Our Kids’ Mental Issues Are Shortchanged

by North Shore Child & Family Guidance Center | Mar 20, 2014 | Anton Media

Anton News, Long Island; Opinion – Andrew Malekoff

March 26 – April 1, 2014

The American reality today is 1 out of 10 children has a serious emotional disturbance and more children suffer from psychiatric illness than from autism, leukemia, diabetes and AIDS combined. Yet, we continue to treat illnesses above the neck differently than those below the neck. People with mental health problems, and their families, often feel a sense of shame and suffer in silence; while people with physical health problems evoke the sympathy, support and comfort of others.

In the past 25 years, the mental health system has seen many changes. From a system in New York State that consisted primarily of outpatient clinics, community hospitals, state hospitals, and residential treatment facilities, a continuum has evolved which now also includes a variety of additional services, originally funded with the reinvestment dollars saved from the 1990’s reduction in state hospital beds. The largest of these programs are Medicaid-driven.

Nevertheless, parents still find that there are major gaps in our service system. Even with the available community support services, children with mental illness and their families continue to need good, often intensive, outpatient clinical services. The onset of managed care resulted in hospitals discharging children earlier, often before they are sufficiently stabilized to return home. Mental health outpatient clinics are then left with the task of trying to provide adequate clinical care to these needy and often high-risk youths, but with highly inadequate rates of financial support from insurance companies and government.

Despite a growing demand for community-based children’s mental health care, right here in Nassau County there are outpatient mental health clinics that have closed their doors, have been taken over by larger corporate entities with no community roots, have transformed their operations into fee-for-service factories with little or no capacity for dealing with inevitable crisis situations, or have decided to turn away anyone who does not have Medicaid.

Commercial insurance companies are expected to demonstrate what is called “network adequacy.” 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. Nevertheless, many insurers do not have adequate mental health care networks despite the many names on their rosters. When it comes to seeking mental health care, for many families, the process of finding help is a shell game.

Only quality community-based children’s mental health organizations are capable of providing the labor-intensive quality of care necessary to address the mental health needs of children with serious emotional disturbances. Yet, these vital organizations are being squeezed out of Nassau County because of substandard insurance reimbursement and government neglect. Furthermore, community-acute care hospitals, because of insurance limitations, are not able to keep kids long enough to stabilize them in many cases. And, so, kids are being discharged to a community with inadequate supports.

The NYS Office of Mental Health has established a multi-year vision for the future of New York State’s mental health care system that they refer to as Regional Centers of Excellence. The vision does not include community-based care for middle class and working poor families with commercial health insurance.

Sounds more like Regional Centers of Mediocrity to me.

Andrew Malekoff, North Shore Child and Family Guidance Center, 480 Old Westbury Road, Roslyn Heights, New York, 11577; E-mail:amalekoff@northshorechildguidance.org

Domestic Minor Sex Trafficking in the Suburbs

by North Shore Child & Family Guidance Center | Jul 20, 2013 | Anton Media

July 2013

Domestic minor sex trafficking (DMST) – the commercial sexual exploitation of children within U.S. borders – is a growing problem. Once involved in commercial sexual exploitation, according to group counselors Kristine Hickle and Dominique Roe-Sepowitz, “individuals are at increased risk for economic instability and poverty, as adolescents who begin selling or trading sex prior to any legitimate employment experience may lack skills necessary to obtain employment and achieve economic stability after escaping their trafficking situation.” In addition, they state, “adolescents who run away from home are at increased risk for being exploited and coerced by pimps-traffickers, and may engage in and become victim to violence, including sexual or physical assault.”

It is important to note that DMST is not prostitution. Legally, minors cannot consent to sex with an adult, so, as Forbes Magazine reporter Brooke Axtell observed, “the use of the term ‘child prostitution’ in the media is misleading. In any other context, this would be considered statutory rape. Force, fraud and coercion are used to control the victim’s behavior.”

There is a myth that sex-trafficking is only prevalent in poorer countries. It is widespread in developed nations as well. Because DSMT is hidden, statistics are hard to calculate; however, according to the US Department of Justice (DOJ), more than 250,000 American youths are at risk of becoming victims of commercial sexual exploitation. Human-trafficking, according to the DOJ, is the second leading criminal industry behind drug-trafficking, and half of all the victims are minors.

There is an alarming disconnect between the treatment of domestic-trafficked minors and their status as victims. Many do not receive shelter and treatment in a safe residential setting; rather, they are re-victimized in juvenile-detention facilities. Due to its covert nature, DMST is under the radar in suburbia, yet, a 2011 study by researchers from Hofstra University reported more than 11,000 victims of sex-trafficking on Long Island.

Hofstra Sociology Professor Dr. Gregory Maney, the lead investigator, reported that those victims who sought private help were only the tip of the iceberg. And that the number did not include victims that went to public-service providers, moved out of the area, have not been able to escape their captors or died in the process of being trafficked.

It probably seems unlikely that anyone close to you could be at risk of being sex trafficked. However, traffickers are proficient at seducing and disarming their marks, usually vulnerable young women. Two warning signs for spotting a sex-trafficker include premature promises of undying love that are aimed at cementing a quick emotional connection and a promise of employment.

Hopefully, greater public awareness of DMST will help bring about more humane treatment, better policies and improved access to resources, such as long-term housing and quality mental health care for victims. As Axtell wrote of taking steps to help children break free from sexual exploitation, “we [must] face the disturbing truth that the demand for girls’ bodies is happening in our own communities.”

Sixty Years of Instilling Hope, Restoring Morale and More

by North Shore Child & Family Guidance Center | Mar 20, 2013 | Anton Media

March 2013

“I lost everything”

by North Shore Child & Family Guidance Center | Jan 20, 2013 | Anton Media

A Tribute to STRONG Youth Inc.

by North Shore Child & Family Guidance Center | Dec 20, 2012 | Anton Media

December 2012

The Nassau County legislature made a misguided decision, born of partisan politics, on July 5, 2012, to cut $7.3 million from youth, chemical dependency and mental health services for tens of thousands of people. The decision to de-fund human services in July led to months of protests by humanservices providers, parents and youths. In an attempt to draw wider attention to the impact of the budget cuts, one of the affected agencies, STRONG Youth, Inc., a gangprevention and intervention program that lost all of its funding, staged a symbolic funeral for youth services at the Hempstead Pentecostal Church, in Hempstead, on August 2, 2012. The funeral was followed, a few weeks later, by street theater. Adults and young people from STRONG attended a legislative meeting in Mineola, dressed symbolically as hostages – bound, gagged and blindfolded. One of the legislators said, at the meeting which was attended by hundreds of people, that “child protective services” should be called. A few weeks later, STRONG held a prayer and candle lighting vigil. The vigil drew 150 people. All of the demonstrations by STRONG were peaceful and planned with adults and youths working together. How do I know this? I proudly stood alongside them in each one of the events. Some critics accused STRONG of being too extreme. Others called the symbolic funeral “disrespectful of the dead” and the “parading of hostages” as a disgrace. Nothing could be further from the truth. These events were thoughtfully organized by STRONG social workers and volunteers, young and old, who galvanized a complex network of teenagers and parents (including parents of murdered children) crime victims, clergy, community leaders and local businesses. The skills used to organize this event were the same ones that were used to develop and implement exemplary gang prevention and intervention services that aim to help young people to become successful students and active participants in community affairs. Nassau County should not eliminate STRONG, or programs like it. Rather it should be celebrating and promoting them as national best practices in youth development. One of the speakers at the funeral was a young woman, Amory Sepúlveda. She testified from her wheelchair. “When I was 19-years-old,” she said, “I was the innocent victim of a drive-by shooting that resulted in never being able to walk again. I was hurt physically and emotionally and thought my life was over. With the help of county youth services, I am now a college graduate in pursuit of a master’s degree. I’ve shared my story, changing the lives of thousands of youth in Nassau County.” Today, in her role as crisis 2 counselor for North Shore Child and Family Guidance Center, Sepúlveda is providing aid to hundreds of victims of hurricane Sandy. STRONG Youth Inc.’s approach to protesting Nassau County’s cuts to human services funding were not radical, they were rational. Its tactics were well-planned, intergenerational events that captured the imagination of the public and media. STRONG took effective steps to motivate change. The public should embrace the group for its peaceful protests, which represent the best of our democracy. These events helped many young people to move from apathy to activism. In fact, many of the protesters that were derided by members of the Nassau County Legislature have become volunteers in the hurricane disaster relief efforts, demonstrating their empathy, civic involvement and activism, all for the public good. They have learned their lessons well and now fight not only for themselves, but for the next generation.

Actively Enduring in the Aftermath of Hurricane Sandy

by North Shore Child & Family Guidance Center | Nov 20, 2012 | Anton Media

By Andrew Malekoff Hurricane Sandy has shaken many of us to the core, shattering our sense of safety in the world. Helping children and adolescents to cope during this difficult time when many are struggling, is essential. Following are four interrelated and overlapping ideas to keep in mind in caring for young people impacted by disasters and other traumatic events. Provide protection, support, and safety. Children and youths need safe places to go, with worthwhile things to do and opportunities for belonging. And they need relationships with competent adults that understand and care about them. Living through a disaster like Hurricane Sandy can contribute to a pervasive sense of fearfulness, hypervigilance and despair. Do all you can to ensure a basic level of physical and emotional safety that helps to cultivate a sense of trust. Safe havens in school and the community are prerequisites for helping kids through this disaster. Help to re-establish connections and rebuild a sense of community. Collective trauma, according to Kai Erikson, is “a blow to tissues of social life that damages the bonds linking people together, and impairs the prevailing sense of communality.” The trauma of living through a disaster leads to demoralization, disorientation, and loss of connection. Hurricane Sandy has left individuals feeling unprotected and on their own. Connecting with others addresses the primary need of survivors to affiliate and can promote mutual support, reduce isolation, and normalize young (and older) peoples’ responses and reactions to what feels like a surreal situation. Don’t go it alone. Offer opportunities for action that represents triumph over the demoralization of helplessness and despair. “Talking about the trauma is rarely if ever enough,” advises noted trauma expert Bessel van der Kolk. Children and teens can be encouraged to write poetry, create artwork, engage in social action, volunteer to help other victims or any of the multitudes of creative solutions that individuals can find to confront even the most distressing troubles. Creatively engage your children to give them some control over what feels like and out-of-control situation. Actively endure. Louis Lowy was a World War II concentration-camp survivor. Although he rarely talked about his wartime experiences, his later career as a social work educator was infused with the time he was leader of the Deggendorf Displaced Persons Center. Lowy taught “active endurance,” which he described as “not merely enduring passively, but also learning to endure actively…substituting hope for despair, persevering rather than giving up, persisting rather than surrendering in the face of difficult odds, and helping to sustain ourselves [and those that we care about] through mutual support.” Parents can set this example for their children. If your capacity to actively endure and help your child to cope outstrips your ability to do so during this stressful time, contact your local community-based mental health agency. North Shore Child and Family Guidance Center is always ready to take your call at 626- 1971.

Look Upstream

by North Shore Child & Family Guidance Center | Oct 20, 2012 | Anton Media

In September, County Executive Ed Mangano held a press conference on the growing heroin and prescription pill problem in Nassau County. At the press conference, Mr. Mangano stood with the mothers of children who died from drug overdoses. He said that there were 149 overdose deaths in 2011. To remedy this scourge he announced that Nassau is the first county that was certified by the New York State Department of Health to administer a Drug Overdose Prevention Program. This means that the County will train its employees, as well as families of atrisk individuals, in administering the overdose-reversal agent Narcan to anyone who has ingested large amounts of opioids, such as prescription painkillers like Oxycodone or street drugs like heroin, and who is in a life-threatening situation. Any step that Nassau County takes to save lives is welcome. However, at the press conference there was no mention of $7.3 million in human services funding that was cut on July 5, 2012, that included $1.75 million for outpatient chemical dependency treatment services. I am reminded of the parable about the small village on the edge of a river. One day a villager noticed a baby floating down the river. He jumped in the river and saved the baby. The next day he saw two babies floating down the river. He and another villager dived in and saved them. Each day that followed, more babies were found floating down the river. Consequently, the villagers organized themselves, training teams of swimmers to navigate the treacherous currents and rescue the babies. Rescue squads were soon working around the clock. Although they could not save all the babies, the rescue squad members felt good and were lauded for saving as many babies as they could. However, one day, one of the villagers raised an intriguing question: “Where are all these babies coming from? Why don’t we organize a team to head upstream to find out who’s throwing the babies into the river in the first place!” Implementing a new Drug Overdose Prevention Program that aims to save the lives at the same time that the County cuts drug treatment funding seems contradictory and signals a policy shift. Mobilizing county resources to pull babies from the river while simultaneously cutting back on activities to prevent the babies from being tossed into the river in the first place makes no sense at all and is likely to lead to a net loss of even more young lives. I suggest that the next time Mr. Mangano addresses the problem of drug overdoses, he would do well to turn around and look upstream.

Assault on Human Services

by North Shore Child & Family Guidance Center | Sep 20, 2012 | Anton Media

September 5, 2012 marked two months since 7.3 million dollars, earmarked to support human services, were shifted to the general fund. We were told that this was due to the Nassau County legislature’s failure to pass $41 million in bonding for property tax refunds. But, it is not that simple. How did all of this get started? In 2009, then-County Executive Tom Suozzi “enlisted” the county’s most vulnerable citizens as unpaid lobbyists to advocate for red-light cameras, cigarette taxes and traffic-violation reform. Mr. Suozzi threatened scores of agencies serving tens of thousands of youths and families that they would be closed down or crippled unless the revenue enhancers were passed through Albany. Red-light camera legislation passed and local agencies were assured, by unanimous vote of the full Nassau County legislature, that related revenues would become a sustainable source funding for these services. Three years later, that agreement is null and void. Our young people are now the collateral damage in a political war over bonding and redistricting. More than two months have passed since the July 5, 2012 cuts to human services, which included $1.75 million of chemical dependency treatment funding. Despite extensive testimony, protests and media coverage, not a thing has changed. Advocates, young and old, have held press conferences, prayer vigils and a symbolic funeral for youth services. On August 6, several young people and adults attended a legislative meeting symbolically bound, gagged and blindfolded to point out that youth services were being held hostage. What is the outcome of all of this activity and attention? Democrat and Republican legislators continue to point fingers and holler at one another in front of hundreds of disbelieving youths and family members who have become regular attendees at legislative meetings as well as activists in addressing this issue. Youth services organizations that depend almost exclusively on County funds will close in a short time. Agencies with more diversified funding may not go out of business, but will have to shutter critical services such as after-school and summer programs as well as suicide, pregnancy, gang and drug-prevention programs that keep kids safe, provide enriching activities and offer a sense of belonging and relationships with caring adults during the non-school hours. The developmental tasks necessary for adolescents in our culture to become healthy, functioning adults require great effort and time and more than parent and school support alone. These tasks include forging relationships with peers and adults that lead to the achievement of emotional independence from parents, developing a healthy sexual identity, building a capacity for greater intimacy with peers, learning skills and selecting an economic career; also developing a moral value and an ethical system to guide one’s behavior as well as desiring and employing socially responsible behavior. Adolescence today is an age of particular vulnerability, a time in which youngsters are experiencing the sexual awakenings of puberty earlier than ever while facing increasing social and educational demands, and experimenting with more freedom, autonomy and choice than ever before. The politically-motivated de-funding of youth services is therefore an attack on the family. Nassau County’s broken promises and its propensity to use vulnerable young people as pawns in promoting partisan political interests represents a moral failing and a lack of leadership. Our elected representatives on both sides of the aisle should be ashamed of themselves for putting our most vulnerable young people in the political crosshairs. Who among them will stand and deliver to put an end to this madness?

Parents, Student Athletes and the Penn State Scandal

by North Shore Child & Family Guidance Center | Aug 20, 2012 | Anton Media

Bob, my younger brother, was a die-hard Penn State football fan going back to the early 1960’s. In later years he became a college coach and athletic director. Presently, he is Chair of the Sports Studies Department at Guilford College. He has written and researched extensively on maximizing the educational value of sports participation for youths, middle and high school, and college athletes. I thought there was no one better to ask about the Penn State mess and what lessons parents could take from it? Here is what he told me: “For the past few months, we have been inundated with news about what is now commonly known as the ‘Penn State Scandal.’ Although the focus has been on the horrific acts of Jerry Sandusky and decrying the actions – or lack thereof – of Penn State administrators and others, it may be helpful to consider what the parents of young athletes can learn from this tragic affair. Many parents have paused and asked themselves, ‘What do I really know about the people coaching my children?’ First, the overwhelming majority of youth and high school coaches are solid citizens who have the best interests of your child in mind. But it would be naïve to think that there are not exceptions. Many states have laws requiring youth sport organizations and public schools to run background checks on coaches. Whether or not this is the case for your community, you can speak to the appropriate authorities about conducting these checks and implementing training programs that address how coaches can help young athletes to have a positive and safe experience. Parents need to understand that it is the coach’s job to manage the team and, for the most part, you should not interfere. However, you should be aware of the kind of experience that your child is having and you should feel free to ask questions. We sometimes tend to assign positive personal characteristics to coaches, whether deserved or not. This is particularly so in the case of winning programs; even at youth, and middle and high school levels. But winning championships doesn’t necessarily make someone a good person or role model. And, there is no question that it is difficult to challenge the coach who is competitively successful and has strong support from team parents and in the community. With unconditional support, less sensitive coaches can feel empowered to do as they please, especially if they are oblivious to how youngsters might be adversely impacted by their actions. Finally, you should strive to help your children keep sports in perspective. This starts with you, as a parent, doing the same. An appropriate level of perspective doesn’t mean that your child should not be competitive or do his or her best to excel on the field or court, or should not show respect 2 for coaches and teammates. It does mean that when faced with a coach who behaves inappropriately or a teammate who bullies other children, your child should be encouraged to share what is going on, as opposed to subscribing to the idea that a good team member never questions a coach’s authority, even if it is used to exploit or harm others. The great majority of coaches care deeply about the long term development of the children under their supervision, but parents of young athletes are wise to bear in mind an adage that was lost on a number of people involved in the Penn State tragedy: ‘Power corrupts. Absolute power corrupts absolutely.'”

The Dignity Act and the Real World

by North Shore Child & Family Guidance Center | Jul 20, 2012 | Anton Media

The Dignity for All Students Act was signed into law on September 13, 2010 and took effect on July 1, 2012. According to the New York State Education Department, the dignity act “seeks to provide public elementary-school and secondary-school students with a safe and supportive environment free from discrimination, intimidation, taunting, harassment, and bullying on school property, a school bus and/or at a school function.” According to an official from the New York State Center for School Safety, the dignity act “takes a major step in creating more nurturing environments in all our schools.” The impetus for passage of the act was the increasing number of complaints about bullying at school and through social media. Schools are now expected to provide education and human-relations training for students of all ages to prevent discrimination and harassment. Schools must implement codes of conduct and procedures for reporting incidents of discrimination or harassment on school grounds. Last month, the state legislature passed an amendment to the dignity act that will address cyber-bullying. This provision will take effect a year from now and will enable schools to address ways to curb bullying in and out of the classroom. Parents would do well to familiarize themselves with the provisions of the new law. A sample local policy guideline is available on the Internet at: www.p12.nysed.gov/dignityact/documents/LocalDASAModelPolicyRev6-22-12_1.pdf. This 14-page document offers definitions of harassment, bullying, hazing and discrimination and guidelines for prevention, intervention, training, reporting and investigation. The guideline includes an important section that affirms that there is to be no retaliatory action against any reporter acting in good faith. Some schools across the state have registered for www.anonymoustips.com to assist students who might be afraid to report incidents. Although it is important for families to know that there are protections under the law for reporting acts of harassment, it would be naïve to think that children and teenagers who blow the whistle on their peers, if exposed or even suspected, would be immune from social consequences outside of school. The passage of the dignity act provides an opportunity for parents to talk to their children about how to protect themselves from intimidation, harassment and abuse of power. It also offers them a context to discuss how to be sensitive to others who are different and how to stand up, speak out and fight back in the face of abusive behavior. Students need to know that protecting oneself or advocating for others by speaking out are often tests of character and bold moves that can bring social consequences. 2 Although putting legal muscle into the fight against bullying in schools may prove helpful, it is not enough to tackle this social problem. No amount of legislation and no penalties for intimidating schoolyard behavior, no matter how severe, can guarantee that children will be safe at all times in, or outside of, school. The dignity act, as implemented on school grounds and within the purview of school officials, must complemented by support at home, pro-social bonds among neighbors and consistent community standards against bullying, bias and harassment, including in cyber-communities, otherwise the legislation will be little more than a paper tiger, another layer of bureaucracy, with limited influence in the real world in which kids reside.

When Parents Drink and Drug

by North Shore Child & Family Guidance Center | Jun 20, 2012 | Anton Media

By Andrew Malekoff

The problematic use of alcohol, drugs and tobacco is unquestionably the nation’s number one health problem. While all segments of society are affected, the future of young people is most severely compromised by this epidemic. There has been increased media exposure and public education on the rise of young people’s abuse of pharmaceuticals – prescription drugs – that often leads to heroin use and addiction. Parents have been alerted to the fact that the most likely source of prescription drugs is the medicine cabinets of friends and family, where the pharmaceuticals can be easily attained at no cost; and, that the cost for a bag of heroin is less than that for a six-pack of beer. Despite enhanced media coverage on these drugs, what the public hardly hears about anymore is the fact that there are millions of children who grow up in homes with parents who are addicted to alcohol and other drugs. It has been estimated that approximately one in four children in the US is exposed to alcohol abuse and drug dependence in the family at some point before age 18. There are multiple impacts on children growing up in these homes. These young people are likely to become alcohol or drug abusers themselves without intervention. Children who grow up in families with alcohol and drug addiction learn to distrust to survive. They learn how to walk on eggshells. The behavior and attitude of the addict and the related emotional tone in the home is a day-to-day mystery. When unpredictability dominates a child’s life, they are likely to be perpetually wary, always sensing disappointment or danger lurking nearby. Children who grow up in addicted families become uncomfortably accustomed to living with chaos, uncertainty, unpredictability and inconsistency. These children have no idea what is normal. They live vastly different internal lives than their peers from homes where coping with addiction in the family is not a daily challenge. Denial and secrecy are common for children who live in alcoholic or addicted families. Their lives are organized around concealing the truth. Asking for help is out of the question as that would trigger exposure to the outside world, disloyalty inside the family and it would evoke intense feelings of embarrassment and shame. In an addicted family there is an ongoing and, most often, unspoken agreement to hide the problem to prevent exposure that will erode the image of a “perfect family.” Children may avoid bringing friends home and cringe at the thought of having the family secret 2 revealed. Their own needs and desires take a back seat to fronting for their family and preserving the image that belies the reality. It is hard to be a child in an alcoholic or addicted family. It takes a lot of energy just to get through the day. Growing up in such a family leaves children with little hope that things will ever change. Children who live in these homes often feel trapped, depressed, alone and desperate. There are no simple answers, but there is help. Family members, friends, pediatricians and school personnel who are attuned to this problem can help to break the conspiracy of silence. Understanding the barriers, gently inviting trust and seeking professional support is the first step to overcome the problems involved. If you need guidance about how to proceed, call Tyrone Anthony, coordinator of chemical dependency services at the Leeds Place, a branch of North Shore Child and Family Guidance Center, at 516-997-2926.

Human Services Hunger Games

by North Shore Child & Family Guidance Center | May 20, 2012 | Anton Media

I am gradually losing step with the pop culture juggernaut. By the way, juggernaut refers to a relentless force, movement or object that trounces whatever is in its path. The term originated from the Unstoppable Juggernaut, a fictional character who first appeared in Marvel Comics’ X-Men. I share this only to establish that I do have some pop culture street-cred. Nevertheless, I thought Hunger Games was an eating competition until I discovered that it was a post-apocalyptic science fiction novel written by Suzanne Collins. The book features 16-year-old Katniss Everdeen who volunteers to take her younger sister Prim’s place, after Prim is chosen by lottery to participate in a government-mandated, nationallybroadcast, fight-to-the-death battle among 24 teens and pre-teen “tributes” living in 12 districts of the nation of Panem. The goal of the games is to be the last one standing. I read Hunger Games with a dual consciousness. I was absorbed in the fabulous and chilling story and I was tuned in to the story as a metaphor. The last-man-standing theme reminded me of the struggle for survival that community-based mental health agencies in Nassau County face. I have addressed this extensively in my published commentary and testimony before legislative bodies for years. For instance, in a 2009 piece that appeared in the Albany Times Union I wrote, “More low- and middle-income families than ever are in need of low-cost, high-quality community-based mental health care. Yet, the state Office of Mental Health, along with the state Health Department, is aggressively pursuing a “reform” plan that will assure continued access to care only to children and families with Medicaid fee-for-service insurance coverage. This will leave a significant number of children and adults in the lurch.” Just to show that I wasn’t “blowing smoke,” if you fast-forward to 2012 you will find that there are community-based outpatient mental health providers in our backyard that closed their doors, were taken over by larger corporate entities with no community roots, transformed their operations into per diem factories with little capacity for dealing with complex or crisis situations or restricted their clientele to a residual population of Medicaid-insurance carriers. Others are working diligently to preserve the integrity, character and culture of nonrestrictive, universal community-based care. When our children, and their families, face the worst of times they need a place to go that is easily accessible and available to respond to emergencies, offers a continuum of care and feels like home and not like a factory. For many community-based mental health centers, from a family’s first contact to their last, the work requires collaboration, most of which is not fee-producing, with a variety of service providers. Hours are spent with school personnel, hospital-discharge staff, 2 probation officers, preventive workers, case managers, family advocates and childprotective service workers, to name a few. The children at highest risk need a continuum of outpatient-based triage and emergency services that allow for seamless, timely and successful discharges from hospital to community. Experience has shown that hospitals will often not discharge children to private practitioners. Families, particularly those with children who have serious emotional disturbances or are in psychiatric crisis, require more assistance than can be provided by private practitioners. To continue to provide these vital services and keep children from needing higher and costlier levels of care, many local agencies have been making every effort to streamline service delivery while maintaining the best standards of care. Although it is an uphill battle, it is a fight that we must continue and, hopefully, with a different outcome than the Hunger Games; one where we all remain standing and the character and culture of true community-based mental health centers remains strong.

A Cinematic Twist on Bully Culture

by North Shore Child & Family Guidance Center | Apr 20, 2012 | Anton Media

Like many film-goers I have my list of favorites. Some are hilarious (Airplane), some are gripping (Wages of Fear), some are masterpieces (Godfather) and some are timeless classics (Wizard of Oz). And, then there are those that are so haunting that I cannot seem to shake loose of them. The darkly disturbing 2009 Austrian-German film, The White Ribbon, is one of the more haunting ones. Filmed beautifully in black and white with subtitles, The White Ribbon portrays the residents of a northern German village, dominated by a baron, sometime before World War I. Inhabitants of this village appear to be sliding down a slippery slope of moral depravity. Men in positions of power – a doctor and a clergyman, for example – routinely mistreat women and children. Among the most brutal scenes is one where the town’s widowed physician verbally degrades a kind woman who had faithfully served as his caretaker and mistress. Although it is only suggested, a number of the older children appear to have perpetrated despicable acts. Crops are destroyed, animals are killed, adults are injured and children are abused, including a child with Down’s syndrome. We bring our own meanings to films and modify our interpretations as time passes. After I thought about The White Ribbon for awhile, I came to the conclusion that it contained a strong message about the devastating consequences that a culture of bullying can bring about. Sometime after viewing the film, I thought more deeply about the children living in that German village. I realized that they would soon become young adults during the rise of Hitler. These children lived in an incubator in which the cruelty that they experienced, they perpetrated against unsuspecting and helpless victims. Their circumstances were such that they appeared to have been unwittingly primed to perpetrate the atrocities that would come to characterize the Third Reich. In his 2009 commentary on the White Ribbon, for the San Francisco Chronicle, filmreviewer Mike Lasalle noted that the idea of the film was “that the parenting and education German children received in the early years of the 20th century made them morally susceptible to Nazism…No child is trained to become a martinet, and no one says anything about a master race. Rather, the kids, from their elders, get quiet lessons in moral absolutism, sternness, emotional violence and heartlessness.” Seeing this film led me to wonder about the early years of the 21st century when bullying has become such a prominent thread in the fabric of our culture. And the Internet and all of its gadgets have become the tools with which people of all ages systematically degrade others. But tools are tools. A hammer can be used to build a house or to crush someone’s skull. The Internet and modern technology are not inherently evil, but are tools that can be utilized for evil ends. Although I do not know the answers to some of the questions that The White Ribbon has posed to me; the film, coupled with an acute awareness of the times we live in, brought these disturbing questions to mind: Have our children become susceptible to something ominous that we cannot yet fathom?, If so, what is driving them? And, what are the times we are living in a prequel for?

Occupy the Boys’ Room

by North Shore Child & Family Guidance Center | Mar 20, 2012 | Anton Media

The “Occupy Movement” has been greeted with mixed sentiment ranging from admiration to revulsion. On the plus side, the movement shows young people that folks of any age can come together around their own vision of the world they want. However, one does not have to attain revolutionary goals to work toward social change, as I learned some years ago when I was working with a group of troubled boys. At the time, I was involved in developing an innovative school-based mental health program. I was filling in at the school, for a few weeks, for one of the social workers who had taken a leave. I agreed to work with her boys’ group. The boys in the group – teenagers, all had significant emotional difficulties, ranging from depression to explosive behavior. In my first meeting with the boys, the discussion took an interesting turn. They complained that there were no doors on the boys’ bathroom stalls and that there was yellow soap in the dispensers. It was a bit of a detour, but I encouraged them to say more about their objections. As I recall, Keith was the first to speak out: “Do you think they have any idea how humiliating it is to go to the bathroom with no doors on the stalls? There’s no privacy; it’s embarrassing. It’s like they don’t trust us; they’re treating us like little boys.” Sam added, “It’s disrespectful, that’s what it is – it’s disrespectful.” And then Kurt, getting back to basics, pointed out, “Man, it’s a lot of pressure when you gotta go badly and you know you can’t.” Benji added “It says ‘Boys’ Room’ on the bathroom door! We’re men! Dammit! What kind of crap is this anyway!” A little later, another group member, Rob, asked the others if it was true that kids peed into the soap dispenser. Jay said that he saw someone do it but no one could really tell until it was too late because the soap was yellow. To which one of the group members declared, “We have to get them to put pink soap in the dispensers! Then we’ll know if anyone pees in there. Then we’ll know.” 2 Being heard and really listened to was a rare experience for the dozen boys who comprised the group. They knew about what being misunderstood, rejected and isolated was all about; but not in this group where they felt connected to one another. They were angry and united – outraged. In time their social worker rejoined the group. I filled her in about the boys’ quest for improved bathroom conditions. She then guided them to develop a list of bathroom improvements that would be presented to the principal. She led them through an exercise in which they rehearsed presenting their grievances. Then she urged them to request a meeting with the principal to present their case. Many weeks later, I came to the high school after the dismissal hour and headed down a long vacant hallway to attend an administrative meeting. I pushed open the “Boys’ Room” door and was pleasantly surprised to find pink soap in the dispensers and doors on the stalls. This story affirms that, working towards change does not require revolutionary goals. Supporting young people in taking action against social injustices – big and small – is a great way to help them to think critically, take a stand and prepare to become active citizens in community affairs.