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.
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/
This story was originally published in Long Island Business News.
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.
Andrew Malekoff, executive director of the North Shore Child & Family Guidance Center
Andrew Malekoff, executive director of the North Shore Child & Family Guidance Center.
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.
Jordan and mom Patty in Soho, New York Fashion District.
Jordan and mom Patty in Soho, New York Fashion District.Although I’ve written before about bullying in this column, none of my experiences or research prepared me for my friend Patty Underwood’s reflections about walking the streets of New York with her teenage daughter Jordan, an incredibly talented theater student from the Boston area. I had the pleasure to meet Jordan on a trip to Boston a few months before she departed for New York City to begin her freshman year at NYU. But this story is about more than bullying. It is about a mother’s love and a child’s resiliency.
Patty’s story, painstakingly recalled and beautifully reported, will surely touch many a raw nerve. Her story requires no editorial comment from me, which would only dilute an intimate experience that speaks for itself. Patty granted me permission to share her story with you, my readers. Patty told me, “Walking with Jordan allowed me to be in her shoes. I heard her talk about this experience before, but it was the first time I really experienced it.” She added, “Jordan is all for letting people hear her story.”
Patty Underwood: “As we walked to the MOMA, I glared at the middle-aged woman who was looking at my 19-year old daughter like she was the circus fat woman. The woman appeared to be with her own thin teenagers; as she glanced at them, her face seemed to be mixed with wonder and disgust. I could feel the judgment exuding from her eyeballs, and the anger in me surged back with fire in my eyes. On the next block a group of construction workers smirked and cat-called. Then the teenagers wearing tiny belly-revealing tank tops gawked at her tummy that also peaked out.
“Every New York City block we walked brought eyes that bore holes in my daughter’s body and I was feeling a mix of distress, rage, worry and pure exhaustion. How the hell does someone survive the unrelenting visual persecution and surging negative energy? By the end of the day, I wanted to crawl under a rock and it wasn’t even me that was at the receiving end of this attack. My daughter kept saying, ‘What’s wrong?’ ‘Do you not want to be here?’ ‘You seem distant.’ I told her I was just tired from the long day in the city.
“Truthfully, I was trying to swallow the impact of her walking out the door every day. How does she do it? Who is there to protect her? What is this doing to her brain? I felt paralyzed by witnessing humanity try to crush my daughter’s spirit. At one point I suggested that maybe she not show so much cleavage, and she railed back, ‘Oh, just because I have big boobs it’s okay to comment about them? As a social worker, mom, you should know better. What, are you now going to say that women who get raped asked for it!?’
“We continued to walk, her with her head high and mine stuck down, avoidant of the imminent look. My daughter, it seems, has come to terms with the battle she faces when she walks out the door. ‘Mom, if you weren’t here, I would respond, tell them to f*** off.’ I am reminded of the practice she has had at facing the bullying since middle school. And the barrier it created; and the friends who love her unconditionally. And the dance teachers who see the beauty in how her body moves. And the 10,000 likes she got on Tumbler after posting a video of her dancing.
“Plus-size models are walking the runways and appearing in fashion magazines and Ashley Tipton won Project Runway. [Tipton is a 24-year-old clothing designer.] Tipton is an amazing woman who is advocating for the underprivileged and the eradication of all types of discrimination. Yes, she’s a fighter, fiercely protective of those whose human rights are under attack, passionate, creative, funny, singer, actor, dancer, black belt carrying, plus-sized and beautiful. Jordan is all this and more.”
Thank you Patty and Jordan.
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. The views expressed in this column are not necessarily those of the publisher or Anton Media Group.
This column original appeared in Anton Media Group. Click here for Anton’s website.
Peer pressure can play a major role in the sending of texts, with parties being a major contributing factor.
A few years ago, in an effort to better understand where sex and social media intersect with respect to attitudes and behavior, The National Campaign to Prevent Teen and Unplanned Pregnancy conducted a survey of teens and young adults. The study measured the proportion of them who are posting sexually suggestive text and images. There were a total of 1,280 respondents—653 teens (ages 13 to 19) and 627 young adults (ages 20 to 26).
The survey found that a significant number of the 13 to 19 year olds have electronically sent, or posted online, nude or semi-nude pictures or video of themselves. Sexually suggestive messages via text, email or IM (instant message) were even more prevalent according to the survey. Seventy-five-percent of the teen respondents and 71 percent of young adults said sending sexually suggestive content “can have serious negative consequences,” yet they continue this behavior despite substantial personal safety and legal risks.
In the past few months on Long Island, sexting has been all over the news, including arrests and school suspensions of teens charged with sexting and viewing these messages. Parents, caregivers and other relevant people in kids’ lives need to be attuned to this behavior and be prepared to address it.
Despite the influence of peers, which is not all negative, this is only one part of a four-part community that includes family, larger community and media influences, all of which have demonstrable effects on adolescents’ sexual attitudes and behavior and all of which interact in a complex way. For example, beyond the peer group are information and images transmitted by the media that may typify values that are detrimental to young people’s self-image and health.
In families in which sexuality is not a taboo subject and related discussions occur quite naturally throughout childhood, pathways are forged for ongoing dialogue about all aspects of sexuality. If parental influence is strong enough—that is, if their relationships with their children are warm and close and their parenting style is authoritative—it can be a powerful protector against negative peer influence.
The American Academy of Pediatrics offers some good tips for talking to you kids about texting (go to www.aap.org and search for “sexting”):
• Talk to your kids, even if the issue hasn’t directly impacted your community. “Have you heard of sexting?” “Tell me what you think it is.” For the initial part of the conversation, it is important to first learn what your child’s understanding is of the issue and then add to it an age-appropriate explanation (see next bullet).
• Use examples suited to your child’s age. For younger children with cell phones who do not yet know about sex, alert them that text messages should never contain pictures of people—kids, teens or adults—without their clothes on, kissing or touching each other in ways that they’ve never seen before. For older children, use the term “sexting” and give more specifics about sex acts they may know about. For teens, be very specific that “sexting” often involves pictures of a sexual nature and is considered pornography.
• Make sure kids of all ages understand that sexting is serious and considered a crime in many jurisdictions. If they “sext,” there will be serious consequences, quite possibly involving the police, suspension from school, and notes on the texter’s permanent record that could hurt their chances of getting into college or getting a job.
• Experts have noted that peer pressure can play a major role in the sending of texts, with parties being a major contributing factor. Collecting cell phones at gatherings of tweens and teens is one way to reduce this temptation.
• Monitor headlines and the news for stories about sexting that illustrate the very real consequences for both senders and receivers of these images. “Have you seen this story?” “What did you think about it?” “What would you do if you were this child?” Rehearse ways they can respond if asked to participate in inappropriate texting.
• Encourage school and town assemblies to educate parents, teachers and students.
An important and related problem is that with social networking there is no respite. Social media has a 24-7 quality that leaves many teens feeling that there is nowhere to turn and no escape—not at home, not on vacation, no place.
Social media has opened the door to new avenues of sexual expression and new challenges for families, health educators and human services professionals. Don’t miss this opportunity to educate your youngster about its dangers.
Andrew Malekoff is the executive director of North Shore Child & Family Guidance Center, which provides comprehensive mental health services for children from birth through 24 and their families. To find out more, visitwww.northshorechildguidance.org.
This column original appeared in Anton Media Group. Click here for Anton’s website.
