legislators (see below for contact information)

To find your congressperson: http://www.house.gov/representatives/find/

To find your senator: http://www.senate.gov/general/contact_information/senators_cfm.cfm

To find your New York State Senator in Albany: http://www.nysenate.gov/senators

To find your New York State Assembly member: http://assembly.state.ny.us/mem/search/

Andrew Malekoff is executive director and CEO of the nonprofit North Shore Child & Family Guidance Center in Roslyn Heights, NY

THE DAWNING OF THE MENTAL HEALTH WALMART

THE DAWNING OF THE MENTAL HEALTH WALMART

Submitted to the New York Nonprofit News 12/6/14

Andrew Malekoff, Executive Director / CEO, North Shore Child and Family Guidance Center, Roslyn Heights, NY

New York State's scorched earth policy against mid-size and smaller community-based mental health centers and middle-class children and families has come to fruition on Long Island. Recently PSCH, a $100 million NYC-based agency led by a number former OMH officials, decided to let go of the mental health clinics of two long-standing and highly reputable Long Island-based agencies that they took-over just a few years ago with the blessing of OMH. Pederson Krag and Peninsula Counseling Center's (PCC) mental health programs are gone or on their way out, left to be scooped up by other willing suitors. My friend and colleague the late Herb Ruben, a true mental health advocate who led and built PCC during a 50-year period, must be rolling over in his grave.

OMH has been encouraging mergers (aka takeovers) for years. In this case, two deeply-rooted organizations with more than a combined 100 years on Long Island have seen their mental health services thrown to the wind to be picked up and absorbed elsewhere, never to retain what took the better part of a century to build, a strong, trusted and undeniable presence in the local community.

This is the dawning of the age of the Mental Health Walmart. We are in early stages of a sad time of proliferating Medicaid mills, where children and adolescents with mental health problems will be shuffled along a conveyer of would-be evidence-based care administered by fee-for-service workers with no time to address crisis situations or to make even adequate collateral contacts with schools and other relevant people in the children’s lives. Middle-class families are being pushed out of the so-called “system transformation” process and poorer families are seeing the quality of care erode into to a series of half hour, revenue-maximizing, individual sessions.

The transition from a gold standard to a bronze standard of care is well underway. And, this is happening at the same time that almost $6.5 billion is being thrown at the Medicaid-driven acronym-of-the-year DSRIP – Delivery System Reform Incentive Program, a hospital-conglomerate-run initiative with the admirable goal of reducing emergency room visits and hospital readmissions, for Medicaid patients, of course. Another $1.2 billion is being made available for capital projects.

The other acronyms receiving mere millions are the $7 million to CTAC – Children’s Technical Assistance Center that trains agencies how to best serve Medicaid clients and send those with private insurance packing.  And, most recently on board is the $30 million to VAP – Vital Access Provider initiative aimed at helping agencies that are on life support to find ways to become fiscally self-sustaining on a diet of Medicaid-only clients or take steps to be taken over as Pederson Krag and Peninsula before them. And, oh yes, there is another acronym I almost forgot to mention. That is OT – Overtime. According to NYS Comptroller Tom DiNapoli, the New York State Office of Mental Health spends $100 million annually on overtime expenses.

At North Shore Child and Family Guidance Center, founded in 1953, the only specialty children’s mental health agency on Long Island, we have not received an increase in our Article 31 contract funding in more than 30 years.  If not for our community supporters we would have disappeared long ago, along with our sister agencies. A very small percentage of the billions being spent could make a difference and would go a long way to sustaining needed children’s mental health services on Long Island. But all appeals continue to fall on deaf ears, from the governor to the legislators to the commissioners.

Hello, hello, anyone out there! Does anyone in Albany care?

NEW VAP FUNDING SKIRTS THE ISSUE OF UNIVERSAL ACCESS

New VAP funding skirts the issue of universal access by Andrew Malekoff in the New York Nonprofit News, November, 25, 2014 http://www.nynp.biz/index.php/points-of-view/23292-new-vap-funding-initiative-skirts-issue-of-universal-access

By Andrew Malekoff, Executive Director and CEO, North Shore Child and Family Guidance Center Recently, I participated in a New York State Office of Mental Health Clinic Vital Access Provider (VAP) webinar. The webinar is a first step towards Article 31 mental health clinics applying for funding to preserve long term critical access to community-based mental health services. A total of $60 million in funding, over a three year period, is available. The intention of the VAP funding opportunity is for community-based mental health clinics that are “fiscally challenged” to develop plans that will demonstrate fiscal viability after three years. The funds can be used for such things as incremental costs for staffing and billing software, for example. Each clinic that receives a VAP award will be assigned a “strategic planner,” who would be a financial specialist, to help them to complete their final application, to include measurable outcomes. The ongoing achievement of measurable metrics will be tied to continued payments to agencies that have been awarded funding. The ultimate goal of the project, whether through mergers, improved efficiencies such as centralized scheduling, or agency sharing of back office functions, will be to ensure long term fiscal viability. I thought that the webinar was very informative. Webinar participants were given an opportunity to ask questions by typing them into a chat box function during the presentation. At the end of the almost two hour webinar, the moderator thanked the participants and concluded the session by stating that all questions had been addressed. Not so! Here are three questions that I typed in that the moderator did not acknowledge or respond to: Is the VAP funding initiative biased against middle class and working poor non-Medicaid children and their families who have no other viable access to labor-intensive community-based mental health care? Our specialty children's mental health agency [North Shore Child and Family Guidance Center] works with approximately 68% non-Medicaid and 32% Medicaid and Medicaid Managed Care families? Would a viable VAP proposal look to severely restrict access to care for children in Nassau County who need our outpatient care? It appears that you are supporting mergers. Is there any concern about what has come of the New York City-based PSCH takeovers in Nassau and Suffolk Counties? I felt that I had to ask these questions since, in my attending one webinar after another sponsored by OMH’s Children’s Technical Assistance Center (CTAC), the issue of universal access to children’s outpatient mental health care is routinely skirted. The sole focus of OMH webinars, regarding children in need of mental health care, are Medicaid-eligible children. North Shore Child and Family Guidance Center is a proponent of universal access for children and their families. New York State is not. On the issue of access to care, earlier in the year I asked Governor Cuomo about this and he directed my letter to OMH Commissioner Dr. Ann Marie T. Sullivan, who responded by stating that there is a work group looking into the issue of the non-Medicaid population. One outcome would be to get commercial insurers to increase their rates which, on average, are significantly lower than Medicaid rates. However, the State Department of Financial Services, within which the State Insurance Department is subsumed, does not have the authority to regulate commercial rates. Statute change, which is unlikely, would be required for this to happen. Presently, commercial insurance network adequacy, including for behavioral health care, is monitored every three years by the Department of Financial Services. However, I think it is unlikely that this will lead to significant penalties that would bring about change for entities that do not provide adequate networks of care. After all, the health insurance lobby is well-healed and well-connected in Albany. On the issue of mergers, a few years ago New York City-based PSCH took over Pederson Krag in Suffolk County and Peninsula Counseling Center in Nassau County, both well-established and well-respected community-based mental health agencies on Long Island. When a larger entity takes over a smaller one, the smaller one’s board of directors is dissolved and, at best, becomes an advisory committee, with a few select board members joining the larger entity’s board of directors. This is a step toward diluting the local community’s investment in the organization and its mission. It appears that PSCH has given up on Pederson Krag and its clinics are being dispersed and made available to other interested parties. Will this also be the fate of Peninsula Counseling Center? What are the consequences of decades of dedicated professional and lay leaders building a community-based culture, and then having it demolished by a takeover by a $100 million dollar organization that did not take. And, so, I thought it was a reasonable question to ask the VAP moderator whose agenda would appear to promote mergers and takeovers. What do you think?

$94 Million in Overtime or Universal Access to Mental Health Care?  You Choose

Andrew Malekoff

New York Nonprofit Press - May, 2014

For three decades New York State has been systematically marginalizing middle class and working poor families who have children with serious mental health problems. This is a truth that the public is unaware of unless you have a child who is refusing to go to school, cutting herself, paralyzed by anxiety, deeply depressed or suicidal. Because mental illness is stigmatized, the reality of the State’s neglect has been obscured from view.

We continue to treat illnesses above the neck differently than those below the neck.  People with mental health problems, and their families, often feel a sense of shame and suffer in silence, while people with physical health problems evoke the sympathy, support and comfort of others.

 

In 1991, New York State implemented a plan to use Medicaid dollars to fund outpatient community-based mental health services. That approach, also known as Medicaiding-the-system, is gone.

Medicaiding-the-system was a combination of a base Medicaid rate applied for each outpatient community-based mental health clinic visit for Medicaid recipients only and supplemental dollars paid on top of each base payment to subsidize non-Medicaid consumers (known as Comprehensive Outpatient Funding or COPS). This approach to support community-based agencies was developed to replace local assistance or deficit-financing.

Local assistance was a simple and sensible public-private financing partnership. The partners were the State and County governments (through government funding), mental health consumers (through third party and fee-for-service revenue) and the local community (through fund-raising that was a part of the local assistance government contract). Local assistance funding insured that all stakeholders chipped in their fair share to support an essential community-based service.

In 2009, New York State announced that the Medicaid-bankrolled COPS approach of financing community-based clinics had the inadvertent affect of propping up commercial insurers who were paying substandard rates. Having uncovered that festering wound, OMH got to work on creating a new financing plan that they referred to as clinic restructuring or clinic reform.

The clinic reform plan raised the Medicaid-base rate, added new rates for previously unfunded or underfunded services (known as Ambulatory Patient Groups or APGs), and phased out the supplemental COPS Medicaid rate over a four-year-period that recently came to an end. The Medicaid base-rate and APGs now apply only to those families who have straight Medicaid and Medicaid managed care insurance.

In my discussions with New York State officials about the devastating consequences of the clinic reform plan for middle class and working poor families who do not have Medicaid insurance, I was advised that community-based mental health centers must re-negotiate rates with commercial insurers. That is nothing new. It is common practice. The state officials advised me that if the commercial insurers do not raise their rates to sufficient levels that will help to cover the cost of the services provided, then we should terminate our contracts with them.

Community-based providers routinely re-negotiate rates with the managed-care companies which represent private health insurers. However, they rarely agree to rates that come close to covering the cost of service. As one managed-care representative told me, “C’mon, we’re hurting too.” And, he said it with a straight face, despite record profits. State officials told me that community-based agencies like North Shore Child and Family Guidance Center, a specialty children’s outpatient clinic where I have worked for 37 years, should change their payor-mix. Payor-mix is a euphemism for terminating contracts with private health insurers and, consequently, denying service to thousands of children who need us.

When I pressed him on this, his response was that “the marketplace will take care of it,” referring to private practitioners. But mental health providers know that private child psychiatrists and other private behavioral health practitioners will not accept substandard rates or take on the labor-intensive work required to address the needs of children with serious mental illness (e.g. collateral contacts, crisis intervention, etc.) Nevertheless, commercial health insurers must by license demonstrate “network adequacy.”

Network adequacy refers to a health plan's ability to deliver the benefits promised by providing reasonable access to a sufficient number of in-network primary care and specialty physicians, as well as all health care services included under the terms of the contract. The truth is that many health insurers do not have adequate mental health care networks despite the voluminous number of names on their rosters. But tell me, really, what private citizen or community-based nonprofit can be successful in advocating for the revocation of licenses of private health insurers with the millions of lobbying dollars backing them up? Good luck!

The truth is that for many families, when it comes to seeking mental health care for their children, the process of finding help is a shell game aided and abetted by New York State. New York State claims that they cannot provide additional local assistance funding to help to subsidize universal mental health care in community-based clinics, which must also raise funds by contract, to support these vital services. Consequently many clinics are turning away all but Medicaid applicants for their services. But, is it true that New York State cannot offer local assistance support?

In a recent report issued by NYS Comptroller Thomas DiNapoli, it was revealed that the New York State Office of Mental Health runs up annual overtime expenses of $94 million a year. And, this is happening at the same time that the state is footing the bill for nonprofit community-based mental health clinics to enroll in state-sponsored efficiency classes that are a part of the State Office of Mental Health’s Clinical Technical Assistance Center (CTAC) initiative.

The goal of the efficiency classes is to improve the bottom-line by implementing centralized scheduling, open access and collaborative documentation. Fair enough. However, CTAC trainers have joined the state officials’ chorus about marginalizing the middle class and working poor. One CTAC trainer told me, during a recent webinar when I raised the question about the discrepancy in reimbursement rates, “You must change your payor-mix.”

Can you imagine how much savings there would be if OMH took the efficiency classes and were just a little bit more efficient with their use of overtime; and, how much of that savings could go towards supporting universal community-based outpatient mental health care for children?

And, keep in mind that that OMH’s excessive annual overtime expenditures presents New York taxpayers with a pay now and pay later scenario. We pay today for overtime and we will pay later for elevated pension benefits for State employees, a number of whom have left the Office of Mental Health to take on lucrative administrative positions with large conglomerates that state officials encourage smaller clinics to “merge with”; a euphemism for “be taken over by”.

To sum up, the State claims that there is no additional local assistance funding for community-based clinics to provide universal mental health care; clinics are then “encouraged” to take State-funded efficiency classes to reduce their cost of service by dropping underinsured middle class and working poor clients; The New York State Office of Mental Health generates overtime expenses of $94 million per year (plus increased employee pension benefits in perpetuity, at taxpayer expense); private health insurance companies present only the illusion of network adequacy and hide behind lobbying payoffs; community-based mental health clinics are closing or turning away all but Medicaid applicants or are being taken over by conglomerates administered by ex-OMH officials who are collecting overtime-time inflated State pensions on top of lucrative salaries from the takeover institutions; and kids and families who don’t have Medicaid insurance are being turned away from community-based care.

If New York State will not support essential community-based mental health services for the most vulnerable members of our communities – our children – then who will?

 

Andrew Malekoff, executive director and CEO of North Shore Child and Family Guidance Center in Roslyn Heights, NY. amalekoff@northshorechildguidance.org