IF YOUR CHILD IS NOT HEALTHY, MY CHILD IS NOT SAFE

IF YOUR CHILD IS NOT HEALTHY, MY CHILD IS NOT SAFE

Andrew Malekoff © 2010

Gladys Carrión, Commissioner of the New York State Office of Children & Family Services, oversees 26 juvenile detention facilities that hold close to 2,000 kids under 16 who have committed criminal acts. In a 2008 interview with New York Daily News, she stated that over 80% of the adolescents in this system have serious mental health problems that go untreated. Carrión described the network of juvenile facilities as a “pipeline to prison.” The system damages children and families and fails to make our neighborhoods safer.

Sara Montalbano, a social worker at North Shore Child and Family Guidance Center, who specializes in mental health counseling for delinquents and juvenile offenders and their families, has worked with a wide range of adolescents. “On one end of the spectrum,” she explains, “there are kids who were arrested for punching a hole in the wall at home. On the other end, there are kids who set fires and committed assaults and murders.” Montalbano asserted that, “There are not adequate resources to help these children and families on either end of the continuum.”

In an exposé by New York magazine (Feb. 10, 2010), it was reported that a US Department of Justice investigation found that employees in several New York State juvenile detention facilities were “restraining kids so often and with so much force that kids had endured concussions, broken teeth and broken bones.”

Since her appointment in 2007, Commissioner Carrión has closed 9 juvenile residential facilities. This has been replaced, in part, with alternatives-to-prison prevention programs that include psychiatric support and family therapy. However, historically elected officials have hesitated to support “pay now or pay later” prevention programs.

“The fundamental problem with elected officials,” according to Lee Staples, clinical professor at the University of Boston School of Social Work, “is that they almost always choose to ‘pay later’ because when the bill comes due, they frequently are no longer in the same office. They are resistant to ‘paying now’ for fear of losing the immediate votes of angry taxpayers.” This is a structural problem that works against almost all preventive programs. Add in “the paradox of prevention,” whereby the general public no longer sees a pressing problem when social programs are successful, and those same programs suddenly are at risk.

According to Dr. Staples, “We saw the phenomenon clearly in the city of Boston when gang violence spiked more than a decade ago. Some very effective preventive programs were put in place, violent crime statistics dropped dramatically, the programs were cut and the statistics almost immediately shot back up. It is not so much that politicians cannot learn that prevention really saves money but, rather, they see an imperative to act based on short-term electoral self-interest and immediate budgetary constraints – which, of course, is always present in an underdeveloped social welfare system.”

Closer to home, in 2009, then Nassau County Executive Tom Suozzi threatened to shut down 43 community-based youth services that served over 60,000 children and families across Nassau County, to help close a reported $130-million dollar county budget deficit. The impact of eliminating critical prevention services would have resulted in a greater cost to taxpayers - $200,000 per year to lock-up a juvenile in a state residential facility. And, the return on the investment is poor, as almost 90% of those locked up in these settings engage in ongoing criminal activity.

The citizens that fought back to preserve youth services in Nassau County were operating at a higher moral standard than those who were counting votes. Morality aside, though, advocates for youth services have a visceral understanding about the real consequences of not supporting prevention. They are not, as the old insult goes, “bleeding hearts.” If a person supports prevention it does not mean that they excuse criminal behavior.

It does not take a bleeding heart, only a rationale mind, to know that if your child is not healthy, my child is not safe.

This Parenting Plus column by Andrew Malekoff was first published in the Anton Newspapers chain of Long Island on March 25, 2010.

RED DOT IN HAITI, TEAR DROPS ON LONG ISLAND

RED DOT IN HAITI, TEAR DROPS ON LONG ISLAND

By Andrew Malekoff© 2010

Ludmyard Charles, 16, said that when she got home the phone rang. It was her father. He told her to get a glass of water. Then he asked her if she was sitting down. Next, he shared the heartbreaking news that her aunt, Ludmyard, was killed in the earthquake. The aunt she was named after who was pregnant, had lost her life when the earth opened up. The girl’s eyes filled up and she said of her aunt - “We were like sisters.”

A few days ago, I had the privilege of meeting Ludmyard and six of her fellow Westbury High School students, all of whom have roots in Haiti. I asked them about the emotional aftershocks of the January 12th earthquake that toppled national landmarks and shantytown homes and killed and injured untold hundreds of thousands of people in and around the capital city Port-au-Prince.

Each one of the four girls and three boys learned about the earthquake when they arrived home after being together in an after-school program led by North Shore Child and Family Guidance Center. Eighteen-year-old Vayola Justinian recalled, “When I got home my mom was crying. The TV was on. When I looked at the screen I saw a map of Haiti. There was a red dot.”

I asked the students about the media coverage and they said that it was both good and bad. “It was good to have updates,” said 18-year-old Joes Paraison, “but bad to see pictures of the dead and injured.” The others nodded and Joes said, “By the second day it felt like my family was going crazy” watching television. He said that the faces on the screen were hard to see clearly, leading them to wonder if anyone of them was a family member. Joes then recalled a most troubling of images - “a truckload of dead children.” Seeing such devastation from afar, including pictures of people buried underneath rubble, added to their feelings of helplessness and their wish to be there to help.

Their counselor Pascale Beaubrun, a native of Haiti, who is based at the Guidance Center’s Leeds Place in Westbury, later said that they turned their sorrow into action by collecting money and contributing to the Yéle Haiti Earthquake Fund, a charity initiated by Grammy-award-winning musician and producer, Wyclef Jean.

Myriam Jerome, 18, reasoned that it was better that the earthquake happened in the afternoon when everyone was out and about. Had it happened in the late evening when they were asleep in their homes, she explained, there would have been an even greater human toll.

Unwinding from a day at school Michael Belizaire, 17, played a video game, while the youngest in this group, 15-year-old Policia Jean, turned on MTV. Both were later alerted by family members to tune in to CNN. In a short time they too saw the red dot in Haiti. Michael told us that his family’s house in Haiti was near the National Palace in Champs de Mars. He worried about his father and uncle who, he later learned, had survived.

Joes said that he tried to “move on” and had discovered that it was not as easy as it sounded. “Each day when I go to school, I try to forget, but every day when I get there someone else is crying.”

“How do you cope?” I asked. They turned to one another and gestured in a manner that emphasized their deep connection to one another. They talked about the support offered by groups of Haitian youths in school and in the community.

Camy Pierre, 16, said that it was important “to comfort one another and don’t do anything reckless or lose control.” I asked Camy what he meant by that. He said that some of their peers were insensitive and said hurtful things about Haiti. Michael chimed in and stated how important it was to always “think positive.”

I asked about what they did when friends alone were not enough. One of the girls said that she was worried about a girlfriend who was so distraught that she thought she could hurt herself. When she realized that more than friendship was needed, she advised a trusted school counselor. All of them said that they were aware of where and who to go to for more specialized support in school and in the community and found support in that as well.

Expressions of helplessness and grief quickly turned to frustration and anger as they talked about disturbing phone calls from Haiti and learning about mass graves and rampant lawlessness and rape. I said that it must be unbearable to sit with such news. Joes emphasized the importance of talking and not allowing one’s feelings to get "all bunched up."

Long after we said goodbye, I was left with a feeling of abiding respect and pride for this group of thoughtful and deeply empathic young people. They are, without a doubt, among the finest of Haiti’s - and Long Island’s - sons and daughters. Let us never forget them.

To be published in the Anton Newspapers on Long Island New York, February 24, 2010.

Medicaiding-the-System Redux

Medicaiding-the-System Redux

by Andrew Malekoff©

January, 2010

Executive Director, North Shore Child and Family Guidance Center
Roslyn Heights, New York 11577

BONUS-DOLLAR BLITZ CIRCA 1991

In 1991, New York State implemented a plan to use Medicaid dollars to fund outpatient community-based mental health services. That two-decade-old approach, also known as Medicaiding-the-system, is on its way out.

Medicaiding-the-system was a combination of (1) a base Medicaid rate applied for each outpatient mental health visit for Medicaid recipients only and (2) supplemental or bonus dollars paid on top of each base payment to subsidize non-Medicaid recipients. This approach to support community-based agencies was developed to replace local assistance or deficit-financing.

Local assistance was a simple and sensible public-private financing partnership. The partners were the State and County governments (through government contracts), mental health consumers (through fee-for-service payments) and the local community (through fund-raising).

Local assistance funding insured that all stakeholders chipped in a fair share to support an essential community-based service. However, New York State decided that if Medicaid could cover these costs, that they could systematically reduce and ultimately eliminate the amount that they chipped in through local assistance contracts.

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

BONUS-DOLLAR BLITZKREIG CIRCA 2010

In recent years, New York State recognized that the Medicaid bankrolled bonus-dollar approach of financing community-based clinics had the inadvertent affect of propping up commercial insurers that were paying substandard rates and limiting access to essential services. Having uncovered that festering wound, they got to work on creating a new financing plan that they refer to as clinic reform.

The clinic reform plan will raise the Medicaid-base rate and phase out bonus-dollars over a four-year-period. The Medicaid base-rate will apply only to those individuals that have what is known as straight Medicaid insurance; that is, Medicaid that is not managed by a commercial insurance company. There will be no reliable funding stream to replace the lost bonus dollars except for a finite pool of funds, presumably to cover services for indigent consumers.

In discussions with State officials about the devastating consequences of the clinic reform plan for the middle class and working poor, I was told that clinics must re-negotiate rates with commercial insurers. That is nothing new. It is common practice. The State officials advised me that if the commercial insurers do not raise their rates to sufficient levels that will help to cover the cost of services provided, then we should terminate our contracts with them.

Community-based providers routinely re-negotiate rates with the managed-care companies that represent the commercial insurers. However, they rarely agree to rates that will cover the cost of service. As one such managed-care company representative recently told us, “C’mon, we are hurting too.” For more information on public and private insurance markets in New York I refer you to the following website: http://www.uhfnyc.org/publications/880618.

If we drop the commercial insurers, as I was advised to do, it means that middle class and working-poor families are out of luck. They will not be able to afford to pay out of pocket to access community-based outpatient mental health services that are structured to meet their families’ needs. For example, at North Shore Child and Family Guidance Center, almost 30% of all evaluations in 2009 were emergencies that were seen within 24 to 48 hours. Who will take care of these emergencies? Private practitioners?

Clinic reform is nothing more than a downgraded version of Medicaiding-the-system. With clinic reform, the term community-based mental health center becomes a thing of the past as only a small segment of the local community will be able to access needed services.

APRIL FOOL’S DAY 2010

New York State is throwing in the towel at a time when there is unprecedented need for community-based mental health services. As the complex funding history described above is demystified, more and more families are advocating for a freeze on clinic reform. I urge you to call your local New York State legislators and tell them to extend the projected clinic reform start date of April 1, 2010 and to restore local assistance financing.

Don’t accept, “But there is no money!” for an answer. Please listen; the fact is that the cost to place a child or teenager in a psychiatric or juvenile detention center or a young adult in jail is far greater than what it costs to support quality community-based mental health care that will keep them at home.

We all know that familiar refrain, pay now or pay later.

This is an advance proof of Mr. Malekoff’s monthly column PARENTING PLUS, that is scheduled for publication in January, 2010 in the Long Island, New York Anton chain of newspapers.

BUILDING COMMUNITIES OF CARE

BUILDING COMMUNITIES OF CARE

By Andrew Malekoff©

What do the following have in common? Asthma, Cancer, Crohn's Disease, Cystic Fibrosis, Degenerative Disc Disease, End Stage Renal Disease, Hepatitis C, Hypoglycemia, Idiopathic Dilated Cardiomyopathy, Irritable Bowel Syndrome, Leg-Calvé-Perthes, Marfan Syndrome, Multiple Sclerosis, Migraines, Polycystic Kidney Disease, Scoliosis and Supraventricular Tachycardia.

If you guessed that they were all physical illnesses you are correct. However, another common thread is they are illnesses that a group of young people in the radical-alternative DIY (do-it-yourself) community have been diagnosed with and have written about (along with a few young people that care about them) in a publication entitled Sick, a compilation zine on physical illness.

For the uninitiated, a zine (derived from magazine) is a topical publication typically intended for an alternative or underground audience. A zine tends to include written and visual work aimed at promoting and supporting a social movement. DIY represents an ideal or value for many young people who associate themselves with the punk subculture.

One contributor, Luci, speaks for her fellow contributors when she asks, "How can a disabled person find allies and support?" This book will help supporters and supportees to find some answers, insight and inspiration.

Among the moving narratives in SICK is a love story entitled “Scar Mates” by Rainbow, who has been diagnosed with chronic kidney disease. After being rejected by one young suitor who could not deal with the scars left behind after Rainbow’s open heart surgery and kidney transplant, she fell in love with a young man that she met on-line, who has been diagnosed with Cystic Fibrosis and Diabetes.

Along with providing poignant first-hand accounts of living with physical illness and chronic disease, many of the authors offer practical advice for young people struggling with these ailments, as well as suggestions for friends and family members that care about them. For example, the authors advise patients to be kind and understanding about themselves and to ask for what they need.

There are also useful tips for friends and family members. In a piece entitled, “Illness and support,” Ben Holtzman says that people with illness do want to talk about it. He says that saying something small is almost always better than saying nothing at all. The practical advice contained in the collection might be dubbed as uncommon common sense because, although it seems very basic, it is the kind of advice that requires gentle prodding and encouragement to carry it out.

Beyond practical tips, there is great wisdom sprinkled throughout. For example, Emily Klamer, a student, writer and activist from Missouri, who is living with degenerative disc disease, writes elegantly about the “lurking threat” of illness that we all face sooner or later.

SICK editor and essayist Ben Holtzman, who was diagnosed with cancer at age 26, introduces the collection by stating that, "Illness is considered taboo; it's seen by many as awkward, if not depressing, to bring up...The collective strength of these pieces...is meant to further... action toward building communities of care."

The stories are gritty, no-holds-barred, first-hand accounts of what it is like to live and cope with physical illness and chronic disease, including the struggle to get and then find one’s way through the maze that is health insurance. By openly revealing what it feels like to be young and sick, the authors - mostly young women - go a long way towards supporting Holtzman's vision.

Hospitals and physicians would do well to have this publication, and ones like it, available as resources for young people with physical illnesses and their friends and family members. Giving voice to what it is like to suffer in silence, is a way that these young DIY authors have extended the bonds of belonging to create true communities of care.

Write to illnesszine@gmail.com if you are interested in learning more about building communities of care.

Published in the Anton newspapers on Long Island, NY in December 2009.

LONG ISLAND BUSINESS NEWS ON CHILDREN'S MENTAL HEALTH

Long Island Business News

Pushing for parity

Commentary by Andrew Malekoff

Published: November 2, 2009, page 20A

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

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

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

New York state has a statutory responsibility to make sure that its most vulnerable citizens – our children – get care regardless of their families’ economic status. Instead, what we are getting is institutionalized classism that cuts the middle class and working poor out of the behavioral health equation. Despite rhetoric to the contrary, the new Federal Mental Health Parity Act will not help.

Offering unlimited clinic visits at substandard rates is not parity, but rather a barrier that denies access to the middle class and working poor. Commercial insurers that cannot demonstrate an adequacy of network for behavioral health care should have their licenses revoked by the State Department of Insurance.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

DENTALLY CHALLENGED

DENTALLY CHALLENGED

By Andrew Malekoff©

A few months ago there was a news report about a guy from upstate New York that was accused of practicing dentistry without a license. The report stated that he operated in his kitchen. In lieu of Novocain he offered his patients a slug of wine to help them through the pain. The story brought back a flood of memories from my childhood. One was a traumatic episode that I re-live to this day every time I sit in a dentist’s chair.

Our family dentist, a family friend, reminded me of the actor Peter Lorre. If you are too young to recall him, Peter Lorre was an Austrian-American actor that often played alongside Humphrey Bogart and was typecast as a creepy, sinister foreigner.

Summer Camp

As a pre-teen in New Jersey many of my friends went away to upstate summer camps in “the mountains.” For me, summer days could be fun or long and boring. I stayed at home and spent my summers at area swimming pools and playgrounds or watching baseball games on television. Except, that is, for one summer in the early 1960’s. My mom asked me if I’d like to go to sleep away camp for a month. I was ecstatic for the opportunity and said, “Yes!”

Along with the news about going away, were sudden car trips to the doctor for a physical exam and a series of shots, and to the dentist to get my teeth checked out. I passed the physical with flying colors and took the shots in stride. I didn't do so well with the dentist. On the car ride home mom told me that I needed sixteen fillings. Sixteen! Since camp was only a few days away she said that I had to get all of the fillings at one time. An appointment was set for the next Friday night at eight-o’clock.

Sitting Down

The dentist’s office was in his house and adjacent to his kitchen where my mom sat from 8 pm to 12 am drinking coffee and chatting with his wife. He did not give me Novocain, which was consistent with my other visits. In-between drillings and fillings Peter Lorre slithered away through a door that led to the kitchen, maybe for a slug of wine reserved for adult patients, while I sat quietly waiting for the next assault. I was stoic. I didn’t complain or shed a tear all night.

I discovered that I could endure lots of pain, and hide it well, on that warm summer night. When we left I didn’t say anything about it to mom or to anyone else.

My only four weeks at sleep away camp were fun. What I remember most though, like it was yesterday, were the four hours in the dentist’s chair.

Standing Up

I recently found a website dedicated to “dental horror stories.” One was written by someone much younger that me, who said that his dentist was always in a rush. One time when he was a kid, he said, the dentist started drilling about 30 seconds after he shot him up with Novocain and before he was numb. He said, “I grabbed him by the wrist and told him to stop.”

He left in a huff and came back five minutes later to finish the job when he was fully numb. Nevertheless, he “fired” the dentist after the encounter, despite the fact that he had a close association with his family. His parents were very upset that he refused to see that dentist again. “I didn’t care,” he said, “he acted like a jerk, and I wasn’t going to stand for it!”

Good for him and for all kids (and others) today that are willing to stand up to authority in the right way and at the right time. Good for you!

This column originally appeared in the Anton newspaper chain on Long Island, New York, October 28, 2009.