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PERMIT NO. 137

39 page on Kids see many cases, these “symptoms” will be be will “symptoms” these cases, many ent, one wonders what has gone gone has what wonders one ent, (either poor quality or not enough) com- enough) not or quality poor (either

enough to help resolve these issues. In In issues. these resolve help to enough and in many cases, terrifying. As a par- a As terrifying. cases, many in and care became reflective of inadequate inadequate of reflective became care

anxiety, school phobia, or depression have have depression or phobia, school anxiety, or initiating outpatient counseling may be be may counseling outpatient initiating or son’s functioning, it can be disconcerting disconcerting be can it functioning, son’s and too often abuse, the need for inpatient inpatient for need the abuse, often too and

attendance related to behavioral problems, problems, behavioral to related attendance between the parent and child may suffice suffice may child and parent the between nessing the deterioration in a young per- young a in deterioration the nessing negative light. Born of historic overuse, overuse, historic of Born light. negative

child’s problems in school such as poor poor as such school in problems child’s changes in functioning. Problem solving solving Problem functioning. in changes For those experiencing and those wit- those and experiencing those For has often come to be thought of in a very very a in of thought be to come often has

need for multiple appointments. Or their their Or appointments. multiple for need with their child and may recognize recognize may and child their with their families get “back on track.” track.” on “back get families their In the more modern era, inpatient care care inpatient era, modern more the In

tain a steady work schedule due to the the to due schedule work steady a tain or any individual who has regular contact contact regular has who individual any or of behavior and helping adolescents and and adolescents helping and behavior of Flew over the Cuckoo’s Nest.” Nest.” Cuckoo’s the over Flew

stance, parents may not be able to main- to able be not may parents stance, pist, daycare provider, coach, troop leader leader troop coach, provider, daycare pist, symptoms, interrupting negative spiraling spiraling negative interrupting symptoms, sides as reflected in Ken Kesey’s “One “One Kesey’s Ken in reflected as sides

but family functioning as well. For in- For well. as functioning family but child’s teacher, thera- teacher, child’s their with speaking be extremely effective in stabilizing acute acute stabilizing in effective extremely be ronments were not without their darker darker their without not were ronments

ects not only the child, child, the only not ects aff it that profound mation from their own experience or by by or experience own their from mation evidence that brief inpatient treatment can can treatment inpatient brief that evidence nesses. While well intended, these envi- these intended, well While nesses.

safety risk the impact on functioning is so so is functioning on impact the risk safety vention. A parent may obtain this infor- this obtain may parent A vention. deal of empirical empirical of deal great a have we toga tion for those with more serious ill- serious more with those for tion

mised. For those not posing an imminent imminent an posing not those For mised. assessment, and often, some type of inter- of type some often, and assessment, ports are offered. At Four Winds Sara- Winds Four At offered. are ports inpatient care was virtually the only op- only the virtually was care inpatient

those around him has been compro- been has him around those weight issues are all worthy of attention, attention, of worthy all are issues weight of treatments or sup- or treatments of kinds what or there form of care. For decades this form of of form this decades For care. of form

to the hospital, the safety of the child or or child the of safety the hospital, the to or a significant focus on body image and and image body on focus significant a or says little or nothing about what occurs occurs what about nothing or little says was considered a progressive avant-garde avant-garde progressive a considered was

For the vast majority of those admitted admitted those of majority vast the For tion, feelings of sadness and hopelessness, hopelessness, and sadness of feelings tion, tive. “Inpatient” is a place and the term term the and place a is “Inpatient” tive. ment. This “humane treatment,” in its day, day, its in treatment,” “humane This ment.

inpatient care may be necessary. necessary. be may care inpatient or her fearfulness, withdrawal and isola- and withdrawal fearfulness, her or I evidence that inpatient care is effec- is care inpatient that evidence tions located in a bucolic rural environ- rural bucolic a in located tions

interventions have proved ineffective, that that ineffective, proved have interventions child’s mood, a noteworthy change in his his in change noteworthy a mood, child’s Practices, it is often said that there is no no is there that said often is it Practices, tient care provided in large institu- large in provided care tient

ing or become dangerous or when other other when or dangerous become or ing crease in aggressive acts, volatility in your your in volatility acts, aggressive in crease sis in policy circles on Evidenced-Based Evidenced-Based on circles policy in sis health care began begins with inpa- with begins began care health

symptoms dramatically impede function- impede dramatically symptoms clarify symptoms. For instance, an in- an instance, For symptoms. clarify in general has. During the current empha- current the During has. general in country, the story of how mental mental how of story the country,

days.” It is when the aforementioned aforementioned the when is It days.” lescence, it is important to identify and and identify to important is it lescence, care has evolved just as mental health care care health mental as just evolved has care n New York State, and across the the across and State, York New n

media puts a lot of pressure on kids these these kids on pressure of lot a puts media toms and issues. Particularly during ado- during Particularly issues. and toms The truth is that the inpatient level of of level inpatient the that is truth The

hanging with a different crowd” or “the “the or crowd” different a with hanging hospital present with a variety of symp- of variety a with present hospital based alternatives. alternatives. based

is a mental health problem?). Or, “she’s “she’s Or, problem?). health mental a is Four Winds Hospital - Saratoga Saratoga - Hospital Winds Four trauma. Children who are admitted to the the to admitted are who Children trauma. tor in the development of community community of development the in tor

know what is teenage behavior and what what and behavior teenage is what know and David Woodlock, MS MS Woodlock, David and or even some type of abuse or or abuse of type some even or care has also been seen as a limiting fac- limiting a as seen been also has care

attributed to “hormones” (i.e., How do I I do How (i.e., “hormones” to attributed By Joseph Commisso, PhD PhD Commisso, Joseph By wrong. You may suspect illicit drug use, use, drug illicit suspect may You wrong. munity based care. The cost of inpatient inpatient of cost The care. based munity

Kids Do Get Better: Values Driven Inpatient Care Care Inpatient Driven Values Better: Get Do Kids

40 page on NIMH see havior. Share this with your child's doctor doctor child's your with this Share havior. symptoms in my child? child? my in symptoms anxiety disorders, attention deficit hyper- deficit attention disorders, anxiety

been showing worrisome changes in be- in changes worrisome showing been about mental, behavioral, or emotional emotional or behavioral, mental, about Disorders affecting children may include include may children affecting Disorders

many everyday stresses can cause changes changes cause can stresses everyday many in school ask the teacher if your child has has child your if teacher the ask school in Q. What should I do if I am concerned concerned am I if do I should What Q. options for children with mental illnesses. illnesses. mental with children for options

A. Not every problem is serious. In fact, fact, In serious. is problem every Not A. symptoms that worry you. If your child is is child your If you. worry that symptoms

questions about diagnosis and treatment treatment and diagnosis about questions

everything you can about the behavior or or behavior the about can you everything sion, eating disorders, and schizophrenia. schizophrenia. and disorders, eating sion, This fact sheet addresses common common addresses sheet fact This

are serious? serious? are care provider. Ask questions and learn learn and questions Ask provider. care trum disorders, bipolar disorder, depres- disorder, bipolar disorders, trum treatment. treatment.

Q. How do I know if my child's problems problems child's my if know I do How Q. A. Talk to your child's doctor or health health or doctor child's your to Talk A. activity disorder (ADHD), autism spec- autism (ADHD), disorder activity with mental illnesses are not getting getting not are illnesses mental with

yet cure) many disorders, many children children many disorders, many cure) yet

your child, and your family. family. your and child, your though we know how to treat (though not not (though treat to how know we though

make decisions that feel right for you, you, for right feel that decisions make behavior and more difficult to treat. Even Even treat. to difficult more and behavior

you can work with your child's doctor and and doctor child's your with work can you becomes a regular part of your child's child's your of part regular a becomes

diagnosis. The more you learn, the better better the learn, you more The diagnosis. ders. Once mental illness develops, it it develops, illness mental Once ders.

everything you can about the problem or or problem the about can you everything may prevent the development of disor- of development the prevent may

ist to find the right fit. Continue to learn learn to Continue fit. right the find to ist parents manage difficulties early in life life in early difficulties manage parents

afraid to interview more than one special- one than more interview to afraid in life. Helping young children and their their and children young Helping life. in

problems I see in my child?" Don't be be Don't child?" my in see I problems range of mental illnesses that appear later later appear that illnesses mental of range

ask, "Do you have experience treating the the treating experience have you "Do ask, more about the early stages of a wide wide a of stages early the about more

If you take your child to a specialist, specialist, a to child your take you If dren's brains develop, we are learning learning are we develop, brains dren's

your child. child. your when and how fast specific areas of chil- of areas specific fast how and when

pists. Educators may also help evaluate evaluate help also may Educators pists. Through greater understanding of of understanding greater Through

psychiatric nurses, and behavioral thera- behavioral and nurses, psychiatric any symptoms appear. appear. symptoms any before earlier, much

chiatrists, psychologists, social workers, workers, social psychologists, chiatrists, body leading to mental illness may start start may illness mental to leading body R

problems. Specialists may include psy- include may Specialists problems. discovering that changes in the the in changes that discovering

with experience in child behavioral behavioral child in experience with begin by age 14. age by begin Scientists are are Scientists

1

needs further evaluation by a specialist specialist a by evaluation further needs lifetime cases of mental illness illness mental of cases lifetime

from child to child. Ask if your child child your if Ask child. to child from esearch shows that half of all all of half that shows esearch

language, motor, and social skills, varies varies skills, social and motor, language,

velopment, such as when children develop develop children when as such velopment,

of Mental Health (NIMH) (NIMH) Health Mental of every child is different. Even normal de- normal Even different. is child every

By The National Institute Institute National The By or health care provider. Keep in mind that that mind in Keep provider. care health or

Mental Health Services for Children and Adolescents Adolescents and Children for Services Health Mental

FALL 2010 2010 FALL FROM THE THE FROM LOCAL, STATE, AND NATIONAL NATIONAL AND STATE, LOCAL, NEWS SCENE SCENE NEWS VOL. 12 NO. 4 NO. 12 VOL.

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PAGE 2 visit our website: www.mhnews.org MENTAL HEALTH NEWS ~ FALL 2010

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Mental Health News Education, Inc. Ira H. Minot, LMSW, Executive Director Mental Health News Education, Inc. David H. Minot, BA, Associate Director 16 Cascade Drive, Effort, Pennsylvania 18330 Mental Health News Education, Inc. E-mail: [email protected] Phone: (570) 629-5960 MENTAL HEALTH NEWS ~ FALL 2010 visit our website: www.mhnews.org PAGE 3 Table of Contents

Our Theme: Mental Health Services 8 The Economics of Recovery: When Worlds Collide for Children and Adolescents 9 The Mental Health Lawyer: On Medicating Minors 1 NIMH on Child and Adolescent Mental Health 18 Advancing Anti-Racism Work: The First Monday Collaborative 1 Kids Do Get Better: Values Driven Inpatient Care 19 Getting Federal Benefits the Safe, Convenient Way 10 Experiences Conducting Multiple Family Groups 21 Four Winds Hospital Fall Supplement 10 Risk Assessment for Children and Adolescents 25 “Breaking the Silence” Found to be Effective 12 Poverty and Mental Health in The Bronx 29 Maniscalco Lecture Held at Saint Joseph’s Medical Center 14 The Role of the Home Care Mental Health Nurse

16 An Interview with Wellspring Residential CEO Mental Health News 18 Considering Culture in Child and Adolescent Care 2011 Theme and Deadline Calendar

19 The Next Generation of Family Support Programs Winter 2011 Issue: 25 The Road to Independence “The Impact of Race and Racism on Mental Health Clients, Practitioners, Organizations 26 Engagement in the School Based Clinic Setting and Mental Health Delivery Systems” (Please Note: Articles for this issue are by invitation only) 28 Positive Behavioral Interventions and Supports for Children Deadline: November 1, 2010 30 Managing the Patient with an Eating Disorder Spring 2011 Issue: 30 Maternal Depression and Children’s Behavior in School “The Mental Health Needs of Older Adults” 32 Child Care, Academic Achievement and Behavior Deadline: February 1, 2011

38 Celebrating the Life and Resiliency of Young People Summer 2011 Issue: “Women’s Issues in Mental Health” Other Articles of Interest Deadline: May 1, 2011

4 From the Publisher: Divorced People and Stigma Fall 2011 Issue: “Health Reform and Mental Health Parity 6 Point of View: Mental Health Needs in Kinship and their Impact on Peopl e and Service Providers” 7 The NYSPA Report: DSM-5: The Future Face of Psychiatry Deadline: August 1, 2011

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By Ira H. Minot, LMSW believe Bart’s Place is still in operation tried to go back to work, but it was obvi- Founder and Executive Director today. If it or any similar programs like ous by my behavior that I was not the Mental Health News Education, Inc. it do exist today, I would like to hear same eager, bright, and confident man. from these programs and feature them My employer wished me well and I was in Mental Health News. soon let go from my job. Losing my job in his issue of Mental Health News The mental health care system must that way was a horrible experience and examines the topic “Mental address the needs of divorced parents with over the next few years I managed to sur- Health Services for Children mental illness in the same manner that vive on my savings. I clung to the notion and Adolescents.” As children they help married couples when one has that getting back to work was the one Tare our future, there can be no more im- or falls ill to a mental illness. Mental thing that validated my worth as a human portant area of vital concern than provid- health reimbursement allowances must being—otherwise I didn’t deserve to live. ing for their mental health. Our topic also be made by insurance companies to In addition my depression and inability to could fill volumes, yet in the short span of provide family counseling for children support myself convinced me that I was a this issue we have compiled several excel- and their divorced parent as they do for “bad parent,” which added to the pain I lent articles that I believe you will find married couples with children. This is felt as a divorced father. very interesting. especially needed today with the thou- Nine years had passed after my first In this column I would like to address sands of soldiers returning from the Mid- breakdown and my illness had exhausted two issues that have concerned me for dle East with PTSD and other serious my savings, left me homeless and I was some time. One is, “Why doesn’t the mental health problems. Divorce rates for still caught in the grip of depression. It mental healthcare system address the these brave veterans are high. There needs was at that point that I was fortunate to be needs of divorced people with mental to be a new mindset within the mental admitted to a psychiatric teaching hospital illness that have children in the same way health system that puts counseling be- in New York. It wasn’t fortunate, how- they do for married people with mental Ira H. Minot, LMSW tween divorced individuals and their chil- ever, that I was brought in on a stretcher illness?” The other issue concerns the use dren high on the list of required steps in following my third suicide attempt. It was of the term “being on the dole” to de- the additional burden placed on him by my the treatment process. at this hospital where I agreed to undergo scribe someone who is receiving govern- illness. However, he and I were never in- a full course of ECT, commonly known as ment entitlements or disability benefits vited into any counseling sessions to- The Expression “Being on the Dole” “shock treatments.” It would be the magic when they are in need of them. gether—a monumental oversight by my Is Hurtful and Stigmatizing bullet that brought me back to life and As many of you who have followed team of treatment professionals. Looking which I credit for saving my life. It was my writings know, I often draw upon my back, I firmly believe that this was because According to my search of the internet, like being revived from being in a coma own experience as a survivor of a horrible of the fact that I was divorced. the first use of the expression “being on for almost 10 years. The first thing I said 10-year battle with depression. My analy- A search of the internet on the subject the dole” began around 1919 following to my doctors when I began to come sis of the aforementioned issues is not of “When a parent has a mental illness” World War I and referred to the “doling around was “I’ve got to get back to done with any specific research other than reveals a wealth of information about the out” or “handing out” of charitable gifts work.” “No,” they said, “You have to a thorough search of the internet and my problems that children encounter and how of food or money. During those times the spend time healing before you can do own opinion gathered through real-life to help them cope when one of their par- expression certainly was meant to have a that.” I realized they were right, and fur- experience. ents has a mental illness. However when humanitarian and life-saving meaning ther realized that my resume had been left you search for “When a divorced parent during the horrors of that war. Today in tatters anyway, showing a 10-year lapse Helping Divorced Parents with Mental has a mental illness,” nothing related to however, whenever I hear someone say, in employment. At the doctor’s insistence, Illness Stay Close to Their Children that specific situation comes up at all. I “He’s on the dole,” or “When are these I was told to forget about going back to find that incredibly hard to believe. people going to get off the dole,” I get a the high-stress world of fundraising as a I was in my mid 30s when I became ill, My son and I fortunately had a happy sickening feeling in my stomach because I career choice. I had to start all over again a short time after several deep personal ending. When I finally received the treat- know that today’s use of this expression is and had no clue what new career I could losses I had experienced within my fam- ment that broke the chains of my illness, meant to stigmatize and cast the person find to support myself. It was there at that ily. One of these losses was the physical my son and I were able to begin rebuild- who is receiving financial assistance in a hospital that the case-management staff and psychological separation from my ing the many years of lost time, terrible totally negative fashion. I am especially arranged for me to be put on Social Secu- then five year old son following the hurt, and misunderstanding about my sensitive to the use of this expression rity Disability (SSD) and arranged for me breakup of my marriage. The other was illness that had taken place. When I be- when referring to someone with a medical to be placed in a supportive housing apart- the loss of my mother following her hard gan to get my life back and started this condition, be it physical or mental. ment. This became the safety-net which fought battle with cancer. Unbeknownst newspaper, my son was finally able to When I had my first bout of depression allowed me to begin the healing process I to me was that I was not prepared to cope understand that my illness was not his in my mid 30’s, (which I often refer to as so desperately needed to succeed in my with such losses. It was a perfect psycho- fault or my fault, and was a medical con- my first breakdown), I was convinced that recovery—a process that the doctor’s be- logical storm that was about to hit me like dition. It is regrettable that the mental it was merely a normal short-term reac- lieved would take me a number of years. a hurricane whose path I could not avoid. healthcare delivery system failed to bring tion to the losses I had experienced within The support I received from those enti- The worst did happen and I was thrown my son and I together into counseling my family. I guessed that it would pass in tlement programs saved my life. I never into a black hole that became a serious where these hurts and misunderstandings a few days, and at worse I would be pre- wanted a hand-out from anyone, but with- depressive illness. could have been addressed while they scribed a medication that would calm my out the aid I received I never would have Being the father of a young child and were happening. A great deal of pain and nerves and allow me to go about my life made it. I remember friends and family missing the closeness of living with him, suffering could have been avoided for as if nothing major had happened. Up referring to my being on this assistance as combined with the heartless cruelty be- both of us. until that point in my life, I had rarely “being on the dole,” and I found this very ing dealt to me in the form of the pain of I believe there have been a few programs missed a day of work, and was climbing hurtful. Having a mental illness was stig- my deepening depression only made over the years that have tried to address the the ladder within my career as a social matizing enough. Having others refer to matters worse. But I was in treatment. importance of helping parents with mental worker and fundraiser for non-profit or- my receiving life-saving SSD and suppor- Shouldn’t the mental health professionals illness stay close with their children. There ganizations. My first thoughts were that I tive housing as “being on the dole” just that were caring for me have been able to was one a few years ago in Ohio that I read had no time for these inconvenient feel- added to the hurt and shame I already felt. also help me address the pain I felt from about on the internet called Bart’s Place ings of depression and that I had to get Let us remove this expression from our being separated from my son, and help (http://psychservices.psychiatryonline.org/ back to my job in a few days. Little did I vocabulary and treat people who are me and my son better cope with my ill- cgi/content/full/52/1/107). It was a program know that this first breakdown was to be bravely recovering from their illnesses ness? The answer was NO. It wasn’t located at a psychiatric hospital that united the first of many that would hurl me into a with the respect they deserve. I have al- even on their agenda. and counseled young children and their hos- life and death battle that I would endure ways thought that people who casually I found that over the many years I strug- pitalized parent while they were inpatients. for over 10 years and would end up de- use stigmatizing language like this were gled with my illness, I was seen more as a A little thing they did was to take photos of stroying my life as I had once known it. simply ignorant and uneducated. I invite single adult than as a divorced parent with the parent with their child that the child My plunge into the darkest days of my them to walk a mile in our shoes. This a young son. Thankfully, my son was in could take home and the parent could keep illness followed soon after my first break- would surely enlighten them. counseling to help him adjust to his par- by their bedside while in the psychiatric down and I quickly reached a state where ent’s divorce, and I imagine that in these hospital. This is the best medicine that I had to be hospitalized. Following my Good Luck in Your Recovery sessions he was also able to get support for could be given. Unfortunately, I don’t discharge from the hospital, I bravely Have a Wonderful Fall Season! MENTAL HEALTH NEWS ~ FALL 2010 visit our website: www.mhnews.org PAGE 5 PAGE 6 visit our website: www.mhnews.org MENTAL HEALTH NEWS ~ FALL 2010 — Point of View — Mental Health Needs in Kinship

Michael B. Friedman, LMSW own needs second to those of the kids they • Developing a training initiative for be- are raising. Outreach to encourage them to havioral health professionals related to the take care of themselves can be very impor- specific emotional needs of kids separated here are 350-400,000 children tant to their physical and mental health. from their biological parents, to the bur- and adolescents in New York dens and distress common among kin State that are in kinship care. • The needs of biological parents with caregivers, and to the needs of biological I.e., they are raised by relatives mental disorders are often neglected. parents separated, or facing separation, Tother than their biological parents. Al- There is great controversy and confusion from their children. This could include a though there is some evidence that these about when parents’ with mental disorders tool kit for mental health and substance children do better psychologically than are incapable of providing adequate care abuse services providers: Your Clients those who are in foster care with strang- for their children, when they need support, May Be Parents or Caregivers. ers, there are serious mental health chal- and when they can be good parents on their lenges for these kids, for their kin care- own despite the fact that they have a men- 3. Support Current Efforts to Inte- givers, and for their biological parents. tal disorder. In addition, psychiatric reha- grate Physical and Mental Health New York State can and should do more bilitation, which could help parents with Services: As noted above, primary to address these challenges. serious mental illnesses develop the child- health care provides an opportunity to This was the overarching conclusion of rearing skills they need, generally does not identify and to respond appropriately to a workgroup on mental health that AARP focus on this as a major life goal, despite behavioral health problems of kids in and the NYS Kin Caregiver Coalition con- the fact that for many parents with mental kincare, their caregivers, and their bio- vened to identify key mental health issues disorders raising their own children is their logical parents. Integrating mental in kincare and to develop recommenda- highest personal priority. health services into these settings just tions regarding how to address them. makes sense. In addition, some biologi- Kin caregivers include grandparents Michael B. Friedman, LMSW Needless to say, addressing these is- cal parents with behavioral health prob- raising grandchildren, aunts and uncles sues is exceedingly difficult—especially lems may be getting services from spe- who fill in for their siblings, older broth- How can these mental health chal- during a period of history when the econ- cialized mental health or substance ers and sisters, who are often kids them- lenges be better addressed? A group of omy makes service expansion largely abuse programs. In these cases integrat- selves, and other family and friends who experts (including kin caregivers them- politically impossible in New York State. ing physical health care into behavioral are willing to take on parental responsi- selves) met in December 2009 and an- Nevertheless, the workgroup identified health centers often makes more sense bilities despite the burden it creates in other group met in June 2010 to answer steps that are possible now that could be than expecting them to get care from their lives. this question. Their observations and rec- extremely valuable later. These include: primary health care providers. Sometimes kin caregivers step in because ommendations were far-reaching and too of the death of the children’s parents, but extensive to report in this column. But 1. Make Kinship Care A Policy Priority: 4. Focus on Mental Health Promotion more often it is because the biological par- here are a few highlights: rather than just waiting to respond to ents are unable to provide basic care for • Multiple state and local agencies touch diagnosable disorders. One way to do their children. For example, military service • The mental health and substance abuse on the lives of people involved in kincare, this would be to develop and disseminate members who are deployed away from service systems are often not able to pro- including mental health, substance abuse, a toolkit—“Kids in Kincare and their home may have to turn to their parents or vide adequate services to kids, kin care- health, education, aging, corrections, and Caregivers: How You Can Help Them others to raise their children while they are givers, and their biological parents be- more. Each should include kincare among Thrive”—in multiple service systems. away. Similarly, some parents have non- cause services are in short supply; be- its priorities. military work assignments that take them cause they are often difficult to access due 5. Confront the Issue of the Relevance of away for long periods of time. Other parents to distance, office hours, language barri- • Planning processes related to children, Mental Disorders to Child Protection by: are away from home not because they are ers, or cost; and because often they are not health and mental health, aging and more serving their country or working to earn a provided by staff with expertise regarding are constantly underway in New York • Convening a joint behavioral health and living but because they have been incarcer- this population. State at both the state and local levels. child welfare workgroup to develop real- ated for crimes. Others have physical, men- Few of these address kinship care at all, istic and unbiased strategies and sugges- tal, or substance use disorders that impede • All of the systems that serve this popula- let alone the mental health challenges of tions regarding removal of the child of a caregiving. In many cases the children have tion could do more to promote mental kinship care. But they should. parent with a mental and/or substance been victims of abuse and/or neglect at the health rather than waiting for a disorder to abuse disorder for child protective service hands of their parent(s) or step parents and emerge. This includes primary health care, • In addition, a number of inter-agency workers and for the Family Courts. may, therefore, have been removed from schools, child welfare services, aging ser- groups have been convened at the state their homes by the child welfare system for vices, the criminal justice system, etc. and local level to develop coordinated • Hammering out a position about the their own protection. When this happens, approaches to address health, behavioral state law regarding parental mental ill- relatives may become “formal” kin caregiv- • Most service systems have tunnel vision health, and human service needs. All of ness and terminating parental rights that ers and get financial support and oversight and fail to notice or do anything about the these planning and advisory groups reflects contemporary knowledge and like unrelated foster parents. But far more fact that the children they serve may be in should include kinship care among their values. often, families make arrangements on their kincare or that the adults that they serve major priorities. own (“informal” kincare) with limited, or no, are also parents or kin caregivers. These recommendations reflect only a assistance from the child welfare system. 2. Improve The Mental Health and Sub- portion of the observations and sugges- The mental health challenges inherent • The fragmentation of the service sys- stance Abuse Systems: Issues of access, tions that came out of the process set in in kincare are numerous. Children who tems—a problem noted in all discussions outreach, engagement, and quality all need to motion by AARP and the NYS Kincare have been separated from their parents of the limitations of service provision in be addressed by the mental health system not Coalition. A full report will be released almost inevitably experience grief and our society—also affects kincare. It is just in general but specifically with regard to later in 2010. It will contain important suffer various forms of trauma that can particularly important to improve the inte- the hundreds of thousands of kids in kinship observations and recommendations about have a long-lasting impact on their devel- gration of physical and behavioral health care. Immediately this could include: the more than half-million children and opment. Kin caregivers generally experi- services because primary health care pro- kincaregivers in New York State. Hope- ence tremendous stress and are at in- vides opportunities to promote mental • Establishing a workgroup to review and fully, policy makers and advocates in creased risk for mental and physical disor- health, identify mental and substance use make recommendations to improve OMH’s New York State will realize that services ders, which are often exacerbated because disorders, and provide treatment. But clinic standards to assure appropriate atten- for this population need to improve and the caregivers do not have the time or integration is also important in schools, tion to the family context and to the chal- should be a priority for a state that prides resources to address their own needs ade- child welfare programs, aging services, lenges involved in reaching and treating itself on supporting families. quately. The biological parents also often the criminal justice system, employee family caregivers. experience grief and trauma, and some assistance programs, and the military and Michael Friedman served as the fa- have had their children removed because veterans’ service systems. • Establishing a workgroup to recommend cilitator of the Mental Health Kincare the child protective service believes that ways to include parenting as an important Workgroup until he retired at the end of they have mental and/or substance abuse • Kin caregivers often do not get physical goal of psychiatric rehabilitation. This June. He continues to teach at Columbia disorders and has concluded (not always and mental health care, especially preven- would include recommendations for University’s schools of social work and correctly) that for this reason they are not tive care and regular check-ups, in large OMH’s guidelines for “Personalized Re- public health. He can be reached at capable of raising their children. part because kin caregivers tend to put their covery Oriented Services” (PROS). [email protected]. MENTAL HEALTH NEWS ~ FALL 2010 visit our website: www.mhnews.org PAGE 7 — The NYSPA Report — DSM-5: The Future Face of Psychiatry

By Carol A. Bernstein, MD, President are now preparing to enter the next major work groups using the online feedback as American Psychiatric Association stage of the revision process: field testing. part of subsequent deliberations on po- Proposals that involve significant changes tential changes to criteria. Although no (e.g., new disorders) will be tested in a longer open to submissions from the ost people who walk into a series of small studies that allow DSM-5 public, I would encourage you to visit psychiatrist’s office have developers to “evaluate” the potential the site to learn more about how this never heard of the Diag- impact of new criteria in real-world set- process is proceeding. The public will nostic and Statistical Man- tings. This includes academic institutions have another opportunity to provide ualM of Mental Disorders (DSM), and yet commentary through DSM-5.org in the and large hospitals, as well as private it is one of the most important and practitioners and smaller clinical offices. summer of 2011, after initial field tests widely used texts in all of medicine. The field trials will allow the work group are complete and further revisions to the According to the National Institute of members to determine whether their pro- draft criteria are posted online. Mental Health, more than 50 million posals are helpful for patients, useful to Proper diagnosis and treatment are adults in the United States have a diag- clinicians, and can be reliably used by vital to reducing the burden caused by nosable mental disorder in a given year. different healthcare professionals across psychiatric diagnoses. The impact of All psychiatric disorders recognized by different systems of care. After these field mental illness can be felt in nearly every the U.S. healthcare system – from trials are complete, work group members aspect of society, from healthcare and ADHD and Alzheimer’s, to Substance will make additional modification to pro- legislation, to education and the econ- Use and Schizophrenia – are included in posed revisions, and there may be a sec- omy. Continued revisions and improve- the DSM, and without the manual, ond round of field tests to further evaluate ments to the DSM are critical to assuring proper detection and treatment of mental proposed changes. The APA will begin that those suffering from psychiatric dis- illnesses simply could not occur. drafting the text for DSM-5 within the orders receive the most scientifically The DSM provides a listing of the next two years, and the final version of based and clinically beneficial treatment symptoms and diagnostic criteria that Carol A. Bernstein, MD DSM-5 will be published and released at possible. psychiatrists and other mental health and the APA’s Annual Meeting in San Fran- healthcare professionals use to determine or memory, and several others. However, cisco, Ca., in May 2013. Carol A. Bernstein, M.D., is President whether someone has a psychiatric disor- busy clinicians do not always ask patients As part of DSM-5 development, in of the American Psychiatric Association der. It also includes descriptive informa- about these common problem areas – February of 2010, the APA developed a and is an associate professor of psychiatry, tion to help clinicians arrive at the correct which means some patients do not always web site www.dsm5.org, where all of the Vice Chair for Education, and Associate diagnosis, such as text that clarifies how receive the treatment they need. One of diagnostic criteria and proposed changes Dean for Graduate Medical Education at to differentiate a particular disorder from the proposed changes for DSM-5 is to for DSM-5 are listed. A two-month pe- New York University School of Medicine, a other similar disorders. Furthermore, the include questionnaires that clinicians will riod of public comment followed, with part of NYU Langone Medical Center. manual provides important statistics about use to more thoroughly review these com- mental disorders, such as how common a mon symptoms. This is similar to the

disorder is and how often it occurs among “review of systems” your physician uses

males and females. While clinicians make when he or she is assessing your general up the majority of DSM users, it is an medical health. Given that nearly half of important tool for other professionals, all people who have one mental disorder New York State such as researchers, who conduct studies also meet criteria for two or more mental about the occurrence and treatment of disorders, DSM-5’s “mental review of Psychiatric Association psychiatric disorders, health insurance systems” approach will hopefully aid cli- workers, who use DSM to decide whether nicians in determining whether a patient is a treatment is “medically necessary” and experiencing symptoms that need treat- reimbursable, as well as U.S. lawmakers ment, in addition to identifying any num- and government executives, who refer to ber of psychiatric diagnoses that he or she Area II of the American Psychiatric Association DSM in determining insurance coverage might also have. in the public healthcare system. Other proposed changes to DSM-5 are Representing 4500 Psychiatrists in New York The first edition of the manual, DSM-I, more specific to actual diagnoses, such as was published in 1952. Since that time, changing the wording of diagnostic crite- four editions have been produced, with ria to more accurately describe patients’ the most current version, DSM-IV, re- symptoms. These also include proposing Advancing the Scientific leased in 1994. The American Psychiatric new psychiatric disorders that are not cur- Association (APA) is in charge of over- rently a part of DSM-IV, as well as sug- and Ethical Practice of Psychiatric Medicine seeing the revision and publication of gesting that some disorders be included in DSM. Why are revisions needed? Simply existing disorders or are removed from put, to ensure that patient care keeps pace the manual altogether. with science. As advances in research The process for determining whether a Advocating for Full Parity create a clearer picture of factors such as change should occur is lengthy and com- in the Treatment of Mental Illness how mental disorders develop; why cer- plex but is designed to produce revisions tain disorders, like depression and anxi- that are based on science and intended for ety, tend to occur together; and the symp- the betterment of patients. There are 13 toms that patients experience, we need to DSM-5 Work Groups, each representing Advancing the Principle that all Persons refine the diagnostic criteria to make sure expertise in a specific area of psychiatry, that patients are diagnosed correctly. The such as mood disorders, anxiety disorders, with Mental Illness Deserve an Evaluation use of this manual also helps assure that eating disorders, etc. Since the groups patients receive the appropriate and most were officially appointed in 2007, they with a Psychiatric Physician to Determine effective treatments. have been reviewing published research The process to develop the next edition studies, examining data from previous Appropriate Care and Treatment of DSM – DSM-5 – has been underway studies, and conferencing with colleagues for nearly 10 years. Experts hope that and with each other to draft their proposed potential changes in DSM-5 will bring revisions for each disorder. No decision about improvements in patient care. For will be made without careful and thought- Please Visit Our Website At: instance, we know from research and ful consideration of the evidence, and from working with patients that certain whether a given change is truly necessary. symptoms are very common in most indi- In every case, the impact on patient care viduals with psychiatric disorders. These will be of utmost importance. www.nyspsych.org symptoms include depressed mood, anxi- As work group members are complet- ety, sleep problems, changes in thinking ing their draft criteria, DSM-5 developers PAGE 8 visit our website: www.mhnews.org MENTAL HEALTH NEWS ~ FALL 2010

The Economics of Recovery: When Worlds Collide

By Donald M. Fitch, MS make of this new reality will depend, meetings took less than an hour as folks Executive Director rather, on how we pursue the timeless learned to summarize and speak faster. Center for Career Freedom goals of all social and economic prosper- (Oh how brief our endless meetings could ity and individual empowerment.” be if there were no places to sit!) The many issues IBM is seriously ad- Bloomberg and his staff have developed a o quote Rahm Emanuel, “You dressing include the environment, safe unique set of governance tools which never let a serious crisis go to water and food, sustainable/empowered demonstrates the power of everyday citi- waste - it’s an opportunity.” In cities, smarter work force, education, en- zens to create change. The public-private the past decade, it’s been one ergy and healthcare. (www.ibm.com/ partnership models they’ve created can Tcrisis after another: 9/11, Iraq and Afghani- corporateresponsibilityreport2009) turn dreams into reality throughout the stan, Katrina and tsunamis’, Wall Street Other CSR leaders’ initiatives include country. But to accomplish this, we need meltdown, global warming, the gulf oil Pepsi-Cola and Walmart. Beginning in courageous leaders. As stated by Mayor spill, Haiti, bankrupt governments, even August, the Pepsi Refresh Project will Bloomberg, “What we can’t afford is to the safety of our food, medicines and toys! support a number of community projects, continue upholding a failed status quo by Many feel our problems are beyond the including “refreshing” the Gulf in the funding programs and sustaining ap- capacity of government to solve. Govern- wake of the tragic oil spill proaches that don’t work. The silver lining ments are felt to be too big, bureaucratic and (www.refresheverything.com). Walmart in any economic crisis is that it can force political to react quickly and effectively. has used its buying power to reduce its government to take necessary steps that, in A recent public opinion survey found carbon footprint and save over three bil- more comfortable times, would fall victim almost two-thirds of Americans believe: lion dollars a year by requiring their over to the forces of inertia – but it is up to us, “Corporations are better able than govern- sixty thousand suppliers to reduce their all of us, to seize the opportunity.” ment to respond effectively to disasters.” Donald M. Fitch, MS energy consumption and packaging. A survey of over one-hundred social Three-quarters also believe: “Businesses When you study these CSR websites entrepreneurs across the country con- bear as much responsibility as govern- and helpful with your customers. Some (and I hope you will), what these leaders ducted by Duke University found the ments for driving positive social change,” corporations realized they needed to go of tomorrow all seem to understand is that greatest barriers to systemic reform were and eighty-six percent agree that, “It is beyond being “helpful” – they had to their company’s futures are determined by “the network of relationships that develop important that companies stand for some- genuinely become world citizens. They the quality of people they are able to at- among government bureaucrats, politi- thing other than profitability” (Good for realized that a solid reputation was worth tract. Fortune’s “100 Best Places to cians, agency heads, and funders who Business, 2010). its weight in gold and only deeds, not Work” lists a core purpose that goes believe that more of the same will make a Opinion studies have also shown that words, would get them there. Corporate above and beyond the bottom line. In- difference. This iron triangle produces as the crises multiply, so do the public’s Social Responsibility (CSR) was their creasing sales and shareholder value de- barriers to entry for new actors.” “The belief that corporations can and should do ultimate solution. Today nine out of ten pends on attracting the best employees political economy of social systems in- more to solve them. If, as the Supreme Fortune 500 companies have initiatives which means you’d better be a positive duces providers to seek protection over Court decided this year, corporations have focused on CSR. force in the community (The Responsibil- performance.” An oligopoly develops the same legal rights as “natural persons,” However, there are perhaps only a few ity Revolution, J. Hollander, 2010). when a group dominates decision making then they are also expected to accept the dozen U.S. Corporations that are fully Here in New York City, we are very via its control over knowledge, resources responsibilities that come with being a engaged in this exciting new social move- fortunate that Mayor Michael Bloomberg, and communication (CASE, 2007). part of the human family. ment. IBM is, in my opinion, the world self-made billionaire and social entrepre- The study also found that these civic With the almost universal access to the leader. As stated by Samuel J. Palmisano, neur, has chosen to donate his extraordi- entrepreneurs, armed with innovative internet in recent years, consumers have Chairman, President and Chief Executive nary business talents to the betterment of thinking, a bottom-line sensibility, and a been able to wrest control of the dialogue Officer of IBM, “As a global citizen, we the citizens of New York City. One of my willingness to tackle some of the nation’s away from corporations with product rat- believe that the issues facing the world are favorite “Mayor Mike” stories illustrates most intractable social problems, are tap- ings, posted comments, hostile websites too critical and far too urgent – and the how a minor and inexpensive collision ping into a powerful energy and sense of and leaked memos. Transparency was opportunities to make meaningful pro- between the worlds of business and gov- purpose via the Internet. “This growing only a click away. The traditional top gress on them too immediate – not to act ernment can produce a lasting increase in cadre of change agents is shattering tradi- down, command and control style of do- now. Indeed, the most interesting result of efficiency. The story I heard was that the tional policy approaches and replacing ing business was out. The Internet had our Smarter Planet initiative, to me, is weekly meetings of the five Borough them with creative solutions and unique firmly put the consumer in charge – the how it is causing our business strategy Presidents, their aides and the Mayor typi- partnerships to produce dramatic re- only tenable business strategy left was to and citizenship strategy to merge. The cally lasted three hours, until the Mayor sults” (The Power of Social Innovation, “just do the right thing.” Be open, honest barrier is no longer technology. What we had the chairs removed! The subsequent Goldsmith 2010). MENTAL HEALTH NEWS ~ FALL 2010 visit our website: www.mhnews.org PAGE 9

THE MENTAL HEALTH LAWYER

Obtaining Judicial Authorization to Medicate a Minor

By Carolyn R. Wolf, Eric Broutman, medication, even if the patient consents to sary action. Hence, it is still unclear if a and Douglas K. Stern, Esqs., Abrams, medication. The law, however, is not very hospital must bring a neglect proceeding Fensterman, Fensterman, Eisman, well established in this circumstance. in this type of situation or merely that it is Greenberg, Formato & Einiger, LLP What exactly the hospital must prove in one possible route a hospital could follow. order to obtain a Court Order, what is the One thing is clear though, if a hospital role the parents play in these proceedings, wishes to provide treatment to a patient decision to give a child power- in what Court should the matter be raised? under the age of 16 where the parents ful psychotropic medication is These are all unanswered questions under object to giving their child medication, the a difficult one, fraught with the current state of the law in New York. hospital must make the parents parties to A uncertainty and is often viewed There are very few cases that have any action seeking Court authorization for as the lesser of two evils. While the ad- dealt with this situation. In one of the few treatment. The parents would then have ministration of medication to a child is that has, an Appellate Court admonished a the right to hire counsel to have their in- itself a complicated decision the stakes lower Court for authorizing a hospital to terests represented and to have their are raised if either the child or the parents treat a minor patient without demanding voices heard in order for the Court to ren- do not agree with the psychiatrist’s treat- that the parents be made parties to the der a fully informed decision. ment recommendation that medication is case. In other words, in the lower Court Where parents consent to medication the most appropriate treatment path. proceeding the parents were not formally or where the child is over the age of 16 This article will discuss the legal land- involved in the case and therefore had no the law is fully developed with regard to scape that treatment providers and law- legal right to have their voices heard be- the appropriate procedure to follow to yers must navigate when seeking to obtain fore the Court rendered a decision. The obtain legal authorization to treat the pa- judicial authorization to medicate a minor Appellate Court alluded to the fact that a tient. For children under the age of 16 the either over the minor’s objection, or the neglect proceeding, like the kind seen in law has still not fully developed in the parent’s or guardian’s objection. Where Family Court where a parent is not appro- realm of seeking Court authorization for the parents object to medication and the priately caring for a child, might be most treatment over the patient’s objection. child is less than 16 years of age, the legal Carolyn R. Wolf, Esq. appropriate in instances where parents Whether a neglect proceeding is necessary picture of what process should be em- object to the administration of needed or simply a Rivers type hearing where the ployed is fuzzy at best. Courts have al- The much more difficult situation is medication. Under this theory, the argu- parents are parties to the action, it would luded to recommendations on the best where the parents object to treatment. ment would follow that because the par- behoove the Courts to add clarity to the way to proceed, but the picture is still New York’s Mental Hygiene Law has ents are the guardian and decision maker situation. In its current state, the law is uncertain. This article will attempt to shed created a distinction between patients who for the child it was incumbent upon the uncertain, which could easily lead to de- some light on the matter. are over 16 years of age and those who hospital to show that the parents were lays in treatment for those who need it, as Minors, like adults, have the right to are under 16 years of age. If the patient is endangering their child by refusing medi- well as the infringement of a minor object to the administration of any medi- over 16, and wishes to take medication, cation. Although the Appellate Court child’s right to bodily integrity and the cation they do not wish to take. The Su- but the parents disagree the hospital may opined that this would be a potential reso- right of parents to decide what is in the preme Court of the United States has rou- be able to treat the minor even without lution, it did not conclude it was a neces- best interest of their child. tinely acknowledged an individual’s right Court authorization. to bodily integrity as one of the most sa- If the patient’s treating psychiatrist, as cred guarantees implicitly recognized well as a second psychiatrist who is not an Carolyn Reinach Wolf, Esq. within the Due Process clause of the Con- employee of the hospital, determines that stitution. In line with this right, even if (1) the patient has the capacity to make a and Douglas K. Stern, Esq. of parents want their child to take psychiatric reasoned decision to take medication; and medication, if the child objects, a hospital (2) it is in the patient’s best interest to ABRAMS, FENSTERMAN, FENSTERMAN, EISMAN, must seek Court authorization before ad- take medication, the medication can be GREENBERG, FORMATO & EINIGER, LLP ministering medication. administered to the patient even though In New York, this Constitutional right the parents object. In the event that the Attorneys at Law was recognized in the landmark case of hospital decides to provide medication to Rivers v. Katz. In Rivers, the Court rea- a minor child under this circumstance the Devoted to the Practice of Mental Health Law soned that if a hospital wished to provide hospital must provide notice of the deci- medication to a patient over the patient’s sion to the parents. The Firm represents more than twenty major medical centers, objection the hospital had to bring a pro- In instances where the treating psy- as well as community hospitals, nursing homes and outpatient clinics, ceeding in which it proved, by clear and chiatrist believes that it would be detri- in the New York metropolitan area in the field of mental health litigation, convincing evidence, which is the highest mental to the patient to seek consent from consultation, advocacy, and related disciplines. burden in a civil proceeding, that the patient the parents to treat the patient with medi- lacks the capacity to make a reasoned deci- cation the hospital does not have to in- In addition, our team of attorneys, with more than forty years combined sion regarding medication, that the benefits form the parents that the patient will re- of the medication outweigh the potential ceive medication. This is true so long as a experience, offers legal representation to families and individuals affected risks, and that there is no less restrictive way second psychiatrist who is not an em- by mental illness. We provide a broad range of legal services and counsel on to administer treatment to the patient. ployee of the hospital agrees that (1) it such matters as: mental health case management and continuity of care; Where the parents consent to medicat- would be detrimental to seek consent discharge planning; Assisted Outpatient Treatment (Kendra’s Law); ing their child, but the child objects, from from the parents; (2) the patient has the Mental Health Warrants; Hospital Treatment over Objection and a legal perspective, it is a rather straight- capacity to accept medication; and (3) it is Retentions; Patients’ Rights and Guardianships. forward process. The hospital seeks au- in the patient’s best interest to receive thorization to medicate the child and a medication. It should be noted that where Our firm regularly contributes to a number of publications concerned with hearing is held much like a hearing where the patient objects to taking medication Mental Health and related Health Care issues and participates in seminars the patient is an adult. The only difference regardless of how old the patient is the and presentations to professional organizations and community groups. being, it is presumed that the minor lacks hospital must seek Court authorization to the capacity to make a reasoned decision provide medication. and so that specific criteria is dispensed A whole new set of issues are raised 220 E. 42nd Street - Suite 505 1111 Marcus Avenue - Suite 107 with. The hospital need only prove that where the patient is under the age of 16 the benefits of medication outweigh any and the parents object to medication. In New York, New York 10017 Lake Success, New York 11042 potential risks and that there is no less such an instance the hospital must obtain (212) 279-9200 (516) 829-3838 restrictive alternative. a Court Order to treat the patient with PAGE 10 visit our website: www.mhnews.org MENTAL HEALTH NEWS ~ FALL 2010 A Clinic’s Initial Experiences Conducting Multiple Family Groups

By Peter Wildeman, LCSW emphasize the importance of following Clinical Supervisor them. Together, we also identify goals for Institute for Community Living’s each family. The goals are revisited fre- Guidance Center of Brooklyn Heights quently throughout the course of the group and provide a focus for families; something to work towards. ose is an 11-year-old boy who has, An integral part of this group experi- for years, been threatening his fam- ence is sharing a meal. Time is allocated ily to run away and never return during the group for staff and families to J when he is upset with them. His enjoy a meal with one another. Most of family has tried to cope with these behav- the children request pizza, so that is what iors the best they could, but things reached we order. In an attempt to promote the point that they felt they needed further healthy eating and to supplement the chil- assistance. His grandmother made a deci- dren’s food of choice -- pizza, we also sion to bring Jose to the clinic to obtain order salads. The experience of sharing assistance, and the Multiple Family Ther- ideas and issues while eating together apy Group was suggested as an approach creates a bond with participants that feels that might be helpful. like a family experience as well as a Each fall for the past two years at the group process. Ours is a hands-on group. Institute for Community Living’s Guid- Many of the activities involve games and/ ance Center of Brooklyn Heights, we have or encourage writing and working to- conducted a group in conjunction with gether toward a common goal. Mount Sinai School of Medicine’s De- The first year, the group was conducted Initial group activities are focused on The first few sessions include ice partment of Psychiatry Research Center by a clinical supervisor from the outpatient helping the families understand the pur- breakers though which the families be- called the Multiple Family Therapy clinic and a parent advocate from the pose and goals of the group and to iden- come acquainted and begin to understand Group. The group runs for a 16-week cy- Brooklyn Parent Resource Center. The tify the concerns of each individual in the that there are others with similar issues. cle, including time for research data col- second year, it was run by New York Uni- family. Every effort is made to elicit ver- With this newfound knowledge, the group lection. The clients are children ages 7-11 versity interns supervised by the clinical bal participation and engagement so that becomes a safe place to share problems. diagnosed with Oppositional Defiant Dis- supervisor. The participants are families of all members of the group are invested in As the group proceeds, the members take order, and they are accompanied by their children in the designated age range who the process. After all, each member of the on specific roles, often replicating the parents and other family members. The are diagnosed with oppositional defiant family contributes something unique to roles they assume within their own group curriculum focuses on teaching the disorder. The group can consist of up to six the culture and dynamics of the house- homes. For example, one parent is the participants the “Four R’s:” Rules, Respon- families at the same time. A “family” is hold. The process of setting rules is initi- “biggest talker,” often taking over the sibilities, Relationships and Respectful defined as those individuals who partici- ated by the group facilitators, but the chil- group and sharing the most frequently. Communication. The goal is for both par- pate in raising the child and who can com- dren are asked to contribute rules as well. One of the children may act as a ents and children to learn how to incorpo- mit to a 16-week group treatment process. All the rules are written on a large sheet “protector” for other children in the group rate the four R’s into their lives with result- Once started, the group is closed to new and posted on the wall for everyone to ing improvement in the child’s behavior. members after the third meeting. see. Then the families sign the rules to see Groups on page 41

Risk Assessment and Its Importance for Children and Adolescents

By Elizabeth N. Cleek, PsyD, Vice of others, up to and including suicide, are to support work with consumers around tems, regulatory, medical or other exper- President, Adam P. Chaiken, LCSW-R, rarely solitary acts—at the very least, they identification of triggers and subsequent tise pertaining to the situation. Vice President, and Michael Blady, LCSW-R, impact family members, friends and even intervention strategies, including both in- The clinical risk assessment process is Associate Executive Vice President the broader communities in which people house and linkage services, e.g., urgent ongoing—it needs to be assessed at every Institute for Community Living live. For example, in the same CDC sur- clinic treatment visits, mobile crisis teams session, particularly with youth who may vey, 28.3% of students rode in a car with and in-patient hospital services. not be in control of the situation, and for someone who had been drinking at least In ICL’s four community- and school- whom impulsivity, fluctuating emotions ore than four years ago, the one of the thirty days preceding the sur- based clinics and on-site school services and large-scale issues that could easily Institute for Community vey, and 5% had not attended school on at throughout Brooklyn, risk assessment challenge adults, are the norm. When Living (ICL) extended its least one day out of concern for their begins at the initial interview with client. youth are involved, the issues are always focus on risk assessment safety either at school or on the way to or As the clinician completes the psychoso- more complex, and the terrain is chang- andM intervention to provide staff with ad- from. According to the Citizens Commit- cial interview, there are very structured ing. We are currently reviewing the child ditional tools and strategies to support tee for Children, in East New York, one and purposeful questions relating to risk. and adolescent clinic assessment process integrated and coordinated assessment of the areas in which ICL operates both a These pertain to legal involvement, to ensure that we remain current with and intervention of and for clinical risk. clinic and services in schools, there were abuse / trauma assessment, witness to emerging risk factors, such as cyber- The purpose of the model is to facilitate over 1000 juvenile misdemeanor and/or violence or victim of such, anger manage- bullying, as well as continue to focus on communication, supports and a culture of felony arrests in 2006. ment issues, history of fire-setting, use more traditional areas, such as drug and mutual responsibility across disciplines In 2008, the New York State/New of / access to weapons, as well as adher- alcohol use, possession of weapons, gang and organizational boundaries to create a York City Mental Health-Criminal Justice ence to prescribed medication routines. At involvement and others. comprehensive and cohesive system that Panel Report and Recommendations were the conclusion of the psychosocial assess- Concurrently, clinicians have contin- emphasizes integrated care and preventive published with guidelines for standards of ment, a clinician will consider informa- ued to participate in an ongoing monthly interventions. care and screening for risk of violence in tion from this process, as well as the men- training on best practice interventions, Risk and risk-taking behaviors are un- mental health clinics. ICL built upon this tal status exam and other pertinent infor- spanning from those specific to risk as- fortunately as applicable to youth as they guidance in the development of an initial mation to determine a level of risk for the sessment and intervention to ongoing are to adults. According to the Center for and ongoing assessment process to iden- incoming client. treatment, and family work. Disease Control (CDC), in 2009, 13.8% tify areas of potential danger to self and/or When a client is identified as at high It is the intent of the clinical risk initia- of the high school students surveyed seri- others. The goal of this ongoing work is clinical risk, a summary of risk factors is tive that we will have a better opportunity ously considered suicide, and 6.3% at- to develop systems that assist staff in col- forwarded to the clinician’s supervisor for to identify those clients at risk and to fa- tempted suicide. Further, 5.6% of stu- lecting the pertinent data and helping review. It serves as a trigger for ongoing cilitate a more comprehensive system of dents surveyed had carried a weapon on them to convert the data to clinically rele- discussion and possible outreach for fur- ongoing support, follow-up and monitor- school grounds on at least one of the vant information regarding factors that ther consultation. A case conference may ing. However, nothing is stagnant—as we thirty days preceding the survey, and indicate the potential for risky behavior. be convened involving family members, continue to evolve this process, the field 7.7% had been threatened with a weapon Supervisory staff and clinical training and clinical specialists, other self-identified will continue to develop, and new areas of on school property. Risk taking behaviors consultation can then be provided to staff supports and other individuals with sys- risk, as well resource, will emerge. MENTAL HEALTH NEWS ~ FALL 2010 visit our website: www.mhnews.org PAGE 11 PAGE 12 visit our website: www.mhnews.org MENTAL HEALTH NEWS ~ FALL 2010 Through a Glass Darkly: Poverty and Mental Health in The Bronx

By Julie List, LCSW, Director neighbors, invisible but trying to leave an forgotten to take them to school or are Harry Blumenfeld Pelham Counseling imprint. We come to make a difference, using a drug of choice. Or because their Center, JBFCS but my question is: Are we able to help own untreated traumatic histories have them help themselves? They didn't make wounded them so deeply they can’t find the rules, after all; we did. the resources to parent, especially without ach day I take a journey to the We are an outpatient mental health the help of extended families. But these northern tip of our city, to the clinic in the Northeast Bronx run by clients are not statistics to us. Each one Northeast Bronx, where I am the JBFCS, a city-wide social service agency has a history, a new story, a family tree, a director of an outpatient mental that is largely government funded and newborn baby and dreams they aspire to. Ehealth clinic. I am a visitor from another also supported by the UJA and other phil- We see them every week, and listen to country, Manhattan, and I inhabit this anthropic donors. At my clinic we have each detail the clients provide, to every world and see it through the eyes of a 750 out patients at any given time; about effort they make to provide a good life for white, middle-class outsider. As the 5 half are kids. Our referrals are from their children, and to every obstacle they train snakes along the track above ground neighboring schools, hospitals, and physi- encounter along the way. As much as we at East 180th Street, I can see the last hint cians treating patients who suffer not only are able, we try to clear the road ahead of of the spires of Manhattan. The Empire from obesity, asthma and diabetes, but obstacles (the ones we have some control State Building, sharp and shining, points also depression, anxiety and post- over) and open our clients to the possibil- upward, a beacon of wealth, seemingly a traumatic stress disorder. It’s a commu- ity of hope. million miles away. On the way to my nity without community centers. An over- office, walking down Astor Avenue off of whelmed school district with underper- Some of Our Patients and Their Stories: Boston Road, I pass the field of dead um- forming schools armed with metal detec- brellas, broken birds. It is more an empty tors. No PTAs, and one guidance coun- With one small child at home and seven lot, actually, with capless soda bottles and selor for hundreds of kids. The children months pregnant with her second, Josie ragged wrappers strewn alongside the come to us via the psychiatric emergency tried to kill herself at 22 by jumping onto metal spokes. In one block we have our Julie List, LCSW room, sent there by teachers and princi- the subway tracks as the train ap- Dominican bodega, the American- pals who fear the thrown chair, the curs- proached. She had just discovered that the Albanian bakery, China Kitchen and Ir- tered jackets and wizened faces. Women ing mouth, the threat to shoot somebody father of her unborn baby had conceived ving Freireich, the accountant. He may be looking twenty years older than their age dead or jump out of a window. another baby at the same time, and that the last Jew in the neighborhood where all occupy themselves with the children. We are the DMZ for this part of the woman called her to brag that she would our Jewish grandparents grew up. Next “There’s no Hope in Dope” is the sign on Bronx; we offer neutrality, sunlit offices give birth in two months as well. Josie lost door to him a storefront houses two-foot the wall of the Albanian bakery, next to a and a bright and comfortable waiting her leg up to the knee and part of her figurines of Madonnas, Kings, and Saints carving of “Nene Tereza 1910-1997,” room with colorful posters by Black and hand, but she survived, as did the baby. lined up to watch the spectacle that passes their Sister of Mercy. Latino artists, carpets, books and plants. She came to her first session in a wheel- daily. They’ve seen fistfights and fake The Bronx is the borough New York Members of our Board donate books for chair with her mother, and she was not fights and the “Albanian Boys Incorpo- left behind. Local physicians report that our waiting room, as do New York City happy about being alive. rated” threaten the Black and Latino kids the patients in the Bronx are the un- publishing companies I seek out. Our who previously owned our corner. One healthiest they have ever treated. There is patients read, gobbling up books and Maria had twin teenage sons and a day I looked out my office window and an increase in Type 2 diabetes, and chil- magazines hungrily. They read every- younger son. One of her twin sons was saw an old fashioned rumble, shirtless dren make up half of the diabetes cases. thing, from Brides’ Magazine to The Na- found hanging in the shower after he was Albanian teens with bats and chains, chal- Bronx County has the third highest rate of tion, The New Yorker and Yachting. The kicked out of school for a minor infringe- lenging the kids of color who make up the asthma in the entire state. As a result of classics, autobiographies, Golf Digest and ment of the rules. The family was referred majority in this neighborhood. There are the link between obesity, air pollution and The Little Engine That Could. to us one week after the suicide and the some Bloods and some Crips and some asthma, Bronx MDs see a “systemic in- One third of our staff members are mother was paralyzed with grief and guilt. gang wanna-be’s. flammation” and breathing gets more and people of color, with their own varied The remaining boys were ashamed to go It’s the wanna-be’s who make it fur- more laborious for these Bronx residents. backgrounds: from the Caribbean, via to school and could not articulate their ther down the street to our door. And their The official unemployment rate in the England; from Puerto Rico and the Do- feelings. The boys are finally coming up parents, who are nurse’s assistants, bus North Bronx is about 14 percent and in minican Republic. We also have an Ira- for air, having lived with the empty bed at drivers and cashiers, as well as housing the South Bronx nearly 20 percent, com- nian American, two Iraqi Jews, and Asian home every single day. Two years after project managers and food service person- pared to the national rate of 10 percent and Russian support staff. We run bi- they first came, their mother gave birth to nel, some teachers, waitresses and cops. (From “Health of the Bronx: Have We weekly Diversity Seminars for clinical a baby girl. The mother’s therapist gave And many who can’t find work or are Created the Perfect Storm?” Lower Hud- and support staff, trying to deal with is- her a baby shower with the members of emotionally unable to work, who struggle son/Bronx MDNews, April 2010, available sues of race and racism that emerge Maria’s therapy group at the clinic, with to get by on Disability or Public Assis- at: http://lowerhudsonbronx.mdnews.com/). amongst staff or with clients. This, in pink decorations on the office walls. tance. They pray they can keep their The actual unemployment rate may be turn, assists the therapists in their goal of Medicaid, and thank God daily for Child twice those already appalling numbers, if genuine interaction with the people who Elena was bathing the baby when she Health Plus, the state government pro- you take into account people working come to us for help. Our clients are over- received a phone call in the living room. gram. This is an overwhelmingly poor only part time and “discouraged workers.” whelmingly people of color, making those In an instant of poor judgment, she ran neighborhood, with many working low- The rooftops are covered in graffiti the of us who are white especially stand out. out to answer the phone and when she wage and minimum-wage jobs and many way the 9th Ward was after Hurricane The problems our clients bring us, how- returned, the baby had drowned. She more who don’t work at all. Katrina, SOSs in spray paint. The boys’ ever, cross all color and class lines, and came to us when the authorities refused to It’s Spring in one of the nation’s poor- pants are not only below their hips, the pain they suffer is magnified by the let her keep her second child. As she est counties, and the yellow forsythia is they’re belted below their butts. Rows of economic and racial disparities and indig- mourned for her first, she grieved for the the only spot of color near streets littered boys with boxers billowing strut down the nities they experience in the world around loss of her second. After a year in ther- with dog poop, where the churning wheels street from Columbus High School to them. The rage or depression they live apy, the authorities reunited her perma- of the El make harsh atonal music amidst reach the Dominican bodega next door. with can explode at a moment’s notice, nently with her second child. the groaning of sirens and the urgent horn “F*** this and Mother f*** that”; the and the expression of it can go from zero blaring of fire trucks. There is no silence girls are shrill in their condemnation of to a hundred in a split second. There is no Latasha is bipolar, as are her two teenage here. The poverty is evident in the gray- every imaginable thing as they saunter by slow burn, no long fuse. A breakup, a daughters. The elder daughter stabbed her ness of the faces, the canes and walkers the clinic in tight pants and painted nails, verbal taunt, a slap in the face, can pro- father. The family was separated as the and wheelchairs, the expanding thighs and some with sparkles or stars. At three PM voke self-inflicted cuts on the inside of father had to leave the home. The family hips of the many eating McDonald’s on there are bursts of electricity as they light the wrist, taking a whole bottle of Tyle- then moved from shelter to shelter and all the run, sipping huge Cokes. The Albani- up our street with excitement: they're fi- nol, or wielding a knife in self defense. Or three stopped taking their medications. ans around us are a closed and quiet peo- nally leaving school, where not much all three responses. Most of our women Latasha was unable to function and risked ple. The men have no work. They sit in seems to go in and very little seems to clients were sexually abused as children, psychiatric hospitalization; she had been groups in an all-male bar where they come out. The neighborhood is alive in a and they are haunted by trauma. Many of many times. Once re-stabilized on her smoke and peer cautiously out at this dying community where the Verizon store the children have witnessed their parents medicines, Latasha managed to hold her American land of no opportunity. The is the only sign of the 21st century. hit each other. Some have been taken family together. older generation meets around the cement I am the white ghost on the train, away from their homes and sent to foster chess table on Pelham Parkway, with tat- weaving in and around my 9 to 5 care, because one or both parents have see Poverty on page 42 MENTAL HEALTH NEWS ~ FALL 2010 visit our website: www.mhnews.org PAGE 13 PAGE 14 visit our website: www.mhnews.org MENTAL HEALTH NEWS ~ FALL 2010

The Role of the Home Care Mental Health Nurse in Identifying, Accessing, and Treating Children and Adolescents Requiring Mental Health Services

By Elizabeth Cymerman, MNH, BSN, changes. ( D) Attitude changes may in- RN-C, HNC, Assistant Clinical clude a negative outlook pertaining to Manager - Mental Health Program themselves and the future. (E) Suicidal- Visiting Nurse Services in Westchester ity . Suicide is the third leading cause of death in adolescents. 90% of children who commit suicide have a mental health dis- s Assistant Secretary for Health order. 6.9% of 9-12th graders have at- and Surgeon General of the US, tempted suicide. Any child or adolescent Dr. David Satcher (2001) with depression is at risk for suicide, and A stated, “The burden of suffering need to be monitored for suicidal thoughts experienced by children with mental health and actions.(F) Substance Abuse- 43% of needs and their families has created a youths with a mental health disorder also health crisis in this country…children are abuse drugs and alcohol. .19.7% of 9-12th suffering needlessly because their emo- graders have tried marijuana. Adolescence tional, behavioral, and developmental is very stressful, and poor coping skills needs are not being met…it is time we as a can lead to drug and alcohol use to escape nation took seriously the task of preventing problems. These substances can reduce and treating mental illness in youth.” impulse control, making it easier to at- This was Dr. Satcher’s address to the tempt suicide. report of the Surgeon General’s Confer- Bipolar Disorder or Manic Depression: ence on Children’s Mental Health. Not A child or adolescent who demonstrates much has changed since that Conference extreme mood changes, from highs due to many factors, which are still not (excited behavior) i.e manic phase, to lows partially or fully attained. This conference ie depression, may have bipolar disorder. was the accumulated knowledge from These extremes may follow with periods of many sectors of society, which concluded moderated mood. When having manic be- that the obstacles to delivery of mental symptoms of mental illness. Due to lack ferent venues. (1) Where the child is the havior, the child may be hyper verbal, health services are many, including: inade- of education and knowledge of mental primary problem. A Pediatrician, Pediat- show a reduced need for sleep with poor quate public awareness, fragmented ser- illness symptoms in children and adoles- ric Psychiatrist, Social Worker, school judgment and impulsiveness. Adults with vices, racial/ethnic disparities, and more. cents, parents may conclude that the child system or Clinic may have referred the this disorder often experience their first The Conference also pointed out our coun- is impudent and punish the child for their child. The early problems may be parent- symptoms during their teen years, and are try is facing a public crisis in mental health inappropriate behavior, which can cause ing, sibling, and developmental, or school approximately 1 % of the population. for infants, children and adolescents. low self-esteem in both the child and par- related issues. (2). The parent as the pri- Attention Deficit/ Hyperactivity Disor- The World Health Organization ent. Parents themselves may be suffering mary problem and its impact on the men- der (ADD and ADHD ): ADD is when the (WHO) stated that “by the year 2020, from mental illness and/or substance tal health of the child, either due to paren- child has difficulty focusing attention and/ childhood neuropsychiatric disorders will abuse, and not be able to cope or respond tal decompensation of mental or physical or is easily distracted, and does not have rise proportionately by over 50 % interna- to the child’s issues. There may also be illness or biological issues. In either case, the hyperactivity component, whereas tionally, to become one of the five most lack of resources- money, availability of the home care mental health nurse will ADHD does include it. ADHD occurs in common causes of morbidity, mortality, mental health resources, and a nurturing play a key role in early detection, educa- up to 5 % of children. These children have and disability among children.” But yet, parental figure in the household. tion of parents and child, referral to ap- difficulty remaining still and keeping quiet. most people do not recognize that mental Primary care physicians, due to required propriate services, monitoring of compli- Learning Disorders: These children health is a critical component of health immunizations and physicals for day care ance to the plan of care, evaluation of the have difficulty processing information. and wellness. and public schools, are also providers that plan of care, and communication with all They may have problems with spoken or Approximately 1 in 5 (20%) of chil- are critical for early identification of chil- services and professionals involved. written language, coordination, attention dren and adolescents may have a mental dren with mental illness, and often give All mental health nurse professionals or self-control. health disorder, and often these children counseling and prescribe psychotropic must have knowledge of the most com- Conduct Disorder: Children with this have more than one disorder. (U.S. Dept drugs, however, families do not view this mon mental health disorders in children disorder tend to violate the rights of others of Health and Human Services, 1999). as mental health services, and may not be and adolescents and their symptoms, in and rules of society. They act out their Failure to recognize and treat mental ill- getting the appropriate treatment. order to be effective in early detection. impulses in destructive or inappropriate ness can cause a cascade of events for a Since children have to attend school, Anxiety Disorders are the most com- ways. A child may start out lying or steal- child with deleterious effects. It reduces schools should be the place where early mon mental health diagnosis. 13% of 9-17 ing, and move on to more serious crimes the child’s quality of life and ability to diagnosis would be most likely to happen, year olds have either anxiety disorders or such as vandalism, aggression, and vio- develop into a mature healthy member of however this is not the case. Cole (2001) phobias and fears of objects or situations. lence. 1-4% of children 9-17 years old society. These children can face school states, “Students with mental health needs (A) GAD or Generalized Anxiety Disor- have Conduct Disorder. failure and drop out, possible substance are usually identified only after teachers der, seen as excessive, unrealistic worry, Eating Disorders: Society, culture and abuse and addiction, incarceration, delin- cannot manage their behavioral problems. (B) Panic Disorder, seen as attacks with the Media send powerful messages about quent behavior and violence. Therefore, less than 1% of children are physical symptoms of palpitations and the ideal, thin body, by which our youth Modern psychopharmacology and diagnosed with depression, attention deficit dizziness. (C) OCD or Obsessive- Com- feel they must attain, in order to be pow- health insurance reforms’ push to keep hyperactivity disorder (ADHD), and post- pulsive Disorder, Where the child is erful, sexy and successful in life. This sets patients in the community has fashioned traumatic stress disorder secondary to “trapped” by repetitive thoughts and be- up children and adolescents to only value forward thinking home care agencies to abuse. Consequently, these students are haviors, such as repeated hand washing . themselves for the body image that they incorporate and employ mental health mistakenly treated for primary learning or Post-Traumatic Stress Disorder, which project, and can lead to poor self-esteem, nursing services. We are the “glue” that language disorders. National data indicate is usually, exhibited by “flashbacks” from poor body image and potential eating dis- encourages compliance and communica- that 22% of children ages 5 and younger exposure to a psychological distressing orders.(A) Anorexia nervosa-extreme tion, monitors for mental health symp- live in poverty, which is a scientifically event, such as abuse, exposure to violence, weight loss, fear of eating and food ritu- toms, and provides a liaison with treating proven risk factor for mental illness. Other natural disasters, or war. als. (B) Bulemia- Binging and Purging by Psychiatrists, mental health clinics, and risk factors are prematurity, family stress- Severe Depression: Only in recent induced vomiting, laxatives, enemas, and outpatient day treatment programs, all in ors (divorce, death, illness).” Teachers, years have experts agreed that children compulsive exercising to prevent weight the attempt to keep individuals stable and since they see the child for hours, days and can suffer from severe depression. 2% of gain. Anorexia mostly effects girls (.5-1% in the community. months, need to be educated and evaluated children and 8% of adolescents may have of adolescent girls). Bulemia is 1-3% of In order for the home care mental health on their ability to detect early signs of ma- major depression. Symptoms in children all adolescents.(C) Obesity- The causes nurse to be of help to children and adoles- jor mental illnesses in children, and have may include: (A) Affect changes- such as are multifactorial- poor lifestyle choices, cents within her area of practice, one must the support and ability to refer the child to sadness, crying and worthlessness. (B) genetics, less structured family life, etc. know the issues, which interfere with chil- a specialist when appropriate. Loss of interest in playing and school The changing roles of parents in our soci- dren getting mental health services. The home care mental health nurse activities, truancy, and poor school per- ety, where both are needed to sustain the Parents may feel guilty that the child may come upon the child or adolescent formance. (C) Physical signs may include may be mentally ill and ignore early with mental health symptoms in two dif- appetite, weight, and sleeping habit see Home Care on page 42 MENTAL HEALTH NEWS ~ FALL 2010 visit our website: www.mhnews.org PAGE 15 PAGE 16 visit our website: www.mhnews.org MENTAL HEALTH NEWS ~ FALL 2010 Residential Treatment Services as a Vital Part of the Continuum of Care for Children, Adolescents and Young Adults An Interview with Harvey Newman, MSW, CEO of Wellspring Residential Treatment Facility

By Ira H. Minot, Executive Director A: We do not view substance abuse or sachusetts, New York and New Jersey. Mental Health News Education, Inc. eating disorders as primary diagnoses, but Our coursework is accepted by home rather as secondary diagnosis. We are schools and is credited towards graduation seeing kids with primary diagnoses of from the school of origin. We maintain ellspring is a residential severe anxiety, depression, bipolar disor- ongoing communication with our resi- treatment facility located in der, and personality disorder, along with dent’s school system and try to meet the Bethlehem, Connecticut. secondary diagnoses of attempted suicide individual needs of the student and her W Mental Health News re- or self harm. We treat these problems in a school. On occasion, we have tutored cently met with Wellspring CEO Harvey very holistic way. The core of our service students in a foreign language and sub- Newman, MSW to discuss residential care is relational. We work with our kids and jects such as advanced calculus so that and its benefit to the patients that it their families to help them increase their they can complete the requirements for serves. In the interview that follows, we ability to relate to family, community, and their home school system. Just recently, learn from Mr. Newman how Well- school, to become functioning and pro- we coordinated an advanced placement spring’s residential treatment facility is ductive members of their social commu- class for one of our residents who re- meeting the ever changing needs of chil- nity. There are often very complicated, ceived college credit for that course at a dren, adolescents, and young adults who sad, angry, and difficult relations between local community college. We get many are experiencing emotional difficulties. parents and child. Those core relation- educationally high-functioning kids at ships with parents are mirrored in the Wellspring and we work to maintain their Q: Tell us about the history of Wellspring. community with other figures at the academic levels and success during their child’s school. These are difficult situa- residential stay with us. Our recent state A: Wellspring was started 33 years ago tions for the kids to manage, and we work approval process was outstanding and by two therapists from Connecticut, Rich- very hard to help them achieve a rela- Wellspring received five commendations ard and Phyllis Beauvais. In the beginning, tional level that permits them to function along with a five year approval. the Beauvais’s took young adults into their in these environments. home and worked with them in a therapeu- Harvey Newman, MSW Q: Do some of the kids come to Well- tic community environment. Being suc- Q: Once a child arrives at Wellspring, spring with a history of harming them- cessful at this, demand grew quickly and and therapy per week for the children and how do they become part of campus life? selves or a pre-existing flight risk given over the course of its 33 year history, Well- their families. In our Adolescent program, Wellspring’s open campus environment? spring has evolved into a multi-faceted we require parents to participate in family A: In addition to schools, we frequently clinical facility with 41 beds. therapy and to be involved in multi-family receive referrals from psychiatric hospi- A: As an open and unsecured facility, we We have a 10 bed residence for young group and parent support programs every tals such as New York-Presbyterian Hos- have a requirement that our kids have adults, a 19 bed residence for adolescent other week while their children are in pital, in White Plains, New York and Sil- little or no risk of walking off campus, of girls, a 7 bed residence for children, and a residence. Our biggest challenge is to ver Hill Hospital in New Canaan, Con- returning to drugs, of having an active 5 bed therapeutic group home, also for return our kids to their families, commu- necticut. New York-Presbyterian Hospi- eating disorder or other situations in children. We also have the Arch Bridge nities, and schools, and to make their tal has residential psychiatric hospital which a child may be actively involved in School on our campus, a 51 seat special home and community environment a services for children and adolescents, and any dangerous self-injurious behaviors. education facility that serves our residents healthy and permanent place for them. Silver Hill Hospital has services for ado- This obviously limits the kinds of kids we and community day students who struggle This requires a lot of family involvement, lescents and young adults. Prior to a child can serve. We do not serve kids that re- with academic success due to emotional because as the kids get better there needs coming to Wellspring, a thorough discus- quire a secure locked environment. and behavioral issues. Historically, about to be simultaneous changes within the sion takes place between the referring half the students are Wellspring residents family unit itself. institution and our admissions staff to Q: What role do medications play in the and half day students. The day students make sure the patient being referred is a therapeutic approach at Wellspring? travel within a 40-50 mile radius of Well- Q: What is the process of a child being good match for us. We then get paper spring and come as a result of their school referred to Wellspring for care? work on the patient from the referring A: Medications do play a part. Whether system not being able to serve them. We institution and set up a meeting to inter- it’s a big or a small part in the client’s have an outpatient clinic on our campus in A: Every child who we take into Well- view the prospective resident and his or therapy depends on each individual. One Bethlehem, and a larger office located in spring has been known to some provider, her family. The next steps involve a pre- of the things we do with new admissions Middlebury. The Bethlehem campus is community institution, or organization admission tour of our facility and intro- is to lower dosages or eliminate medica- located about 90 miles from New York that notes their emotional problems and ductions to therapists and other key per- tions, in the safest possible way, in order City in the southern part of beautiful difficulties in living at home. Right now sonnel who will be working with that to find out who the child is without the Litchfield County. Our campus has farm we get a substantial number of referrals child, adolescent, or young adult. blanket of these drugs. Last year, we had animals and gardens, both part of the from school systems where the child is We then set up a date for admission a child that came to us on five psychotro- therapeutic work programs. Our resi- not making it because of some emotional which includes a meeting with our psy- pic medications. In 14 months, she re- dences provide home-like atmospheres issue that is affecting their academic per- chiatrist, our nurses, and the psychothera- turned home taking only Flintstones vita- that welcome kids and their families in a formance. We have a number of referrals pist who will be assigned to the case. mins. It is our goal to reduce, eliminate, very special way. Our founders, Richard on a consistent basis, particularly from This helps broaden our understanding of change, improve, and test out the client’s and Phyllis, are active members of our Westchester County, New York, and Fair- the patient and their family. medications, so we can work with the real Board of Directors. I came to Wellspring field County, Connecticut where the A new resident always go through an person behind all of the screens that those in 2007 to move the facility from a very school systems feel a need for the child to adjustment period. Along with an orienta- medications create, and help them access personal, small, and quiet program to a be enrolled in residential treatment and tion program, she is assigned a current and appreciate their own personal value more broadly visible facility in the local receive residential education. They select resident to act as a mentor. The orienta- and giftedness and build a foundation on community and within the professional Wellspring for those services. In other tion process introduces the new resident which they can build stable, creative lives. community. The response to our ex- instances, we have kids who have been in to life at Wellspring, and the mentor panded geographic outreach has been very higher levels of care – be it at a psychiat- works with staff to make the transition Q: Do all the kids attend a general sched- well received by psychiatric hospitals and ric hospital, an eating disorder rehab pro- easier. ule of programs during the day – or are schools in the northeast and in local com- gram, or a drug rehab program. After the there individualized daily schedules set up munities, all of whom are seeking our initial rehabilitation, referrals are made to Q: Can you tell us about the campus for each child? level of care. In the past year, we have Wellspring through those institutions or school at Wellspring? served kids regionally from as far south as the families. Wellspring works to get at A: We do have a general program, but Princeton, New Jersey, and as far north as the underlying issues that may have A: Part of our pre-admission process also within the program are individualized Boston - with others from as far as Cali- caused the child to develop these prob- involves interfacing with the patient’s activities designed to specifically meet the fornia and England. lems behaviors. school of origin so that we have an ac- needs of an each resident. All the adoles- We are highly professionalized with a ceptable assessment and special education cents attend school and participate in ex- great deal of clinical expertise, and run a Q: Are substance abuse and eating disor- plan that meets the requirements of the pressive therapy, art therapy, and our program that is very clinically intense. der the most common diagnoses of the sending school system. Our campus We provide over 15 hours of treatment kids that come to Wellspring? school is approved by Connecticut, Mas- see Residential on page 34 MENTAL HEALTH NEWS ~ FALL 2010 visit our website: www.mhnews.org PAGE 17 PAGE 18 visit our website: www.mhnews.org MENTAL HEALTH NEWS ~ FALL 2010

Advancing Anti-Racism Work: The First Monday Collaborative

By Peter D. Beitchman, DSW, LMSW racism on the lives of our clients and and Onaje Muid, MSW, LMHC, staff of color and, in recognizing institu- CASAC, FDCL tional bias, we have focused on how to make structural changes to achieve both equity and accountability. or the past three years, as a direct Since the conversation on race is diffi- outgrowth of the Undoing Racism cult and acknowledgement of racial bias training workshops provided by in our organizations takes both courage The People’s Institute for Survival and encouragement, the Collaborative has andF Beyond , a learning and action col- created a safe, open environment for mu- laborative consisting of human service tual learning and support to explore these executives and senior managers, as well issues and share solutions. The fact that as leaders from academia and the human such a safe space could be created was a service advocacy sector, has been meet- major accomplishment, allowing for hon- ing to advance anti-racism work. est, self-reflective dialogue among the Brought together by the powerful train- participants. During Collaborative meet- ing of The People’s Institute, the cost of ings, organizational efforts to address which was initially subsidized by United racism are discussed, including the formu- Way of New York City, a diverse group lation of organizational goals, how to ini- of human service leaders formed the tiate the discussion using a common lan- First Monday Collaborative Members (from left): Andrea Harnett-Robinson, “First Monday Collaborative” to further guage, and models of intervention to ad- anti-racism efforts within our organiza- President, Harnett-Robinson Consulting; Lawrence Mandell; Onaje Muid, dress racism in the provision of services tions and beyond. Clinical Associate Director, Reality House, Inc.; Dr. Alan B. Siskind; and in organizational operations. The First Monday Collaborative is co- Mary Pender Greene, Assistant Executive Director, Jewish Board of Family and Mental health agencies are particularly facilitated by Dr. Alan Siskind former Children’s Services; Maurice Lacey, Executive Director, Faith Mission Crisis important in these efforts. Given our un- Executive Vice President of the Jewish Center; Michael Stoller, Executive Director, Human Services Council of New York derstanding of the impact of racism on Board of Family and Children’s Services City; David Billings, Core Trainer, People’s Institute for Survival and Beyond; personal and social development, the (JBFCS), Mary Pender Greene, LCSW-R, Dr. Alma Carten, Associate Professor, NYU Silver School of Social Work; mental health community has a special Assistant Executive Director of JBFCS Dr. Peter Beitchman, Executive Director, The Bridge; Dr. Robert Schachter, role to play in confronting the realities of and David Billings, Core Trainer for The Executive Director, National Association of Social Workers NYC Chapter. racism and the urgent need to address People’s Institute who acts as a resource them in our services and organizations. for the group. The Collaborative is based vides a place to share and creatively de- issues to be addressed. Using the frame- on the principle that organizational lead- velop strategies to transform organiza- work and language offered by the Peo- Editor’s Note: This is the second of ers have a crucial role to play in recogniz- tional structure and practice to embody ple’s Institute as a crucial common two introductory articles devoted to the ing and addressing the impact of racism anti-racist principles. ground, including the lessons of history, impact of race and racism on mental on the human service system and their The Collaborative has been an impor- tools to identify and analyze structural health and human service practice. The organizations, as well as clients and staff tant forum for learning about racism in racism and the crucial roles of organiz- Winter issue of Mental Health News, of color. The Collaborative offers an op- the current American experience and in ing, leadership and networking in ad- whose theme is The Impact of Race and portunity for participants to deepen our our own organizations. Many of us ini- dressing it, participants have learned to Racism on Clients, Practitioners, Organi- understanding of the impact of racism in tially viewed racism as being individual identify contemporary forms of racism at zations and Delivery Systems, will include general and specifically its impact on the and intentional acts of meanness, not large, in our agencies and delivery sys- a number of invitational articles that will delivery of human services. It also pro- recognizing the structural and systemic tems. We have recognized the impact of explore this topic in depth.

Considering Culture in Child and Adolescent Care

By Dr. Efrain Diaz very language we use and the questions we For example, the very establishment differences influence the expression and DMHAS raise that are culturally driven as well. The and growth of the United States was ac- identification of the need for services. Office of Multi-cultural Affairs United Sates as a culturally diverse society companied by the dislocation and destruc- Studies have shown ethnic and “racial” provides a fertile background for teaching tion of a myriad of indigenous peoples differences in youth’s self-report of prob- cultural diversity, environmental and ethi- who had successfully managed local eco- lem behaviors, caregivers’ value judg- nce upon a time our society cal issues relating to the behavioral health systems for long-term sustained use. In ments of what is normative behavior, and began teaching children the of children and adolescent. addition, these societies were, in general, care giver expectations of the child. Eth- story of Christopher Colum- Historically, ethnic diversity in the characterized by internal social equality nic and “racial” bias in who gets identi- O bus, which inhibited children U.S. derived from two sources the diverse which allowed for satisfaction of human fied, referred and treated within certain from developing critical multicultural indigenous populations of Native Ameri- needs without elevating production and institutions has also been documented. thinking and reinforced racist ideology. A cans, and the diverse populations of immi- consumption beyond local subsistence For example, African origin youth are big and powerful “white” country is in- grants, both voluntary and involuntary. demands. This pattern is in marked con- more frequently referred to conduct prob- vading the country of poor Indians of Though there has been a significant trast to that of industrialized capitalist and lems for correction rather than psycho- color. You know the rest of the story. amount of gene flow between these di- post-revolutionary communist states alike. logical services, even with lower or equal Nowhere can issues of cultural diver- verse populations, patterns of socially J. Bodley, (1990) noted, the notion of measures of aggressive behavior. Quality sity and change be addressed as clearly in constructed isolation and inequality of “progress has ushered in an explosion of of care is also impacted. For example, the curriculum as they can be in early access to both physical health and behav- population growth and consumption of ADHD is less often treated by medica- education, for there is a long-held belief ioral health resources have led to dramatic resources unparalleled in scope and catas- tions in “minority’ groups than in “white” in our field that concepts of health and differences in illness patterns and rates of trophic in the nature of the transformation populations. There is also a high prob- disease are intrinsic to every culture and morbidity and mortality at various points that it has initiated.” Any critical exami- ability of misdiagnosis among “minority” ethnicity and are, therefore variable. Mul- in time. Far too often explanations of nation of environmental issues related to individuals, affecting subsequent care. ticultural behavioral health is concerned these epidemiological patterns have been health in the United States must focus on Furthermore, there are challenges in with a myriad factors contributing to dis- laid solely at the feet of “cultural behav- investigations of “race” ethnicity, gender, identifying the mechanism by which orders, etiology of dysfunction, and a va- iors and belief”. Medical science has con- and the class that have accompanied this “race” and culture accounts for disparities riety of ways in which human populations tributed to this misconception; more re- transformation of disparities. in behavioral and emotional problems and respond behaviorally to psychological cent analyses have focused on inequalities Culture, “race,” gender, ethnicity, and service delivery. Understanding this distress (clinical manifestations) and the of power, and the “medicalization” of socio-economic status of children plays a mechanism has important implications for person’s experience. It is not only the as- difference brings new insights to the rela- major role in shaping the behavioral how to intervene correctly. Factors that sumptions concerning education, health tionship between the social environment health care provided to children by health and illness that are culturally based but the and behavioral health. institutions. “Racial,” ethnic and cultural see Culture on page 38 MENTAL HEALTH NEWS ~ FALL 2010 visit our website: www.mhnews.org PAGE 19 The Next Generation of Family Support Programs: MHA-NYC Leads the Way in New York City

Giselle Stolper, EdM ‘I understand, Mami, I’ve been there,’ and as well as workshops on a variety of top- President and CEO I can see those mothers relax a bit and let ics of interest, including how to access Mental Health Association go of some of their distress and burdens. appropriate educational services for your of New York City It is amazing what I have seen parents be child, services for transition age youth, able to accomplish on behalf of their chil- childhood mental health disorders and dren when they are provided with support, diagnoses, what parents need to know or the past twenty years, MHA- information and advocacy tools they about psychotropic medications and advo- NYC has been a champion of need.” Because Parent and Youth Advo- cacy skills training. strength-based, family driven, cates have “earned their stripes” coping youth-guided mental health service with their own mental health challenges 11. Information and Referrals: Family delivery.F In collaboration with a dedicated resource center staff provide families with and negotiating the City’s mental health group of caregivers – MHA-NYC has been service delivery system, their efforts have referrals and linkages to mental health a driving force in building the family em- tremendous credibility. They have not services and other community resources powerment movement in New York City. only survived, but found ways to flourish that will help families and youth achieve In 1989, we launched one of the city’s first and give back. They are powerful role their goals. Family Support Programs (FSP) at Gou- models and sources of hope. verneur for caregivers of children with seri- All newly funded Family Resource One only needs to track Joan, one of ous emotional disturbance and subsequently Centers provide a core set of services. our current parents enrolled in the North- started the city’s first Parent Resource Cen- They include: ern Manhattan Family Resource Center’s ter (PRC) in the Bronx in 1993. These two progress from the moment she first placed programs became the prototypes for other 1. Warmline: A call in line for parents in a call to to today’s long list of accom- Parent Resource Centers and Family Re- Giselle Stolper, EdM need of resource information and support. plishments to see the power of peer sup- source Programs developed by MHA-NYC port to reduce stress, build confidence and over the next 15 years. When a parent walks into one of our 2. Peer-to-Peer Empowerment Groups reclaim lives. Joan has moved from a state Armed with lessons learned over two new Family Resource Centers , they know for Parents of despair, isolation, and being over- decades of providing family support ser- they are not alone, parents and caregivers whelmed with her children’s special needs vices in NYC, MHA-NYC was well posi- immediately meet Family Advocates, 3. Peer-to-Peer Empowerment Groups to a confident parent who is informed and tioned to respond to the New York City who have been in their shoes- other care- for Youth able to advocate effectively for her chil- Department of Health and Mental Hy- givers who have struggled with the chal- dren. She is now part of a community of giene’s request for proposals to operate the lenges of parenting a child with emotional 4. One-on-One Advocacy parents who are connected to each other

next generation of Family Support Centers. and behavioral challenges. Youth advo- and community resources. 5. Public Education and Outreach In 2009, MHA was awarded 5 contracts to cates are also on hand to offer peer sup- operate Family Resource Centers in North- port and advocacy for children and youth. 6. Care Coordination Services: Care To refer a family member or youth to ern Bronx, Southern Bronx, Northern Man- All of MHA-NYC’s Advocates have per- coordination services are offered to fami- one of MHA-NYC’s Family Resource hattan, Southern Manhattan and Western sonal experience with the mental health lies with complex situations for which Centers call: Queens. The new Family Support Centers system either because of their children’s there is a need for coordination between importantly provide services in the highest needs or – in the case of the Youth Advo- many providers or systems. The Family Northern Bronx- 718-220-0456 need community districts within each of cates – because of their own mental health Network Model is used to help families Director- Wanda Greene the boroughs where they are located. The challenges. We are proud that many of and caregivers develop a single coordi- addition of care coordination services, our Advocates were trained and hired nated, individualized care plan across Southern Bronx- 718-220-0456 warm lines and computer resource rooms from among those who initially came to providers and systems. Director- Yvette Pena at each of the centers provide families with us for help. important new resources. Our cross-site The fact that our Family and Youth 7. Respite Northern Manhattan- 212-410-1820 collaboration with Resources for Children Advocates share the perspectives, experi- Director- Olga Vasquez with Special Needs, Inc. also helps to pro- ences, languages and cultures of the peo- 8. Recreational Activities vide parents and caregivers with the most ple with whom they work means that Southern Manhattan- 212-964-5253 up-to-date information about how to access those who seek help are freed from the 9. Youth Advocacy Director- Janet Rosa appropriate early childhood and educa- pressure and pain of constantly having to tional services for children and youth with explain and justify their needs. As one 10. Workshops and Seminars for Family Western Queens- 718-651-1960 emotional and behavioral challenges. staff member stated: “All I have to say is: Members: Parenting Groups are offered Director- Lorraine Jacobs

Help People with Disabilities Get Their Federal Benefits the Safe, Convenient Way

By U.S. Department of the Treasury Plus, money is available on payment day sign up for a prepaid debit card, called the of electronic payments in your presenta- Financial Management Service each month, so there's no need to wait for Direct Express card, which is issued by tions, workshops and public speaking the mail to arrive or to make special trip Treasury's financial agent. Details about fea- engagements. to cash or deposit a check. tures and fees for optional services can be n 2009, more than 440,000 Social The U.S. Department of the Treasury found at www.USDirectExpress.com. paign and Direct Express* card materials, Income (SSI) checks were reported paper checks: including posters, fliers and pamphlets at lost or stolen and had to be reissued. How You Can Help events. DespiteI the risks, too many people with 1. Direct Deposit: The Go Direct campaign

disabilities and their caregivers continue gives people with bank accounts a free, easy NYSOMH encourages you to spread For more information, visit the Part- to receive their federal benefits by paper way to switch from paper checks to direct the message about this important issue. ners section of www.GoDirect.org or contact campaign The New York State Office of Mental deposited into a checking or savings account representative, Ashley Czernis, at (312) Health (NYSOMH) encourages you to each month (www.GoDirect.org). Direct Express card materials in your materials, please contact Ashley Czernis paper checks to electronic payments for lobby. at [email protected]. Or federal benefits. Electronic payments 2. Direct Express: Debit MasterCard card. contact Ashley via phone to order materi- eliminate the risk of lost or stolen checks. People who don't have bank accounts can 2. Include information about the benefits als, (312) 988-2419. PAGE 20 visit our website: www.mhnews.org MENTAL HEALTH NEWS ~ FALL 2010 FALL 2010 ADVERTISING SUPPLEMENT SPONSORED BY FOUR WINDS HOSPITAL PAGE 21

A Message from the CEO

By Martin A. Buccolo, PhD and values that have yielded a philosophy smooth transitions. To this end, we have CEO, Clinical Director that can inform our treatment. DBT maintained a significant effort and com- Four Winds Hospital (Dialectical Behavioral Therapy) has pro- mitment to improving our services in both vided the tools in this process particularly our admission process and in our patients’ for our adult and older adolescent popula- transition back to the community. Most of s I look back at the past year, tions. DBT has created a common lan- our admissions involve a crisis and a com- we at Four Winds have been in guage that has served as a bridge between plicated exchange of information, under a constant process of change. us and our patients. The same examina- time pressure, between ourselves and A Paradoxically, our task has tion and development of shared principles emergency rooms, clinics, or schools. The been to balance order and change, as we has occurred on our children's units clarity of information exchanged and the change the order of things. Like people, through the use of Applied Behavioral speed of our response are extremely im- organizations often find comfort in rou- Analysis. Again, shared language, expec- portant to our patients and the providers tine and sameness. We all know that com- tation, and experience have produced a who entrust them to our care. Part of our fort doesn't necessarily lead to a better more cohesive treatment team and en- commitment to organizational change has life, experience, or outcome. Over the past hanced patient outcomes. been to analyze and improve every ele- two years, we have committed to and em- We believe that patients suffer as they ment of this process. Over the past year, braced a process of orderly change. We fall between the gaps in the overall ser- our Admissions Department has made a have questioned our paradigms and clini- vice delivery system. Gaps in reimburse- transition away from paper-based systems cal assumptions, upset the order of our ment and insurance coverage present seri- toward real-time, technology-based solu- routines, and set in motion a process to ous impediments to good care. We believe tions. We have improved our response enhance our treatment and our service to that patients are always best served when time to crisis calls. Our outreach staff has benefit an ever-changing patient popula- Martin A. Buccolo, PhD services are linked and integrated into a implemented new technology and wire- tion and treatment environment. This has coherent whole. Patients are most vulner- less based systems to enhance our been an exhilarating and energizing proc- Our clinical efforts have centered on able as they move between systems and ess, and it has not been easy. creating a consistent series of assumptions they always benefit from integrated and see Message on page 24

Spirituality at Four Winds

By Janet Z. Segal, LCSW When we asked some of our patients at Our patients work hard when they are Executive Vice President Four Winds to describe what makes them in the hospital and in our outpatient pro- Four Winds Hospital feel spiritual, many raised their hands. grams, so we decided that a non- Here are some of the spontaneous answers: denominational approach to spirituality could provide them with what Father his past year, Four Winds Hos- “When I listen to music that I love, it Booth calls the ‘More in Life’- a tool to pital, a 175-bed psychiatric hos- makes me feel wonderful.” give them relief from their stressors when pital and outpatient treatment they are overcome with their problems. center in Katonah, NY, has in- “Talking to a friend who inspires me.” Clearly many were already using spiritu-

Ttroduced a highly successful program that ality to give them a sense of relief from “Taking a walk in the woods surrounded brings spirituality into the lives of patients by nature.” their troubles. as an effective aspect of treatment. Our We chose a weekly meeting focused weekly, voluntary gatherings incorporate “Thinking about my mother and how on spirituality as a beginning. While Four singing and discussion in a non- much I love her.” Winds treats child, adolescent, and adult denominational context. patients, we decided voluntary attendance While spirituality can spring from reli- “When I feel I have overcome something would start at age ten. We begin the gious belief, it can also originate from daily that frightened me.” meeting with music and singing as we life experiences that lift spirits beyond indi- want to ensure that the experience is in- vidual troubles and pain. In his book enti- Patients define a vast array of feelings clusive and unifying for all ages. Inspira- tled Treasures: Awakening our Spiritual as “spiritual,” many involving inspiration, tional songs like This Little Light of Mine, Gifts, Father Leo Booth describes spiritual- strength, self-confidence, happiness, de- This Land is Your Land, Lean on Me, and ity as the ‘More in Life’. He goes on to termination, love, nurturing, wonderment He’s Got the Whole World, set the tone say, “It is about moving out of the box. Janet Z. Segal, LCSW and a sense of community. None asked for the meeting and create a sense of joy Moving beyond the frame that keeps you what we meant by spirituality. They all and enthusiasm as every one gathers. encased. Transcending the rigid thinking Experiencing a ‘moment’ of awakening knew, and there was no reference to relig- that keeps us judgmental, fearful or angry. that changes your life forever.” ion in any of the answers. see Spirituality on page 24

Four Winds Hospital is the leading provider of Child and Adolescent Mental Health Services in the Northeast. In addition to Child and Adolescent Services, Four Winds also provides Comprehensive Inpatient and Outpatient Mental Health Services for Adults, including Psychiatric and Dual Diagnosis Treatment. PAGE 22 FALL 2010 ADVERTISING SUPPLEMENT SPONSORED BY FOUR WINDS HOSPITAL FALL 2010 ADVERTISING SUPPLEMENT SPONSORED BY FOUR WINDS HOSPITAL PAGE 23 PAGE 24 FALL 2010 ADVERTISING SUPPLEMENT SPONSORED BY FOUR WINDS HOSPITAL

Message from page 21 ment emphasis. Our commitment to combine a full range of therapies, from communication and response to our refer- evidence-based cognitive behavioral ral sources. treatment models to spiritual and crea- We have also become more focused tive experiences, are all part of our belief on enhancing the patient experience at that healing requires not only excellence Four Winds over the past year. We have in treatment but also understanding and created groups that emphasize, explore, caring about our patients from a holistic and engage the spiritual aspects of our perspective. We firmly believe that pol- patients’ lives. We have created regu- ishing these facets of health is an impor- larly occurring non-denominational tant part of the healing experience. spiritual groups and activities, and The coming year will no doubt be through our involvement with local filled with change, promise, and chal- spiritual leaders, we have been able to lenge. Our collective hope is that health provide individual spiritual counseling care reform will enable us all to better and comfort. We have reinvigorated our care for patients. We share your concerns Adult Co-Occurring Disorder treatment on how issues currently in play in Albany program by adding daily groups led by will impact our collective ability to pro- master’s level alcohol and substance vide excellent care. As these issues un- abuse counselors. We have developed a fold, we remain mindful of the awesome highly creative Therapeutic Arts Depart- responsibility that we share and remain ment that utilizes and integrates art, mu- committed to providing the best care pos- sic, and the movement modalities of sible as we continue our efforts to adapt, yoga and tai chi as an alternative treat- change, and grow.

Spirituality from page 21 morning. Staff members report that the rest of the day is usually calm and quiet. The next part of the meeting is a guest It seems that the feelings of spirituality speaker, often Pastor Paul Briggs from the are strong and can create a lasting sense local Antioch Baptist Church, who agrees of well-being. Of course we hope the with our approach to spirituality and un- effect on our patients will continue when derstands the need to have our meetings be they are discharged and that they will be non-denominational, non-religious and all- able to access their life experiences in inclusive. The focus of Pastor Briggs’ talk order to feel spiritual at those times they is usually about choices made in life and seek relief from their daily troubles. the importance of believing in oneself. He The Spirituality Initiative is a reflection gives examples of those who have over- of the on-going effort at Four Winds to come adversity by using their coping continually seek out ways to help our pa- skills, their belief in themselves and their tients feel better, stronger, happier and access to their spiritual feelings. These more productive. We have started many talks transmit a strong sense of hope and new initiatives such as DBT (Dialectical emphasize the importance of finding the Behavior Therapy) for adolescents and ‘more’ in one’s life. Judging by the com- adults, and ABA (Applied Behavioral ments and questions at the end of Pastor Analysis) for our children. We have added Briggs’ talks, the patients are stimulated in many new creative arts programs like mu- a very positive way and seem eager to sic therapy, art therapy, choir groups, and interact and discuss the experience. The journal writing, as well as an array of meeting ends with more singing and light physical activities and special events. Ad- refreshments. ditionally, our on-campus school keeps our The staff has been extremely enthusi- patients up-to-date on the work they are astic and instrumental in making the missing in their own schools. We believe Spiritual Meeting a success, with well the Spiritual Meetings are a valuable addi- over 100 people attending each Saturday tion to our programs. MENTAL HEALTH NEWS ~ FALL 2010 visit our website: www.mhnews.org PAGE 25 Mental Illness Education Does Make a Difference: “Breaking the Silence” Found to be Effective

By Amy Lax found that the BTS middle school lessons Director of PR & Development are effective in increasing knowledge and NAMI Queens/Nassau changing attitudes and behavior relating to mental illness. Middle school students in New York, tudents would ask, “What’s wrong South Carolina, New Mexico and Florida with Doug, Mrs. Susin?” Those participated in the study. Janet Susin, BTS are the words heard by Janet lead author and BTS Project Director and S Susin, then a teacher in the same Lorraine Kaplan, BTS co-author and Di- school where her son was a student, from rector of Educational Outreach collabo- his high school friends twenty-three years rated with Otto Wahl, Ph.D., Professor of ago when they were searching for an ex- Psychology, University of Hartford. planation of why he had suddenly disap- “Results of our study show that even peared from school. Although Susin says brief instruction (2 ½-3 hours) can pro- she was comfortable speaking to her own duce change in how students understand friends and fellow teachers about her son’s mental illnesses. BTS is a very promising hospitalization for schizophrenia, those approach to improving the way children words from his classmates left her speech- perceive and respond to mental illnesses. less with tears streaming down her face. We can now statistically document that Searching for a way to discuss the instruction in BTS does result in improve- situation without breaking down, she ments in knowledge, attitudes, and/or sought out the school health teacher, rea- behavior related to mental illnesses,” soning that if she knew what students stated Dr. Wahl. were learning about mental illness, it Dr. Otto Wahl, PhD, Professor of Psychology, University of Hartford, Susin, and/or Kaplan accompanied Dr. would be easier to tackle the subject with Janet Susin, BTS lead author and BTS Project Director, and Lorraine Wahl to the school sites to carry out the Doug’s friends. What she found out was Kaplan, BTS co-author and Director of Educational Outreach research. In an email after their visit, a shocking. Although before the age of South Carolina teacher wrote this about fourteen half of those who will go on to tired teachers, each a NAMI (National Although the lessons, in one form or her experience, “I just wanted to let you develop a serious mental illness are al- Alliance on Mental Illness) Queens/ another have received much praise and know how much my students enjoyed the ready showing symptoms, students in her Nassau member with children living with been available for over 20 years and in stories and the game. They asked thought- school learned absolutely nothing about mental illness, Susin developed “Breaking use across the United States and interna- ful questions and were intrigued to learn mental illness. It wasn’t part of the cur- the Silence” (BTS), innovative teaching tionally, their effectiveness has never about mental illness. One of my students riculum. That was a turning point in packets with lessons, games and posters been assessed. Thanks to a grant from the even felt compelled to share that her sister Susin’s life, as her heartache became her on mental illness for upper elementary, National Institute of Mental Health passion. With the help of three other re- middle, and high schools. (NIMH), a recent three year study has see Education on page 37

The Road to Independence: Addressing the Needs of Adolescents and Young Adults with a Serious Mental Illness

By Denise Molloy Vestuti, LCSW cally have high rates of school absentee- Program Coordinator, The Mental ism and difficulties completing high Health Association of Westchester school due to disruptions caused by their County, New York (MHA) mental illness, such as psychiatric hospi- talizations and family problems. In Cross- roads, approximately 50% of young adults iagnosed with schizo-affective in Crossroads do not have a GED or high disorder, Tom has spent most school diploma upon entering the pro- of his teen years in and out of gram. Other issues they confront are a psychiatric hospitals. He was lack of skills to live independently and to livingD with his mother, who was unable to establish and maintain supportive rela- provide the support and guidance he tionships; limited facility with problem needed, and at age 17 was about to age solving; poor decision making skills; lim- out of the children’s mental health system. ited impulse control; and difficulty in de- Yet he did not have the tools that prepared veloping work skills. In addition, many him for independence and the transition to have developmental delays. the adult mental health system. Due to his On their own, they are frequently unable hospitalizations, he regularly missed to successfully continue their education or school for long periods, and as a result did secure employment. Transition-age youth not graduate from high school or create with a diagnosis of a serious emotional dis- any friendships. He had no work skills, turbance (SED) or SMI have higher rates of and as he saw it, no future. substance abuse than any other age groups Tom was referred to The Mental with mental illness and are three times more Health Association of Westchester skills, education or financial stability to of MHA’s licensed mental health clinics. likely to be involved in criminal activity County, Inc. (MHA)’s Crossroads pro- live independently. Since many of these The period from adolescence to adult- than those without an illness. In addition, gram which serves Westchester residents young adults cannot afford to travel, or hood is challenging, even more so for serious mental health conditions in adoles- aged 17.5 to 22 years who meet the New having lived with a mental health “label” older teens who are struggling with a seri- cence generally continue into adulthood and York State Office of Mental Health crite- for years, are reluctant to come to a men- ous emotional disturbance or severe men- young adulthood is also a high-risk period ria for a serious mental illness (SMI). The tal health clinic, Crossroads provides tal illness. Crossroads participants are for developing new disorders. (Seeking only program of its kind in Westchester counseling and support in the home and in returning to the community from a resi- Effective Solutions: Partnerships for Youth County, Crossroads provides develop- the community. Crossroads is one of the dential treatment facility, hospitalization, Transition Initiative (PYT), June 2007, mentally appropriate services specifically only programs to provide mobile services foster care and other living situations and http://ncyt.fmhi.usf.edu/index2.cfm) designed for youth like Tom, who are to this population and it is crucial to its are usually from families who need sup- considered adults, but do not have the success. Services are also provided at one port. Like Tom, these young adults typi- see Independence on page 36 PAGE 26 visit our website: www.mhnews.org MENTAL HEALTH NEWS ~ FALL 2010

Engagement in the School Based Clinic Setting: Challenges and Opportunities

By Erin Alvarez, LCSW-R In the fields of social work and psychol- drive, camp scholarship funds, and other Program Coordinator ogy, the clinical supervision process en- miscellaneous donations throughout the WJCS - SCOPES ables the clinician to meet and discuss with year. Families experience this concrete a supervisor on a regular basis areas of support as extremely helpful and as clear work that are challenging. There is an im- evidence that the agency is interested in he early phase of mental health plicit understanding that to reveal areas of their wellbeing. For faculty members, the treatment called “engagement” challenge or even countertransferential support offered by clinic staff is often help- marks the beginning of an experiences is a positive way to work ful in an immediate way. Implementing a emerging collaboration among through aspects of the clinical work that successful behavior plan for a disruptive Tprovider, child and family. During en- stagnate. The field of teaching offers a child or offering a teacher useful strategies gagement, clients develop important different culture relative to the worker- in dealing with a certain situation allows a senses about their providers: Do I like this supervisor relationship. While teachers are teacher to understand the potential success person? Can they help me? Does it seem offered some administrative support and of the program, value it more highly, and be like they care about me? Clinicians de- are backed by strong unions, the implicit more inclined to collaborate in the future. velop their own set of senses about cli- message is that teachers need to figure out In conclusion, successful engagement ents: Is this someone I can really help? Is a way to independently handle problems as relies upon consistent communication and this client seriously committed to getting they arise. Therefore, faculty tends to hold clarity on all levels in a school-based men- better? Is this case interesting or appeal- on to problems and attempt to manage hard tal health clinic. Schools are busy places ing? It is during engagement that a his- situations, avoiding asking for help until and the constant bustle of children and tory is shared and areas for work are pri- the situation reaches a crisis level. When demands of the day make such communi- oritized and agreed upon mutually. It is teachers are encouraged to consult with the cation a challenge at times. It is the job of also during that time that the boundaries school-based clinic from both clinic staff the program manager to ensure that com- of treatment are set, tested at times, but A challenging aspect of engagement in as well as from their own administrators, munication and clarity remain a priority, ultimately established. For these reasons, the school setting is the development of a engagement among clinic, school and and this is achieved by arranging regular engagement is a critical time in the treat- collaborative and mutually satisfying rela- families is best. meetings with school administrative staff ment relationship. tionship with partners in the school – fac- There are additional ways that the and faculty. Program staff must be adept at All of these aspects of engagement ulty and administration. Particularly when school-based clinic works to engage both approaching faculty, being direct and clear pertain to clients who have demonstrated the school-based clinic is new or re- clients and school partners. In terms of about the collaboration, and revisiting is- some interest in seeking help, as have establishing itself with new school per- clients, the participation by a larger agency sues when miscommunication and misun- many families who have sought help for sonnel, identifying “who we are and what that maintains excellent relationships with derstandings arise. Together, school per- their children in school-based clinics. In we do” on a regular basis is essential. outside resources to provide financial and sonnel, families and school-based mental the school setting, too, there are parent There should ideally be clarity and a mu- supportive services can be particularly health clinicians can work cooperatively to populations who do not actively seek tual desire for the existence and success- beneficial. The school-based clinic partici- improve functioning of children with be- treatment for their child or family. In ful operation of the school-based clinic pates in programs that offer families addi- havioral, emotional or mental health issues. these cases, engagement involves chal- from top administration to supportive tional supports: a pajama program, a back- SCOPES: Supporting Children's Opportu- lenges beyond those described above. staff. Reviewing and revisiting themes of to-school clothing and school supplies nities and Parent Empowerment in Schools. Factors such as denial, avoidance, fear of how to identify children in need of mental stigma, excessive psychosocial or eco- health counseling beyond the expertise of nomic stressors, parental substance use or Pupil Personnel staff, when and how to mental illness all complicate the engage- refer families, and why it’s important to ment process. It is difficult for any family use the school-based clinic for consulta- to hear their child is struggling at school, tion should occur on an ongoing basis. and when additional barriers to engage- Utilizing faculty meetings or other forums ment exist, other measures are needed. A when all school personnel convene is op- program within a school-based clinic pro- timal. Allowing faculty to ask questions vides some flexibility to reach out to about the school-based clinic in an open families repeatedly, allowing them time to manner always, in this writer’s experience, assimilate information about the services results in an increase in both referrals to available. It is also essential to clarify and consultations with the program. repeatedly that the program and agency Establishing clarity early on in the are separate entities from the school. This clinic-school partnership about the is crucial because at times families have boundaries and limits of the program received what they perceive to be a bar- helps offset future misunderstandings and rage of calls and complaints about their disappointments. For example, helping child from school administrators or teach- the school understand that family partici- ers. Helping the family view the school- pation and consent to treatment is manda- based clinic as separate, confidential, and tory and that children are otherwise un- supportive of the child’s functioning at able to be served encourages school per- school is important. Meeting with families sonnel to become partners in the engage- off-site in locations such as at Head Start, ment process with families. Highlighting in the community or in the family home the difference between mental health are ways to connect on a level that may be treatment and constant crisis intervention more accessible and friendly. is also important in order to avoid misuse Fortunately, most children easily and read- of the program as a receptacle for misbe- ily engage with program staff. They are ex- having children. Marketing the program’s posed to the clinical staff daily from the onset clinical services as offering both mental of the school year, and the program offices health counseling to children and consul- appear inviting with toys and materials. The tative services to faculty in order to sup- issue of engagement is not usually a chal- port their management of behavior chal- lenge in gaining the child’s cooperation, but lenges makes the most sense. When ex- rather in collaborating with teaching staff cessive clinical time is occupied by tend- around scheduling and best times to remove a ing to children who have been removed child from class for treatment. Classmates from the classroom, the program cannot can grow curious. They want to know why a function optimally. Teasing out with fac- particular child “gets to go play with you” ulty and administration those issues that and why they are not allowed. Being pre- are really disciplinary and require admin- pared with an answer that is appropriate to a istrative intervention versus those that young child’s understanding and preserves require mental health support on a regular the privacy of the client/family is important. basis allows for optimal collaboration. MENTAL HEALTH NEWS ~ FALL 2010 visit our website: www.mhnews.org PAGE 27 PAGE 28 visit our website: www.mhnews.org MENTAL HEALTH NEWS ~ FALL 2010 Positive Behavioral Interventions and Supports for Children

By Jeannette Palmesi, RN, Program Director/Nurse Manager, Child Unit at Cliffside, Four Winds Hospital Katonah, New York

ur Cliffside Child Inpatient Unit, treating children ages 5- 10, has implemented a unit- O wide positive behavior sup- port plan known as Positive Behavioral Interventions and Supports (PBIS). This program has been derived from the prin- ciples of Applied Behavior Analysis (ABA). Decades of research and exten- sive use in education verify the effec- tiveness of strategies and tactics based on ABA. ABA is the branch of behav- ioral science that deals with the applica- tion of scientific principles to improve socially significant behavior. It includes So how is PBIS used at Four Winds? the methods by which behaviors are ob- Expectations for every activity are clearly served and measured, and new behaviors defined. Having clear expectations sets are taught. Since ABA has a significant each child up for success. Posters display- research history, especially for children ing the expectations are on the walls. Staff with disabilities, it is the primary ap- selectively praise children for appropriate proach taken at many schools and psy- behavior instead of focusing on undesired chiatric treatment centers. behavior. The development of social skills Learning is defined as change in be- is the foundation for all activities. Each havior due to experience. PBIS is a sys- child participates in academic instruction tems approach to evaluate the purpose of and social skills groups on a daily basis. a child’s behaviors, reinforce appropriate Both activities are co-lead by the teacher, behavior and effectively manage disrup- clinical and the nursing staff and PBIS is tive behavior. The primary goal is to implemented during every activity. Edu- create an environment that provides cation is a very important part of the pro- positive reinforcement for improved gram. Our goal is to have school time in socially appropriate behavior and pre- the hospital resemble a day of school in the vents challenging behavior. Four Winds community and to have the child practice staff have been trained to understand appropriate behaviors. what purpose each behavior serves for Throughout the day our children earn an individual patient and what maintains stars for engaging in expected behaviors. or reinforces specific behaviors. The children choose various rewards such Our treatment teams, which include as time playing video games, a later bed- therapists, nurses, mental health workers time and other reinforcing activities, de- and teachers, have adopted PBIS. All of pending on the number of stars earned. our staff are in the process of ongoing Appropriate behaviors increase as the intensive training to identify disruptive children are consistently reinforced. behavior early so that they can redirect During the past year using PBIS, our the child to use the coping skills that they behavior management incidents have de- are learning. Four Winds’ approach is creased significantly. We remain commit- based on the belief that there are reasons ted to this approach and continue to en- behind difficult behavior, that children hance the training our staff receives. We should be treated with compassion and are confident that PBIS has made a major respect, and that behavior can be pre- impact on the quality of the treatment. dicted and managed when the principles For further information please call 1- of behavior are understood. 914-763-8151 ext. 2413. MENTAL HEALTH NEWS ~ FALL 2010 visit our website: www.mhnews.org PAGE 29

Annual Maniscalco Lecture Held at Saint Joseph’s Medical Center

Staff Writer units in general, non profit, hospitals. Mental Health News Also influencing the process was richness of available services in the county and the poverty level in the area in which the hos- ark Olfson, M.D. presented pital was located. The need for prior au- the 21st Annual Anthony thorization of outpatient visits also Maniscalco, M.D. Lecture weighed against successful aftercare. In in Public Psychiatry to the trying to improve aftercare linkages and DepartmentM of Psychiatry of Saint Jo- outcomes important factors include set- seph’s Medical Center in Yonkers, New ting appointments, having transportation York. The lecture was created in honor of accounted for, visits by aftercare provid- Dr. Maniscalco who had been the Director ers with the patient prior to discharge, and of the Department of Psychiatry from setting visits for substance use disorder 1970 until 1980, a period during which a treatment. After discharge, checking for number of the full range of mental health kept appointments with the patient and/or services currently available at Saint Jo- family is helpful as is use of intensive seph’s were established. case management in the immediate period Dr. Barry B. Perlman, Director of the after hospitalization. Department of Psychiatry, introduced this Dr. Olfson went on to underscore the year’s lecturer. Dr. Olfson is Professor of importance of patients taking prescribed Clinical Psychiatry at Columbia Univer- medications as a critical variable in reduc- sity’s College of Physicians and Surgeons. ing emergency room visits and hospital Widely published in scholarly journals, he readmissions. He noted that psychiatrists has received awards from such organiza- Grant Mitchell, MD, Commissioner, Westchester Dept. of Community are not good at predicting which of their tions as the American Foundation for Sui- Mental Health, Ms. Nancy Maniscalco, Mark Olfson, MD, and Barry B. patients is compliant with their medica- cide Prevention and the National Associa- tion regime. Several elements to focus on tion for Research on Schizophrenia and Perlman, MD, Director, Dept. of Psychiatry, Saint Joseph's Medical Center with the aim of improving adherence are Affective Disorders. This recognition re- simplification of the medication schedule, flects his research interests in the identifi- schizophrenia disengage from care and were age, sex, race, and an history of sub- building a trusting alliance with one’s cation, provision and economics of mental how best to affect the transition from in- stance abuse treatment. Factors which had patients, use of a variety of reminders, health care and its interface with primary patient to outpatient care. Noting the im- a significant impact were items such as skill training and use of long acting depot care and other medical specialties. He also portance of successful linkages, he noted whether the individual had been in treat- injectible antipsychotics. Dr. Olfon’s lec- shapes perspectives on contemporary prac- that when studying a national Medicaid ment prior to their admission and whether ture presented data which offered practi- tice and delivery systems through his par- data set only 40% of those discharged they had been receiving antipsychotic cal approaches to improving linkages to ticipation on the editorial boards of a num- were seen within seven days and 60% medications prior to the admission. At aftercare and improving medication com- ber of prominent journals including Psy- within 30 days. Those for whom there more macro levels, type of coverage gen- pliance, each of which can contribute to chiatric Services, Administration and Pol- was no successful linkage had much erally did not matter although those en- improved outcomes and lives for persons icy in Mental Health and Mental Health greater likelihood of readmission. Noting rolled in managed care were less likely to involved in treatment. Services Research. that we are not good predictors of who be seen for aftercare. The auspice of the The Department of Psychiatry at Saint Dr. Olfson addressed two important would receive timely aftercare, he elabo- hospital influenced the outcome with Joseph's Medical Center includes a wide issues for those involved with the care of rated upon the many influences on the those discharged from private for profit array of outpatient and inpatient mental persons with serious and persistent mental process beyond the individual clinician institutions being less likely to be seen health services as well as substance use illness. They were why persons with and patient. Among the poor predictors after discharge than those discharged from disorder treatment programs.

Supporting Change to Last a Lifetime Join your peers from across the state and enjoy all the education, networking and fresh mountain air that we can offer!

THIS YEAR’S HIGHLIGHTS INCLUDE: • 2 Pre-Conference Institutes • Over 35 workshops during 5 different sessions • Keynote presenter Fred Schaeffer – the “Fit Food Dude” • A private screening of the documentary “Unlisted: A Story of Schizophrenia” followed by a Q&A with director Delaney Ruston

esort • The annual awards banquet ury R y Lux at the • And the final night theme party! Enjo tions moda Accom For detailed information please go to WWW.ACLNYS.ORG Association of Community Living Agencies in Mental Health

If you are experiencing a difficult time in your life, always remember that you are not alone. There is a caring and helpful mental health community nearby that can help you get through this difficulty. Don’t feel embarrassed or afraid to ask for help, it is not a sign of weakness.

Best Wishes from Mental Health News. PAGE 30 visit our website: www.mhnews.org MENTAL HEALTH NEWS ~ FALL 2010

Creating a Team of Professionals to Manage the Patient with an Eating Disorder

By Ann L. Engelland, MD parents or patients to come or be referred • collaborating on decisions about higher Specialist, Adolescent Medicine to me first for evaluation of a problem levels of care, eg hospitalization, that is ultimately diagnosed as a mental health concern. What makes our specialty • coordinating responsibilities among arlier this Spring an 18 year old different is the comprehensive medical the team leaders, and graduating senior came to my and developmental approach to this age office for a checkup and told group. Many choose to visit a medical • evaluating other treatment options me about the stomach pains she doctor who uses a comprehensive ap- when current strategies are not working. Ewas experiencing. She had already seen a proach because they are not sure if the gastroenterologist who had instructed her underlying issues are physical, emotional In addition, I often will have the sib- to eat more fiber and check back in six or psychological. lings in my care and have learned to pay weeks. Upon further questioning, it be- The team for a patient with a con- special attention to them. In a recent arti- came clear that other symptoms included firmed eating disorder may consist of a cle in the Journal of Adolescent Health a strong urge to vomit after meals and the psychologist, a dietician, a psychiatrist, by Areemit, Katzman and colleagues, need to exercise up to three hours a day and a medical doctor. In addition, other 80% of twenty siblings of ED patients especially after dinner. participants in care may include the reported that their quality of life was It also became clear that we needed to school social worker, psychologist, or negatively affected by the onset of their nail this incipient eating disorder. How coach. Sometimes clergy are brought into siblings’ ED. would she manage in college if the prob- the mix if their approach and insight can Much of this kind of intensive work is lem was not addressed now? I could be helpful. As a physician, the role I play made possible by our ability to use email imagine her returning the following in this group is to lend support to a diag- and electronic communication. Although Spring, unable to complete her courses, nosis, consider all medical possibilities, there are pitfalls and concerns with this metabolically unstable or worse. Within a and act as the “orchestra conductor,” as new way of connecting a team, we all week—and in no small part because she Ann L. Engelland, MD one of my early mentors taught me. Often know that reimbursement for time on the was able to talk openly with her parents my role includes: phone or even team meetings is minimal and because they were understanding up very frequently and I rely on a network or non-existent. Truly, the ability to com- about the addictive nature of disordered of professionals in the mental health field • translating a clinician’s thoughts and pare notes, share information and give eating behavior—we were able to assem- to collaborate with me. Adolescent medi- concerns to the patient or the family, each other a heads-up on progress and ble a team of people to help her. cine is a sub-specialty composed largely problems makes it possible to treat com- How did this come about? It was made of pediatrics and internal medicine practi- • supporting fellow clinicians to avoid plex disorders and share the stress and possible by the extraordinary resources tioners who care about and for adoles- splitting the treatment team, responsibility we all experience. available to all of us who care for patients cents and young adults. in Westchester. As an adolescent medi- In my particular practice I see patients • interpreting medical test results to the For more information visit Dr. Eng- cine specialist, this sort of situation comes from age 12 to 25. It’s not uncommon for family, patient and team, land at www.AnnEngellandMD.com.

Maternal Depression and Children’s Behavior in School

By Andrew Malekoff, LCSW, CASAC One young mother who is recovering pressed, or hopeless? and 2) Since your Executive Director, North Shore Child from post-partum depression at RFTS re- new baby was born, how often have you and Family Guidance Center cently told a rapt audience at a recent had little interest or little pleasure in do- North Shore Child and Family Guidance ing things? The women who answered Center event, about how she could barely "often" or "always" to either question are to venture a guess as to lift her head off of her pillow, let alone lift were classified as experiencing self- what grade level of student has and hold and cuddle and care for her baby. reported post-partum depressive symp- the highest rate of expulsion The Center for Disease Control (CDC) toms. Detecting the problem is the first C from school because of prob- reports that postpartum depression affects step in getting moms and their families lematic behavior? Let’s see how you did. up to 20% of mothers within the first year the help they need. According to a research study at Yale after giving birth. The rate of depression for We must encourage primary care phy- University, led by Dr. Walter Gilliam, the mothers living in poverty is close to a stag- sicians and other health professionals to rate of expulsion in pre-kindergarten pro- gering 50%. Mental health experts agree incorporate these questions into their en- grams serving three- and four-year-olds is that constancy of relationship from early counters with pregnant women and moth- more than three times that of children in childhood is the single best predictor of ers of infants. If you are reading this arti- grades K through 12. According to Dr. positive outcomes in later life. Promoting cle, highlight these two questions and pass Gilliam the study did not explore reasons safe and warm relationships with parents it along it to your local pediatrician, ob- why the children were expelled, “We were- and other caregivers is key to young chil- stetrician and gynecologist or pediatric n't measuring behavioral problems, we dren’s healthy development and later suc- hospital unit. Add a personal note. Who were measuring the decisions teachers cess in school and beyond. Maternal de- knows, maybe it will keep one more child make.” So, we are left to speculate and to pression, left untreated, may be a key factor from being expelled. study the risks that pre-school children face leading to the expulsion of pre-schoolers. Children grow best when they feel safe that contribute to this astounding statistic. Andrew Malekoff, LCSW, CASAC According to Wolkoff, “Depressed and are safe. Healthy attachments are not Early childhood mental health expert mothers tend to perceive their children as about children getting what they want, Jane Knitzer offers a clue when she tells histories of these families found between being more difficult and frequently view- but getting what they need—the assurance us that “research indicates that babies 50 and 75% of the children were living ing their children more negatively. Moth- that an adult caregiver is by their side, whose mothers are depressed…may ‘act with a depressed parent, most often a ers who are suffering from depression can looking out for them, teaching them how out’ in early childhood programs, and mom with a history of depression. respond with too little emotion or energy, to manage their own feelings, and learn- sometimes be ejected from them.” At the Sandra Radzanower Wolkoff, RFTS or overreact with aggression and irritabil- ing about the give and take of relation- Marks Family Right from the Start 0-3+ director, advises that we need to pay atten- ity. The origin of this inconsistency in ships. All children deserve this. Let’s take Center (RFTS), a division of North Shore tion not only to maternal depression, but to parenting is not a lack of desire. Rather, it a small step to make sure they get it. Child and Family Guidance Center, we the mood disorders that accompany child- is consequence of utter exhaustion.” know that the emotional health of a parent birth and that are often an unexpected com- The Center on Disease Control in At- For more information on post-partum de- influences a child’s development. In a plication of pregnancy. Although we are not lanta administered a surveillance project pression and perinatal mood disorders call San- survey we found that over 60% of fami- always sure of the causes for onset, what we aimed at identifying maternal depression dra Wolkoff, Zero-to-Three Fellow and Direc- lies of 147 recent admissions reported do know according Wolkoff, is that “danger early on. Two questions that they asked tor of the Guidance Center’s Early Childhood serious behavior problems in children as lies in how they incapacitate mothers, moms are: 1) Since your new baby was Services at 516-484-3174 ext. 222 or Email at: young as 2 years of age. A review of the frighten fathers, and embroil infants.” born, how often have you felt down, de- [email protected] MENTAL HEALTH NEWS ~ FALL 2010 visit our website: www.mhnews.org PAGE 31

PAGE 32 visit our website: www.mhnews.org MENTAL HEALTH NEWS ~ FALL 2010 Link Between Child Care Academic Achievement and Behavior Persists Into Adolescence

By the U.S. Department of Health and ies have noted similar trends, but the From 1 month of age through sixth higher quality care and higher results on Human Services, National Institutes of study is the first to track children for a full grade, children were evaluated at least cognitive and academic assessments, includ- Health (NIH), Eunice Kennedy Shriver decade after they left child care. annually on tests of cognitive and aca- ing reading and math tests. This correlation National Institute of Child Health and "Previous findings from the study indicate demic progress. In addition, researchers was similar at age 4½ and age 15. A new Human Development (NICHD) that parents appear to have far more influence queried parents regularly and recorded the finding that emerged at age 15 was that on their child's growth and development than type, quantity and quality of child care youth who had spent more time in quality the type of child care they receive," during the children's first 4½ years. The child care as young children reported fewer eens who were in high-quality said James A. Griffin, Ph.D., deputy chief of researchers also observed child care inter- acting-out behavior problems as teenagers. child care settings as young chil- the Child Development and Behavior Branch, actions to evaluate the quality of care. Of "These results underscore the impor- dren scored slightly higher on at the Eunice Kennedy Shriver National Insti- the children studied, nearly 90 percent tance of interaction between children and measures of academic and cog- tute of Child Health and Human Development, spent some time in the care of someone their daytime caregivers," said first author Tnitive achievement and were slightly less the NIH institute that funded the study, "The other than their mother by the time they Deborah Lowe Vandell, Ph.D., professor likely to report acting-out behaviors than current findings reveal that the modest associa- reached 4½ years of age. High-quality and chair of the Department of Education peers who were in lower-quality child tion between early child care and subsequent care was characterized by the caregivers' at University of California, Irvine. "We're care arrangements during their early academic achievement and behavior seen in warmth, support, and cognitive stimula- seeing enduring effects of the quality of years, according to the latest analysis of a earlier study findings persists through child- tion of the children under their care. staff-child interaction." long-running study funded by the Na- hood and into the teen years." The researchers also requested that Similarly, the researchers noted a cor- tional Institutes of Health. The study results appear in the May/June caregivers or teachers evaluate the behav- relation between the average number of And teens who had spent the most hours issue of the journal Child Development. ior of children under their care at 4½ and hours children spent in child care each in child care in their first 4½ years reported The 1,364 youth in the analysis had every two years through elementary week through age 4½ and the youths' own a slightly greater tendency toward impul- been evaluated periodically since they were school. When the students were 15, the evaluations of impulsivity and risk-taking siveness and risk-taking at 15 than did 1 month of age, as part of the NICHD researchers tested the students' academic tendencies at 15. This correlation was peers who spent less time in child care. Study of Early Child Care and Youth De- achievement and, using a questionnaire, independent of the quality of child care Although the study followed children's velopment (SECCYD), the largest, longest had the students evaluate their own be- the children experienced. experience in child care, it was not de- running and most comprehensive study of haviors. These included measures of be- Moreover, the correlation reflected signed to determine cause and effect, and child care in the United States. havioral problems (acting out in class); earlier associations between hours in child so could not prove whether a given aspect Families were recruited through hospital impulsivity (acting without thinking care and caregivers' reports of problem of the child care experience had a particu- visits to mothers shortly after the birth of a through the consequences); and risk tak- behaviors that the researchers had origi- lar effect. It is possible that other factors, child in 1991, in 10 locations in the United ing (engaging in behaviors that might nally detected when the children were not measured in the study, were involved. States. Although the children studied were harm themselves or others). 4½. Hours in child care were calculated The study authors noted that the differ- not a representative sample of children in Rating child-care quality on a scale of 1 as the average number of hours per week ences in these measures among the youth the U.S. population, the families that par- to 4, researchers found that more than 40 a child spent in child care in infancy, as a in the study were small, but the magnitude ticipated in the study were from diverse percent of the children experienced high- toddler, and as a preschooler. of both patterns was consistent from early geographic, demographic, economic and quality or moderately high-quality care. childhood to adolescence. Previous stud- ethnic backgrounds. They noted a modest correlation between see Academic on page 38

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Residential from page 16 selves come in with when enrolling their you, but I am so much more comfortable turning our kids back to their communi- child at Wellspring? being able to communicate with you in a ties. We find that a structured approach to adventure program. In addition, each more positive way.” Those kinds of things this issue helps. We make sure that the participates in individual and family ther- A: Each set of parents is unique. Because are said and discussed in the multi-family kids’ return to school coordinates with the apy sessions. We pay close attention to some of the children who come to Well- group. The kids provide a lot of support beginning of the term or school year. This the type of therapy each client responds spring are approaching young adulthood, for each other in a visible way. Siblings gives them the opportunity to keep up aca- to, and structure more time around those many parents have already experienced often participate in the group process. The demically and socially. People (neighbors, modes. For example, some of our kids their child being at one or more inpatient small family groups are part of the larger even school personnel) who don’t under- respond better to nonverbal therapies such or longer-term facilities, where they might multi-family group, creating the potential stand the depth of the emotional problems as working with our farm animals or art. not have had a successful outcome. There- of all groups becoming more cohesive. our kids have can make it very difficult for In these instances, we make sure these fore, these parents are experienced with On occasion we see magical things hap- the child when they return. We help our specialized activities are added to their having their child at a residential facility. pening with kids and families in this kind kids understand that there will be bumps in schedule. On any day, you might see kids On the other hand, it’s usually a first of environment. Parents groups and multi the road, no matter how well they are do- working in the garden, two or three kids placement for our youngest population of -family groups engage parents to support ing when they leave our campus. We try to working with animals, and another group kids between eight and twelve, so it’s also each other as much as possible. keep abreast of the kids that we return working on art projects that may be thera- a first placement for those parents. First home without intruding on their home- peutically directed. time placements are a particularly emo- Q: Is there an average stay at Wellspring? based support system, so we can provide tionally wrenching experience. We have additional support for them. Q: Do you provide vocational guidance found that on a number of occasions – A: Yes, there is an average stay. For young This coming October, we’ll be hosting for the older kids who are approaching even though we advise differently – the children it is 12 to 18 months; for adoles- an Alumni Family Day here at Well- high school graduation? parent doesn’t tell their child that they are cents, 9 months to 1 year; and for young spring, and one of the workshops will be going to a residential facility until they adults, 6 to 9 months. However, these num- called ‘Bumps in The Road,’ to be pre- A: We don’t have a vocational program actually arrive at the campus or at some bers do not reflect the real picture. What we sented by kids and families who have per se. However, our school staff and point after they arrive on campus. The look for is an appropriate and flexible length experienced these bumps firsthand. Our therapists work with our students’ college emotional angst about leaving their child of stay for each individual. process of addressing stigma is to stress advisors and other educational consultants at a residential facility is very high, no the importance of getting parents to un- to prepare for their future. We do have a matter how competent the staff or com- Q: What are your goals for the kids at derstand what stigma is, how harmful it work program that is related to serving the forting the environment. On the other Wellspring? can be for the kids, and to teach them needs of residents that includes taking hand, we have had foster care kids who creative ways to be supportive and to help care of the house, working in the kitchen, have had 18 previous placements with A: Our goal is to always return a child to their kids deal with this issue. For some working in the gardens and caring for our foster families, psychiatric hospitals, their family, community, school, or work parents it is very difficult because they farm animals. In that sense, we are pre- group homes, and other residential treat- situation. We hope to accomplish this as feel guilty that their child had an emo- paring kids to return to their homes and ment facilities with little ongoing parental quickly as possible with mutual agree- tional problem and that they might have community better capable of taking care contact. ment with parents, therapists and other contributed to their child’s problem. of themselves. These activities give them In our children’s programs, we have facilitators that are involved in each case. needed skills to take charge of their own kids who don’t have legal families, as We also need to have an assurance that Q: In closing, would you like to comment daily living responsibilities - skills that well as kids who have been in foster or there is a local support system (therapist, on some of the challenges you see in com- many don’t have when they come to adoptive homes. In our adolescent pro- home visitors, mentors, etc.), whatever is bating the current tide of disfavor that Wellspring. Many of the parents are gram we require children to have families necessary, to make the return to commu- some treatment advocates are promoting thrilled that their kids can cook and care – adoptive or biological families – or nity permanent. We also must coordinate against residential treatment facilities? for themselves when they return from some related adult in their life. In our with the school systems, which are the Wellspring, and that’s not a bad outcome adult facility where the residents are free most important out-of-home activity that A: As a CEO of what I believe is a high- from a residential stay – in addition to to sign themselves out at any point, we children will be engaged in. For that rea- quality, open door residential treatment being emotionally healthier. almost always have family involvement, son, the rhythm of our admissions and facility, I am very concerned and upset and we usually require the resident to discharges are timed to be in sync with about the flood of advocacy, governmen- Q: Do the kids all dine as one group? permit us to talk with their family and the school year. On June 18th, we gradu- tal activity, and literature against residen- engage their family with them as part of ated four residents and two day students tial treatment. This wave of sentiment has A: Yes, everyone dines family style at the treatment process. from our campus school who returned reached a point where some advocates dining room tables along with therapists home, went on to a new therapeutic feel that residential treatment is not a and milieu counselors. This creates a real Q: When you speak about engaging fami- school, or on to college. meaningful part of the continuum of care. environment with room to engage in lies of Wellspring residents, how does this The Arch Bridge School works closely In Connecticut, Massachusetts, and New meaningful personal and group discus- work for the siblings of residents? with the school districts to identify the York State, generally speaking, residential sions during mealtime. The dining room appropriate time and place for a student to treatment facilities are not the dark vision tables in our adolescent residence can seat A: One of the most fascinating treatment return. Often, that’s a difficult process, of the Dickens orphanages that the advo- twenty people at a time, along with sev- activities that I found when I came to Well- because of the limited resources in local cates are using in their arguments against eral side tables. The side tables can be spring is something we call “multi-family schools where they only see one or two residential treatment. used by a therapist or outside consultant group.” Every two weeks on a Sunday kids like ours a year. Wellspring is a very thoughtful, delib- who needs to meet with a child one-on- evening, parents and other family members erate, professional, and experienced ser- one, and still be part of the group. are required to participate in a whole- Q: When kids return to their homes and vice that is a vital part of the community- community therapeutic family group. Each communities following a stay at Well- based treatment system. There are some Q: It sounds like you have created an family comes with their own configuration. spring, do they encounter any forms of kids that can’t live in their home commu- extended family environment for the kids. It can be mom and dad, grandparents, and stigma towards them relating to where nity without some form of intensive clini- often siblings of the resident. We often get they have been and what might have cal residential intervention. These kids A: That’s a good description. We work as many as 15 family units, with 2 to 4 caused them to be sent to a residential need our help to temporarily remove them to create a family environment in Well- people in each unit participating around a facility? from the tensions they are experiencing in spring’s basic philosophy which is “high large circle, for a total of as many as 50 their home community so that they can nurture – high structure.” There is always people working with two very experienced A: I am ashamed to say that stigma is still work with us to figure out and develop the a lot of verbal support as well as a very Wellspring therapists. a terrible burden that children with serious means and competence to return home. structured day and a structured means for We engage the families in public affir- emotional issues have to endure. Kids Open door residential treatment, in com- developing relationships, and communi- mations, identification of issues, concerns who have been is residential treatment can parison to locked door psychiatric hospi- cating within those relationships. We also and supports that are both inter- and intra- have a difficult time upon return to their tals, is a way back for them into the com- work with the parents to develop a means family. Quite often you will hear from a community and school. There are always munity. For many of these kids, our cam- for them to carry through a high nurture/ mom whose child has been here for 10 “bumps” in the road to recovery. Quite pus facility provides the means of making high structure kind of environment when months tell a rookie mom and dad that “It often their peers will press them with their home and community life more sta- the kids are home on passes for weekends will take a little time to get adjusted to questions such as: Where were you when ble. We provide a means for the child to and when the kids return home on a per- this environment, but in the long run it you were away? Why were you away? repair and rebuild their damaged sense of manent basis. will become productive – so stay with it.” What were you doing? These questions family as well as helping them to build Or you may hear a dad saying to his tend to stigmatize the kids that have been their own self-confidence in order to grow Q: Let’s talk more about the parents. daughter, “I am so thrilled with the pro- in treatment, and so we try to work with and develop into successful and happy What are some issues that parents them- gress you are making, I have always loved the least stigmatizing approach when re- young adults.

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Independence from page 25 ment with four visits per month, and Sup- portive Case Management, two visits per These young adults have the same month are provided. Therapy sessions goals as their peers who do not have a are available weekly and psychiatric ser- MHA in Putnam County mental illness: They want to attend and vices are generally provided on a monthly finish school, obtain a job and have basis. All services can be provided more Promoting a vision of recovery for individuals meaningful relationships. When asked often as clinically indicated. their priorities for assistance, youth with a With the case manager, each Cross- and families coping with mental health issues diagnosis of SED/SMI identify finishing roads client establishes two or three long- school and career training; securing a term goals that become the basis for the Consumer-Drop-In-Center - Peer Bridging Program - Self-Help Groups decent job; learning independent living Service Plan that guides services, and Peer-Run Information and Referral Warmline - Community Outreach skills; managing and living within a identifies the individual’s strengths and budget; finding an affordable, safe and possible barriers to achieving goals. The Education and Support for Family Members comfortable home; and coping with their program strives to empower these young — All of our services are available free of charge — family issues. (ibid) adults, normalize their lives through con- Established more that 15 years ago, nections to social and peer support pro- Crossroads has proven its effectiveness in grams, and help them to navigate systems (845) 278-7600 providing mental health and support ser- by themselves. www.mhaputnam.org vices to this underserved sector of West- Crossroads respects the young adult’s chester’s population. The program has developmentally appropriate need for 1620 Route 22, Brewster, NY 10509 created a strong network of collaboration greater independence and greater control with other service providers and is per- over goals, services and life decisions. ceived as a leader in the community in For Tom, that meant his case manager did addressing the mental health needs of this not give up when he wouldn’t stay in a population. GED program, or insist that he accept an Studies show that programs like apartment in a supportive housing pro- Crossroads, which provide continuity of gram when he said that he wasn’t ready. care and developmentally appropriate Over time, Tom achieved success. His services can improve outcomes for young case manager connected him with a peer people with a SED/SMI. Over time, these support program which provided him young people are more likely to be em- with acceptance and friends who under- ployed and to be pursuing high school or stood his experiences. No longer isolated, post-secondary education. They are less his confidence improved. He obtained his likely to drop out of high school and less GED and is now enrolled in a community likely to experience interference in their college and is a leader in the peer support lives from their mental health conditions program. Though still living at home, he or from drug or alcohol abuse. (ibid) now can see a future. He is interested in a Crossroads’ multi-disciplined team of career in human services, and has told his licensed clinicians, case managers, and case manager that he is ready for greater psychiatrist help these young adults move independence. With his case manager’s toward self-sufficiency and economic support, he obtained a leaner’s permit – a security by providing a full range of men- milestone that most youth take for tal health treatment and case management granted, but one that is a crucial step to services. Both Intensive Case Manage- self-sufficiency for Tom. MENTAL HEALTH NEWS ~ FALL 2010 visit our website: www.mhnews.org PAGE 37

Education from page 25 this study establish that, by educating chil- dren about mental illnesses, we can change has obsessive compulsive disorder. I also attitudes and foster more accurate under- Human Development wanted to let you know how much I standing and acceptance of people with learned while teaching the Breaking the psychiatric disorders,” says Dr. Wahl. Silence lessons. My mom was diagnosed Lorraine Kaplan adds “These results will Services of Westchester with bipolar disorder last year and these help us with our goal of moving mental lessons actually taught me a lot about illness into the mainstream; we look for- what she is going through. Thank you for ward to a time when schizophrenia and Creating Community sharing this wonderful program with me depression will be discussed as openly in • and my students.” the classroom as diabetes or cancer.” Human Development Services of Westchester serves adults and families who are “Substantial research has established NAMI is a nationwide grassroots, self- recovering from episodes of serious mental illness, and are preparing to live that the public holds inaccurate negative help, and advocacy not for profit organiza- independently. Some have had long periods of homelessness and come directly beliefs about those with mental illnesses, tion dedicated to improving the lives of all from the shelter system seeing them as dangerous, unpredictable, those affected by severe mental illness. For unattractive, unworthy, and unlikely ever more information on BTS and the NIMH • In the Residential Program, our staff works with each resident to select the to be productive members of society; cre- study visit www.btslessonplans.org. For level of supportive housing and the specific rehabilitation services which will ating an environment that impedes both NAMI Queens/Nassau call 516-326-0797or assist the person to improve his or her self-care and life skills, with the goal of treatment seeking and recovery. Children visit www.namiqn.org. The project de- returning to a more satisfying and independent lifestyle. and adolescents are particularly sensitive scribed was supported by Grants Number to public opinion and attitudes. Ostracism, R01MH076093 and R01MH075837 from • The Housing Services Program, available to low and moderate income

rejection, teasing, and damage to self- the NIMH. The content is solely the respon- individuals and families in Port Chester through the Neighborhood esteem, as well as reluctance to seek or sibility of the authors and does not neces- Preservation Company, includes tenant assistance, eviction prevention, home accept mental health treatment, are among sarily represent the official views of the ownership counseling, landlord-tenant mediation and housing court assistance. the possible consequences. The results of NIMH or the National Institutes of Health. • Hope House is a place where persons recovering from mental illness can find the support and resources they need to pursue their vocational and educational goals. Located in Port Chester, the Clubhouse is open 365 days a year and draws members from throughout the region.

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Culture from page 18 origin population is expected to increase 12.5% with 50% of those individuals be- Celebrating the Life mediate such challenges may be related ing under age 17. The Native American to lack of early detection by providers Indian population is expected to increase and Resiliency of Young People and parents; untrained and culturally to 6.0%, 25% of whom will be adoles- biased providers; lack of parent and pro- cent. Concurrently, the population of vider knowledge of efficacious treat- Caucasian children in the U.S. is expected By Odell Jno-Charles, BA dance a glimpse into his state of mind. ment. For example, “Latino” youth have to decrease by about 3.0% (U.S.Census and Andres Esguerra, MA He shared how his mental health diagno- the highest rate of suicide, yet they are Bureau, 2007). Alarmingly, 7 million Institute for Community Living (ICL) sis has left him “feeling like an outsider” less likely to be identified by their care- children, or 10% of the population under needing to mask a part of himself in order givers as having problems. Disparities in age 18, have a parent under some form of to maintain the respect he has gained. He service may be due to different barriers correctional supervision, (Bureau of Jus- inden House is a Child Commu- went on to share how half a year was such as insurance status and setting tice, 2006). nity Residence in East Flatbush, wasted in the hospital, before he found where behavioral health services are Failure to adapt children and adoles- Brooklyn. At any given time, up himself and changed the expectations he delivered. “Minority” children tend to cent services to various socio- cultural to eight adolescent boys partici- had regarding his future. Instead of con- receive behavioral health services perspectives can result in the underutili- Lpate in treatment while residing at the tinuing to mask his diagnosis and spend- through the juvenile justice and welfare zation of services and consequently can house. All the young men who come ing unnecessary time in the hospital, he systems more often than through schools result in unmet needs. The increasing through the program’s doors have experi- likened that period of time to “a fresh or special settings. magnitude of poverty, substance use/ enced hardships during their lifetime, breeze that opened a new door of oppor- Unfortunately, efforts to address abuse, violence, illiteracy and teen preg- which have impacted the way they view tunity.” This allowed for “a new life to “racial” and ethnic disparities in behav- nancy have profound effects on the unmet themselves and the world around them. emerge” and as stated in the last stanza of ioral health delivery are constrained by service needs of diverse populations. Our Despite some of the challenges they have his poem: “I will see my life as it begins profound socio-environmental, institu- efforts must focus not only on equalizing endured, these young men persevere to unfold.” tional and market forces. Currently young access to services, but also on equalizing every day to attain the same goals that Another youngster spoke of the lack of people in the U.S. are increasingly ethni- outcomes of care. Moreover, we must other adolescents strive for, from finding understanding he feels his mother has cally diverse. Data indicates that children move beyond policy interventions to employment to completing high school, regarding his diagnosis. “I am a young and adolescents of “color” make up as more socio-education approaches, where while also attempting to build and nurture man who has been in hospitals diagnosed much as 40% of the U.S. population. It is government agencies are not agents of relationships with peers and family. with ADHD, ODD and Mood Disorder. I estimated that the “Latino” population control but agents of support and The month of May has been recog- am a son with no mom to love, living will become the largest ethnic group in change. Early identification and educa- nized as Children’s Mental Health Month. with another person’s mom, that doesn’t American society. Asian and Pacific Is- tion about psychosocial disparities and As a means to honor and acknowledge trust me, who doesn’t understand”. These lander make-up the second fastest- culturally flexible definitions of behav- the young men and their resilience, the powerful words came from a young soul growing “minority;” of that group 50% ioral problems can assist in the preven- boys decided to share poetry with friends who lost his biological mother at a very are new immigrants, and about one third tion and provision of services to multi- and family at an event held at Linden young age, and feels that his adoptive are younger than age 17. The African cultural children and adolescents. House one Friday evening. The idea of mother does not understand him. He holding a poetry event had been explored shares how his diagnosis makes it diffi- with the boys at their weekly Community cult for him not to be “impulsive and ag- Meeting and was met with no resistance. gressive,” which then leads to conflict A sense of eagerness took hold of the and misunderstanding regarding his be- young men, as this particular group uses havior and true intentions. Mental Health News writing as a means to share their All the young men took turns reading thoughts and feelings. This formal event their poems. Staff became involved as 2011 Theme and Deadline Calendar provided them with the opportunity to well, sharing poems written by other boys put their pain, struggle, resilience and who were not at a place to offer their triumph on stage. work to an audience themselves. Each It was a Friday afternoon, as the in- young man poured his heart into their Winter 2011 Issue: vited guests slowly began to creep into work, leaving everyone at the residence the residence. A bit of nervous energy feeling the numbing impact of their ex- “The Impact of Race and Racism filled the room, perhaps in anticipation of periences and words. Everyone at Linden on Mental Health Clients, Practitioners, Organizations what was in store. Or it may have been House, including the young men was able the raw emotion of what the young men to acknowledge that their experiences, and Mental Health Delivery Systems” were about to reveal that was gnawing at although painful, were predecessors to them. Either way the first youth valiantly their strengths in character and overall (Please Note: Articles for this issue are by Invitation Only) rose and began to give those in atten- resiliency. Deadline: November 1, 2010

Spring 2011 Issue: Academic from page 32 in adolescence. These findings underscore the importance of studying the linkages “The Mental Health Needs of Older Adults” The study's findings were consistent between early care and later development." among boys as well as girls. In addition, A video of Dr. James Griffin discussing the previous studies had suggested that child study findings can be viewed on YouTube at: Deadline: February 1, 2011 care could have benefits for children from the researchers created a risk index with The NICHD sponsors research on devel- Summer 2011 Issue: such factors as family income, the opment, before and after birth; maternal, mother's level of education, and mothers' child, and family health; reproductive biol- “Women’s Issues in Mental Health” reports of depression symptoms, dividing ogy and population issues; and medical reha- their group into three based on risk. Both bilitation. For more information, visit the Deadline: May 1, 2011 the achievement and behavior patterns Institute's Web site at . three groups. The National Institutes of Health (NIH) -- "High quality child care appears to pro- The Nation's Medical Research Agency -- Fall 2011 Issue: vide a small boost to academic perform- includes 27 Institutes and Centers and is a ance, perhaps by fostering the early acqui- component of the U.S. Department of Health “Health Reform and Mental Health Parity sition of school readiness skills," said and Human Services. It is the primary federal James A. Griffin, Ph.D., deputy chief of agency for conducting and supporting basic, and their Impact on People and Service Providers” the NICHD Child Development & Behav- clinical and translational medical research, and ior Branch. "Likewise, more time spent in it investigates the causes, treatments, and cures Deadline: August 1, 2011 child care may provide a different sociali- for both common and rare diseases. For more zation experience, resulting in slightly information about NIH and its programs, visit more impulsive and risk-taking behaviors . MENTAL HEALTH NEWS ~ FALL 2010 visit our website: www.mhnews.org PAGE 39

Kids from page 1 plan - triggers, early warning signs, devel- concepts: physical appearance and attrib- oping and practicing new skills - are an utes, freedom from anxiety, intellectual become overwhelming. integral aspect of programming through- and school status behavioral adjustment, The thought of inpatient hospitaliza- out the day. They are established in the happiness and satisfaction, and popular- tion can be frightening to parents, guardi- context of the child’s chronological and ity. We have over a decade of data from ans, and siblings as well as the child. The developmental age and/or level of func- this instrument and a response rate of over separation alone can be cause for signifi- tioning and these issues are addressed 80%. Results consistently indicate a clear cant anxiety and concern. Some parents throughout the hospitalization in the mi- change in the youngster’s self perception may ask questions such as: Why can’t this lieu, recreational activities, skill building from the time of admission to the inpa- be done on an outpatient basis? Do I have modules including daily goal setting tient unit to the time of discharge. Spe- to give my child up to these people/ where goals for the day are established cifically, over the last year alone, a thou- strangers? Will they just drug my and discussed, Focus and Wrap Up meet- sand children rating themselves on Piers- child? What will she do all day in ings to discuss progress, and Dialectical Harris, scores improved 30% to 40%. The there? How do I know this place is any Behavior Therapy interventions where individual subscales consistently showing good? Will I get to have contact with my target symptoms are identified, the sever- the greatest change during hospitalization child? Can I call and visit him? Young- ity is rated and progress noted daily. A are the child’s self-perception scores re- sters may ask: Are they taking me from token economy system is in place on each lated to “anxiety”, (a 55%-65% improve- my parents? Are my parents sending me of the respective children’s programs and ment) and “happiness”, (a 50%-60% in- there because I was “bad? When will I adapted to the child’s age. It is important crease), both of which are key to a young get out? Can I see my family? Will I to note that emphasis is placed on persons experience of depression. ever see my friends again? “earning” and not losing points, tickets, or Simultaneously, youngsters and par- These are the type of concerns that privileges. This positive perspective, the ents are asked to complete an anony- have been perpetuated by the stigma of strength based emphasis, and the compre- mous satisfaction survey relating to their psychiatric care and the artifacts of nega- hensive and reinforcing approach to treat- experience in the hospital encompassing tive inpatient experiences. It is important Joseph Commisso, PhD ment planning and interventions have all aspects of their experiences from the to remain cognizant of the fact that inpa- been critical to quality care. Furthermore, admission process, financial arrange- tient is NOT just a place, but rather a and most importantly, the individualized ments, comfort of the physical environ- treatment intervention. The role of expert parents and their children are expert in nature of the approach to care has greatly ment to clinical interventions such as indi- inpatient care has improved just as mental their knowledge of their own lives, func- contributed to successful outcomes. vidual and family therapy, discharge plan- health care in general has adjusted to ex- tioning, strengths, and areas of concern. The commitment to quality care and ning, medication management, and direct ternal pressures, new treatment options, The focus of treatment is to help the the intensity of the involvement with chil- nursing care, among others. The child and data collection and analysis, and the feed- child and family to identify the issues dren and family members is critical to the parents are also given the opportunity to back of those receiving treatment. contributing to the crisis that lead to ad- success of the treatment process. An at- provide a narrative about his or her ex- As providers in an established inpa- mission and most importantly, the tempt to engage the patient in treatment perience during the hospitalization. The tient program, Four Winds-Saratoga has strengths of the child and family which often begins at the time of the referral and results have been overwhelmingly posi- found that the role of the hospital has to can be emphasized to facilitate the mitiga- the admission assessment by gathering as tive including some surprising results be multifaceted in order to meet the di- tion of problematic issues. These much information as possible during each from our youngsters who are asked the verse needs of the children and adoles- strengths are idiosyncratic and vary interaction. After the initial interview the following question: Would you come cents we serve. A comprehensive psychi- greatly from situation to situation and child and family are oriented to the living back to Four Winds? Most, we thought, atric evaluation occurs in the context of family to family. For instance, strengths unit, staff members and many aspects of would interpret the inquiry in such a way 24 hour nursing care and skilled milieu may include a supportive family, above the treatment program. Family members as to discount the value of their experi- programming. Multiple assessments are average intelligence, favorable premorbid are encouraged to regularly visit and ence and want to separate them from the conducted including, a psychiatric evalua- functioning, a comprehensive outpatient speak with their child in order to maintain setting, particularly at the time of dis- tion, a nursing assessment, medical/ plan for some, a history of medication the connection. Contact with the physi- charge. While the rating is without excep- physical evaluation, and a social and lei- compliance (which is often overlooked as cian and therapist occurs very quickly in tion, the lowest of the survey, the children sure skills assessment. A therapist is as- strength), a sense of humor, readily en- order to gather further data, discuss treat- and teenagers typically respond in a posi- signed to each youngster who will con- gaging with adults, and a history of en- ment options and discharge planning. It is tive fashion as evidenced by the 80%- duct individual and family therapy as well gaging in hobbies, athletics, or other ex- important to engage quickly since the 90% favorable response. as actively working toward establishing a tracurricular activities. Furthermore, em- treatment in the hospital is relatively brief In conclusion, it is important to recog- comprehensive discharge plan. The unit phasis is placed on helping the child to (six to twelve days in many cases) and the nize that “inpatient” is a complex inter- Medical Director (psychiatrist) provides identify triggers to his or her distress, intervention is one aspect of the contin- vention and the quality and treatment ap- clinical oversight and medication manage- which frequently relates to interpersonal uum of care for children and adolescents. proach of these programs can vary ment, when necessary, for each child. In issues such as teasing or bullying at At Four Winds- Saratoga we are com- widely. Those programs that are charac- addition, school services are provided school, abandonment or rejection by a mitted to quality patient care and actively terized by the following qualities would which includes collaboration with the significant adult in his or her life, or obtain and utilize empirical data obtained seem to be most effective: Respecting the child’s home school in order to maintain trauma related issues, among many oth- during the hospitalization in the form of youngster and family members, emphasiz- as much continuity as possible. The mul- ers. Simultaneously, children and family feedback from the youngster’s experience ing individualized care, maintaining a tidisciplinary team also collaborates with members are encouraged to recognize the in treatment. We also utilize a structured focus on strengths (and avoid the trap of a the child and parents/ guardian to develop early warning signs of a beginning crisis patient and parent satisfaction survey in purely pathological perspective), include a a plan for treatment and discharge. and potential deterioration in functioning the data gathering process. We use the trained committed group of providers in This description may be similar to other – emphasis here is on “early.” Again, Piers Harris Children’s Instrument Self– the program that is reflective of an organi- inpatient programs. What is it that sets one there are many variations to these Concept scale, 2nd edition, which is a zation whose mission is driven by quality apart from the other? How do you know signs. Some examples include, subjective well established tool developed by Ellen care, compassion, and safety. In addition, what components of the program actually feelings of agitation and impatience, ob- V. Piers PhD, Dale B. Harris, PhD, and a program that is focused and places em- contribute to its positive outcome? We servable changes in facial expressions or David S. Herzberg, PhD. This instru- phasis on target symptoms and coping believe that one of the most critical aspects body movements such as leg shaking or ment provides an overall view of a young- strategies, comprehensive follow up care, of a treatment program is the intimate in- finger tapping, thoughts of self-harm, ster’s (ages 7-18) self perception. This is and the creation and utilization of a con- volvement of the child and their parent or changes in the youngster’s choice in mu- a hand scored tool with test items that structive feedback loop involving both guardian. It is critical that parents and col- sic or clothes (i.e. darker, more moribund cover six different subscales, as well as young people and their families are criti- lateral individuals, such as extended family themes relative to the typical presenta- two subscales that account for biased re- cal aspects of a quality program and pro- and outpatient providers are involved in the tion), and sleep and appetite changes sponding and random answering. Items vides the best opportunity for change. assessment, treatment, and discharge proc- among many, many others. New coping are presented as descriptive statements ess throughout the hospital stay. We be- and target skills are identified by the child and the youngster answers in a “yes” or Joseph Commisso, PhD, is Director of lieve that professionals on the treatment and family within the treatment program “no” fashion indicating whether or not the Adolescent Services, and David Woodlock, team need to be expert in the areas of child and practice is encouraged. statement applies to himself or her- MS, is Chief Executive Officer at Four development and psychiatric care and that All of these aspects of the treatment self. The subscales address the following Winds Hospital in Saratoga, New York.

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NIMH from page 1 While diagnosing mental health prob- ment training in combination with CBT A. Psychotropic medications include lems in young children can be challeng- for the child. In other cases, a combina- stimulants, antidepressants, anti-anxiety in your child's behavior. For example, the ing, it is important. A diagnosis can be tion of medication and psychosocial thera- medications, antipsychotics, and mood birth of a sibling may cause a child to used to guide treatment and link your pies may be most effective. Psychosocial stabilizers. Dosages approved by the temporarily act much younger than he or child's care to research on children with therapies often take time, effort, and pa- U.S. Food and Drug Administration she is. It is important to be able to tell the similar problems. tience. However, sometimes children (FDA) for use in children depend on difference between typical behavior learn new skills that may have positive body weight and age. NIMH's medica- changes and those associated with more Q. Will my child get better with time? long-term benefits. tions booklet describes the types of psy- serious problems. Pay special attention to More information about treatment choices chotropic medications and includes a behaviors that include: Problems across a A. Some children get better with time. But can be found in the psychotherapies and chart that lists the ages for which each variety of settings, such as at school, at other children need ongoing professional medications sections of the NIMH Web site. medication is FDA-approved. See the home, or with peers; Changes in appetite help. Talk to your child's doctor or spe- FDA Web site for the latest information or sleep; Social withdrawal, or fearful cialist about problems that are severe, Q. When is it a good idea to use psycho- on medication approvals, warnings, and behavior toward things your child nor- continuous, and affect daily activities. tropic medications in young children? patient information guides. mally is not afraid of; Returning to behav- Also, don't delay seeking help. Treatment iors more common in younger children, may produce better results if started early. A. When the benefits of treatment out- Q. What does it mean if a medication is such as bed-wetting, for a long time; weigh the risks, psychotropic medications specifically approved for use in children? Signs of being upset, such as sadness or Q. Are there treatment options for children? may be prescribed. Some children need tearfulness; Signs of self-destructive be- medication to manage severe and difficult A. When the FDA approves a medica- havior, such as head-banging, or a ten- A. Yes. Once a diagnosis is made, your problems. Without treatment, these chil- tion, it means the drug manufacturer pro- dency to get hurt often; and Repeated child's specialist will recommend a spe- dren would suffer serious or dangerous vided the agency with information show- thoughts of death. cific treatment. It is important to under- consequences. In addition, psychosocial ing the medication is safe and effective stand the various treatment choices, which treatments may not always be effective by in a particular group of people. Based on Q. Can symptoms be caused by a death in often include psychotherapy or medica- themselves. In some instances, however, this information, the drug's label lists the family, illness in a parent, family finan- tion. Talk about the options with a health they can be quite effective when com- proper dosage, potential side effects, and cial problems, divorce, or other events? care professional who has experience bined with medication. approved age. Medications approved for treating the illness observed in your child. Ask your doctor questions about the children follow these guidelines. A. Yes. Every member of a family is af- Some treatment choices have been studied risks of starting and continuing your child Many psychotropic medications have fected by tragedy or extreme stress, even experimentally, and other treatments are a on these medications. Learn everything not been studied in children, which the youngest child. It's normal for stress to part of health care practice. In addition, you can about the medications prescribed means they have not been approved by cause a child to be upset. Remember this if not every community has every type of for your child. Learn about possible side the FDA for use in children. But doctors you see mental, emotional, or behavioral service or program. effects, some of which may be harmful. may prescribe medications as they feel symptoms in your child. If it takes more Know what a particular treatment is sup- appropriate, even if those uses are not than one month for your child to get used Q. What are psychotropic medications? posed to do. For example, will it change a included on the label. This is called "off to a situation, or if your child has severe specific behavior? If you do not see these -label" use. Research shows that off- reactions, talk to your child's doctor. A. Psychotropic medications are sub- changes while your child is taking the label use of some medications works Check your child’s response to stress. stances that affect brain chemicals related medication, talk to his or her doctor. Also, well in some children. Other medica- Take note if he or she gets better with to mood and behavior. In recent years, discuss the risks of stopping your child's tions need more study in children. In time or if professional care is needed. research has been conducted to under- medication with your doctor. particular, the use of most psychotropic Stressful events are challenging, but they stand the benefits and risks of using psy- medications has not been adequately give you a chance to teach your child im- chotropics in children. Still, more needs to Q. Does medication affect young children studied in preschoolers. portant ways to cope. be learned about the effects of psycho- differently than older children or adults? More studies in children are needed tropics, especially in children under six before we can fully know the appropriate Q. How are mental illnesses diagnosed in years of age. While researchers are trying A. Yes. Young children handle medica- dosages, how a medication works in chil- young children? to clarify how early treatment affects a tions differently than older children and dren, and what effects a medication might growing body, families and doctors adults. The brains of young children have on learning and development. A. Just like adults, children with mental should weigh the benefits and risks of change and develop rapidly. Studies have illness are diagnosed after a doctor or men- medication. Each child has individual found that developing brains can be very Q. Why haven't many medications been tal health specialist carefully observes needs, and each child needs to be moni- sensitive to medications. There are also tested in children? signs and symptoms. Some primary care tored closely while taking medications. developmental differences in how chil- physicians can diagnose your child them- dren metabolize - how their bodies proc- A. In the past, medications were seldom selves, but many will send you to a special- Q. Are there treatments other than ess - medications. Therefore, doctors studied in children because mental illness ist who can diagnose and treat children. medications? should carefully consider the dosage or how was not recognized in childhood. Also, Before diagnosing a mental illness, the much medication to give each child. Much there were ethical concerns about involv- doctor or specialist tries to rule out other A. Yes. Psychosocial therapies can be more research is needed to determine the ing children in research. This led to a lack possible causes for your child's behavior. very effective alone and in combination effects and benefits of medications in chil- of knowledge about the best treatments The doctor will: Take a history of any with medications. Psychosocial therapies dren of all ages. But keep in mind that seri- for children. In clinical settings today, important medical problems; Take a his- are also called "talk therapies" or ous untreated mental disorders themselves children with mental or behavioral disor- tory of the problem - how long you have "behavioral therapy," and they help peo- can harm brain development. ders are being prescribed medications at seen the problem - as well as a history of ple with mental illness change behavior. Also, it is important to avoid drug in- increasingly early ages. The FDA has your child's development; Take a family Therapies that teach parents and children teractions. If your child takes medicine for been urging that medications be appropri- history of mental disorders; Ask if the child coping strategies can also be effective.2 asthma or cold symptoms, talk to your ately studied in children, and Congress has experienced physical or psychological Cognitive behavioral therapy (CBT) is doctor or pharmacist. Drug interactions passed legislation in 1997 offering incen- traumas, such as a natural disaster, or situa- a type of psychotherapy that can be used could cause medications to not work as tives to drug manufacturers to carry out tions that may cause stress, such as a death with children. It has been widely studied intended or lead to serious side effects. such testing. These activities have helped in the family; and Consider reports from and is an effective treatment for a number increase research on the effects of medi- parents and other caretakers or teachers. of conditions, such as depression, obses- Q. How should medication be included in cations in children. Very young children often cannot ex- sive-compulsive disorder, and social anxi- an overall treatment plan? There still are ethical concerns about press their thoughts and feelings, so mak- ety. A person in CBT learns to change testing medications in children. How- ing a diagnosis can be challenging. The distorted thinking patterns and unhealthy A. Medication should be used with other ever, strict rules protect participants in signs of a mental illness in a young child behavior. Children can receive CBT with treatments. It should not be the only treat- research studies. Each study must go may be quite different from those in an or without their parents, as well as in a ment. Consider other services, such as through many types of review before, older child or adult. group setting. CBT can be adapted to fit family therapy, family support services, and after it begins. As parents and caregivers know, chil- the needs of each child. It is especially educational classes, and behavior manage- dren are constantly changing and grow- useful when treating anxiety disorders.3 ment techniques. If your child's doctor Q. How do I work with my child's school? ing. Diagnosis and treatment must be Additionally, therapies for ADHD are prescribes medication, he or she should viewed with these changes in mind. While numerous and include behavioral parent evaluate your child regularly to make sure A. If your child is having problems in some problems are short-lived and don't training and behavioral classroom manage- the medication is working. Children need school, or if a teacher raises concerns, you need treatment, others are ongoing and ment. Visit the NIMH Web site for more treatment plans tailored to their individual can work with the school to find a solu- may be very serious. In either case, more information about therapies for ADHD. problems and needs. tion. You may ask the school to conduct information will help you understand Some children benefit from a combina- an evaluation to determine whether your treatment choices and manage the disor- tion of different psychosocial approaches. Q. What medications are used for which der or problem most effectively. An example is behavioral parent manage- kinds of childhood mental disorders? see NIMH on page 41 MENTAL HEALTH NEWS ~ FALL 2010 visit our website: www.mhnews.org PAGE 41

NIMH from 40 Q. What special challenges can school havior changes. Finally, support groups sities or medical schools; State hospital present? help parents and families connect with outpatient clinics; Family services, social child qualifies for special education ser- others who have similar problems and agencies, or clergy; Peer support groups; vices. However, not all children diag- A. Each school year brings a new teacher concerns. Groups often meet regularly to Private clinics and facilities; Employee nosed with a mental illness qualify for and new schoolwork. This change can be share frustrations and successes, to ex- assistance programs; Local medical and/ these services. difficult for some children. Inform the change information about recommended or psychiatric societies. Start by speaking with your child's teachers that your child has a mental ill- specialists and strategies, and to talk with You can also check the phone book teacher, school counselor, school nurse, or ness when he or she starts school or experts. under "mental health," "health," "social the school's parent organization. These moves to a new class. Additional support services," "hotlines," or "physicians" for professionals can help you get an evalua- will help your child adjust to the change. Q. How can families of children with phone numbers and addresses. An emer- tion started. Also, each state has a Parent mental illness get support? gency room doctor can also provide tem- Training and Information Center and a Q. What else can I do to help my child? porary help and can tell you where and Protection and Advocacy Agency that can A. Like other serious illnesses, taking care how to get further help. help you request the evaluation. The A. Children with mental illness need guid- of a child with mental illness is hard on More information on mental health is evaluation must be conducted by a team ance and understanding from their parents the parents, family, and other caregivers. at the NIMH Web site. For the latest in- of professionals who assess all areas re- and teachers. This support can help your Caregivers often must tend to the medical formation on medications, see the U.S. lated to the suspected disability using a child achieve his or her full potential and needs of their loved ones, and also deal Food and Drug Administration website. variety of tools and measures. succeed in school. Before a child is diag- with how it affects their own health. The nosed, frustration, blame, and anger may stress that caregivers are under may lead Citations Q. What resources are available from the have built up within a family. Parents and to missed work or lost free time. It can school? children may need special help to undo strain relationships with people who may 1. Kessler RC, Chiu WT, Demler O, these unhealthy interaction patterns. Men- not understand the situation and lead to Merikangas KR, Walters EE. Prevalence, A. Once your child has been evaluated, tal health professionals can counsel the physical and mental exhaustion. severity, and comorbidity of 12-month there are several options for him or her, child and family to help everyone develop Stress from caregiving can make it DSM-IV disorders in the National Comor- depending on the specific needs. If special new skills, attitudes, and ways of relating hard to cope with your child's symptoms. bidity Survey Replication. Arch Gen Psy- education services are needed, and if your to each other. One study shows that if a caregiver is chiatry. 2005 Jun;62(6):617-27. child is eligible under the Individuals with Parents can also help by taking part in under enormous stress, his or her loved Disabilities Education Act (IDEA), the parenting skills training. This helps par- one has more difficulty sticking to the 2. Silverman WK, Hinshaw SP. The Second school district must develop an ents learn how to handle difficult situa- treatment plan.4 It is important to look Special Issue on Evidence-Based Psychoso- "individualized education program" specifi- tions and behaviors. Training encourages after your own physical and mental cial Treatments for Children and Adoles- cally for your child within 30 days. parents to share a pleasant or relaxing health. You may also find it helpful to cents: A Ten-Year Update. J Clin Child If your child is not eligible for special activity with their child, to notice and join a local support group. Adolesc Psychol. 2008 Jan-Mar;37(1).

education services, he or she is still entitled point out what their child does well, and 3. Silverman WK, Hinshaw SP. The Second Q. Where can I go for help? to "free appropriate public education," avail- to praise their child's strengths and abili- Special Issue on Evidence-Based Psychoso- able to all public school children with dis- ties. Parents may also learn to arrange cial Treatments for Children and Adoles- A. If you are unsure where to go for help, abilities under Section 504 of the Rehabilita- family situations in more positive ways. cents: A Ten-Year Update. J Clin Child ask your family doctor. Others who can tion Act of 1973. Your child is entitled to Also, parents may benefit from learning Adolesc Psychol. 2008 Jan-Mar;37(1). this regardless of the nature or severity of stress-management techniques to help help include: Mental health specialists, his or her disability. them deal with frustration and respond such as psychiatrists, psychologists, social 4. Perlick DA, Rosenheck RA, Clarkin JF, The U.S. Department of Education's Of- calmly to their child's behavior. workers, or mental health counselors; Maciejewski PK, Sirey J, Struening E, fice for Civil Rights enforces Section 504 in Sometimes, the whole family may Health maintenance organizations; Com- Link BG. Impact of family burden and programs and activities that receive Federal need counseling. Therapists can help fam- munity mental health centers; Hospital affective response on clinical outcome education funds. Visit programs for children ily members find better ways to handle psychiatry departments and outpatient among patients with bipolar disorder. Psy- with disabilities for more information. disruptive behaviors and encourage be- clinics; Mental health programs at univer- chiatric Serv. 2004 Sep;55(9):1029-35.

Groups from page 10 the group is very small, which makes it acting out. For instance, one child in the ginning of the group. If they participate in difficult to walk around and check in per- first group consistently talked back to his an activity, they receive an additional star. Still another is the “jester” who makes sonally with all of the families. Staff grandmother and the grandmother was If they act out, a star is taken away. By jokes and does not listen well. As these makes an effort to move about and touch unable to redirect her grandson. One of the end of the group, if the children have roles surface, they are acknowledged by base with each family and their progress. the other mothers became exhausted with 10 stars, they are rewarded with a toy. the staff and the other families and associ- There is also a good amount of coordina- this routine and firmly told the child that Our goal was to create a system in which ated behaviors and patterns are identified tion required to ensure that the group runs he was disrespecting his grandmother and every child is rewarded with a prize by and discussed. smoothly. Ordering food, writing notes, that if he lived in her household, that be- the end of group, and it worked. Communication is both verbal and non distributing Metro Cards and preparing havior would not be tolerated. The behav- Both groups of families expressed -verbal. Children learn how to communi- material are a few of the concrete tasks ior stopped and the grandmother shared verbally how much they gained from cate from their parents and their peers. involved. that she felt more empowered. attending the multi-family group. Ap- What they learn is not always respectful The first year that we ran the group we Relationships are our key to interacting proximately one-half of the participants communication. One of the goals in the had a particularly challenging group of with the world. The relationships we have completed their treatment following the program is to increase communication participants. Children with oppositional with our parents and the relationships our group and acknowledged that their goals between parents and children and to teach disorder presented unique behavioral is- parents have with each other teach us how had been achieved. The remaining fami- listening skills as well. To warm up the sues beyond actions and symptoms asso- to behave with those outside the family. lies stayed on and were assigned an indi- group, we play a game of telephone where ciated with the majority of children in To help families understand the impor- vidual therapist. We plan to run the a statement is whispered around the room. treatment. Children do not always feel tance of relationships, we focus on posi- group again this fall in a different set- This illustrates that if the communication like talking about their issues from school tive activities the families can do together. ting: the ICL Emerson-Davis Family is not clear and attention not focused, the or home and they tend to act out their Individual families choose their activities, Development Center. While this will add idea does not get across accurately. Chil- anger instead of verbally expressing it. and then as a larger group we discuss a new set of challenges concerning dif- dren and parents are asked separately how Video games, phones and Mp3 players are rules around family time, obstacles to ferent age groups and confidentiality they know if someone is listening: eye not permitted in the group since they tend to spending time together and how to priori- among residents of the same congregate contact, verbal acknowledgement, body distract everyone. Asking a child to put tize family fun time. facility, a positive aspect is that residents language and ultimately the response are aside a video game to talk about stress at We learn new lessons every time we will not need to travel to get to the the answers we tend to get. Families know school may provide the group with a clear run the group. During the first year, we group. Since families live where the how to listen and how to talk to each other and immediate example of defiant behavior. found that a reward system is an ex- group takes place, there should be fewer but they do not always exercise these One added benefit of having multiple tremely effective tool to encourage the instances of absenteeism. We look for- skills effectively. parents in the room is that they act as par- kids to participate. Even a small, inexpen- ward to extending our experiences within There are challenges that we face dur- ents to all the kids. If a parent is not man- sive toy is an incentive to get children a clinic setting to a residence and to con- ing the group; some are physical, some aging her own child, rest assured another back on track. We used the star system. tinue learning from the challenges that are emotional. The room in which we run parent will let the child know they are Children start out with 5 stars in the be- will present.

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Poverty from page 12 Room for an assessment of suicidal intent. stantly comparing himself to his very suc- scout out neglect like squirrels foraging About half are hospitalized. cessful younger brother. We continue to for nuts. Since the majority of our clients Patrice, a victim of years of domestic vio- monitor him very closely, and his fanta- are people of color, and many on staff are lence at the hands of her husband, was Tiana was 13 when she attended a “hooky sies have lessened. white, the racial hierarchy is even more unable to work as the result of an unmedi- party”, where she consumed a lot of alco- pronounced. We are the strictest mothers cated case of bipolar disorder. Her es- hol and willingly had sex with a boy she Edwin, 13, had been in treatment at our and fathers, we follow rules and respect tranged husband kept her on his health didn’t know. Later on at the party she was clinic for over a year, for sexualized be- limits. We also acknowledge the strength insurance so she was unable to get Medi- raped by another boy. Her mother called havior towards girls in school and one they show in the face of terrible odds: caid and he refused to pay her co-pays or the police, who are conducting an investi- psychiatric hospitalization for suicidal they start at a disadvantage and never cover any medical expenses. Off medica- gation. Tiana had a history of self-cutting. thinking. Over one summer weekend, we quite catch up. tion, Patrice often felt unable to care for Since the rape she has had to have multi- learned that his father had allegedly stran- There is an advantage to being a white, her young teenage sons and asked her ex- ple examinations for STDs and is taking gled Edwin’s pregnant, 16 year old sister middle class ghost in the Bronx. As in to keep them for a few extra days. Instead HIV medications prophylactically. and tried to hide the nude body in the fur- most situations when one is white, I have he dropped them off at her home when she nace of his building. Edwin’s mother’s the choice to come or to leave when I was feeling acutely depressed. She went to A 15-year old Latino boy accepted that he world crashed around her, since she had want to. But, I am always deeply affected the emergency room for medication and was gay, but his mother could not and let the kids visit her ex-husband knowing by the stories I hear day after day. I am while there, social workers observed continued to shame him with insults and his past history of violence towards her. never inured to the heartbreaking tales of bruises on the boys; the boys indicated subtle slights. He ran away from home for The family was destroyed as Edwin’s fa- human betrayal, as male family members that their father had hit them. Patrice felt a week and stated he just “hung out at ther went to jail and his sister was dead. and strangers alike steal the innocence so overwhelmed she stated she couldn’t Barnes and Nobles in the city” until clos- Later we learned that the father was re- from their young girls, leaving them fear- take them home and they were sent to a ing. After he returned home, it was never sponsible for the sister’s pregnancy. ful of going to the dentist where their foster home. There are times when she clear where he had really been or what he mouths feel exploited once again; untrust- cannot afford food or household supplies, had been doing. A lot of gay kids of color So many questions arise when working ing in relationships with men who may often has no money for tampons or toilet in the Bronx are in the closet, in spite of in this parallel universe. How is it that so have no wish to hurt them when they paper. She had no winter coat. The older efforts to provide them extra support. many African -American and Latino boys grow up; or passing on fear and twisted boy began writing about death on his aged 6 to 13 have “Attention Deficit Dis- notions of sexual development to their Facebook page, and soon after had carved In session, eight-year old Darnell admit- order”? Is it because they no longer have daughters. My staff, who hear the stories a broken heart on the inside of his arm. ted his father hits him on the head with recess at school so the boys are literally in great detail week after week, do tend to the wooden pole of the broomstick, with bouncing off the walls or because a label get numb, and my job is to try to prevent Our patients’ lives are so difficult not only wet shoes and a belt. He said he really and medication are easier to dispense than the vicarious traumatization to which they because of their personal histories, but tries to be a good boy. We reported it to a response to the larger crises they live are vulnerable. They have to have a place because of the poverty they live in, the the State Central Registry in Albany. The through? If kids have been physically or to debrief, to cry if they need to , to take a racism they encounter, the language bar- parents continue to come to us for mar- sexually abused, how can they sit still and long, steady exhale between the stories of rier faced by our Latino population, and riage counseling and psychoeducation on learn geometry? What happened to school grievous loss and destruction of the spirit. the lack of steady work or affordable ways to set limits with their children with- personnel handling things that happen in It is these close encounters with the cru- health insurance. As a result of these dis- out resorting to violence. school? Now 911 is the first response and elty of human nature that can dehumanize parities, they have lived in constant crisis, children no taller than a sapling are trans- us, and we have to keep fighting to be- and have experienced a series of complex Sixteen-year old Thomas told his therapist ported in ambulances to a psychiatric lieve that there is goodness left in resil- traumas. In these times of economic that he had fantasies of hurting some of emergency room in a hospital for a mental ience and in the struggle itself. Sometimes stress, we see an increase in domestic the kids in his high school. He had been health evaluation. There they are prema- it just takes your breath away; all of it. violence and substance abuse, and conse- fascinated by the murderous events at turely saddled with a label, a diagnosis quently, a higher frequency of suicidal Columbine and Virginia Tech and was and a stigma. When parents stop bring- Julie List, LCSW, is a licensed clinical thinking in children. Every week there reading articles about them online. A psy- ing their depressed or suicidal children to social worker, psychotherapist and the are a handful of child and adolescent pa- chiatric evaluation revealed that Thomas us for therapy, we have to call ACS and Director of the Harry Blumenfeld Pelham tients taken to the Psychiatric Emergency had very low self esteem and was con- we lose our role as neutral parties. We Counseling Center of JBFCS .

Home Care from page 14 Autism Spectrum Disorders: These them understand, at their developmental treating Psychiatrist, Clinic, and Therapist children have problems interacting and level, what is happening to their sister/ to know in order to fashion a plan that household financially has impacted the way communicating with others, and are iden- brother, may help ally fears and concerns. will take into account the willingness and a family spends their time and effort. Many tified prior to age 3. The behaviors in- Education of the child and caregiver is an ability of the caregiver in the home. rely on fast and convenience foods as a clude; repetitive behavior such as banging ongoing part of the Home Care nurses visit. The home care mental health nurse can quick and easy way to feed children in the their head, rocking, and spinning objects, Anxiety of both the child and caregiver are be an invaluable tool in preventing, access- evenings, rather than a meal that is home poor awareness of others and are at in- to be expected. It is difficult to retain infor- ing, treating, and monitoring children and cooked. These fast and easy foods are much creased risk for other mental disorders. mation when you are very anxious, so, it is adolescents with mental health issues, in higher in fat, sugar and salt. The after school Autism affects 1 in every 110 children. better to allow the first part of the visit to be preventing relapses in children with mental time is when children can be more active, Schizophrenia: Children have psychotic used for therapeutic interaction, followed by health problems, supporting and encourag- doing fun activities outside. However, due episodes with hallucinations, withdrawal, educational issues. Education regarding ing the parents/caregiver to continue treat- to parents working, children may be re- delusions, disordered thinking, and loss of services, diagnosis, symptom management, ment and reinforcing good parenting skills, quired to go home, lock the door, and stay at contact with others and reality. Schizophre- emergency management, medications and and preventing acute hospitalization of the home until the first parent arrives home. nia affects 5 out of 1,000 children. administration, and need for continued fol- child with a mental health disorder. This encourages sedentary activities and As a home care nurse, in order to de- low up and treatment are some of the items unmonitored snacking. The lack of proper velop a plan of care for a child with a men- addressed. Safety regarding medications and ENDNOTES

adult/parent availability does not lend itself tal illness, he or she must be treated within children is an issue, which may be solved - American Psychiatric Assn., Obesity can be for time to talk about their daily stresses and a holistic paradigm. The child lives with with the use of a locked box to prevent acci- harmful to your child’s Mental Health. Re- concerns. This may lead to emotional eating other family members one (or two) of dental overdose. The learning must not be search shows Significant risks and impact.

to fend off their mood. These children are at which is the primary caregiver. Along with given all at once, but based on comprehen- - Cole, M., (April 16, 2001). The Gridlock in increased risk for mental disorders. In one earning trust with the child, it is of utmost sion and degree of importance. Mental Health Services for Children. New York Nursing News. study, 13-14 year old girls were four times importance to earn trust with the caregiver Since the mental health home care more likely to suffer from self-esteem is- (s). Building upon a trustful therapeutic nurse sees the child in the home, we have - Marcus, L., and Baron, A. Childhood Obesity. sues. Low self-esteem apparently leads to relationship will most likely make the dif- access to knowledge the other mental The Effects on Physical and Mental Health. NYU Child Study Center. loneliness, sadness, nervousness, poor body ference between compliance or noncompli- health caregivers do not. We can evaluate image, and are at high risk for substance ance. This person will play a key role in how the caregiver functions within the - National Mental Health Information Center. abuse, smoking, and depression, which, if whether a child gets to MD or Clinic appts, home. Is the caregiver organized, appear SAMHSA Health Information Network. Chil- left untreated, may contribute to the cause or obtaining and administering medications to competent and willing to support the dren’s Mental. Health Facts. Children and Adolescents with Mental, Emotional, and Be- effect of obesity. In a recent University of the child and being alert to any changes in child? Does the caregiver have illnesses havioral Disorders. Minnesota study, overweight children who the child’s physical and mental status. of her/his own to deal with? Is the care- - United Way (2005). Overcoming Disease and are teased by family and other children, Other siblings in the home also need giver employed? How will the caregiver Disabilities. Focused Care Council. Mental 26% had considered suicide, and 9% at- attention and support of the home care take the child to his or her appts or obtain Health Issues in Children and Adolescents. tempted suicide. In another study Schwim- nurse. Other children may suffer from medications? Will the caregiver remem- - U.S. Department of Health and Human Ser- mer, et al (2003), obese children rated their lack of attention of the caregiver, espe- ber what to do in an emergency? How vices.(1999). Mental Health. A Report of the quality of life with scores as low as young cially during a period of crisis. Giving well are they adhering to the plan of care? Surgeon General. Rockville, MD, U.S. Health cancer patients on Chemotherapy. some brief attention to them, and helping All of this information is important to the and Human Services. MENTAL HEALTH NEWS ~ FALL 2010 visit our website: www.mhnews.org PAGE 43

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Ad Sizes - In Inches Deadline Date Winter Issue - November 1, 2010 Width Height Spring Issue - February 1, 2011 Full Page (1) 10.4 12.8 Summer Issue - May 1, 2011 Half Vertical (2) 5.1 12.8 Fall Issue - August 1, 2011 Half Horizontal (3) 10.4 6.4

Quarter Vertical (4) 5.1 6.4 6 3 4 Quarter Horizontal (5) 10.4 3.1 1 2 Eighth Vertical (6) 5.1 3.1 5 7 Eighth Horizontal (7) 10.4 1.5 Full Page Half Vertical Half Horizontal Quarter V & H Eighth V & H $1,000 $750 $750 $500 $300 Business Card (not shown) 5.0 1.5 PAGE 44 visit our website: www.mhnews.org MENTAL HEALTH NEWS ~ FALL 2010

Recovery from mental illness is possible but it takes a community of support.

Mental Health News provides news, information, education, advocacy, and resources in the community that adhere to our strict evidence-based standards and is a vital link to that community of support.

Learn how Mental Health News can help provide your organization or community group with an affordable and trusted source of mental health education.

Call us today at (570) 629-5960 or visit our website at www.mhnews.org