A MATTER OF CIVIL RIGHTS

A Matter of Civil Rights

By Andrew Malekoff

Did you know that every day more than 290 Americans die from suicide or a drug overdose? With proper treatment, many of these tragedies could be prevented—but despite a law that guarantees coverage, people face enormous roadblocks when they seek care.

In 2008 President George W. Bush signed the landmark Mental Health Parity and Addiction Equity Act (Parity Act). The Parity Act mandates equal insurance coverage for mental health and substance use disorders (MH/SUD) as compared to other medical/surgical benefits covered by the plan.

According to its new website parityat10.com, “Parity at 10 seeks to ensure that insurance carriers and state Medicaid programs comply with the law so that consumers can access the evidence-based health care they need and are entitled by law to receive.”

What does equal insurance coverage mean? It means ending insurer discrimination against access to timely and affordable care including high out-of-pocket costs and shorter lengths of care for MH/SUD. Parity—which is another word for equity—in this case means that MH/SUD coverage must be provided on par with coverage of medical and surgical care.

Notably this legislation was the result of a bipartisan effort by Senators Paul Wellstone, a liberal Democrat, and Pete Domenici, a conservative Republican. What the senators had in common were personal family experiences that motivated their tireless efforts to pass this law.

Parity saves lives. Parity law is a civil rights law that has not been vigorously enforced by the States, which have the primary responsibility for enforcement of private insurance and Medicaid.

One of the most pernicious violations and barriers to care is inadequate networks of MH/SUD providers. North Shore Child & Family Guidance Center documented this in its 2018 Project Access Study which surveyed 650 Long Island consumers of MH/SUD care. Nearly 50% of respondents said that it was easier for them to access medical/surgical care than MH/SUD Care.

Nationally, patients responding to a National Alliance on Mental Illness (NAMI) survey reported being denied twice as often for mental health care as for medical surgical care under the Affordable Care Act.

The actuarial firm Milliman reviewed claims data in New York and found that patients had to go out-of-network for MH/SUD care far more often than for medical/surgical care—a very expensive proposition that flies in the face of the Parity Act.

At North Shore Child & Family Guidance Center, we are a proud partner of the Parity at 10 Compliance Campaign. On August 10 I attended an inaugural Parity at 10 meeting in Albany with my fellow advocates and top officials in the Cuomo administration.

Some of the details in this column were included in the policy brief provided to Governor Cuomo. The consensus among the advocates was that insurers do everything in their power to skirt parity.

Another staunch supporter of the original legislation was Patrick J. Kennedy, a former member of the U.S. House of Representatives. Kennedy struggled with mental illness and addiction for most of his life.

In his book A Common Struggle, Kennedy said the battle ahead is for the law to be enforced in the face of health insurers who stand to profit by denying the full range of coverage for people living with mental illness and addictions. Kennedy rightly frames the inequities that people with mental illness and addictions face as a matter of civil rights.

Discriminatory insurance coverage for those with mental health and substance use disorders must end. When insurers do not comply with the law and enforcement is inadequate, millions of Americans are at risk.

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.

This article appeared in TheIslandNow.com on August 16, 2018

ANIMAL ASSISTED THERAPY FOR VULNERABLE YOUTH

By Andrew Malekoff©, Summer 2018

For almost two decades, my agency, North Shore Child & Family Guidance Center has been utilizing Animal Assisted Therapy (AAT) in outpatient mental health work with youths and their families, working in partnership with local canine and equine organizations.  An adjunct to traditional therapy, AAT relies on the human-animal bond in goal-directed interventions as an essential part of the therapeutic work. 

According to leading AAT expert Cynthia Chandler some of the reasons to include animals in therapy are:

1.     Consumers may be more motivated to attend and participate in therapy because of a desire to spend time with the therapy pet.

2.     Consumers may receive healing nurturance and affection through physical contact with the therapy pet.

3.     Consumers may experience genuine acceptance by the therapy pet.

4.     In many instances . . . consumers may be able to perform activities and achieve goals that would not otherwise be possible without the assistance of a therapy pet.

Following is an illustration of animal assisted group work using a therapy dog to build social competencies and self confidence in group members.

In a group that was composed of early adolescents who were identified as painfully shy or socially awkward, the group members were all drawn to the therapy dog Elvis, who was introduced as a new “group member.”

Everyone wanted to pet Elvis, a Basset Hound, and feed him treats. The norm in groups like this is to earn time with Elvis by taking steps forward in skill development. For example, speaking up and talking about one’s experiences in the previous week could earn time with Elvis. In addition, the work is metaphorical in the sense that the group members are directed to notice things about Elvis. 

For example, one group member says, “Elvis looks a little shy.” To which the worker asks, “How can you tell?” This ignites a process in which members begin to build their powers of observation and reading non-verbal cues, for example.

In animal assisted groups the group worker must work closely with a co-facilitator, the animal handler. The handler is like an interpreter who can teach about his or her dog. For example, “This is how Elvis will show you if he is a little shy and here is how you can approach him.” The group members transfer learning by observing and learning about and interacting with the animal. They can then practice without being hit over the head with it by being lectured to.

Success comes by noticing the animal or by failing to do so. For example, if an animal shies away, group members learn that maybe he needs some quiet time. In other words, the members discover that there are lessons learned from not having their wishes fulfilled all the time.

Having an animal handler as a co-leader is not very complicated since their role is circumscribed. The handler is an interpreter who loves to talk about the personality of his or her dog and its uniqueness. They can humanize how the dogs speak and keep appropriate boundaries (e.g. not rushing at someone socially). Using dogs are a little easier to arrange for logistically, but there are a growing number of settings that offer equine facilitated therapy, which add another dimension to group work for shy and awkward youths.

According to my North Shore Child & Family Guidance Center colleague social worker Lee Holtzman, Animal Assisted Therapy is a viable alternative to work with children and youths who have a history of trauma. Expanding research in the area of how trauma affects the brain has highlighted the role of adjunct therapies such as yoga and animal assisted therapy, for example, to help people safely regain the ability to feel their bodies and to uncover and release painful memories stored in the body.

Finally, two guidelines to keep in mind when planning to use animals are: (1) Seek parental permission. This is particularly relevant to culturally sensitive practice. There are certain cultures that may have strong attitudes towards human-animal interaction that might preclude practice with animals. In any case, engaging parents in the process is a must; and (2) Screen for proper credentialing and training. Carefully screen animals and handlers to be sure that they are properly trained and credentialed.

Published in the New York State Behavioral Health News, Summer issue 2017

DEPRESSION, SUICIDE, DISCRIMINATION AND PARITY

Depression, Suicide, Discrimination and Parity

By Andrew Malekoff© Summer, 2018

In the immediate aftermath of the suicides of Kate Spade and Anthony Bourdain Gov. Cuomo issued a press release about new funding to address the rising rate of suicide.

He stated: "Two high-profile suicides this week put mental illness front and center, but while those names were the ones in the press, every day there are thousands of New Yorkers who struggle with suicidal thoughts, and we must do everything we can to support them. Depression does not discriminate. It affects every part of society and people from all walks of life."

I applaud the Governor for bringing this matter to light. He stated, “Depression does not discriminate.” Nevertheless, health insurers that do not comply with federal parity law, denying timely access to care, do discriminate. When New York State government does not enforce this law, they aid and abet discrimination against the “thousands of New Yorkers,” who the Governor referred to as those “who struggle with suicidal thoughts”.

The difficulty people have accessing mental health and addiction care is not simply a matter of stigma. It is a matter of discrimination. This is a civil rights issue that an announcement of new funding alone will not solve.

On December 15, 2017, North Shore Child and Family Guidance Center held a press conference at its headquarters in Roslyn Heights and issued the results of a research study – Project Access that we conducted in collaboration with LIU Post Department of Social Work. 

In this year-long study, hundreds of Long Islanders were surveyed about their experiences attempting to obtain help for mental health and addiction problems.

Of the 650 Long Islanders who took part in the survey, almost half said that it was more difficult finding help for mental health or substance abuse problems than finding help for physical illnesses, nearly 40 percent said that their insurance company did not have an adequate number of providers and two-thirds said that their insurance company was not helpful to them in finding a suitable provider for themselves or a loved one.

NY State Senator Todd Kaminsky, who attended the December 15th press conference, stated that the findings were “Damning.”

In a bipartisan effort, Kaminsky and Senator Elaine Phillips wrote to the Department of Financial Services (DFS) on January 9, 2018 citing the Project Access study and requesting “a thorough investigation to determine why insurance companies are not being held accountable for network adequacy.” Network adequacy is the part of the federal parity law that states that health insurers who cover mental health and addiction care must have an adequate number of providers in their network. Many more people wrote directly to Gov. Cuomo, requesting the same.

Almost five months later Scott Fischer, Executive Deputy Superintendent for Insurance, a division of DFS, responded in writing to the Senators. Fischer wrote: “DFS’s review of the various networks has confirmed that each of the insurance companies in Long Island exceeds the standards for mental health and substance use providers, for the purpose of the commercial products sold outside of NYSOH.”

Translation: There is no problem. There is nothing more to do. This does not square with the results of Project Access.

Health insurers and government ignoring federal parity law is discrimination. When it comes to suicide prevention: access delayed, is access denied.

Discrimination deserves a place alongside stigma when the conversation turns to access to care.

It’s a matter of civil rights.

Long after the tragic deaths of Kate Spade and Anthony Bourdain fade from the front pages, the lack of compliance and enforcement of federal parity law will persist and the thousands of people that the Governor spoke of in hispress release will still be unable to access care.

Published in the New York State Behavioral Health News, Summer 2018 issue

MENTAL HEALTH EDUCATION A MUST FOR SCHOOLS

New legislation signed by Governor Cuomo in 2016 requires that public schools in New York State begin providing instruction in mental health on or after July 1, 2018. The legislation was co-sponsored by Senator Carl Marcellino (R-Nassau) and Assemblywoman Kathy Nolan (D-Queens).

The new legislation adds mental health education to areas of learning that were already required by law, including education on the use and misuse of alcohol, tobacco and other substances and the early detection of cancer.

According to Glen Liebman, CEO of the Mental Health Association in New York State, “By ensuring that young people are educated about mental health, we increase the likelihood that they will be able to recognize signs in themselves and others that indicate when help is needed and how to get help.”

Why is this legislation so important? One in five adolescents ages 13-18 is diagnosed with a mental health problem, yet only 40% get help. The average time from onset to seeking help is eight to 10 years. According to Centers for Disease Control and Prevention, one in 12 high school students attempt suicide, the third leading cause of death for 10 to 24 year olds.

Teaching about mental health in schools and educating to reduce stigma is long overdue. There is great misunderstanding and fear among many who have erroneous ideas about people with mental illness. Consequently, young people suffering with mental illness walk around school feeling isolated, believing that there’s something inherently wrong with them that will never change.

These children and teens often feel shunned, unlike their peers who have a physical health problem and who have others rally around them. I can vividly recall a news report and photo of a middle school boy afflicted with cancer who was receiving chemotherapy. In the photo he was surrounded by his teacher and a smiling group of his classmates, all of whom shaved their heads in solidarity with him. Imagine if instead of cancer he was depressed and suicidal. There would be no such image of public support, only one of isolation, shame and despair.

A caring school community can offer a young person a safety net of meaningful and helpful connections. It is not unusual for a teenager to feel defective when struggling alone with a mental illness. Mental health education in schools can begin with mental wellness practices for children as early as four or five years old, for example, by teaching social skills and how to manage angry feelings.

As children grow they can learn about the concept of wellness including self-care and personal responsibility. They can learn to recognize the signs and symptoms of developing mental health problems, how to manage crises such as the risk of suicide and self-harm and how to identify appropriate services and supports for treating and maintaining recovery from mental illness.

can already hear those voices that will decry using educational resources for addressing the emotional needs of kids. If that is your view, I ask you to consider that approximately 50% of students age 14 and older who are living with a mental illness drop out of high school. Youngsters’ mental health and their ability to learn and become productive citizens in the community and workplace go hand-in-hand.

We owe it to our children to support this vital new legislation by encouraging schools to incorporate meaningful education into the curriculum that reinforces the idea that mental health is an integral part of wellbeing. Our children need to learn that there is help that can lead to recovery.

Andrew Malekoff is the Executive Director and CEO 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.

This article first appeared in Long Island Weekly, an Anton Media Group publication, on September 27

MENTAL HEALTH EDUCATION A MUST FOR SCHOOLS

New legislation signed by Governor Cuomo in 2016 requires that public schools in New York State begin providing instruction in mental health on or after July 1, 2018. The legislation was co-sponsored by Senator Carl Marcellino (R-Nassau) and Assemblywoman Kathy Nolan (D-Queens).

The new legislation adds mental health education to areas of learning that were already required by law, including education on the use and misuse of alcohol, tobacco and other substances and the early detection of cancer.

According to Glen Liebman, CEO of the Mental Health Association in New York State, “By ensuring that young people are educated about mental health, we increase the likelihood that they will be able to recognize signs in themselves and others that indicate when help is needed and how to get help.”

Why is this legislation so important? One in five adolescents ages 13-18 is diagnosed with a mental health problem, yet only 40% get help. The average time from onset to seeking help is eight to 10 years.  According to Centers for Disease Control and Prevention, one in 12 high school students attempt suicide, the third leading cause of death for 10 to 24 year olds.

Teaching about mental health in schools and educating to reduce stigma is long overdue. There is great misunderstanding and fear among many who have erroneous ideas about people with mental illness. Consequently, young people suffering with mental illness walk around school feeling isolated, believing that there’s something inherently wrong with them that will never change.

These children and teens often feel shunned, unlike their peers who have a physical health problem and who have others rally around them. I can vividly recall a news report and photo of a middle school boy afflicted with cancer who was receiving chemotherapy. In the photo he was surrounded by his teacher and a smiling group of his classmates, all of whom shaved their heads in solidarity with him.  Imagine if instead of cancer he was depressed and suicidal. There would be no such image of public support, only one of isolation, shame and despair.

A caring school community can offer a young person a safety net of meaningful and helpful connections. It is not unusual for a teenager to feel defective when struggling alone with a mental illness. Mental health education in schools can begin with mental wellness practices for children as early as four or five years old, for example, by teaching social skills and how to manage angry feelings.

As children grow they can learn about the concept of wellness including self-care and personal responsibility. They can learn to recognize the signs and symptoms of developing mental health problems, how to manage crises such as the risk of suicide and self-harm and how to identify appropriate services and supports for treating and maintaining recovery from mental illness.

I can already hear those voices that will decry using educational resources for addressing the emotional needs of kids. If that is your view, I ask you to consider that approximately 50% of students age 14 and older who are living with a mental illness drop out of high school. Youngsters’ mental health and their ability to learn and become productive citizens in the community and workplace go hand-in-hand.

We owe it to our children to support this vital new legislation by encouraging schools to incorporate meaningful education into the curriculum that reinforces the idea that mental health is an integral part of wellbeing. Our children need to learn that there is help that can lead to recovery.

by Andrew Malekoff

Published in Long Island Weekly, September 2017

SPRINGSTEEN SPEAKS OUT AGAINST STIGMA

I recently read rock star Bruce Springsteen’s 2016 autobiography Born to Run. I have to admit: I started the book a virtual stranger. Of course I was familiar with Springsteen’s music, but mostly as background. I wasn’t a faithful fan. My only obscure connection is that I attended junior high and high school in South Orange and Maplewood, NJ with his drummer Max Weinberg.

Max and I weren't close friends but, I would say, friendly acquaintances. I remember him telling me one day in the early 1960s that he was going to be playing drums on a UHF television show hosted by John Zacherle. On the night of the broadcast, I set up the UHF antenna on my parent's black-and-white TV and was proud to see someone I personally knew performing on the tube. It was almost as exciting as the build up to the Beatles on Ed Sullivan.

Although I had no intention of reading Springsteen’s book, I decided to pick it up on the recommendation of a friend who knew I worked in the field of children’s mental health. At the same time I read the book, I turned my dial to E Street radio to add a sound track to my reading experience. By listening to the music I thought I could better get to know the author, who wrote extensively about his personal life in his songs.

Born to Run blends many elements of Springsteen’s life, from early family experiences to first steps as a musician to forming a band to becoming a rock star, husband and parent—and much more. But the core of the book is the enduring and troubling impact of his relationship with his father Doug. Near the end of Born to Run, Springsteen reveals a dream in which he is performing on stage. His then deceased father is sitting in the audience. Bruce approaches him in the dream and says: "Look dad...that guy on stage...that's you, that's how I see you." You’ll have to read the book to have a more complete understanding what the dream represents.

As I worked my way through the book and his music, I was struck with the overwhelming feeling that it was written in its entirety in the voice of vulnerable young boy, as opposed to world-renowned rock icon. The boy has been fighting the isolation and loneliness of living with mental illness in the family his whole life and, at the same time, he has been seeking enduring and healthy relationships. And, he found them.

As much as it is a book about rising to music stardom, Born to Run is a story about debilitating depression, mental illness and adverse childhood experiences. But it’s also a story of hope. Springsteen shows that despite his most troubling childhood experiences, resilience and healing are possible. Readers owe him a debt of gratitude, not only for the decades of socially conscious and uplifting music, but for stepping beyond stigma to, in his own words, “show the reader his mind.”

I started the book a stranger; now I'm a fan.

https://longislandweekly.com/springsteen-speaks-stigma/

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.

HOW INSURERS ARE FAILING CHILDREN WITH MENTAL HEALTH NEEDS

http://nynmedia.com/news/how-insurers-are-failing-children-with-mental-health-needs

What happens when something that affects children’s lives is widespread but hidden in plain sight? What if it is something that creates untold heartache in lives that are already unnecessarily damaged? It should be addressed and corrected. Yet, because it is hidden from our collective consciousness it remains unaddressed, it persists, and this has consequences.

I am referring to the plight of countless middle-class families with children who have mental health and substance abuse problems and who have health insurance but cannot gain access to timely care.

Under a government mandate called network adequacy, commercial health insurers, used by many working, middle-class families, are required by license to offer adequate networks of providers (child psychiatrists, psychotherapists) for families confronting mental health and substance abuse problems. In other words, they are expected, as per their insurance plan, to provide ready access to a provider near where policyholders live. The reality, though, is that too often they do not.

Why? Because commercial health insurers that pay substandard reimbursement rates have too few in-network providers. Their low rates of reimbursement serve as a disincentive for providers, including community-based mental health agencies that should be providing universal access to care, to enroll in their networks. Consequently, many community-based agencies, along with those in private practice, will accept only higher paying Medicaid insurance.

The gap between reimbursement rates for commercial health insurance and Medicaid is vast. In some cases, for example, the rate paid to providers by commercial insurers is half the rate paid by Medicaid. Although a health insurer is expected to help families find an in-network provider, most often they do not. They simply give them a list of names, and few if any of those providers accept the insurance because the rates of reimbursement don’t come close to covering the cost of services. This then frustrates already anxious parents who have had to work up the courage to ask for help.

It is very difficult for a parent to pick up the phone and seek help when their child is suffering from mental illness or addiction. When they are repeatedly turned away by their supposedly in-network providers, who tell them “I no longer accept that insurance,” it is devastating. When a child is denied access to timely care for mental illness or addiction the results can be life-threatening. 

A few weeks ago a mother seeking mental health care for her teenager came to us at North Shore Child & Family Guidance Center and told a familiar story.

"It's very hard. Decent psychiatrists don't take new patients and the rest don't take our insurance. Most of them don't take your insurance," she said. The intake worker asked her how many turned her down before she called us. She said 20.

What needs to be done? The New York State Department of Financial Services, a relatively new state agency formed by Gov. Andrew Cuomo, has regulatory jurisdiction over insurance companies. However, in my experience, their inaction on this issue indicates that they do little, if anything, to monitor network adequacy.

Substandard rates of reimbursement (e.g. the gap between Medicaid and commercial insurance rates) may be considered a violation of the Affordable Care Act’s parity protections, which require health insurance companies to treat annual or lifetime dollar limits for mental health and substance abuse the same as they do medical benefits. If that is the case, the attorney general also has the power to address this matter if DFS will not. But what remedy is there if they do not take action?

The New York State Comptroller’s Office has the primary responsibility to ensure that state agencies such as DFS are using taxpayer money efficiently and effectively. If DFS does not investigate the issue of network adequacy, then they are open to the scrutiny of a state audit as it relates to their effectiveness in the use of taxpayer dollars to properly monitor insurance companies under their jurisdiction.

Although mental health legislation, The Helping Families in Mental Health Crisis Act, has been introduced in Congress, it will do little good if families cannot find a provider. The act will only work when the issue of access to care is monitored and enforced. It’s time for DFS to do its job and launch an investigation of any commercial insurance company suspected of not having an adequate network of providers. It could truly save lives.

Andrew Malekoff is the executive director of the North Shore Child & Family Guidance Center in Roslyn Heights, a nonprofit that provides comprehensive mental health services for children from birth through age 24 and their families. To find out more, visit www.northshorechildguidance.org. - See more at: http://nynmedia.com/news/how-insurers-are-failing-children-with-mental-health-needs#sthash.omFazlzp.dpuf

(c) 2016 City and State NY, LLC. All rights reserved.

FAMILIES CAN'T AFFORD TO WAIT FOR MENTAL HEALTH SERVICES

L.I. Business News, March 4, 2016 

Access delayed is access denied.

These are words that ring true for thousands of families across Long Island who have been unsuccessful in accessing timely and affordable mental health and addictions care through their health insurer.

How do I know this? From the stories that people tell us at North Shore Child & Family Guidance Center, a 63-year-old children’s mental health agency in Nassau County.

Health insurers are mandated by government to offer panels of providers so that families can find easily accessible, quality care for their loved ones; and not only for physical illnesses. This requirement is known as network adequacy, referring to adequate networks of care.

The problem of access for mental health care, however, is more complex and may begin with a family’s hesitance to ask for help and to reveal that they are living with someone who is suffering from a mental illness. Families coping with mental illness or addiction do not as readily seek help as they might for heart disease, cancer or diabetes. Why? Because of stigma and the shame it generates. When there is a mass shooting for example, and the perpetrator is labeled mentally ill, it casts a shadow on all people with mental illness, despite the fact that mentally ill persons are disproportionately the victims of violence.

In the United States we have chronically failed to treat illnesses above the neck the same as illnesses below the neck. For example, a parent who would not hesitate to reach out for help if their child was in an accident and appeared to have broken an arm, might wait weeks and months, if not longer, to ask for help if it was a mental health or substance abuse problem.

What makes all this so insidious is that once a parent picks up the phone to ask for help, and they are told repeatedly by providers, “I’m sorry I don’t accept that insurance any longer, I only accept cash,” there is a chance they will give up.

When a parent gives up, they risk their child deteriorating further. This is also true for adults with mental illness and increases the odds that they will ultimately need more costly care or confinement; hospitalization or incarceration.

What to do? Gov. Cuomo created the Department of Financial Services, charged with the responsibility to monitor private health insurers to ensure that they have adequate networks of care as a condition of their license. This means they must demonstrate the consistent ability to provide timely access to care for individuals and their families.

Just this week parents who came to the Guidance Center after taking their child to the emergency room, told us that they called no less than 20 different therapists or agencies and were turned down by all of them. Finally they called another hospital that made the referral to us. We turn no one away for inability to pay.

This is an all too familiar story that we hear frequently and that my colleagues from sister agencies tell me as well. You might wonder why this happening.

Private health insurers pay substandard rates of reimbursement for mental health and addictions care, as compared to Medicaid; sometimes 50 percent or less the than the Medicaid rate. Consequently, participating providers bail out because they cannot afford to accept such low rates. The insurers fail to carefully monitor their lists and the state fails to monitor and regulate the insurers.

In the case of delayed care for a child, this represents corporate and state child abuse.

I have reached out repeatedly to the governor, attorney general and numerous state legislators to issue a call to action to demand that DFS do their job. There is sympathy, but no action.

Andrew Malekoff is executive director of North Shore Child & Family Guidance Center in Roslyn Heights.

If you subscribe to Long Island Business News: http://libn.com/2016/03/04/malekoff-li-families-cant-afford-to-wait-for-mental-health-services/

WHEN ARE THE CARTOONS GONNA COME BACK ON?

Violence—random, sudden, illogical, and lethal—has become a fact of life. Shootings and acts of terror, homegrown and imported, with or without racial or religious overtones, have become gruesome signposts along a seemingly endless path of public and private horrors. They are taking a toll on our children.

No child should have to wake up each day as if he or she was on 24-hour-a-day guard duty. But in the United States this is the reality.

We can no longer think of these as isolated incidents, aberrations or confined to urban settings. Denial, an emotional trap door, is not a viable escape in a world where a sense of imminent threat is ever present.  

In the immediate aftermath of the September 11, 2001 attack, writer Jeph Loeb and artist J. Scott Campbell produced a nine-framed cartoon entitled “Please Stand By,” that featured a very young girl watching cartoons.

By the third and fourth frames, the image on the screen changed to a live feed of the Twin Towers ablaze. As the little girl stood transfixed, stuffed animal in hand, the commentator announced, “We interrupt this program to take you live…,” the little girl turned away and called, “Mommy…” The next three frames began with her mother dropping a basket of laundry. Then, with her face contorted in anguish, she embraced her daughter to shield her from the unrelenting images. The final frame is a close up of the little girl asking, “Mommy, when are the cartoons gonna come back on?”

Among those who are left in the wake of violent acts are the survivors - friends and family members of victims, who live with the emptiness, frustration, and rage of incomprehensible death by violence.

Earlier this month, as the mother of the oldest child of Alton Sterling, the black man fatally shot by Baton Rouge, Louisiana police, expressed sorrow and outrage at his death, Cameron Sterling, 15, the oldest of Sterling’s children wept inconsolably by her side, for the entire world to see and experience his heartbreak.

One day later a St. Paul, Minnesota Montessori school cafeteria supervisor Philando Castile met a similar fate. Just one day after his shooting, five police officers, protecting  hundreds of people in Dallas, Texas, who were peacefully protesting the two shootings, were gunned down and murdered, ambush-style, by a lone shooter who was fueled by racial hatred and bent on misguided revenge. Ten days after the Dallas shootings, three Baton Rouge police officers met a similar fate.

Beyond those left in the direct wake of violence are growing numbers of young people who are fed a regular diet of horrific episodes of violence through graphic media accounts such as the live streaming of a bloodied and gasping Philando Castile, filmed by his girlfriend Diamond Reynolds who wanted the world to join her in bearing witness as he took his last breaths.

In the aftermath of trauma, children (and others) feel fearful, unprotected, hyper-vigilant, and hopeless and on their own; similar to orphans who feel they must take care themselves.

We are living in world gone mad, a place where the rich diversity of colors, shades, languages, orientations, beliefs and rituals should be shared and celebrated rather than drawn as battle lines. The answers do not lie in books of psychology or popular bromides, or in aspiring national leaders who have proven to be untrustworthy.

The answer lies in being mindful - paying attention on purpose, making connections with one another and building a sense of communality.

https://longislandweekly.com/cartoons-gonna-come-back/

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.

DAVID AND GOLIATH

On January 21, 2016 I received a most unusual award – a David Award – that was described to me as follows:

For each of the past 15 years, every January Networking® magazine has honored eight exceptional men – “Renaissance Men” who have performed generous and unselfish acts for the benefit of us all. The David Awards are named for David, the giant slayer, who represents the Renaissance Ideal Man memorialized by Michelangelo’s famous 16th century statue of David. Each of our honorees has been a true Renaissance man having excelled in business or academics and also accomplished outstanding heroic and humanitarian acts.

I thought that I would make this column a little more personal than usual and share my remarks here.

Having been selected for this honor led me to consider, "If I am David, then who is Goliath in my life?" I can think of many but I’ll share just two with you.

On the same day in late September that Networking Magazine publisher Christine Sheehan delivered the good news to me about this honor, my doctor called with the results of a biopsy and PET scan. She said that my cancer, which had been in remission for five years, transformed into something more aggressive. It was rapidly spreading and required immediate treatment.

In fact, if the David Awards breakfast was held just one week earlier to the day, instead of my sitting on the dais you would have found me seated in a recliner at Sloan Kettering, hooked up to an IV, and receiving what I am hoping will be my last infusion.

I tell you about my personal Goliath not for your sympathy. I tell you because I know I am not alone in this room of more than 500 people. I salute my fellow cancer survivors and family members of those who have battled cancer.

Although my first Goliath is more personal, and now public, my second Goliath is more insidious. It cannot be slayed by science and medicine, and it demands the attention of our hearts, minds and souls.

My second Goliath is stigma – the stigma that brings shame to people with mental illnesses and addictions; the stigma that denies them the sympathy and support that I have received in abundance while battling cancer.

Please understand that no parent would hesitate for even a moment to get help for a child with cancer. However, parents who have a child suffering from a mental illness or addiction wait weeks, months and even years to ask for help. Stigma causes many to hide and retreat, rather than stand and advance.

Stigma has two co-conspirators. They are the government and the health insurance industry. Government neglect and corporate greed represent nothing less than institutional child abuse and neglect that prevent sufferers from choosing and accessing life-saving treatment options. This is a clear denial of civil rights.

Defeating the Goliath stigma is a good start. It requires that we make a collective commitment to treating illnesses above the neck the same as illnesses below the neck.

If my being a David Award winner helps to inspire that, then I will truly feel a worthy recipient. Thank you.

https://longislandweekly.com/david-and-goliath/

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. 

HELPING TEENS GROW THROUGH WILDERNESS PROGRAM

Even though the chill of autumn is well upon us, it’s always a great time to enjoy the outdoors—and it’s also important for a youth’s development to keep their connection to our natural world.

With teens so immersed in texting and video games and other tech-focused  pursuits, they often lose both the connection to each other and to the world around them. That’s why North Shore Child & Family Guidance Center designed our Wilderness Respite Program, which provides a unique opportunity for at-risk adolescents to participate in nature activities that foster individual growth, leadership skills, self-esteem and friendships while also promoting environmental stewardship.

Following is a “slice of life” from the program:

During one of the planning meetings for an upcoming hike, a few of the boys tried to take control of the situation by dominating the other group members through physical posturing and verbal banter. That all changed once the teens drove to the state park and departed from the van. We found ourselves immersed in the forest, with no pavement, stores, traffic lights or any of the usual trappings of the home neighborhood—the kind of pure, natural environment many of the teens had rarely if ever experienced.

To our surprise, the boys did not volunteer to lead the way. Instead, they followed the girls, who became models of leadership. Little by little, all of the teens learned to work together, decoding the trail markers located on trees and rocks. Relying on their growing awareness of themselves and the direction of the staff, the teens gradually learned to hike at a controlled, measured pace, rather than starting out in a sprint and tiring as the day wore on. Although this was emphasized during preparation meetings, it was in the “doing” that this learning was integrated by the hikers, who soon learned how easy it was to get worn out.

The hike was a challenging one, lengthy and with rough terrain. It was an experience most of the teens felt was beyond their capabilities, but once they realized they could overcome these perceived limitations, they felt exhilarated. They also developed a noticeable respect, admiration and affection for each other. Tired and done-in, the group gathered around some rocks, leaning on one another for support, warmth and belonging.

Self-discovery took another turn on a canoeing trip by the same group. The teens were faced with strong winds and an unfriendly current as they attempted to learn basic canoeing skills on Long Island Sound. All of the teens experienced a great deal of frustration, disappointment and anger as they struggled in teams to control the direction and progress of their canoes. They learned that the elements and obstacles proved too formidable on that day for us to reach our destination, when after three hours of tiresome paddling, we needed to turn around and paddle back to our starting point, rather than continue to our original destination six miles away.

But the trip wasn’t by any means a failure, because learning how to handle disappointment is just as valuable as experiencing success. The group learned that when the challenges of the wilderness became tiring and weather conditions on the water became burdensome and oppressive, they had to reach inside themselves to summon up additional strength to overcome frustration, anger and fear. So, even though the trip had more than its share of disappointments, the teens were able to carry over the feeling that they could handle it when things don’t go smoothly.

These wilderness outings to excursions on both land and sea were successful because they all serve to prepare the teens for unknown challenges ahead.

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 HEALTHCARE GETS SHORT SHRIFT FROM INSURERS

Have you ever sought mental healthcare for your child? What about care for a drug addiction? Have you made calls to multiple providers on your health insurer’s “list” and had the door slammed repeatedly in your face? Or were you fortunate enough to make a good connection and then unceremoniously have the rug pulled out from under you, with your insurer denying continued care?

Welcome to the club.

If you have a child with a mental health or addiction problem, you know how hard it is to make that first phone call. A parent with a child with cancer or diabetes doesn’t hesitate to call for help. But when mental health is the problem, it can take weeks, months or even years because of the crippling effect of stigma. But what about the two situations I described above: You make that call, but you are denied continued care, or you’re denied access to care in the first place?

The federal parity law, formerly known as the Mental Health Parity and Addiction Equity Act, is designed to prevent group health plans and health insurance companies from imposing less favorable benefits than they do for other medical conditions. The law is supposed to guarantee that people with mental illnesses have the same access to treatment as patients with diseases like cancer or diabetes, but some insurers have continued to limit treatment in subtle ways.

According to a recent report by NPR, since 2010, the Department of Labor, which is the main federal agency in charge of parity, has found 140 instances in which a patient's parity rights were violated. Although all those issues were resolved voluntarily, no insurer has been fined, and none of the results are public.

Regarding gaining access to care in the first place, 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 healthcare services included under the terms of the contract. The reality is that, because private insurers pay substandard rates as compared to Medicaid, middle class families are finding it harder and harder to find providers to help their children. They look at their insurer’s list of providers, make phone calls, and are repeatedly told, I’m sorry, I don’t accept your insurance. The lists are inadequate, outdated or just plain falsehoods.

On July 22, 2015, Assemblyman Todd Kaminsky authored a letter to the New York State Department of Financial Services to express deep concern about the lack of commercial insurance coverage for mental health services for middle class families on Long Island. He requested that DFS launch an investigation to determine the scope of this pressing problem.

Assemblyman Kaminsky said, “After hearing from numerous constituents and closely studying this issue, it is clear that commercial insurance companies do not have adequate mental health service networks for hard-working families.  This lack of access to care is alarming, and I hope DFS will immediately respond by commencing a thorough study of this issue.”

While Medicaid covers comprehensive mental and behavioral health services, commercial insurance frequently does not provide coverage, or if they do, the rates are miniscule compared with the cost of treatment.  The reality today is that fewer community-based mental health clinics are accepting privately insured clients who earn too much to qualify for Medicaid, which leaves these families with nowhere to turn for affordable care. They have few options to access care for their children, even those experiencing life-threatening crisis situations.

“In this day and age, it is disgraceful that mental health treatment is still not being taken seriously.  Turning children and their families in need away is simply unacceptable,” said Assemblyman Kaminsky.

I applaud Assemblyman Todd Kaminsky’s calling for a NYS Department of Financial Services investigation of commercial insurance companies with respect to network adequacy and substandard rates of reimbursement for behavioral healthcare.

By ignoring the enforcement of the federal parity law, the majority of representatives in government are turning their backs on the millions of Americans who are in need of essential mental healthcare services. We cannot trust insurance companies, whose eye is on their bottom lines, to do the right thing. It’s no exaggeration to say that lives have been and will continue to be lost unless we pressure our politicians to make this a top priority.

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

LET THE GO, LET THEM GROW

As parents, we naturally want to keep our children safe. But it’s important to remember that, while it’s a parent’s job to protect, it’s a child’s job to explore. But for mothers and fathers who came to the United States from countries in Central and South America that are rife with war, gang violence and poverty, allowing their children—and especially their daughters—to explore the world around them can be terrifying.

Regardless of their origins, it’s natural for all teens to want to be accepted by their peers and feel like they are part of American culture, but it’s understandable that the parents of first-generation Latinas are extremely overprotective. Many immigrated to America because they wanted their families to be safe, which results in a tendency to continually hover over their daughters. Many of them won’t let the girls participate in typical teen activities such as sleepovers, dating or trips to the mall, which makes the girls feel trapped and isolated.

Even if the teens are allowed to go out with friends, they are required to have a chaperone, such as a parent or brother. In addition, they are often relegated to gender-biased roles, required to cook, clean and take care of their siblings while their brothers are treated, as one girl said, “like princes.”

The result of these conflicts: An increasingly large number of teenage Latinas were coming to North Shore Child & Family Guidance Center with depression, self-harming behaviors and suicidal thoughts. Some had even attempted suicide.

Determined to help these girls and their families, Associate Executive Director Regina Barros-Rivera gathered a team of bilingual, multicultural counselors from the Guidance Center and created the Latina Girls Project, an innovative program that employs counseling, monthly outings and other activities designed to tackle issues such as hopelessness, poor self-esteem and school refusal.

Individual, group and family therapy are integral pieces of the program. Through therapy, the girls develop trust, learn healthy ways to deal with stress and depression, and find better ways to communicate with their parents.

But the monthly outings are also a very important element of the Latina Girls Project. During one trip to Manhattan, the girls took part in a workshop led by female artists, dancers and poets, all accomplished and confident Latina women. This was a huge adventure for the teens, because they were so often stuck in their home communities—and also stuck in feelings of low self-esteem, shame and self-consciousness.

At first, the girls couldn’t say anything positive about themselves; they had no access to such self-affirming feelings. But they gradually spread their wings, bit by bit, and took part in art, dance and writing. The teens were uplifted by witnessing the confidence and compassion of these powerful role models, who told the girls to look in the mirror and see their own strength and beauty.

This workshop, along with other trips to historical sites, artistic venues and nature settings, help the girls shift from feelings of helplessness to hopefulness. Over time, they find their voices and discover the inner strengths that had eluded them.

By participating in family therapy and also witnessing the transformation their daughters experience, the girls’ parents become more compassionate and understand that they need to let their teens separate in healthy, age-appropriate ways. As one girl put it, “My parents learned that I just wanted them to be there for me and listen. They learned that it doesn’t help to question why I feel the way I do but to accept it and support me.”

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.

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. 

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.