POISONED CHILDREN IN AMERICA

Published in The Hill, February 16, 2016

By Andrew Malekoff

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

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

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

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

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

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

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

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

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

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

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

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

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

TREATMENT LAWS AREN'T BEING ENFORCED

Tucked into the heartbreaking story by Newsday about a young women’s lack of access to lifesaving healthcare to treat her addiction (“A daughter lost to heroin,” Editorial, May 15, 2016) is the fact that Bridgette Kurtzke was diagnosed with bipolar disorder as a teenager.

A 2014 study by the U.S. Substance Abuse and Mental Health Services Administration, 7.9 million people had both a mental health disorder and substance use disorder.

Newsday’s editorial stated that Gov. Andrew M. Cuomo has created a task force on opioid addiction that will propose new legislation. The fact is, we already have federal legislation; namely, the Mental Health Parity and Addiction Equity Act and the Obama Patient Protection and Affordable Care Act. Both state that it is illegal to treat diseases of the brain differently than those of any other part of the body.

Before proposing bills, the governor and his task force should know that these laws aren't being adequately enforced in New York, especially as it relates to having an adequate network of services. Insurers must provide enrollees with timely access to a sufficient number of providers included in the benefit contract.

Andrew Malekoff is executive director for the nonprofit children’s mental health agency North Shore Child and Family Guidance Center in Roslyn Heights, NY

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

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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/

IT'S TIME TO OPEN DIALOGUE WITH YOUNG PEOPLE

If you are a sentient being you’re well aware of the alarming degree of divisiveness that has been generated as a result of the presidential campaign. Given the growing incidence of hateful speech and action, there is a desperate need for open dialogue with young people.

I can vividly recall meeting with a therapy group for troubled teens some 25 years ago. They raised the subject of race and racism after having been exposed repeatedly to the videotaped TV footage of the Rodney King beating, which foreshadowed the current era of cell phone videos and body cams.

Rodney King was an African-American man who became widely known after being beaten by Los Angeles police officers after a high-speed car chase on March 3, 1991. A local resident witnessed the beating and videotaped it from his nearby apartment. The officers were tried in court but were found not guilty.

The two minority members of the group spoke about their own fear and “paranoia.” I listened and then told them “just because you’re paranoid doesn’t mean they aren’t out to get you.”

In 1968, psychiatrists William Greir and Price Cobbs noted in their book Black Rage that, for some people, a suspiciousness of one’s environment is necessary for survival.

Indeed, the phenomenon of adaptive paranoia—which recognizes real threats, not imaginary ones—is not at all uncommon to minority groups who have experienced profound prejudice historically and who now, after the brutal 2016 campaign, are more concerned than ever.

Here’s what we know for sure: Reports of hateful intimidation and harassment are on the rise since the election.  According to the Southern Poverty Law Center there were more than 850 accounts of racism, Islamophobia and xenophobia between November 9 and the morning of November 14. 

Recently, I posed these questions on social media: What is the emotional impact of the trickle-down divisive campaign rhetoric on the nation's children? What signs are you seeing? What can you do? Here are two responses:

“Hispanic students are afraid to go to school because classmates bully them and tell them they are being deported.”

 “Immigrant children are terrified! They are afraid their parents are going to be sent away. I think it is important to allow a space for dialogue.”

Now, more than ever, rather than squash discussion on these sensitive matters, we owe it to the young people in our lives to foster open dialogue. Noted family therapist Harry Aponte’s reflection on diversity might serve us well as a guideline. He said,

“Diversity is not about us-versus-them. And neither is it about easy agreement among different cultural, ethnic and racial groups… It is a bold, rich and complex tapestry. It has to do with being different in values, traditions and speech, and the same in human need, suffering and love. It has to do with living in separate neighborhoods, and together in the larger common community of nation. Diversity of culture, ethnicity and race gets its significance and specialness in the context of our universal identification as human beings.”

Although a better understanding and respect for cultural differences is important, we owe it to our children to reach for commonalties experienced across cultures. That is the way we will open new pathways for connection.

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 or find them on Facebook.

WHO'S THROWING THE BABIES INTO THE RIVER

Despite feeling blindsided, most of us now know that we are living in the midst of an unprecedented drug epidemic. According to the U.S. Department of Health and Human Services (HHS), since 1999, the rate of overdose deaths including prescription pain relievers, heroin and synthetic opioids such as fentanyl, nearly quadrupled.

Some of the steps taken to save lives include improving prescribing practices and expanding access to medication-assisted treatment and the use of Naloxone.  

Medication-assisted treatment combines talk therapy and medications such as methadone or buprenorphine to treat opioid addiction. Through affordable, accessible and quality care people can recover and go on to live productive lives.

Naloxone is used to treat a narcotic overdose in an emergency situation by reversing the effects of opioids, including slowed breathing or loss of consciousness.

Notwithstanding the increased attention to lifesaving measures, there is less focus on the devastating impact of addiction on children living in families where a parent is addicted to drugs or alcohol.

Perhaps nothing drove home the reality of America’s opioid problem more than the recent photo taken in Ohio of two overdosed adults spread out in the front of a car, while one of their young grandsons looked on from the back seat.

There are more than 8 million children younger than 18 years of age that are growing up in homes with alcohol and other drug-abusing parents. These young people are likely to become alcohol or drug abusers themselves without intervention.

Parental alcoholism and drug addiction influence the use of alcohol and other drugs in several ways including increased stress and decreased parental monitoring.

Children who grow up with an addicted parent learn to distrust to survive. When unpredictability dominates a child’s life, he or she is likely to be wary, always sensing disappointment lurking nearby.

Children growing up with an addicted parent become uncomfortably accustomed to living with chaos, uncertainty and instability. When a child grows up under these conditions, they learn to guess at what normal is, with no roadmap to assist them.

Denial, secrecy, embarrassment and shame are common experiences of children who live with an addicted parent. Even seeking help outside of the family might in itself be seen as an act of betrayal, a step toward revealing the family secret.

Children who grow up with an addicted parent live with an unspoken, emotionally numbing mandate - don’t talk, don’t trust, don’t feel.

Growing up with an addicted family member leaves one with little hope that things will ever change; unless, we take steps to change it. I am reminded of a parable about the small village on the edge of a river.

One day a villager saw a baby floating down the river. He jumped in the river and saved the baby. The next day he saw two babies floating down the river. He and another villager dived in and saved them. Each day that followed, more babies were found floating down the river. The villagers organized themselves, training teams of swimmers to rescue the babies. They were soon working around the clock.

Although they could not save all the babies, the rescue squad members felt good and were lauded for saving as many babies as they could. However, one day, one of the villagers asked: "Where are all these babies coming from? Why don't we organize a team to head upstream to find out who's throwing the babies into the river in the first place!"

Mobilizing resources to pull babies from the river, while neglecting the one’s left behind makes no sense.

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. 

DOES THE PATH HAVE A HEART

As Election Day 2016 approaches I am wondering how first-time voters, especially young people, are faring. Even when my powers of concentration are sharpest after a full night’s sleep, I cannot fully trust that I can accurately differentiate substance from style, image from authenticity. As I watch and listen, I am reminded that we tend to place great emphasis on intellect, especially language skills and ability to reason and less emphasis on more personal intelligences. 

Howard Gardner, author of Multiple Intelligences, identified key areas that we should look for in leaders that go beyond intellect. They include abilities to understand oneself and others, and to address profound human concerns, especially during times of crisis. These are abilities that we cannot possibly know about through scripted sound bytes and clever marketing.

We know that Donald Trump is a wealthy businessman, gifted salesman, media personality and, by all accounts, a celebrity. We know that Hillary Clinton is a lifelong public servant, former first lady, politician and advocate for many vulnerable groups; and, also a celebrated figure. Both are spouses, parents and grandparents.

We know that both lead candidates are far from perfect. Their character flaws, vulnerabilities and missteps have been revealed repeatedly in what is perhaps the bloodiest presidential campaign in memory. Let’s assume, just for the sake of argument, that the character issue is a wash. Does that make it any easier for young people placing their ballot for the first time? I think not.

We cannot forget about the fear factor - terrorism, homeland security, crime, illegal immigration, gangs, the drug trade - that the candidates and their surrogates aim at fence sitters – the independents that can be swayed one way or the other and whose collective votes can make all the difference. And, of course, there is the economy.

For the last 15 years, the income of the typical American family has been at a standstill, health outcomes for many children are poor, and globalization and technological change have made it most difficult for poorly educated Americans to achieve the peace of mind and self respect that a secure livelihood enables.

So when one checks off character, wades through media deceit and considers the fear factor and economic concerns, first-time voters are left only with faith about what they glean each candidate to really stand for in the areas that are most important to them.

Reverend Theodore Hesburgh, former president of Notre Dame University said, “Voting is a civic sacrament.”

As I consider my final decision about who to vote for, I am reminded of a line by Carlos Castaneda in his book, A Separate Reality: “Anything is one of a million paths. Look at every path closely and deliberately. Try it as many times as you think necessary. Then ask yourself, and yourself alone, one question: Does this path have a heart?”

I offer good wishes to first-time voters who have sacrificed their time and energy to make some sense out of who to support on November 8th. It is the soul searching and the struggling through that make you the true winners on Election Day. 

https://longislandweekly.com/does-the-path-have-a-heart/

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.