LOOK AT WHERE WE HAVE COM

By Andrew Malekoff

If you haven’t been initiated just yet, the twitterspere is a fascinating place on the Internet populated by all kinds of people, from your neighbors to local shopkeepers to your long lost cousin to your favorite film actress to world leaders.

By Twittersphere or Twitterverse I refer to postings made on the social media website Twitter, considered collectively.

At any given moment in time postings might include news of the day, personal reflections, political leanings and gleanings, conspiracy theories, calls for social action, fond memories, jokes and riddles, aphorisms, recipes, links to music, film and book reviews, humorous gifs (animated or static images) and much more.

Some posters have millions of followers. Others have less than 10. Anyone can participate by posting or just by scrolling and reading.

If you wish you can respond to posts. You can approve or disapprove of what someone else wrote. Or simply add your own voice to a discussion.

If you do decide to post, beware: there are trolls in the twittersphere. Wikipedia defines a troll as “a person who starts quarrels or upsets people on the Internet to distract and sow discord by posting inflammatory and digressive, extraneous, or off-topic messages with the intent of provoking readers into displaying emotional responses whether for the troll's amusement or a specific gain.”

Fortunately, not every person who responds is a troll. Many are thoughtful and respectful and only interested in expanding a conversation.

Just the other day I was on Twitter and found a discussion about the beginning of the school year. The opening tweet was written on August 22 by a mom from Las Vegas who goes by the handle, @CandaceToddLV: “It’s the 8th day of the school year & I just received a call from my daughters high school informing me they arrested a child with a loaded 9mm gun on campus this morning. I am now standing in my kitchen sobbing. I should not have to live like this. @MomsDemand ”

Candace’s post drew a significant response. Almost 90,000 people “liked” her post and more than 1,700 people responded. One response was written by @marci6687 from Florida who replied, “While absolutely not as scary as your situation, in our 8th day as well we are on our 4th written threat and 5th day of controlled or alert campus.”

Another response was sent by @rememberpink1: “My heart bleeds for you. I had two nephews & a niece at Sandy Hook. As an aunt the pain & fear & anger was unexplainable. It STILL is. And I wasn’t their mother. I stand strong w/ you. I fear every day my kids are in school. We shouldn’t have to fear. THEY shouldn’t have to fear.”

Many of the responses, which I will not share here fed into a debate on gun control, politics and the NRA.

One guy @joe1lane1 wrote, “My wife (school teacher) was in bed when I got home. Asked, “rough day?”  She said they had to do training on stopping wounds, suicides and other things. It wears her out emotionally. Educators are true “Heroes” in this country and get nowhere near the credit they deserve!”

My wife is a teacher as well. As I’m writing this she is on her way to her second day of school. She too will be participating in a similar training today. This has become the new normal.

In a few weeks at my agency North Shore Child and Family Guidance Center our staff members will be participating in an “active shooter” training.

Look at where we have come.

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, visitwww.northshorechildguidance.org. You can also visit: momsdemandaction.org, a grassroots movement of Americans demand reasonable solutions to address our nation’s culture of gun violence, that Candace tagged @MomsDemand in her opening tweet.

Published in TheIslandNow.com August 31, 2018 - https://theislandnow.com/opinions-100/kids-first-look-at-where-we-have-come/

THE LIVES OF BLACK MOTHERS AND BABIES

By Andrew Malekoff© May 2018

In a report issued by Nassau County’s Department of Health - Community Health Assessment and Community Health Improvement Plan (2016-2018) – there is no mention of maternal mortality or information on social and environmental risk factors for women and infants of color. Consequently, no initiatives to address maternal and infant mortality disparities are recommended, yet overall Nassau County health data indicates that it ranks at the top of all counties in New York State.

To address this “invisible injustice,” maternal and child health advocates convened at Hofstra University on March 23, 2018 for a Birth Equity Breakfast organized by the Nassau County Perinatal Services Network.

Birth equity refers to the assurance that all human beings have the best possible births, buttressed by careful attention to racial and social disparities. 

Keynoter Dr. Martine Hackett, assistant professor at Hofstra University’s School of Health Professions and Human Services, presented data from the NYS Department of Health that showed the disparate outcomes for Black mothers and babies as compared with their White counterparts.

Infant mortality refers to the death of children before their first birthdays, which is a key indicator of the overall health of a population. According to the United Nations International Children’s Fund (UNICEF), Japan is the number one ranked country for newborn survival, while the United States ranks only 22nd in the world.

Among the eye-opening data that Dr. Hackett cited are the differences between the infant mortality rates in contiguous communities in Nassau County. For example, in Roosevelt there were 11.1 infant deaths per 1,000 births from 2012-2014, while neighboring Merrick had zero deaths. Overall, in Nassau County the Black infant mortality rate is more than four times that of the White infant mortality rate and even higher than in New York City.

Dr. Joia Creer-Perry, President of the National Birth Equity Collaborative, spoke about the perception of Black mothers and the barriers to receiving holistic care by the health care system. If a woman is living under great stress she will have trouble carrying her baby to term. Premature birth to underweight babies is a leading cause of infant mortality.

Social justice activist and attorney Fred Brewington condemned the institutional racism prevalent in healthcare that has resulted in infant mortality figures today that are no different than they were almost a century ago.

Just weeks after the Birth Equity Breakfast, Tasha Portley, a nurse living in Tyler, Texas, spoke at a similar forum halfway across the U.S. In a report published in the April 16th edition of the Tyler Morning Telegraph, Portley stated that “Pregnant Black women often experience casually degrading remarks from White people when they seek maternal health care.”

Portley shared the story of a Black woman who had some difficulty acquiring a breast pump from a local social services agency and, in the process, was the target of demeaning remarks by an employee. Portley went on to say, “We are dying because we are Black and we are living in a country where there is inherent racism. It is systemic. It is the thread; it is the fiber of everything that exists.”

Dr. Hackett highlighted what needs to happen in order to turn the corner on disparities in Nassau County. Among her recommendations were to inform women after childbirth of warning signs for hemorrhage, embolism or infection, especially when there are preexisting conditions; to enhance service integration for women and infants; and to treat women of color with dignity, respect and culturally relevant care.

Bringing birth inequities to light is an important step forward. When this issue is not identified in Nassau County health data, people don’t know about it and it cannot be addressed. The breakfast concluded with the unveiling of the Birth Justice Warriors, an initiative envisioned by Dr. Hackett, to train birth advocates with the hope of ameliorating the birth inequities in Nassau County.

Published in the Long Island Weekly in May 2018

A TREE FOR ALL SEASONS

In a four year span during the mid to late 1990s my now-grown children lost three of their grandparents and their dog. My boys were 10 and 6 when my father died in 1994. Three years later there were three more losses. My mom died in 1997.  A little more than one year later my father-in-law and dog Kirby, a cairn terrier, died on the same day in August 1998. My wife and I were in Quebec City at a music festival, at the time, on our first extended vacation away from our children when we received the news in two heartbreaking telephone calls just six hours apart.

As a mental health professional who has spent time with bereaved children and adults over many years, I had extensive knowledge about how children process death at different ages. Over the years I developed good skills in listening and gently encouraging the expression of feelings through talk and play. But I also knew that addressing the death of strangers was not the same thing as coping with one’s own losses.

Like so much that I have struggled with as a parent, I knew I had to put my credentials aside and simply do the best I could to support my family and take care of myself, as I was bereaved as well.

Soon thereafter my family and I experienced  another death—this time  with an impact I had not expected and effects that linger to this day. In our yard was an old pine tree that had to be felled after it contracted a disease. None of the tree “experts” that I employed could bring it back to health.

It was a splendid tree of great character, oddly shaped, home to a squirrel’s nest and countless birds, and with branches sitting low enough for swinging and climbing. Its trunk was thick enough to run around to evade contact during games of tag. It was free enough of branches in one high spot to support a backboard and hoop.

It wasn’t easy to dribble on the grass but it was just perfect for endless games of H-O-R-S-E. On the warmest summer days its shade offered respite from the oppressive sun. Each fall I was left with the unpleasant task of raking pine needles. But our tree also bore pine cones that I threw into the winter fireplace for extra snap, crackle and pop that rivaled Rice Krispies.

It was our family tree, a tree for all seasons.

Today, when I look outside or sit in the yard I am flooded with memories of my old friend and the times we had together. We’ve planted a few new trees around the perimeter of the yard in the intervening years, but the hole in the center remains.

Henry David Thoreau wrote, “I frequently tramped eight or ten miles through the deepest snow to keep an appointment with a beech-tree, or a yellow birch, or an old acquaintance among the pines.”

Life is full of surprises, and it came as a surprise to me to think that I would one day be thinking about how much I really loved that old tree.

by Andrew Malekoff

Published in Long Island Weekly, July 2017

https://longislandweekly.com/a-tree-for-all-seasons/

"WHEN YOU TONGUE IS SILENT, ONLY THEN CAN YOU HEAR"

Living or working with teenagers can be unsettling and disorienting even when you think you have it all figured out. Teenagers will spare no time reminding you that, as an adult, you are not a part of their world.

I am reminded of a quip attributed to Mark Twain:  “When I was a boy of 14, my father was so ignorant I could hardly stand to have the old man around. But when I got to be 21, I was astonished at how much the old man had learned in seven years.”

Having worked with countless teenagers for more than forty years, and having raised two of them, I discovered early on that whatever world I occupied outside of their presence with my professional reputation and credentials, these meant little to the kids I worked with or for that matter, to my own kids.

Decades ago I found something that one of my sons, then about 10-years-old, wrote about me in school. The heading on the page was, “My Dad.” Naturally I read on with great anticipation and a swelling sense of self-importance. Underneath the title he wrote, “My dad is 6’1”, bald, wears glasses, and busts my chops. He likes dogs. My dad has brown eyes and brown hair, at least what’s left of it. He’s a social worker.”

The kids I’ve worked and lived with invariably drew their conclusions about me as they got to know me. In turn, I drew my conclusions about them as I got to know them, despite what might be called their credentials, that is - the often-negative labels assigned to them. It is important to recognize the difference between the way in which young people are viewed and classified by others, and their own experiences and perceptions.

Assuming a stance of uncertainty is one way of saying how important it is for us to be open and reflective, to listen intently to the kids we see only then can we think more deeply and see outside the box.

One of my colleagues, Camille Roman, tells a story about growing up in an economically deprived and chaotic family and how desperately she struggled as a teenager to be heard, and how no one was ever listening. During one particularly troubling and heated exchange at a holiday gathering Camille, whose family is from Puerto Rico, recalled, “My face apparently betrayed my fear and confusion to an elderly aunt who was secretly thought to be a witch. Tia Mercedes turned to me with her soft face and wise eyes and whispered, ‘when your tongue is silent only then can you hear.’”

Camille said, “My Tia was telling me that something else was going on here and if I didn’t get caught up in the noise then maybe I could understand and make sense of the chaos and it would be less frightening and I would not feel so powerless.” And so this powerful bit of homespun advice became a life lesson for her in her work as a social worker and, I think, a powerful insight for all of us.

https://longislandweekly.com/tongue-silent-can-hear/

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.

HUMAN SERVICES HUNGER GAMES

Human Services Hunger Games

by Andrew Malekoff © 2012


I am gradually losing step with the pop culture juggernaut. By the way, juggernaut refers to a relentless force, movement or object that trounces whatever is in its path. The term originated from the Unstoppable Juggernaut, a fictional character who first appeared in Marvel Comics’ X-Men. I share this only to establish that I do have some pop culture street- cred.

Nevertheless, I thought Hunger Games was an eating competition until I discovered that it was a post-apocalyptic science fiction novel written by Suzanne Collins. The book features 16-year-old Katniss Everdeen who volunteers to take her younger sister Prim’s place, after Prim is chosen by lottery to participate in a government-mandated, nationally-broadcast, fight-to-the-death battle among 24 teens and pre-teen “tributes” living in 12 districts of the nation of Panem. The goal of the games is to be the last one standing.

I read Hunger Games with a dual consciousness. I was absorbed in the fabulous and chilling story and I was tuned in to the story as a metaphor. The last-man-standing theme reminded me of the struggle for survival that community-based mental health agencies in Nassau County face. I have addressed this extensively in my published commentary and testimony before legislative bodies for years. For instance, in a 2009 piece that appeared in the Albany Times Union I wrote, “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.”

Just to show that I wasn’t “blowing smoke,” if you fast-forward to 2012 you will find that there are community-based outpatient mental health providers in our backyard that closed their doors, were taken over by larger corporate entities with no community roots, transformed their operations into per diem factories with little capacity for dealing with complex or crisis situations or restricted their clientele to a residual population of Medicaid-insurance carriers.

Others are working diligently to preserve the integrity, character and culture of non-restrictive, universal community-based care. When our children, and their families, face the worst of times they need a place to go that is easily accessible and available to respond to emergencies, offers a continuum of care and feels like home and not like a factory.

For many community-based mental health centers, from a family’s first contact to their last, the work requires collaboration, most of which is not fee-producing, with a variety of service providers. Hours are spent with school personnel, hospital-discharge staff, probation officers, preventive workers, case managers, family advocates and child-protective service workers, to name a few.

The children at highest risk need a continuum of outpatient-based triage and emergency services that allow for seamless, timely and successful discharges from hospital to community. Experience has shown that hospitals will often not discharge children to private practitioners. Families, particularly those with children who have serious emotional disturbances or are in psychiatric crisis, require more assistance than can be provided by private practitioners.

To continue to provide these vital services and keep children from needing higher and costlier levels of care, many local agencies have been making every effort to streamline service delivery while maintaining the best standards of care.

Although it is an uphill battle, it is a fight that we must continue and, hopefully, with a different outcome than the Hunger Games; one where we all remain standing and the character and culture of true community-based mental health centers remains strong.

Published on May 31, 2012 in the Anton News chain of 18 Long Island newpapers.

THE CHILDREN'S PLAN

The Children’s Plan

by Andrew Malekoff ©

New York State launched an initiative known as The Children’s Plan that focused on the promotion of mental health and the treatment of children with emotional disturbance. I was pleased to serve on the statewide workgroup that was engaged in the development of the Children’s Plan.

To understand the need that was addressed, let us take a look at the American reality:

• 1 out of 10 children has a serious emotional disturbance;
• More children suffer from psychiatric illness than from autism, leukemia, diabetes and AIDS combined;
• Only 1 out of 5 children who have emotional disturbance receive help from a mental health specialist;
• Emotional disturbance is associated with the highest rate of school dropout among all disability groups;
• Only 30% of children age 14 and older with emotional disturbance graduate with a standard high school diploma and
• Suicide is the third leading cause of death for 15- to 24-year-olds.

At North Shore Child and Family Guidance Center, where our mission is to restore and strengthen the emotional well-being of children and families, these statistics are brought to life daily. We are fielding an unprecedented number of emergency calls regarding young people who are so anxious or depressed that they feel that life is no longer worth living. Some live in homes that are like war zones where the rules for survival are: don’t talk, don’t trust and don’t feel. Some are so isolated and lonely that they feel invisible. Others are targets of bias and bullying and suffer in silence.

I will never forget the 12-year-old boy who attended one of our school-based mental health programs - the Intensive Support Program (ISP), a joint venture with the Nassau Board of Cooperative Educational Services. He was a transfer student from a district school where he struggled to learn and was a target of bullying. Upon his return home from ISP, one afternoon, he told his mom, “Mommy, for the first time in my life I feel like a normal kid.” His mother recalled the story to us in tears of relief. One simple sentence, “Mommy, for the first time in my life I feel like a normal kid,” and a lifetime of potential unlocked.

Community-based mental health agencies offer children opportunities to feel competent, fit in with others, stand tall and have a voice. But we cannot do it alone. Early intervention and partnerships with key stakeholders such as pediatricians and teachers are critical.

According to renowned psychiatrist Harold Koplowicz who heads up the Child Mind Institute in New York City, “The sooner we get these kids help, the sooner they can get back to being kids, and growing into happy, successful adults.” He calls for pediatricians and teachers to be better trained in identifying the signs and symptoms of emotional disorders and empowered to notify parents when a child’s behavior falls outside a typical range. His sentiments are reinforced by the key findings and recommendations of the Children’s Plan.

We can no longer afford to operate in “silos” of care that are barriers to integrating and coordinating mental health care for our children. By working together to nurture all children’s potential we give them the boost that they need to have the best chance for a successful future.

Originally published in the Anton chain of 18 Long Island, NY newspapers in November 2011.

MAKING ROUNDS

MAKING ROUNDS

by Andrew Malekoff © 2010

I have been writing this column since February 2007. Although I try to make points to be helpful to parents and other community members that care about kids, sometimes I think what I make are “rounds” that are less hard-edged and softer than points.

My reflections in this month’s column don’t unfold in a straight line, rather in a circular and pattern. I do not think that my memories are remarkable. They are made up of a combination of milestones, transitions and random, mundane associations. I am not sure if they will have universal appeal. I will leave that for you to decide.

I was born in Newark, New Jersey on May 14, 1951. In my early years I grew up in a second floor flat in the same neighborhood where author Philip Roth once lived. The best thing about where I lived was that there were stores around the corner. Among my favorites were a bakery, candy store, luncheonette and a burger joint with a pinball machine.

My grandfather Joe was a carpenter who emigrated from Russia. He lived with us for a few months. He lost an eye in an on-the-job accident. It was replaced with a glass eye that he removed from time to time to show to me. He once mistook a box of Spic ‘n Span, a cleaning product, for a box of Wheatena oatmeal. The boxes were similar in size, rectangular shape and orange color. As a result of the mix-up, a pot of boiling water and cleaning powder overflowed and flooded the kitchen with soap suds.

My other grandfather Harry was a tavern owner who came to the U.S. from Poland. He had diabetes and two prosthetic legs that I once saw him take off and put on. I often wondered what fake parts I would have when I got older.

My aunt Rose, my dad’s younger sister, told me a story about when my mom and dad first met. The two families planned a get together at my mom’s house. I found out that my dad’s family was worried because Grandpa Joe slurped his soup. Aunt Rose told me that, although they were poor, they did not want to appear to be low class. When the soup was served they held their breath waiting for Grandpa Harry to start. He slurped too. Everyone was relieved and, well, the rest is history.

We moved to a suburb of Newark called Maplewood when I was 10-years-old. It happened fast and without any warning. There was a moving truck one day and the next day my younger brother and I were sleeping in a new bedroom where we heard crickets outside the window. No one consulted me about moving. I left all of my friends behind and had to make new friends.


In the suburbs I rode my bike everywhere since there were no stores around the corner. My father, Izzy, took over the tavern after Grandpa Harry died. The tavern was called the P.O.N. which stands for the Pride of Newark. One day someone set the P.O.N. on fire. Some years later there were race riots in Newark. I did not see my dad that much in those days.

My mother, Evelyn, started her own business when I was in junior high school. I didn’t understand. I later learned that it was to help pay the bills. She was an antiques dealer. In time she opened her own store. The sign on the store read: Antique Evelyn. That is what she was known by for the rest of her years.

My parents died in the 1990’s after at least a decade of serious health problems.
My father had multiple myeloma and my mother had heart disease. During my earlier childhood years my parents each smoked three packs of Camels every day. Sometimes they sent me to the store to buy them for twenty-five-cents a pack.

One day in the early 1990’s, when her health was failing and she was living alone, my mother fell. She called me from a hospital in Newark. The call came at two-in-the-morning. She sounded groggy when she asked me to bring her a box of tooth powder. By this time I was living on Long Island. I drove to the hospital. Her face was bruised and swollen from the fall. She wanted the tooth powder to hold her dentures in place so that she would look good. I stayed with her for a little while and then drove home and went to work.

My father died in the same hospital where I was born. I slept in my dad’s hospital room for several days before I watched him take his last breath on a late Sunday afternoon in May. And, then I drove back to Long Island, to a neighborhood where there are stores that I can walk to, just around the corner from where I live.

Published in the Long Island based Anton Newspapers in April / May 2010.

REFORM PLAN LEAVES CHILDREN AND ADOLESCENTS BEHIND

REFORM PLAN LEAVES CHILDREN AND ADOLESCENTS BEHIND

By Ronda Fein, PhD

First published: Saturday, August 8, 2009, Albany Times Union

In his very articulate July 27 commentary, "It's not reform when it hurts the poor," Andrew Malekoff expresses concern about the state Office of Mental Health and the state Health Department pursuing a "reform" plan that will leave a significant number of children and adolescents without access to mental health care.

The plan will assure continued access to care only to children and families with Medicaid fee-for-service insurance coverage but not to families that have no insurance, or insurance with limited mental health coverage. Families struggling with serious emotional challenges will have trouble finding help if not covered by Medicaid fee-for-service. Clinics and mental health care providers will not be able to continue to accept the low rates offered by Medicaid managed-care carriers and families will not be able to access help.

Anyone who has been through a period of time with a child who is seriously depressed, anxious or behaviorally challenged knows how it affects every facet of one's life.

Our society has moved toward a very misguided view of treatment for mental health issues as being provided in a pill, mainly as a result of pharmaceutical companies' marketing efforts. Medication may be helpful but there is no substitute for the intensive work provided by community clinics, which can target the whole family.

As Mr. Malekoff suggests, the Office of Mental Health must also restore and enhance local assistance funding, which includes a partnership among local and state government, local community and client-consumers for specialty children's outpatient mental health clinics that serve non-Medicaid fee for service clients. Low- and middle-income families deserve access to this care, which is often provided by high quality community-based mental health clinics.

Ronda Fein, Ph.D.

Saratoga Springs
The writer is a licensed clinical psychologist in private practice.

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.

MIND OVER MATTER

MIND OVER MATTER

by Andrew Malekoff

More low income and middle-class families than ever are in need of low cost, high quality community-based mental health care. Yet, as I reported in my April 2009 column, the New York State Office of Mental Health (OMH) in conjunction with the New York State Department of Health is aggressively pursuing a “reform” plan (clinic reform) 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 continued access to care. This will leave a significant number of children and adults living on Long Island in the lurch.

For more than a half a century North Shore Child and Family Guidance Center has been a proud provider of community-based mental health services here on the Island. We are in receipt of the recently released New York State Office of Mental Health Outpatient Clinic Reform Implementation Paper (March 11, 2009) that describes a “soup to nuts” reform of our services. Not only does the reform plan threaten the viability of our agency, but it sets up a mental health service delivery system that will no longer assure access to mental health care for children regardless of their parents’ ability to pay.

This policy shift represents a dramatic departure from what we see as a statutory responsibility on the part of New York State to make sure our most vulnerable citizens – our children - get care, regardless of their families’ economic status. New York State government is moving away from a universal model to a residual model of care where Medicaid coverage is the ticket of admission for community-based mental health.

I have been wondering if the individuals that helped to craft this plan experienced any conflict related to the inconsistency between their beliefs and actions. In my conversations with clinic reform workgroup members, my impression is that they believe strongly in quality community-based mental health care for all children and families. Yet they support a plan that cuts a large segment of the population out of the equation.

To their credit, OMH leadership is committed to the development of an “uncompensated care pool,” consisting of funding to address the uninsured. However, that still leaves the underinsured middle class, lower middle class and working poor on the sidelines.

Three further steps are needed. First, the New York State Department of Health must put pressure on Medicaid managed care insurance carriers to increase their rates to match the government rate. Second, the New York State Department of Insurance needs to do the same with private insurers. Insurance carriers that cannot demonstrate an “adequacy of network” can have their licenses revoked. Third, consumers must be educated about these issues so that they can effectively fight back when denied community-based services because their carrier’s rates are too low to offer them an adequate network of care.

CNN anchor Lou Dobbs, who wrote about the war on the middle class said, “I believe our middle class has suffered in silence for far too long, and simply cannot afford to suffer or be silent much longer. Hardworking Americans have not spoken out about their increasing marginalized role in this society, and as a consequence they’ve all but lost their voice.”

I believe that the clinic reform plan is further validation of Dobbs’ contention. We cannot afford to be silent. Perhaps for some policy makers and insurance carriers, quality community-based mental health for middle class children and their families all boils down to a question of mind over matter – they don’t mind and we don’t matter.

Please join the fight to save children’s community-based mental health services on Long Island. Our children matter - all of them.

Published in the Long Island Anton chain of newspapers in June 2009,copyright Andrew Malekoff