Kathy Rivera became the first woman of color to take the helm of North Shore Child & Family Guidance Center when she assumed the executive director role last month at the Roslyn Heights-based nonprofit.
The organization provides mental health services for Nassau County’s children and young adults. Newsday recently spoke with Rivera, 47, of Fresh Meadows, about the pandemic’s impact on youth mental health and how her upbringing as a first-generation Asian American shaped her work.
Q. How did you get interested in the field of social work?
There has been a history of mental health issues in my immediate family. I have … witnessed domestic violence, food insecurity and housing instability. So from a very young age developmentally, I was exposed to that. So it was not surprising that as I got older, in recognizing what my own needs were growing up and experiencing all of this, I knew I wanted to find a profession where I could help communities that struggled with issues that I struggled myself with.
Q. How did your upbringing as a Thai American with immigrant parents shape your understanding of what you do?
In the Asian culture in general, mental health is often frowned upon. … What I experienced going back to my childhood [shaped] what I recognize [in] a lot of our communities that we serve. Parents sometimes don’t seek help because they fear it is a reflection of them as being a bad parent. It can feel embarrassing to ask for help, and so they don’t. . . . So [it’s] realizing that how not getting the right … help at the right time can really cause lifelong damaging changes and fracture a family.
Q. Has your organization seen a rise in cases during the pandemic?
We have gotten more calls for our triage unit from local hospitals and urgent-care centers where children are at risk of an inpatient hospitalization. … We’ve been finding more and more calls coming in and actually even for some younger kids. At one of our sites, we even are treating a 4-year-old [for mental health]. … We’ve definitely been getting calls from parents as well, really worrying about the social impact of the pandemic, the isolation, just the overall mental well-being of their own child and asking for their child to engage in therapy. So we’ve been seeing it from families, too, more so than in the past.
Q. How do people go about getting services from your organization?
Anyone who needs our services can just be a phone call away. … Our payer mix is a combination between self-pay, commercial insurance to Medicaid. And for those who have a struggle where the service may not be covered but yet they need it, we find a way to raise funds and cover those costs.
Q. Anything else you want to add?
One thing that I want to give the pandemic credit for is the exposure of the mental health crisis in our children. Again, it did not cause it, it exposed it, and it enhanced it. And I think that it helps naturalize it — being able to talk about it without the stigma.
The nonprofit was founded in 1953 and served 2,590 clients (from birth to age 24) in 2020.
Rivera said her organization has seen a roughly 45% increase in intakes from pre-pandemic times to now.
The agency serves Nassau County but at times accepts residents in Queens, Brooklyn and Suffolk counties through its maternal depression program, Rivera said.
When Marie, 11, called a suicide prevention hotline in October, nobody saw it coming. Not even Marie herself, who had been bottling up feelings of loneliness and sadness for months without telling anyone.
Her relationships with some of her closest friends had started to suffer when school went online last year, and she worried about losing other people in her life, too. What if they moved away? What if they died?
One weekday afternoon, she put on her headphones and listened to music while taking a walk, and she began to get increasingly upset. Even now, she isn’t sure exactly why.
“I knew that I needed help, but I didn’t really know who to go to,” she said.
She searched for a suicide prevention hotline on her phone, and wondered momentarily whether the crisis counselors would take her seriously. Then, she called.
With Marie’s permission, a counselor conferenced in Marie’s mother, Jackie, who was a 25-minute car ride away. They came up with a plan to keep Marie safe until Jackie could arrive. (Their surname and those of other families interviewed for this article are being withheld to protect their privacy. Marie is being identified by her middle name.)
The next day, Marie told her mother that “in the past, not too long before that, she had brought scissors in her bedroom with the intention of hurting herself, but didn’t know how to,” Jackie said. “I was completely blindsided.”
It wasn’t as though Jackie was unaware of the mental health crisis affecting adolescents. She works as a nurse at two different pediatric intensive care units on the East Coast, where she has treated many children who attempted suicide in the past year.
“Some of them we’ve asked, ‘How did you get the idea to do this?’” Social media is their typical response, she said. “They don’t grasp that if they hurt themselves, it might not be something we can fix, and they might not get better.”
Interviews with mental health providers and data from hospitals across the country reveal that while providers are continuing to see a surge in teenagers visiting the emergency room for mental health problems, the number of children in crisis under the age of 13 is also on the rise, and has been for years.
The youngest patient under Jackie’s care who had recently attempted suicide was 8 years old. She survived, but another child, also under 13, was not as fortunate, and became an organ donor. Jackie said that most of the children who come in after suicide attempts are girls who have overdosed on pain medication, like Tylenol. Some of them now face liver damage. Once, after a particularly difficult day at work, Jackie called her husband and asked him to lock up all the Tylenol and Motrin in their home.
“I don’t want to ever think we’re immune to these things,” she said.
‘We will see this crisis grow in the fall.’
Even before the pandemic, a mental health crisis was brewing among children struggling with bullying, abuse, eating disorders, racism or undiagnosed mental health conditions. But now, children are facing even more stressors, like the loss of a family member to Covid-19, adjusting to remote school or the anxiety of returning to in-person school.
“It’s almost like the pandemic threw gasoline on embers that were already glowing,” said Heather C. Huszti, chief psychologist at Children’s Hospital of Orange County in Orange, Calif. “We’ve never seen it this bad.”
For young children, the pain can feel endless.
“It’s like, ‘This is my life now. Do I have anything to look forward to?’” Dr. Huszti said. “Because they just can’t think long term.”
CHOC, where Dr. Huszti works, has the only inpatient psychiatric center in Orange County that can take children under 12. In order to be admitted to one of the center’s 18 beds, a child must be a current or imminent threat to themselves or to others. When the center first opened in 2018, about 10 percent of the children were under the age of 12. In 2020, that number began to increase, and now has more than doubled, Dr. Huszti said.
“We have some days where every kid in the unit is under 12,” she said.
National data shows a similar pattern. In November, the Centers for Disease Control and Prevention published a study that compared how often children came to emergency rooms in the United States for mental health reasons versus other types of concerns. The agency found that between April and October of 2020, there was a 24 percent increase in the proportion of mental health emergency department visits for kids ages 5 to 11 compared with the same period in 2019.
The problem appears to be particularly dire among girls. During 2019 and 2020, the proportion of mental health-related emergency department visits was higher for girls under 18 than it was for boys of the same age, the C.D.C. reported.
“I anticipate that we will see this crisis grow in the fall as kids return to school and are trying to adjust to making up for a year of lost development,” said Dr. Jenna Glover, a child psychologist at Children’s Hospital Colorado in Aurora.
Among children who die by suicide, there are stark racial disparities. The rate of suicide in Black children under 13 has been increasing over the last decade and is two times higher than among white children. In two editorials published on Monday in JAMA Pediatrics, the authors called on funding agencies and journals to prioritize research on Black youth suicide; and emphasized the need for preventive efforts that target stigma and institutional racism.
‘The younger the child is, the longer they wait.’
Children’s hospitals, which typically have few (if any) available inpatient beds for mental health patients, have begun to run out of room.
“The younger the child is, the longer they wait,” Dr. Huszti said. “It just breaks my heart.”
Some inpatient psychiatric units may not be able to admit kids under 12, she added, because they often require more one-on-one monitoring than older kids, as well as age-specific therapy.
In April, 11-year-old Lu and her mother, Nicole (their middle names), had to wait in an emergency room in Ohio “all day and all night” because the hospital’s 13 pediatric beds were full and two kids were in line ahead of her. They were eventually transferred to a behavioral health hospital nearby. Lu befriended other kids there who had their own mental health struggles, including some who were several years older. At one point, she saw someone get sedated and restrained.
“I was concerned,” Nicole said. “She was exposed to so much there that I wouldn’t want her to be exposed to.”
During the pandemic, Lu underwent “a really big personality change” that Nicole attributed to the “perfect storm” of isolation, hormones and genetics. (Nicole was diagnosed with depression and anxiety when she was in her early 20s.) Lu became immersed in social media, and appeared to be caught in an algorithm that kept showing her videos of sad kids, her mother said.
“I had to actually explain that to her,” Nicole said. “I was like, ‘Hey did you know if I like a picture of a pair of tennis shoes, I’m going to probably keep seeing pictures of tennis shoes?’ And she looked at me, and she was like, ‘Really?’”
A couple of months ago, Nicole had the sudden urge to check the text messages saved on her daughter’s tablet. That was when she discovered that Lu had been planning on harming herself and had also written a goodbye letter.
How did we get here?
Even though the stigma surrounding mental health care has declined somewhat in recent years, “we have not yet given people the skill set or the resources to know how to manage their mental health, how to prevent or how to respond to suicidal thoughts,” said Dr. Christine Moutier, chief medical officer of the American Foundation for Suicide Prevention.
Many children also have underlying psychological problems that simply aren’t being addressed. A study published in JAMA Pediatrics found that in 2016 half of the estimated 7.7 million children in the United States with a treatable mental health disorder did not receive treatment from a mental health professional.
Finding a provider can be difficult. The American Academy of Child and Adolescent Psychiatry reported that there is a severe shortage of child psychiatrists in nearly every state in the country. In California, for example, there are only 13 practicing child and adolescent psychiatrists for every 100,000 children under 18.
Insurance companies don’t reimburse mental health services as highly as they do medical services, which makes it far less profitable for providers to treat mental health patients, experts say. For example, in Connecticut, Medicaid reimburses hospitals $2,665 per day for a standard pediatric inpatient admission and about $1,000 per day for a pediatric psychiatric hospitalization, said Ryan Calhoun,thevice president of strategy and care integration at Connecticut Children’s.
Finally, the American Academy of Pediatrics recommends mental health screening for all children 12 and older during well-child visits, but it is not standard practice to screen children younger than that, said Dr. Tami D. Benton, psychiatrist-in-chief of child and adolescent psychiatry and behavioral sciences at Children’s Hospital of Philadelphia.
“Previously, the under-12’s were identified as a low-risk group,” she said.
That’s not the case anymore, she added.
Kate, who lives in Colorado, was in the third grade when she told her parents that she didn’t want to live anymore. For much of her childhood, she has suffered from sensory processing disorder, attention deficit hyperactivity disorder and anxiety, and she was bullied in elementary school.
“I felt like I was just a waste of space,” Kate, who is now 12, said in an interview. “I was in so much pain.”
Back when she was 8, her parents took her to the emergency room, where they stayed for about 12 hours until it was determined that Kate would be safe at home.
“You just feel like, gosh, what have I done wrong as a parent? How am I not supporting my kid?” said Hope, Kate’s mother.
“Don’t feel shame,” she advised other parents. Instead, take a deep breath and call the pediatrician or a crisis line, Hope said, “so that you don’t feel alone.”
‘There’s no place to send them.’
Connecticut Children’s hospital in Hartford does not have any inpatient beds for pediatric psychiatric patients. It takes an average of one week before kids in the emergency room can find a bed elsewhere, Dr. Jennifer Downs, the division head of child and adolescent psychiatry at Connecticut Children’s, said during an interview in late May.
On that particular day, 10 of the 37 children in the emergency room for mental health reasons were under 13. Some children wait for an inpatient bed for as long as a month, she added.
“There’s no place to send them,” said James E. Shmerling, the president and chief executive at Connecticut Children’s. “Every existing resource in the community has a backlog.”
In Colorado, the situation is also critical. This year, at any given time, about half of the kids in the pediatric emergency department at Children’s Hospital Colorado are experiencing a mental health crisis, which prompted the institution to declare a state of emergency in May.
Not only are Colorado’s emergency rooms full, so are the long-term pediatric residential facilities. More than 70 children with severe mental illness had to go out of state to find a residential treatment program over the last year and a half, some traveling as far as South Carolina, Florida or New York, said Heidi Baskfield, the vice president of population health and advocacy at Children’s Hospital Colorado. It’s a problem that other states, including Connecticut, are grappling with too.
Searching for solutions.
Health care institutions have been scrambling to find ways to treat more children with acute mental health needs. CHOC, for example, is planning to open an intensive outpatient program in the next year for children in middle school who are suicidal as well as a program to offer specialized therapy to children who are 8 and under.
At Children’s Hospital of the King’s Daughters in Virginia, there was a 300 percent increase in mental health emergency department visits among 2- to 12-year-olds from 2015 to 2020. The hospital is in the process of expanding its outpatient program to include group therapy for nearly all children, which will allow them to be treated faster than they would have if they needed to wait for one-on-one therapy, said Dr. Mary Margaret Gleason, a pediatrician and child and adolescent psychiatrist there.
“The emergency room situation is a crisis, but it will be fixed only if we look at the preventive efforts that come well before,” said Dr. Gleason, who has a special interest in working with children under 6. “When you get into the preschool age, the level of unmet needs is extraordinary.”
The hospital is also constructing a new building that will have 60 inpatient psychiatric beds — currently they have none — including units for children with neurodevelopmental disorders and kids with concurrent physical and mental health needs, for example diabetes and depression.
Connecticut Children’s is educating teachers and pediatricians about how to manage children with behavioral and mental health conditions, and provides them with a phone number for real-time advice from a mental health professional, Dr. Shmerling said. He is hoping to add a medical psychiatric unit to the hospital — with as many as 15 beds — next year.
Some states, including Colorado, are starting to funnel more money toward mental health services, though providers say even more is needed.
“For now, we do need beds to meet the surge,” Ms. Baskfield said. But, she added, children also need support from schools and at the primary care and outpatient level so that fewer of them require intensive care.
“We can’t build our way out of this crisis,” she said.If you are having thoughts of suicide, call the National Suicide Prevention Lifeline:1-800-273-8255 (TALK) or text TALK to 741741
Published originally by Johns Hopkins University, Lifelines: Stories from the Human Safety Net, 2014
A team of bilingual, bicultural social workers try to help at-risk girls
Five years ago, a 12-year-old Latina girl committed suicide in her family’s garage in the town of Westbury, NY, a diverse suburb on Long Island that has pockets of poverty and has seen an influx of immigration from Central and South American countries in the last few decades.
The town – adjacent to Old Westbury, which was cited by Forbes Magazine as the 10th most expensive zip code in the United States–is rife with overcrowded, rundown multi-family housing, and a large percentage of the population is struggling to make ends meet. Day laborers wait on corners in hopes of picking up some jobs. Many of the immigrants speak little or no English. Some are undocumented, making them hesitant to reach out for legal, medical or mental health services. Even if they are willing, they can’t apply for a driver’s license and therefore are unable to travel to appointments.
It’s an unsafe and stressful environment for anyone, but especially perilous for teenage girls.
While it’s unclear exactly what led to this particular girl’s suicide, her desperate action wasn’t an isolated event, according to Regina Barros-Rivera, Associate Executive Director at North Shore Child & Family Guidance Center, a not-for-profit children’s mental health agency whose social workers, psychiatrists, psychologists and counselors provide extensive services to residents of Nassau County, Long Island.
“We were experiencing a huge influx to our agency of Latina teens with clinical depression and suicidal thoughts,” says Barros-Rivera. “Many were failing school, exhibiting self-harming behaviors such as cutting and talking about ending their lives.”
According to the Centers for Disease Control and Prevention, (CDC), one out of every seven Latina teens attempts suicide.
Some of the girls have neurological or mental health issues, such as impulsivity connected to ADHD, Barros-Rivera notes, while others have been abused. “The girls come with different stories,” she says. “Some are suicidal because their parents are fighting all the time, and they just can’t take it anymore. Some have been sexually abused. But they all were depressed and felt that suicide was their only way out. It was a very alarming trend.”
Barros-Rivera gathered a team of bilingual and bicultural social workers and mental health counselors from North Shore Child & Family Guidance Center to review research on the topic of depression and suicide in the Latina teen population. They discovered that the trend was a nationwide problem.
Family Values
The CDC study, along with other research, indicates that the major factor contributing to the high risk of depression and suicide among first-generation Latinas is the intense pressure they’re under to adhere to the traditional values of their parents’ homeland and not become too “Americanized.”
The activities that are such an accepted part of a typical teen’s life–going to the movies, to the mall, to sleepovers–are forbidden for many Latina girls. And, if they are allowed to venture out, they’re often required to have a chaperone in the form of a parent or older brother. These unrealistic limitations make the girls feel angry, hopeless and marginalized.
In many ways, it’s not surprising that these immigrant parents are overprotective of their daughters, according to Barros-Rivera. “The families have come from very distressed lands, where they have been victims of war, violence and poverty,” she says. “Many of them have been traumatized, and they’ve come here to find safety for their children. They often hover over their daughters and watch their every move. But that leaves the girls feeling they have no way out, which creates a very dangerous situation.”
Edenny Cruz and Vilma Barber of the Guidance Center Latina Girls Project.
A Creative Solution
North Shore Child & Family Guidance Center’s high-risk team knew that something had to be done. The result: The Latina Girls Project, a multifaceted program for Hispanic girls (ages 12-16) that employs individual, family and group therapy, along with monthly outings and other activities, all designed to tackle issues such as depression, suicidal ideation, hopelessness and low self-esteem.
One of the program’s clients is Maria (not her real name), a 16-year-old with large, soulful brown eyes who was born in the United States to parents from El Salvador. According to Edenny Cruz, an LMSW who, along with Barros-Rivera, counseled Maria, the teen was severely depressed and suicidal when she began treatment. Her biggest complaint was that she hated school, and she was distraught and angry that her parents pushed her to attend.
“School wasn’t a healthy or safe place to be for me,” says Maria. “I was being bullied all the time. The other kids called me names and laughed at me ever since elementary school, and I felt like I wasn’t getting any support from the teachers.”
Maria tried to explain to her mother and father the reasons school was difficult for her, but “they didn’t understand,” she says. “They told me to ignore the bullies.” Maria’s parents thought she was being dramatic and defiant, not realizing that her behavior was a sign of depression.
The prevalence of not going to school because of safety concerns was highest among Hispanic females, at 12.6%. In comparison, white females report 7.4% and black females report 8%.
The troubled teen began to skip school, which created many heated arguments in her household. Part of the reason Maria’s parents had come to the United States was to give their children a good education–something they didn’t have in El Salvador, where they spent their days working on farms instead of studying in classrooms.
“My dad hates the fact that he can’t read or write,” says Maria. “He wants me to be more successful, so school is very important to him.”
The constant pressure and fighting at home took its toll, and Maria began to feel that suicide was her only option. “I didn’t know how to deal with everything and get rid of how I was feeling,” she says. “I felt like I was just a big bother to everyone.”
Self-Harming Behaviors
In an attempt to alleviate the pain, Maria began cutting herself–a common response to stress in teen girls.
“Some of them self harm because they feel numb,” says Barros-Rivera. “It helps them experience their pain, which paradoxically provides them with some relief. It’s also something that they are in control of, which gives them a sense of autonomy.”
According to a 2011 study, self-harm among teen girls of every nationality is common, with nearly one in 12 teens deliberately hurting themselves, most often by cutting or burning their own flesh. Self-harming is one of the strongest predictors of who will go on to commit suicide. Some of the findings:
Self-harm is common, reported by about 8 percent of 14- to 19-year-olds.
At every stage, more girls reported self-harm than boys.
Those who cut, burned or otherwise deliberately hurt themselves were more likely to be seriously depressed or anxious, and to report smoking, drinking or abusing drugs.
Similarly, a small subgroup of students who began hurting themselves as young adults were more likely to report having been depressed or anxious as teenagers. The proportion of young men and women reporting self-harm substantially declined as they aged.
For Maria, who had carefully hidden her scars, the self-injurious behavior turned out to be the impetus for her parents to get her into treatment. “I didn’t want them to know that I was cutting myself, but one day I feel asleep on the couch at home and my shirt hiked up. When my mom saw the marks on my stomach, she cried and asked what I was doing.”
Realizing the gravity of the situation, Maria’s parents took her to a psychiatrist, who put the teen on medication. According to Maria, it didn’t alleviate her depression. “I just wanted to die,” she says. “I felt like I couldn’t make my parents happy no matter what I did.”
Maria’s parents reached out to North Shore Child & Family Guidance Center and learned about the Latina Girls Project. Maria began working with Edenny Cruz, whose mother and father were born and raised in Puerto Rico. “My parents were very strict,” says Cruz, “so when Maria and the other girls talk about the conflicts with their parents, I can tell them I know just what they’re talking about.”
Fostering a Common Bond
As with many clients, Maria was resistant to counseling at first, says Cruz. “Her attitude was, if you can’t get me out of school, what good are you?” she says. “She was very angry.”
Depression in teens can look very different from depression in adults. For some depressed teens, symptoms of irritability, aggression and rage are more prominent. A depressed teenager may be hostile, grumpy, or easily lose his or her temper.
“Depression is anger turned inward,” says Barros-Rivera. “Even though the girls are angry at themselves, they might express it by behaving defiantly or becoming physically aggressive–and their mothers are the most frequent targets of their outbursts.” In other girls, depression can lead to eating or sleeping disorders, she adds. “There’s no one profile that fits all the girls.”
Cruz’s strategy to help Maria develop trust during her therapy sessions was to focus on the teen’s other interests, which included singing and cooking vegetarian food.
“Talking about their whole lives–not just their problems–is an important way to get the girls to open up,” says Cruz. “With girls who are oppositional to treatment, I tell them we can talk about whatever they like and not the things that they are sad about. Eventually, they bring up those issues on their own.”
For Maria, an important breakthrough came when the team was able to work with her district to get her into a new school that had smaller classes and psychological support systems for at-risk students. The strategy worked, and Maria’s mood improved tremendously after the placement. “The kids there are just nicer, and they understand because they all had issues with school,” she says. “We all just kind of got each other.”
Maria was grateful that the Latina Girls Project counselors had listened to her frustrations and taken action to find a school that fit her needs. “Once I liked school,” she says, “my mind wasn’t so filled with hating everything.”
Drawing from teen in Latina Girls Project
The Gender Gap
While problems such as bullying, poverty, unemployment among family members, lack of access to healthcare, and racial discrimination contribute to the teens’ depression, the cultural and gender-based expectations forced upon these girls are what create the most conflicts, according to Vilma Barber, an LCSW and member of the Latina Girls Project team.
“These girls face so many stresses that the typical American teenager doesn’t have to deal with,” says Barber. “They are expected to clean the house, cook and take care of their siblings–especially their brothers, whom they refer to as ‘the golden boys,’ ” she says. “Traditionally, boys in their culture aren’t expected to do chores, so it all falls on the girls, who are put in the role of surrogate parents.”
That was the predicament for Ana, another teen who came to the Latina Girls Project suffering from severe depression and suicidal thoughts.
Ana (a pseudonym) was born in the United States to parents from Mexico. Her father worked as a sous chef and her mother as a housekeeper; both parents were often away from home. That left the burden on her–but not her brothers.
“My brothers were treated special,” says Ana, a petite, athletic girl with thick, wavy jet-black hair. “They treated me and my sister like servants.”
“It’s very tough on the girls to be put in the position of doing everything while their brothers are given free reign,” says Barros-Rivera. “It makes them feel frustrated and insignificant.”
Ana also began her life with one huge strike against her: She was a girl–not what her father had hoped for, a fact he made crystal clear. “My dad wanted a boy,” says Ana, fighting back tears. “He told me that ever since I was little.”
According to team member Susannah Sanchez-Agosto, MA-MHC, males are valued more highly in many Hispanic families.
“The Latino culture prioritizes having a strong family unit,” she says. But that unit is highly patriarchal, with females relegated to restrictive roles. “Often you can see a mother’s care-giving for her child and submission to the father’s authority as the machista,” says Sanchez-Agosto.
The Impact of Marital Strife
In addition to bearing household responsibilities, Ana carried a lot of guilt for her parents’ failing marriage. “They fought all the time, and it was very hard,” she says. “I felt like I had to be the toughest one in the house. When my siblings and my mom were crying, I’d be the one saying, ‘Don’t cry.’ I was being the mom.”
Ana’s mother acknowledges that her daughter was under enormous pressure. “The children love their father, and our marital conflicts had a negative impact on them,” she says. But she still had a difficult time understanding why her daughter was always so irritable and sad. She compared her daughter’s life with her own impoverished childhood and felt that Ana had it easy.
“I came to the U.S. because of poverty,” says Ana’s mother, the second oldest of 12 siblings. “Many times, we would all go to sleep without having dinner.”
Those kinds of statements only made Ana feel more angry, guilt-filled and worthless. “My mom would talk about how she had to work in the fields when she was growing up and didn’t have much food to eat,” says Ana. “She’d say that my life was not nearly as hard as hers had been.”
Maria had a similar experience with her father, who blamed Maria for her problems.
“My dad would say to me, ‘I’ve given you everything, I work so hard. Why are you like this?’” she says.
When Hospitalization is Needed
All of the tensions at home led Ana to fall into a deep depression; despite being an avid reader and European history buff, she began skipping school and talking about ending her life. Her mother was so concerned that when the school called one day to say Ana had walked out, she feared that her daughter had killed herself.
“There’s a bridge by my school, and my mom thought I had jumped,” says Ana.
The school social worker recognized that Ana was in danger and recommended that she be hospitalized in an inpatient psychiatric program. Despite the difficulty of dealing with that news, Ana’s mother was grateful that the school had taken action to provide her daughter with protective care. “They made me see the seriousness of the problem,” she says.
Although Ana didn’t believe the hospital experience was helpful (“it made me feel caged in,” she says), Barros-Rivera believes that, in some cases, hospitalization is necessary.
“When it’s not clear whether the girl might act out her suicidal thoughts, the hospital is the safest place for her to be,” she says.
“They can also work to determine if she is suffering from a chemical imbalance that might be helped by medication.”
Short-term inpatient psychiatric stays increased for youth of all ethnicities but declined for older adults between 1996 and 2007, according to an August 2011 study in the Archives of General Psychiatry. Hospitalization rates increased most for children ages 5-12, going from 155 per 100,000 children in 1996 to 283 per 100,000 children in 2007. Among teens, the rate rose by about 35 percent.
But hospitalizations are typically short-term, and follow-up treatment is essential, Barros-Rivera adds. “Through the Latina Girls Project, we can help teach them how to deal with their feelings so they won’t need to go the hospital again.
Finding a Safe Place
After her release from the hospital, Ana entered the Latina Girls Project and was assigned to Vilma Barber. At first, however, both Ana and her parents were hesitant to participate in the program. “I didn’t want to come,” Ana says. “My mom cried when we came, and my dad said ‘that’s for crazy people’.”
It’s not surprising that these immigrant families are reluctant to get help, says Barros-Rivera. “Most of them had no mental health care in their countries, so it’s new to them,” she explains. “There’s a cultural taboo against seeking treatment.” Plus, for families who are undocumented, the prospect of being exposed can be frightening.
But for those who do reach out to North Shore Child & Family Guidance Center and learn about the Latina Girls Project, it quickly becomes clear that they are in a safe place. “They see that we are here to help them,” says Barros-Rivera. “And they’re so happy that we speak Spanish.”
As with most girls, it took some time for Ana to develop trust in Barber. “In the beginning, I told her that I wasn’t going to tell her anything,” says Ana.
But the teen soon realized that Barber understood her situation from personal experience, having come from a strict family in Colombia. “She knew what it was like to be in a house where the girls have to do everything and the boys are treated like princes,” says Ana. “She listened when I told her that I couldn’t do anything that my friends could do, like dating. My father didn’t even want me to look at boys.”
Latina girls client at tiki recording studio
The Desire to Fit In
According to Barber, all of the girls’ parents are suspicious of the freedoms given to the average U.S. teen; they resist acculturation, while the girls embrace it.
“The girls go to school where teens dress in a way that their immigrant parents disapprove of,” says Barber. “They want their girls to wear dresses, not jeans. It makes the girls feel like they don’t fit in.”
Dating is taboo, with parents fearing their daughters will lose their virtue, a value highly prized in their culture. “At school, the girls hear about accepting your body and your sexuality,” says Barber. “They learn about issues like homosexuality and birth control, which are things their parents don’t discuss. The only choice in their minds is abstinence.”
Candice Crawford, an LMHC who is part of the Latina Girls Project team, says that the girls aren’t only forbidden to date, they’re not even supposed to text boys. Girls who do become sexually active are a source of shame.
“I had one mother who threatened to kick her daughter out of the house and send her back to El Salvador when she found out she was having sex,” says Crawford. “She called her a slut and said she had to pay the price.”
Language and Economic Barriers
While most of the parents speak little or no English, it is the primary language spoken by the girls. When their daughters speak English at home, says Barber, “the parents often feel a sense of betrayal at the loss of their culture, which is how they perceive it.”
For the teens, their parents’ inability to communicate among the general population can be a source of embarrassment. They want their mothers and fathers to be more like their peers’ parents, many of whom come from wealthier neighborhoods.
“The Latino families are living in these pockets of poverty within middle and upper-class suburbs,” says Barber. “Our girls go to schools where kids are going skiing and doing all sorts of things they can only dream about. It’s very isolating for them.”
All of these conflicts can add up to very unhappy family relationships, says Barber, in which the parents feel abandoned by their Americanized teens while “the girls feel engulfed, trapped and overprotected.”
A Great, Big World
Recognizing the need for the girls to venture beyond their homes and neighborhoods and experience the world around them, the Latina Girls Project team brings the teens on monthly outings to a variety of cultural, natural and recreational sites. These excursions help the girls become more independent, and they also give them respite from the strict oversight and household responsibilities so common in their families.
Although Maria initially didn’t want to participate, Cruz persuaded her by leveraging the teen’s love of music and booking a group trip to see the musical Wicked–an opportunity that Maria couldn’t resist. Soon, the outings were among the teen’s favorite activities.
The outings also helped Ana overcome her resistance to participating in peer group therapy. “I felt very shy,” she says. But when she learned about the monthly trips, her attitude shifted. “They really made me want to be part of the group.”
The Mother-Daughter Relationship
In addition to the outings and the individual counseling sessions, family therapy is a key component in fostering communication and easing conflicts. While involvement by both parents is ideal, it’s the mother-daughter relationship that is most important, according to Barros-Rivera.
“The father is a part of the process, of course, and many do come to the sessions,” she says. “But for these girls, I believe that to activate long-term change, you have to tackle the mother-daughter relationship.”
A 2008 study backs up her contention. The study states, “Conflict with the mother was especially detrimental for Latina girls; highly conflictive mother-daughter relationships were associated with increased internalizing and externalizing symptomatology, and father support added little in predicting symptomatology.”
During family sessions, the therapists help the mothers learn how to let their daughters develop a sense of independence and autonomy. “We’ve found that once we work with the mothers and help them understand how to let their girls separate from them in healthy, age-appropriate ways, the whole family heals,” says Barros-Rivera, herself the daughter of strict immigrant parents from Chile. “We help them see each other’s perspectives and foster healthier communication.”
When fathers do participate in the family sessions, it often serves to help them to see their own behaviors in a new light.
“Traditionally, the parenting roles are very distinctly defined, whereby the father is the primary breadwinner and the mother the primary caregiver,” explains Sanchez-Agosto. “With family therapy, the father gains a stronger sense of his co-parenting role, becoming more involved as an emotional support.”
The goal, she adds, is to involve as many of the family members as possible. “The inclusion of the extended family is a source of strength, wisdom and influence in the nuclear Latino family.”
Regina barros-rivera and vilma barber of the Guidance Center running a group for the Latina Girls Project
The Benefits of Group Support
Peer group therapy is also an important component of the program, with parents meeting in one group and the teens meeting in another.
“In these groups, both the parents and teens are embraced and supported by those who understand their feelings,” says Barros-Rivera. “It’s such an important tool toward healing for the whole family.”
In the girls’ support group, the team helps the teens identify and practice better ways of handling their stress. The group also serves as an avenue for the girls to mature and develop mentoring skills, according to Barros-Rivera. “The ones who have begun to get better are great at engaging the new girls,” she says. “They’ve been in the same spot, and it makes them feel good about themselves when they can help others. It builds their self-esteem.”
At the parent support group, parents (mostly mothers) learn how their overprotective behavior impedes their daughters’ growth. “The mothers work hard in the group, where they’re allowed to express their fear,” says Barros-Rivera. “We discuss things like communicating with your daughter, allowing them to have friends over, and adolescent sexuality.”
In fact, says Barros-Rivera, the group suggested that Planned Parenthood be invited to speak at one of their meetings. “That was an amazing accomplishment for the program goals,” says Barros-Rivera.
Major Shifts in Family Dynamics
According to Maria, her parents’ participation in the support groups marked a major turning point; they became more understanding of her depression and let go of their self-blame, which enabled them to focus on their daughter’s needs. “They realized that I just wanted them to be there for me and listen,” says Maria. “They learned that it doesn’t help to question why I feel the way I do but to accept it and support me.”
The program has also helped many of the mothers become firmer with their sons and more understanding of their daughters’ desire to identify as American teenagers. Says Ana’s mother, “I communicate better with my daughter, and she has a chance to socialize with children who have similar problems.”
Barros-Rivera is thrilled to witness such transformations in the family dynamic. “It’s so important for the girls to get permission from their parents to move on and take advantage of the opportunities this country has to offer,” she says, adding “I love these girls.”
Moving Forward
According to Barber, once Ana saw that her mother understood her need for freedom and respite from the parental role she had taken on, the teen learned to embrace her role in the family, seeing herself less as a “parentified child” and more as a “broker,” says the counselor.
“She feels proud that she can help her siblings while their mom is at work,” says Barber. “And she no longer feels resentful about helping her mother with English translations. It makes her feel important.”
As her confidence grew, Ana – a baseball and softball fan – took a self-defense class, and she’s developed a passion for the practice. She also decided to join a school group that focuses on values such as diligence, leadership, physical fitness and responsibility.
“Ana has definitely embraced those values,” says Barber. “Having come from a family where her father told her girls aren’t strong, this is a huge shift for her.”
Although Ana’s parents are no longer together, her relationship with her father has improved significantly. He bought her a piano, and she’s been learning to play one of her favorite songs: “Don’t Stop Believing” by Journey.
Empowered and self-confident, both Ana and Maria have put their difficulties behind them and are making plans for the future. Ana hopes to leverage her athleticism and desire to help others by becoming a law enforcement official. While the teen acknowledges that her favorite television shows influenced that ambition, she says her main motivation is to help others, like her parents, who don’t have papers and are prey for unscrupulous people.
“There are so many scams out there, and it makes me so mad,” says Ana. “I want to do something to make a difference for people who can’t speak up for themselves.”
Maria is also highly motivated to reach her goals, which include going to a performing arts college and becoming a professional singer. “The program helped me to not be afraid to talk or sing in front of people,” she says. “I first sang in front of my family, and they clapped, so I felt confident enough to sing in front of my school.” She also sang at a celebration for the funders of the Latina Girls Project, bringing many of the audience to tears with her beautiful, heartfelt performance of a song called “Warrior” by her favorite singer, Demi Lovato, who was diagnosed with bipolar disorder in 2011 and has become an advocate for those with mental illnesses.
Most recently, Maria had the opportunity to record the song at a professional studio, which she calls one of the best experiences of her life. “She was so full of joy the entire time,” says Barros-Rivera, who was there for the session. “Her beautiful smile lit up the room.”
The Land of Hope and Dreams
Although their treatment has concluded, Ana and Maria, as with all graduates, are still invited on the monthly outings, which help expose them to possible career paths.
“They leave here knowing that there are options for them in this country,” says Barros-Rivera. “After we work with them in the program, they see hope; they see that there are other ways to deal with life’s challenges. They’ve developed self-reliance and self-esteem, and they no longer feel suicidal.”Barber and the entire Latina Girls Project team are incredibly proud of the progress Ana and Maria have made. “They’re very smart girls,” says Barber. “They’ve learned that it’s not a betrayal to their parents for them to want more out of life than being a caretaker for their families.”
Kathy Rivera takes on leadership role at Long Island’s leading children’s mental health organization
Roslyn Heights, NY, June 22, 2021 — North Shore Child & Family Guidance Center (the Guidance Center) is pleased to announce that today, June 22, 2021, Kathy Rivera will be the organization’s new Executive Director/CEO. Ms. Rivera is taking over the leadership role upon the retirement of Andrew Malekoff, who served the agency for 45 years.
Ms. Rivera spent the last 14 years at the Jewish Child Care Association (JCCA), where she was the Senior Vice President of Care Management Services. Her experience at this multi-service child welfare agency, which provides comprehensive social services to children and families, makes her a perfect fit for the leading role at the Guidance Center, Long Island’s leading children’s mental health organization.
“We believe Kathy will provide the strong leadership, experience and vision the Guidance Center needs to move into the future,” said Paul Vitale, Guidance Center Board President. “She has a proven track record in governance and fiscal management, and she has built and developed an expert, interdisciplinary leadership team that successfully operates a wide range of mental health, physical health, education and social well-being programs that serve more than 1,000 youth and families across Metro New York.”
“North Shore Child & Family Guidance Center’s mission not only aligns with my core values but supports my commitment to strengthening individuals and families to achieve self-determined optimum well-being,” said Ms. Rivera. “It is an honor and privilege to become part of a dynamic team and outstanding organization dedicated to ensuring equity and access with the highest quality services. I am thrilled to begin this new journey with the Guidance Center and look forward to supporting communities and families on their personal paths toward hope and healing.”
Regina Barros-Rivera will serve as COO. “The Board of Directors believes that with Kathy’s leadership and Regina’s long-standing commitment and value to the organization, the Guidance Center will continue to uphold its unwavering dedication to the Nassau community,” said Mr. Vitale.
Kathy Rivera earned her Bachelor of Arts degree from Hunter College of the City University of New York and her Master of Social Work from the Hunter College School of Social Work. She is a Licensed Clinical Social Worker and holds multiple certifications and trainings including being a Sanctuary Model (Trauma Informed) Trainer. She is a first-generation American-born child of immigrant parents from Thailand. When not working, Ms. Rivera enjoys spending leisure time with her husband, two sons and dog Luna.
About Us:
As the preeminent not-for-profit children’s mental health agency on Long Island, North Shore Child & Family Guidance Center is dedicated to restoring and strengthening the emotional well-being of children (from birth – age 24) and their families. Our highly trained staff of psychiatrists, psychologists, social workers, vocational rehabilitation counselors and other mental health professionals lead the way in diagnosis, treatment, prevention, training, parent education, research and advocacy. The Guidance Center helps children and families address issues such as depression and anxiety; developmental delays; bullying; teen pregnancy; sexual abuse; teen drug and alcohol abuse; and family crises stemming from illness, death, trauma and divorce. For more than 65 years, the Guidance Center has been a place of hope and healing, providing innovative and compassionate treatment to all who enter our doors, regardless of their ability to pay. For more information about the Guidance Center, visit www.northshorechildguidance.org or call (516) 626-1971.
Rich Shlofmitz was the first in his family to become a doctor — and his son Evan is the second. At 6 a.m. on any given weekday, the duo will touch base at St. Francis Hospital in Roslyn before they start their day treating heart patients there.
“I came from the projects in East New York,” says the senior Shlofmitz, 66, who is chairman of the cardiology department at St. Francis. “I knew I wanted to do something important with my life.”
Rich’s dedication to medicine made an impression on Evan, 38, when he was growing up in Manhasset. “It was an easy choice for me to follow in his footsteps,” says Evan, also a cardiologist and director of intravascular imaging at St. Francis.
Here are the stories of seven Long Island sons who are in the same line of work as their fathers — and may even work side-by-side with them.
Years ago, when Jonathan Cooper, 71, a social worker from West Hempstead, ran a support group for children with special needs at the North Shore Child & Family Guidance Center, he would bring several of his five kids to interact with the group socially. So, it was no surprise to him when three of his sons followed him into the counseling field.
Aaron Weintraub, 42, his son from his first marriage, works with social skills groups and at a summer camp for children on the autism spectrum in Connecticut. Jacob Cooper, 31, of Massapequa, is a clinical social worker in private practice, and Raphie Cooper, 26, lives at home and is in his second year of social work school.
“It was always about service,” Jacob says. “That was really ingrained in us.” Jacob says his father always encouraged them to value a population that other people might look away from or stigmatize.
Aaron’s job is the closest match to his father’s. “As adults, I’ve had the chance to talk with him about how we both plan our curriculum and help each other with ideas and inspiration to try new things,” Aaron says.
For Father’s Day, the elder Cooper plans to fly to Chicago, where he grew up, with Jacob to show his son the area. “I want him to see that. Those were formative years for me,” Johnathan says.
“Whenever I had off from school, I’d shadow my dad around the hospital and got to see the impact he made on patients,” Evan says of his childhood. “He set the bar high with his innovation and work ethic and his unique way of practicing medicine.” Now that Evan is a peer, he will bounce ideas and approaches off his father, he says.
On the flip side, the elder Shlofmitz says his son’s involvement with clinical research got him motivated to start doing research as well. “I owe a lot to my son,” Rich says, including keeping him up on cutting-edge technology. “I’m so proud. The best part is watching his interaction with patients and staff. Everybody loves him.”
And who knows? There may be a third generation of Shlofmitz cardiologists — Evan and his wife, Lisa, who live in Port Washington, are expecting a baby girl in August.
Peter Lombardo’s late wife was the catalyst for Mike Lombardo joining in his father’s electrical business. The elder Lombardo, 65, launched his eponymous electrician company in Deer Park in the 1980s; his wife was his business partner, handling payroll and accounts.
Their son, now 31 and living in Farmingville, initially wasn’t interested in becoming an electrician. But when his mother got cancer, she showed Mike the ropes so he could take over her position. She died in 2015.
If that event hadn’t transpired, Mike says he wouldn’t have earned his own electrician’s license. “Not a shot. That’s not to say I don’t like it, but there’s just no way. Nope. I would probably have done something in banking or finance.”
The pandemic has been a boon to the company’s business. “Everybody was home, so they were doing home improvements,” Peter says. Many people put in pools that needed wiring, he says.
At some point, Peter hopes Mike will take over the business completely. “I look forward to the day when he says, ‘Dad, I got this,’ and I’ll go on my merry way.”
It was Luis Rosa’s wife who spurred her husband and son working together as well. When Amazon opened a facility in Shirley, she suggested that all three of them apply for jobs, and the trio was hired on the overnight shift Sundays through Wednesdays.
Sometimes they are unloading, other times they are scanning and stowing packages. They drive to work together, and they eat together on breaks.
“Working with my son has been one of the best things I’ve ever experienced. I’ve seen him grow up as a kid, and then to see him working with me, it’s such a great experience,” says Luis, 42. William, 19, says he looks up to his dad: “I always see him working really hard, and I want to work just as hard as he does.”
The toughest part for the duo was adjusting to the new work schedule. “My parents go to bed at 5 p.m.,” says William, who on the other hand, likes to sleep as soon as he gets home from work. The family lives in Mastic Beach, along with William’s two siblings and his sister’s two children. “Sometimes they’re making noise in the house,” he says.
At one point in the pandemic, the whole family had COVID-19. “I just can’t wait until all this is over,” William says. “It’s been really hard on us. Luckily, we didn’t get it that bad.”
When Lee Gaddy, now 64, of Wheatley Heights, joined the New York City Police Force in 1981 and was assigned as a housing officer, it was “the best thing that could have happened to me,” he says. His son, Sean, 36, echoed his dad’s words when talking about his own experience as a Nassau County police officer, now assigned to the department’s Police Athletic League program working on community sports programs to engage kids.
For Father’s Day this year, the family plans to barbecue before Luis, William and Margarita, 40, head to the job.
“Growing up, obviously watching my dad go off to work, it was always interesting to hear his stories over the dinner table,” Sean says. “My dad, he was big on telling me to take the Civil Service test. I thank him to this day. I never would have done it without him putting it in front of me. It’s the best thing I ever did.”
This isn’t the first time the younger Gaddy has mirrored his father, says Lee, who retired after 22 years in law enforcement and now works for the Copiague School District as a security person. “Sean is well-liked, like me. He played high school sports, just like me. I’m happy because I think he has that type of attitude I had coming on: Do the right thing.”
Sean recently had his first child, and he plans to spend his first Father’s Day in part by wearing matching shirts with his newborn during a breakfast visit to Lee’s home. He also hopes to follow in his father’s footsteps as a parent: “I hope to be what he is to me with my son,” Sean says.
