POISONED CHILDREN IN AMERICA

Published in The Hill, February 16, 2016

By Andrew Malekoff

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

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

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

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

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

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

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

There is news coverage and there is finally some action being taken, but it feels muted to me as compared to Sandy Hook, for example. The residents of an entire American city were poisoned for 19 months. There were warning signs, yet government officials told the citizenry that the water was fine. It wasn’t until researchers pointed to elevated levels of lead in children under five after the switch to a cheaper water supply that any changes were made. After 19 months of poisoning.

We are all too familiar in New York with government corruption. We’ve been treated to a parade of legislators and public officials charged with and convicted of bribery, fraud, conspiracy, racketeering, money laundering, tax evasion and such. But poisoning children? 

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

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

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

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

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?

SIXTY YEARS OF INSTILLING HOPE, RESTORING MORALE AND MORE

Sixty Years of Instilling Hope, Restoring Morale and More

Andrew Malekoff© March 2013

This year marks the 60th anniversary of North Shore Child and Family Guidance Center. I wonder if its founders, a small group of parents, could have imagined in 1953 that six decades later the Guidance Center would be taking more than 100 calls a week from parents concerned about their children’s emotional well-being. The callers tell stories about children and teens who are troubled, in trouble or causing trouble. Handling their first call sensitively is a hallmark of the Guidance Center. That first person-to-person contact makes all the difference in whether a parent chooses to take the next step forward towards hope or retreats into a sense of despair.

In the early 1950’s, the north shore communities of Long Island were experiencing rapid change. What was once a bucolic landscape peppered with small villages and large estates was being converted into a vast array of suburban developments. The last remaining farms were leveled as roads. Housing developments and schools suddenly popped up, many clustered near the most prominent new roadway, the Long Island Expressway.

According to Bob Smith, who penned a reflection on the first 50 years of the Guidance Center, “In the beginning there were the parents; a generation of mostly young professionals and middle-class workers who had come of age in the great depression, been tempered by the crucible of war, and then came marching home to an increasingly troubled urban environment. These young men and women came to the suburbs in search of a safer, healthier place to raise their children.” The new residents had come with little children or the expectation of children. They came as a single generation, not as an extended family. The priority of the suburbs became raising children.

The Guidance Center’s beginnings were rooted in a community-based model, where progressive-minded suburban activists organized to establish a children’s mental health clinic for members of the community in need of such services. The message to new suburbanites was that, despite their relocation into more affluent communities, mental health problems were not confined to the underprivileged and poor.

Smith recalled that the founders, “made it understood that the oft repeated remark – ‘wherever you go – there YOU are’ was, in fact, true; that the need for services crossed financial, educational, ethnic and class barriers. And that the suburban environment, because of its isolation, might even be more stressful for these young families than the urban environment might have been, with its close-knit neighborhoods and extended families for support.” This remains true today, despite dramatic changes in the intervening years.

Sixty years later, we are blessed to have modern technological innovations such as the Internet and cell phones that provide us with the capacity to make connections anywhere and anytime. Yet, instant access and social media are no replacements for more intimate face-to-face interaction, the essential medium of a community-based agency.

The 100-plus calls we receive every week tell different stories, yet are similar with characteristics of demoralization such as a sense of helplessness and hopelessness, inability to cope, self-blame, feelings of worthlessness and a sense of alienation. Perhaps the most enduring quality of the Guidance Center, over 60 years, is its ability to connect with struggling families of all backgrounds, up close and personal, and to instill hope and restore morale.

Happy 60th Anniversary North Shore Child and Family Guidance Center!

"TODAY'S WORK AT YESTERDAY'S PRICES"

“Today’s work at yesterday’s prices”

by Andrew Malekoff © 2012

One of the oldest, largest and most well-respected community-based human service agencies closed on January 27, 2012. Some 300 employees at Chicago’s Jane Addams Hull House Association were handed layoff notices and final paychecks and were notified of the immediate discontinuation of their health care benefits. This is a tragedy and an ominous sign.

Hull House was founded in 1889 by social worker and Nobel Peace Prize winner Jane Addams and her lifetime friend and community-activist Ellen Gates Starr. Hull House began as a home for disenfranchised citizens. The organization’s mission was “neighbors helping neighbors.” In its early years Hull House was organized to help immigrants to learn English and the principles of democratic citizenship and to improve the lives and working conditions of many of those living on the west side of Chicago. In recent years Hull House’s focus was on foster care, child care, domestic violence counseling and job training.

Hull House was a beacon for social justice. It was guided by three basic principles: (1) active and side-by-side participation with community residents in addressing local issues, (2) respect for the dignity of all individuals regardless of ethnic background, socioeconomic status, gender or age and (3) belief that poverty and lack of opportunity breed ignorance, crime and disease that are the result of financial desperation and not due to a flaw in moral character.

Hull House’s demise was the result of its over-reliance on government financing. Margaret Berglind, president of Child Care Association of Illinois, commented that “The government is asking you to do today's work at yesterday's prices." I agree.

At North Shore Child and Family Guidance Center we have not seen an increase in our government contracts for a quarter-of-a-century. We are not alone. As with Jane Addams over 100 years ago, we depend on private citizens to invest in our mission - to restore and strengthen the emotional well-being of children and families. Our donors understand what is at stake. They are more than do-gooders, despite the good that they do. They understand that what we do is cost effective, saving tens of millions of taxpayer dollars by keeping troubled young people at home and out of emergency rooms and costly institutional settings.

I have reported extensively on what I believed would be the devastating outcome of New York State’s plan to restructure the financing of outpatient community-based mental health centers. Although I agreed that the over-reliance on Medicaid financing had to change, I strongly disagreed with the planners’ neglecting to provide reasonable local assistance for underinsured middle class and working poor children. State officials told me that that these families could seek help privately. My argument, based on first-hand experience, was that private practitioners would turn away troubled children that only a community-based agency had the culture, resources and wherewithal to serve effectively.

We are beginning to see the consequences of clinic reform on Long Island. In recent years several major community-based mental health clinics have either closed their doors, been taken over by New York City-based conglomerates with no community roots or transformed their outpatient operations into per-diem factories with no salaried employees. Much of this has happened under the radar.

Was it the intention of the New York State Office of Mental Health to shrink the system of care? Although it is not their job to keep providers in business, it is their responsibility to ensure ample access and consumer choice and to make sure our most vulnerable citizens - our children - get care, regardless of their family's economic status.

I am certain that Jane Addams would have agreed.

To be published in the Anton chain of 18 Long Island, NY newspapers in February 2012.