Mental Health Care Gets Short Shrift From Insurers

by North Shore Child & Family Guidance Center | Aug 26, 2015 | Anton Media

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

Welcome to the club.

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

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

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

Regarding gaining access to care in the first place, network adequacy refers to a health plan’s ability to deliver the benefits promised by providing reasonable access to a sufficient number of in-network primary care and specialty physicians, as well as all health care services included under the terms of the contract. The reality is that, because private insurers pay substandard rates as compared to Medicaid, middle class families are finding it harder and harder to find providers to help their children. They look at their insurer’s list of providers, make phone calls and are repeatedly told, I’m sorry, I don’t accept your insurance. The lists are inadequate, outdated or just plain falsehoods.

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

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

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

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

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Talking To Kids About Race And Diversity

by North Shore Child & Family Guidance Center | Jul 20, 2015 | Anton Media

By Andrew Malekoff

The church shootings of nine black parishioners in Charleston, SC, at the hands of 21-year old Dylann Roof, who has confessed to the crime, sends a sobering message to all those involved with adolescents. Although cries of “hate crime” ring out in this instance—and no doubt are true—we need to recognize that issues surrounding diversity and systemic racism are an issue for every teenager and young adult here on Long Island.

Those of us who have the privilege to work with youth in schools, community centers and other arenas face the unique challenge of helping them address diversity and racism openly and honestly. Although discussions about race during the last two presidential campaigns gave a number of people a chance to process their feelings, it doesn’t appear that we have come very far.

An open, nonjudgmental group experience can provide adolescents with a unique opportunity to explore the typically taboo areas of race and ethnicity, exposing deeply ingrained or loosely-formed beliefs and influencing their perceptions and behaviors in the world outside of the group.

When stories like the church shootings and the deaths of unarmed black citizens at the hands of the police dominate the media, young people’s tendency toward stereotyping and polarizing is too often reinforced. Within group settings, we can encourage discussion about ethnic identity, bias, prejudice and intergroup relations as a normal part of adolescent development. We can help young people to tune in to ethnically and racially-charged local, national and international events that affect them.

I vividly recall a meeting I had with a group of local teenagers in the immediate aftermath of the Columbine High School shootings in Littleton, CO. The group talked about their feelings regarding profiling and stepped-up security in schools and in the community. One group member, Carlos, recalled an incident when he was stopped by a police officer who asked to check his arms. “He was looking for gang tattoos. He thought I was MS-13,” Carlos explained as he slowly pulled his shirtsleeve back across his forearm, as if back in the moment. “I told the cop, ‘First of all, I’m Salvadorian and proud of it. Second, I’m not a gangbanger.’ ”

Carlos continued, “A week later, I saw the same cop at my restaurant job, where I work as a maître d’ and wear a tuxedo. He looked me over and seemed really confused. I smiled and said to him, ‘See, I’m the same person.’”
A healthy exchange of ideas and opinions about controversial subjects in a safe environment enables young people to test out their beliefs and attitudes, to practice listening to the views of others, to respectfully express differences and to discover common ground.

By advancing an understanding of differences, we can reach for commonalties experienced among young people across cultures to open pathways for relating among different ethnic groups.
Presently, we all face the sad possibility of seeing a dramatic erosion of empathy and loss of community as a result of the struggle for economic survival. We cannot afford to allow the development of empathy for others to slip away from our youth in the process. As adults, we must do all that we can to help young people confront the issues surrounding diversity openly, honestly and safely. Our survival and humanity depend upon it.

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.

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Let Them Go, Let Them Grow

by North Shore Child & Family Guidance Center | Jun 20, 2015 | Anton Media

By Andrew Malekoff

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

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

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

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

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

Individual, group and family therapy are integral pieces of the program. Through therapy, the girls develop trust, learn healthy ways to deal with stress and depression and find better ways to communicate with their parents.
But the monthly outings are also a very important element of the Latina Girls Project. During one trip to Manhattan, the girls took part in a workshop led by female artists, dancers and poets, all accomplished and confident Latina women. This was a huge adventure for the teens, because they were so often stuck in their home communities—and also stuck in feelings of low self-esteem, shame and self-consciousness.

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

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

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

Andrew Malekoff is the executive director of North Shore Child & Family Guidance Center, which provides comprehensive mental health services for children from birth through 24 and their families. To find out more, visit ww.northshorechildguidance.org.

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Help Your Kids Blossom

by North Shore Child & Family Guidance Center | May 20, 2015 | Anton Media

Finally, what seemed like the longest winter in memory is over. I’m grateful to spend time soaking up the sun, walking and biking along the boardwalk in my Long Beach neighborhood.

But during my excursions, it saddens me to see how many young people are isolated and clueless about the beauty of the world surrounding them. Most are staring down at their phones as they text or scroll through their Instagram feeds.

For other kids, their tech device of choice doesn’t even make it out of the house. It can be a perfect spring day and these youngsters prefer to stay indoors, playing video games or glued to some other electronic device. Regardless of their protestations otherwise, a number of these children and teens are not only lonely and miserable, they’re also at risk of a host of problems.

Here are just a few: We all know that obesity is an epidemic in our culture, and a big reason is that our kids’ addiction to gadgets means they’re not outside running around and playing. When kids spend all their time on Facebook instead of face-to-face with their peers, they feel isolated and alone. Research suggests that nature-deprived kids are prone to anxiety and depression.

Here at North Shore Child & Family Guidance Center, we’ve seen firsthand how children blossom when they “get back to the garden.” At our Roslyn Heights headquarters, groups of children and teens water, seed and weed our organic bed, and they are filled with joy when they see the vegetables grow. Moreover, since much of the produce they harvest is donated to local food pantries, they experience the pride that comes from helping others.

Through their work in the garden, kids who were shy and insecure developed self-confidence and made new friends. They learned leadership and team-building skills. Tending the garden and watching it grow intensified their sense of wonder and curiosity.

Gardening helps kids connect to the earth, to each other and, yes, even to their parents. Young children will be in awe as you show them the fruits (and vegetables) of your joint labor. If your teens are reluctant to work with you, expose them to tools that they can begin to master—and don’t be surprised if they end up joining you in the garden.

Another plus: Gardeners achieve a natural state of calm and focus called “mindfulness.” Though people often associate it with meditation, mindfulness doesn’t require hours of prayerful silence or chanting mantras. Mindfulness at its core is about staying in the present, moment by moment, to feelings, thoughts, bodily sensations and the surrounding environment.

Mindfulness is an inherent part of the experience of gardening; it gives kids new ground to stand on, both literally and figuratively, embracing their senses of sight, smell, sound, touch and taste. Mindfulness in nature calms the brain, allowing for reflection and healing and it’s also great for the body.

If gardening isn’t up your alley, not to worry. Being outdoors—whether hiking, biking or swimming—restores the spirit. There’s bound to be an activity your kids will enjoy.

So, whether you are 8 or 80, take advantage of the beautiful weather and find your bliss. It’s right outside your door.

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.

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Anton Community Newspapers: Bullies Move From the Playground to Cyberspace

by North Shore Child & Family Guidance Center | Apr 20, 2015 | Anton Media

By Andrew Malekoff

Members of a Wisconsin middle school basketball team are being lauded as heroes, and rightfully so. When the boys noticed some bullies making fun of one of their cheerleaders—a 14-year-old girl named Desiree who has Down’s Syndrome—they took action, walking over to the bleachers and telling the offenders to cut it out. As one of the boys told reporters, “They were pointing and laughing at her from the stands. It’s not funny to make fun of somebody by the way they look or act.” Another said, “This is not a one-time thing. You always have to stick up for kids that are bullied. It’s the right thing to do.”

Another group in New York City, Teen Pact, has taken steps to combat cyberbullying by producing public service announcements that are being used nationwide. One PSA depicts a boy texting an affectionate message about a classmate. His friends then pass it on and when it goes viral he becomes the target of unrelenting teasing and taunting. The PSA message is: “It’s not funny anymore, don’t be an accidental bully.”

Just how many kids are being tormented, either online, in school or both? Recent studies report some startling statistics:

• 83 percent of girls and 79 percent of boys report being bullied either in school or online.
• 75 percent of school shootings have been linked to harassment and bullying against the shooter.
• About 160,000 teens skip school every day because they are bullied, and 1 in 10 teens drops out of school due to repeated bullying.
• Kids who are bullies as young adults continue the trend of abuse and violence into adulthood. By the age of 30, about 40 percent of boys identified as bullies in middle and high school had been arrested three or more times.

The most frequent targets are kids seen as “different”—gay or transgender youth, those with special needs or who are overweight—but no kid is immune from being a victim.

While bullying isn’t a new phenomenon, cyberspace obliterates any sense of sanctuary that children once found when they were away from school and in their own homes.

One social media app that’s particularly alarming is Yik Yak, which allows users to send out posts—known as “yaks” — that can be seen by anyone within a 1.5-mile radius. What makes it worse than most other social media forums kids are using is the fact that the posters are anonymous. A user can “yak” out anything they want without fear of being identified. Perfectly acceptable posts: “Jane is an ugly cow,” “John is a fag,” and much more that would be unprintable in this newspaper. It’s devastating to imagine the damage this type of abuse can have on a child or teen.

Laws such as the Dignity for All Students Act , which took effect in July 2012, seeks to provide students with a safe and supportive environment free from discrimination, intimidation, taunting, harassment and bullying on school property, buses or at a school function.

The passage of the dignity act provides an opportunity for parents to talk to their children about how to protect themselves from bullying and offers them a context to discuss how to be sensitive to others who are different. This is, of course, providing that parents are able to engage their children in an accepting and nonjudgmental manner that opens communication.

But laws like the dignity act aren’t enough to tackle what is a social problem. No amount of legislation and no penalties for intimidating schoolyard behavior can guarantee that children will be safe at all times whether inside or outside of school.

These laws must be complemented by support at home, pro-social bonds among neighbors and consistent community standards against bullying, bias and harassment, including in cyberspace. Otherwise, the legislation will be little more than a paper tiger, another layer of bureaucracy with limited influence in the real world.

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The Kindness Of Others

by North Shore Child & Family Guidance Center | Mar 20, 2015 | Anton Media

Despite the influence of some distinguished legislators with big hearts, big government has treated community-based mental health organizations with little respect. For example, at North Shore Child & Family Guidance Center, we have not received a net increase in government funding for our outpatient mental health services for more than 30 years.

Mental health agencies are disappearing all around us. In late January, the Federation of Employment and Guidance Services (FEGS), a $250 million, 81-year-old health and human services organization, announced it was closing. Last month, word came out that Catholic Charities is giving up their Freeport mental health clinic. In the last few years, 100-year-old Peninsula Counseling Center in Valley Stream and 57-year-old Pederson-Krag in Huntington gave up their mental health clinics; South Shore Child Guidance was taken over by the Epilepsy Foundation; and Long Island Consultation Center in West Hempstead and Roosevelt Counseling and Resource Center, which operated since 1958, shut their doors. More than likely, others will follow.

A key factor contributing to this tragic trend is a poorly regulated managed health care system that is more interested in managing costs than managing care, paying a substandard rate for critical services that save children’s lives.

To make up the difference in big government’s neglect and the insurance industry’s greed, mental health organizations have relied for decades on the compassion and generosity of community members who support the cause. But, despite the good that they do, these people are more than do-gooders. They are smart and selfish. They’re smart because they know that what community-based mental health centers do is cost-effective, saving tens of millions of taxpayer dollars by keeping troubled kids out of costly institutional settings. They are selfish because they know, as one of them stated, “If your child is not healthy, my child is not safe.”

Beyond these attributes, our supporters are empathetic. They look into the eyes of their own children, grandchildren, nieces and nephews and feel a deep connection to all children. Perhaps my greatest influence in joining the field of human services was observing the impact of the kindness of others during my youth.

The father of a close childhood friend died in the 1950s. My friend was six-years-old, decades before “grief counseling” entered our lexicon. I lost touch with him as we grew older, but when his mother died years later, I sent him a note. My old friend, who is a physician today, wrote back. I saved his letter, and each time I read it, it leaves a lump in my throat. He wrote: “Dear Andy: What a surprise to hear from you! My mom’s death has caused me to spend hours thinking about my childhood. Some of my most fond recollections involve you and your family. Your father was the dad I didn’t have…”

As a child, I observed my parents and other adults in my family carrying out acts of profound kindness and generosity with no fanfare and no expectation of receiving anything in return. I married a woman who came from a similar family, one in which her parents took in their nieces after the death of their mother. Now I have found these people again among our board of directors and community supporters. What they have in common with my family is their empathy.

Government bureaucracies are by definition dispassionate and without empathy. They have rules and regulations. But only in tyrannies do they get to run things. One can only hope that the policies that guide their rules are based in values rooted in the needs of real people.

I know that we cannot rely exclusively on government to take care of us; we must rely on one another. If we allow empathy to slip away under the cover of economic survival, we’re in trouble. The demise of empathy would be the most perilous consequence of the fragile economy.

Let’s take care to preserve empathy. When all else fails, it’s all that we have to maintain a humane society.

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.

We must start treating illnesses above the neck the same as illnesses below the neck?

by North Shore Child & Family Guidance Center | Feb 20, 2015 | Anton Media

Anton News, Long Island; Opinion – Andrew Malekoff

February 25 – March 3, 2015

When we hear that our neighbor’s teenage son has been diagnosed with cancer, or that our colleague’s newborn has a heart defect, we shed some tears—and then we move into action. We bring meals; we offer to take their other kids to soccer games or piano lessons; we raise money so the parents can stay home from work to care for their ailing children.

But when we learn that our daughter’s best friend has been hospitalized for depression, or that a boy on our son’s basketball team has stopped going to school because of severe anxiety, we’re often at a loss as to how to respond.

Here’s a fact that may surprise you: Although more children suffer from psychiatric illness than autism, leukemia, diabetes and AIDS combined, only one of five with an emotional disturbance gets help from a mental health specialist. Moreover, 50 percent of serious mental illness occurs before the age of 14.

People with mental health problems and addictions, along with their families, often suffer in silence, while people with physical health problems evoke the sympathy and support of others. Why do we continue to treat illnesses above the neck differently than illnesses below the neck?

The sad truth is that there’s still a widespread stigma when it comes to mental health. The result? Parents who need help often wait months and even years to make that first phone call. A parent whose child is diagnosed with cancer doesn’t wait to ask for help. Waiting only happens with mental illness and addiction.

Fortunately, more than 60 years after our founding, North Shore Child & Family Guidance Center is still here to fight that stigma and provide help to children in need. Let me share a few of their stories.

We met nine-year-old Joey 14 years ago, a few weeks after his father died in the World Trade Center. We soon discovered that he was calling his dad’s cell phone number every day. As Joey explained, “I call because, what if he is still alive? I don’t want him to be all alone.”

We met seven-year-old Jeremy two years ago. He came to us holding a large flashlight in his tiny hands. He said he needed it in case the lights went out again, like they did after Hurricane Sandy, when Jeremy lost his toys, his home, his daily routine. And, as Joey before him, he lost his belief that the world is a safe place.

While we do respond to headline stories, we more often are called upon to respond to personal dramas and private disasters that are hidden in plain sight.

For example, we met six-year-old Jerome soon after he attempted to jump out a window because, as he said, “Nobody loves me.” Fifteen-year-old Celeste said the reason that she cuts her arms until they bleed is not to take her life, but to lower her blood pressure. And 14-year-old Maria told us that she lives in a house with a revolving door welcoming men who touch her.

Depression, anxiety, fear, child abuse, school refusal, bullying, isolation, drug addiction, domestic violence . . . we receive more than 100 calls a week, and increasing numbers are emergencies.

All across Long Island, mental health agencies are shuttering their doors, or they’ve been acquired by corporate entities with no roots in the community. That’s tragic, because community-based mental health organizations are as essential to the health and well-being of our children as hospitals or schools.

What can you do? First, tell your representatives that you value the mental health organization that serves your community and would like their support to ensure its future. And if you know someone whose child is suffering from a mental health issue, don’t ignore them. Make that phone call. Let them know you care.

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.