Focus on Volume 1, 2021 Behavioral Health For professionals in the field, from ’s Behavioral Health Services

A new way to connect

Delivering care in a crisis PAGE 2

Supporting students— wherever they are PAGE 6

Racism’s effect on mental health PAGE 8 DELIVERING CARE IN A CRISIS

Delivering care in a crisis As pandemic-induced stress levels soar, behavioral health experts step up

As the novel coronavirus swept across “During a crisis like this one, it’s not Pivoting to telehealth New York state earlier this year, uncommon to see a drop in patients Manish Sapra, MD, executive director seeking care, particularly mental Dr. Sapra and his colleagues quickly and vice president of Northwell Health’s health services,” he said. “But at the started reconfiguring their care delivery behavioral health services, faced an same time, a pandemic is an extremely model, working with stakeholders urgent dilemma: How could he ensure stressful situation. Add to that the across the health system to implement continuity of behavioral health care for fact that many people are isolated telehealth services that would allow the system’s patients? With providers and don’t have access to their usual practitioners to continue to serve and patients under stay-at-home orders coping mechanisms, and we expected patients at home. — and many patients afraid to visit that many patients would experience “Before Covid-19, we struggled to health care offices even if they could — worsening of their symptoms — from devise the best way to set up telehealth Dr. Sapra knew his team would have to increased anxiety to increased incidence services. It looked like it would take find a way to balance the psychological of substance use.” months, even years, of planning,” he and emotional needs of the community said. “With the pandemic, we were with the requirements of safety. A “new forced to do it overnight. Fortunately, normal” would be necessary, and fast. both patients and providers have

2 Focus on Behavioral Health | Volume 1, 2021 DELIVERING CARE IN A CRISIS

“Before Covid-19, we struggled to devise the best way to set up telehealth services. It looked like it would take months, even years, of planning. With the pandemic, we were forced to do it overnight.” — Manish Sapra, MD

accepted the technology and are open evidence-based psychotherapy services “We will continue to collaborate with to using it — so much so that we plan to to our patients,” he said. “We’ve already community partners to provide the make it a part of our services even after educated a number of Northwell best quality behavioral health care to this crisis is over.” providers on an approach to trauma patients,” Dr. Sapra said. “By providing counseling called Stress First Aid, which evidence-based psychotherapy Training providers informs the resilience services we treatments that can help people better offer to our employees impacted by deal with trauma, as well as expanding on trauma Covid-19. We continue to sensitize our telepsychiatry services, we can As losses began to mount across leaders throughout Northwell to an ensure that every patient can get the , Dr. Sapra and his team approach to stress management that is care they need, no matter what.” realized they also needed to ensure thoughtful and supportive.” that behavioral health practitioners were well-trained in trauma counseling, Taking the long view which takes into account the additional Northwell Health behavioral health To learn more about the traumatic impact of a disaster (such as clinicians and researchers are the pandemic) on people’s behavioral Center for Traumatic investigating the long-term emotional health needs. They quickly stood Stress Recovery & and psychological toll of Covid-19 on up the Center for Traumatic Stress the community and working to identify Resilience or to make Recovery & Resilience. the behavioral interventions that are a referral, call “We worked with psychologists and proving to be the most effective during (877) 390-0392. psychiatrists with broad experience in the pandemic. the area of disaster psychiatry to learn more about how to provide strong,

Emotional support on the front lines At the height of the surge last spring, the behavioral health services team faced a particularly tough challenge: supporting health care workers who were enduring a series of psychological assaults, including fears for their own safety, concerns about infecting their loved ones, and a creeping sense of helplessness when it came to their patients. “Many of our colleagues were experiencing trauma as they cared for people with Covid-19,” Dr. Sapra said. “We needed to find a way to make it easy for them to talk to someone and process their feelings about what they were seeing and experiencing.” The team set up an emotional support resource center for Northwell employees, which included a dedicated warm line where health care workers could speak to a wellness coach or behavioral health specialist 24 hours a day, seven days a week. “That number gave staff a place to go when they were feeling overwhelmed,” he said. “And if it became clear that someone needed additional services, we could easily connect them with another one of our providers. We knew how important it was to address the needs of our employees during an incredibly stressful time.” Northwell.edu 3 A NEW WAY TO CONNECT

A new way to connect The pandemic propelled telehealth from “someday” to right now

As associate executive director “Necessity is the mother of invention,” Before Covid-19, wide adoption of at Zucker Hillside (ZHH), he said. “The pandemic compelled telehealth applications was a lofty Michael Dwyer oversees more than a us to find a new way to support goal, said Anna Costakis, MD, who quarter of a million behavioral health continuity of practice for a lot of runs ZHH’s largest outpatient appointments each year. When state different types of patients. We treat mental health clinic. and county authorities issued people with mood disorders, psychotic “The technology was out there, but stay-at-home orders earlier this year in disorders, addictions, and a host neither our clinicians nor our patients response to Covid-19, he and his team of other mental health disorders. were really pushing for it,” she said. had a heavy lift: setting up telehealth Telehealth was really the only logical “There was a lot of good evidence for services so all those appointments option to continue care.” its benefits — for example, we knew could go forward.

4 Focus on Behavioral Health | Volume 1, 2021 A NEW WAY TO CONNECT

To refer a client for behavioral health services, including telehealth, call central intake at at (888) 450-0447. Reach the Adult Behavioral Health Crisis Center at (855) 602-7480.

regulations governing telehealth apps. With a little help, they were able use and reimbursement; just as to make it work.” promptly, the behavioral health team at ZHH started to use telehealth to Moving to a conduct virtual intakes. As the team got more comfortable with the new hybrid model technology, they expanded its use Telehealth is working so well that it’s to other programs, including some probably here to stay, said Mr. Dwyer with very specific needs, such as the — even after the pandemic wanes. Partial Hospital Program for subacute Indeed, it may well help address some psychiatric patients. longstanding challenges to continuity “If you would have told me that a of care. program like that could be virtual “One of the riskiest parts of treatment and still have such positive treatment comes when you’re linking someone to outcomes, I wouldn’t have believed outpatient care after they have been you,” said Mr. Dwyer. “But the virtual in the hospital,” said Mr. Dwyer. “If the model worked quite well — in fact, connection is broken before that first the program has proven to be just as appointment as an outpatient, it can effective online as it was in person. be hard to re-engage them.” Making We’re on track to have most of our and keeping a telehealth appointment patient visits this year via telehealth. can feel less daunting for the newly It’s really been extraordinary.” discharged patient, providing a bridge Telehealth was successful because to ongoing care. the behavioral health team took “Ultimately, a hybrid model may work care to make clinicians and patients best in the post-pandemic world,” comfortable with the technology. Dr. Costakis said. “That would facilitate The team employed a variety of offering both in-person and virtual approaches to set up patients on appointments, depending on an different telehealth apps for treatment, individual patient’s needs. it might afford us the opportunity to even drafting medical students from “Telehealth works for a lot of patients,” increase access to care. But there were the Zucker School of Medicine at she said. “But sometimes a patient just too many barriers and regulatory Hofstra/Northwell to assist patients may need more support, whether due hoops to jump through to feel like we with the different platforms. “Many of to imminent safety risks or because could make it work.” us thought that some of our patients their symptoms necessitate a higher From zero to sixty, fast who are psychiatrically disabled might level of care. In that case, the patient not be able to adapt to this kind of would come to the clinic. This kind of That was before the pandemic treatment,” said Dr. Costakis. “But they hybrid model gives us more flexibility, overwhelmed . Quickly, know how to use FaceTime and other allowing each individual to receive the New York State relaxed some of the right type of support.”

Northwell.edu 5 SUPPORTING STUDENTS — WHEREVER THEY ARE

Supporting students — wherever they are “Back to school” looks different this year, and students need behavioral health services more than ever

As schools across our area shut down New challenges, last spring, students’ educational, physical and social needs didn’t go new ways to care away. Nor did young people’s need As a first step, program leaders for behavioral health services. In fact, arranged to provide the program’s the demand ratcheted up at the peak crucial school support services and of the Covid-19 pandemic — and still access to mental health care remotely, remains high. first via telephone and then by way of Northwell Health’s school-based other devices as well. The quick rollout mental health services program, of telehealth services to participating based at South Oaks Hospital, switched districts was well-received by gears quickly in order to accommodate the community. lockdown limitations, said But it became clear that more was Brian Pritchard, LCSW, the hospital’s needed to help students who were associate executive director. The coping with unfamiliar challenges and program, launched in 2019, provides a stressors. Many worried that they or don’t find ways to cope with these host of services, including embedded their family members would contract stressors in a healthy way, it can have psychiatric support, to school districts the virus. But even kids whose families long-term consequences.” across Long Island. The program has were not directly affected by the virus School administrators struggled to been so successful that it was poised to were experiencing anxiety and grief find the most appropriate ways to expand into fourteen additional in response to the pandemic, said address the emotional upheaval, said districts — covering nearly 60,000 Sharon Skariah, MD, director of Mr. Pritchard, so the school services students — when the novel child and adolescent psychiatry program created a hotline for students coronavirus started to spread across at South Oaks Hospital. the state. Instead, it had to scramble. and their families. They also created The virus upended the routines and guides for educators and caregivers, “One of the key elements of this coping strategies that young people focusing on language and strategies program was to have a physical typically rely on for support, Dr. Skariah to promote resilience and overall well- embodiment of our team within the said. “There were a lot of worries being, regardless of age. The materials school district,” said Mr. Pritchard. among students about missing their provided age-appropriate ways to talk “When that became impossible, we friends, falling behind academically or with young people about the virus, needed to find a way to maintain not being able to participate in sports help in recognizing signs of stress and continuity for the students.” or other activities that usually help anxiety in children and adults, and them manage stress,” she said. “That’s techniques for easing those symptoms. a lot to deal with — and when children

6 Focus on Behavioral Health | Volume 1, 2021 THE CHANGING FACE OF CHILDHOOD

Looking ahead students and staff are feeling about after Covid-19. It’s important that being in close quarters. There’s also a our districts are aware of this and are As districts navigate the 2020–21 lot of uncertainty about whether kids ready to address potential issues in the school year, the program has been will be coming back to school or doing student population. We’re here to help designing and implementing trainings school remotely, and we are providing them be ready.” and community-facing lectures to support, tools and resources to help educate faculty and families about everyone better manage that.” identifying students’ mental health The South Oaks Hospital school needs and connecting them to care, support program, fortunately, as well as helping them deal with School administrators was designed to evolve to meet grief and loss. School districts have can find out more changing requirements. also requested trainings on how to about the South Oaks wear personal protective equipment, “We know that it is very common facilitate infection control and after a tragedy, whether it’s Hospital school-based manage potential anxieties around 9/11 or Hurricane Sandy, to see a mental health services those measures. corresponding uptick in mental health program by calling needs across the population, especially “The kids were out of school for in child and adolescent populations,” (631) 459-4078. months and months,” said Dr. Skariah. said Mr. Pritchard. “It wouldn’t be a “The school districts really want to surprise to see the same sort of thing know how to manage the anxiety

Northwell.edu 7 PAGE TITLE

Racism’s effect on mental health

8 Focus on Behavioral Health | Volume 1, 2021 RACISM’S EFFECT ON MENTAL HEALTH

How Northwell’s behavioral health professionals address structural racism in their field

More than two decades ago, the The insidious American Psychological Association’s (APA) Office of Ethnic Minority Affairs impact of racism initiated a national conversation on Over the past few decades, research the need for psychology to address has shown that systemic racism takes issues surrounding racism. Since a profound toll on health, affecting then, awareness of how the stresses everything from an individual’s access of injustice and the resulting trauma to care and the provider’s assessment of affect the mental health of people and disease to the quality of treatment and communities has increased. follow-up care. These issues are just as But awareness is not enough, as shown evident in behavioral and mental health by the recent high-profile deaths of care, and the statistics are alarming. George Floyd and Breonna Taylor. In Studies show glaring disparities in May, Sandra Shullman, PhD, president of incidence of disease, degree of disability the APA, issued a statement on behalf and treatment outcomes. of the organization. “We are living in a Furthermore, Black, Indigenous, racism pandemic,” she wrote. She called and people of color (BIPOC) receive for systemic change to address the toll treatment for diagnosed mental health that overt and embedded prejudice conditions at a significantly lower takes on people of color. The same day, rate than white people. When BIPOC Daniel Gillison, Jr., CEO of the National can access the care they need, their Alliance on Mental Illness, stated in a symptoms are often minimized by press release that “the effect of racism mental health practitioners, and they and racial trauma on mental health is experience poor continuity of care. real and cannot be ignored.” And people of color report routine Across Northwell Health, members of stigmatization of mental health issues the behavioral health team are adding in their communities. Over time, these their voices to the call for change. inequities result in a greater burden of “Recent events, including the disability in BIPOC that can have serious Black Lives Matter [BLM] movement, repercussions on their family and have shined a light on these issues and economic lives. the incredible disparities that impact “The mortality gap and the discrepancy communities of color when it comes in health care quality and access to behavioral and physical health,” between Black and white Americans said Helena Roderick, PhD, a senior is widely documented,” said psychologist with Northwell Health Melissa Beattie, MD, inpatient chief Physician Partners, who works with resident in psychiatry and one of the the pediatric and young adult HIV, leaders of Fighting Racial Injustice transgender and genetics programs. and Promoting System Equity (RISE), a “A reckoning is happening. At Northwell committee at Zucker Hillside Hospital we are saying, ‘We cannot continue (ZHH). “Racism is a public health crisis this way. We need to make changes to and one of the major causes of death in address these injustices now.’” the United States.” Many systemic issues come to light when patients come to a hospital for

Northwell.edu 9 RACISM’S EFFECT ON MENTAL HEALTH

mental health treatment, said Christine Lee, PhD, a clinical neuropsychologist and a member of ZHH’s Psychology Diversity Training Council. “Often, there is an underlying guardedness among Black patients when they come in,” she said. “They are not always comfortable speaking about their experiences, either because of negative experiences they’ve had with providers before or what they’ve heard from others in their community.” The Covid-19 pandemic, which disproportionately affects people of color, is also taking a heavy toll on mental health in communities of color. The anti-racism protests that swept the country shined a needed light on the issue, but also brought a lifetime’s pain to the surface for many. “Many people are coming into care in acute crisis, and it’s not uncommon to have a patient talk about how racial “It’s critical that we are not only educated trauma or discrimination has affected them,” said Kalli Feldman, PhD, a on the consequences of systemic racism, supervising psychologist on the ZHH Women’s Unit. “We have people coming but also empowered to start undoing in who tell us explicitly that things they see in the media [about protests and the racist structures that hinder effective other events] are contributing to the fears and anxieties they have for social change.” – Melissa Beattie, MD themselves and their families. It’s not something that can be discounted when providing care.” informed care to all patients, regardless offered input on grand rounds sessions of color, creed or socioeconomic status. and potential guest speakers and held a Diversity, awareness “We started out by giving trainees mentorship series and discussions with space to talk about potential areas trainees. Part of the council’s goal is to and progress of improvement,” she said. “It was a collect diversity-related data on interns place to talk about anything related to and staff to understand where efforts Dr. Feldman and her colleagues founded diversity and discrimination as those can be expanded. the Psychology Diversity Training issues came up during various rotations Council several years ago to address “Patients don’t come to us in a bubble,” in the clinical work they were doing, many of these long-standing and Dr. Feldman said. “We need to be able either with patients or with other systemic issues in behavioral health to understand where they are coming staff members.” care in order to improve the quality of from, as well as the environment and both patient care and clinical training. The program has expanded in the the culture of our own institution. As years since, providing ongoing training clinicians and administrators, we have Dr. Feldman said they were following opportunities for clinicians and to have difficult conversations so we the lead of the APA in looking to create staff through workshops and other can better understand our own cultural a place to address challenges and bring educational programs to address issues context and the implicit biases that ideas to help trainees, supervisors pertaining to race, culture, gender or may influence how we view a patient’s and staff psychologists deliver sexual orientation. The council has situation. That’s where it all starts. But compassionate, reflective and culturally it can’t stop there.”

10 Focus on Behavioral Health | Volume 1, 2021 RACISM’S EFFECT ON MENTAL HEALTH

Dr. Lee joined the council as a trainee, on racism and racial trauma into Moving toward equity and diversity remains part of her the residency curriculum; drafted a focus today. She said the council has proposal for resident recruitment In June, Northwell Health employees been instrumental in helping her to and admissions reform; increased the across the system took a knee in think about the ways in which implicit visibility of support for BLM through remembrance of George Floyd and in bias can influence interactions with visits and teach-ins; and launched solidarity with the BLM movement. patients and their care. Training interns several book and movie clubs. RISE Dr. Roderick called the vigil symbolic remains crucial as a means to address recently hosted a full-day workshop of the many ways that Northwell as inequities. That change needs to come on anti-racism and allyship for a whole and its behavioral health from the top down as well as from the residents and faculty at ZHH, which programs are working to address bottom up, she said. featured Kenneth Hardy, PhD, a leading institutional racism in health care. A primary focus at ZHH is creating voice on diversity and social justice For example, Northwell has joined a a strong training environment, in psychotherapy. national collaborative called Healthcare sensitizing staff to systemic issues Education is just the beginning, she Anchor Network (HAN), whose mission and providing them with strategies to said. “For too long, people believed that is to take action to address the myriad ensure those issues aren’t getting in if providers just gained some cultural impacts of structural racism. At the way of care. Still, “we are seeing competency and sensitivity, anyone Northwell, this means actively engaging that there is more that we can do at could provide excellent care. But we and listening to both patients and an institutional level to have a more are realizing that is just one piece of colleagues of color to improve the diverse staff, and we are working to the puzzle.” A key to building trust and health and well-being, both physical join forces with other diversity groups improving care, she said, is to make sure and mental, of our communities. within the hospital to expand our the organization’s leadership, faculty, “Our community wants change to reach,” said Dr. Lee. “To really meet this doctors, residents, nurses and other happen,” said Dr. Roderick. “We are moment, we need to take a combined health care workers look like the patient saying things cannot continue as they approach that will allow some real population they treat. “When we can have in the past. It’s exciting to see change to happen.” truly understand what our patient that these injustices are being called population goes through, we can get out, and that people are actively Rising to the occasion closer to providing the care they need.” working on how to break down these One group joining the effort is RISE has committed to creating really challenging barriers so we can the Fighting Racial Injustice and an admissions equity committee reduce stigma, improve access to care, Promoting System Equity (RISE) for residents. make people feel safe and heard, and make behavioral health, in general, committee. Recently founded by a “We are looking at this problem from more equitable.” group of psychiatry residents at ZHH, multiple angles, and there is no quick RISE’s mission is to educate, challenge fix,” said Sarah-Margaret Marks, Dr. Beattie said that she is also buoyed and empower staff to better address MD, chief resident of education in by the support of ZHH and Northwell systemic inequities in health care. psychiatry at ZHH. “By supporting as a whole. “It has been encouraging “We wanted to make sure the Black pipelines that can get more people of to witness many Northwell leaders Lives Matter movement had a visible color into health care and psychiatry, taking an active stand against systemic presence on our campus,” said Dr. and then supporting their success racism,” she said. “The silence has Beattie. “As physicians and health care and advancement, we have a huge been broken.” workers, it’s crucial that we are not opportunity to start changing the only educated on the consequences status quo when they land at a of systemic racism, but empowered to place like Northwell.” start undoing the racist structures that hinder effective social change within and outside of our hospitals.” RISE is relatively new, but it hit the For more information about the RISE committee at ground running. The group has hosted Zucker Hillside Hospital, contact Kalli Feldman, PhD, at a lecture series on systemic racism in health care; made suggestions [email protected]. about how to integrate education

Northwell.edu 11 Zucker Hillside Hospital 75-59 263rd Street Focus on Glen Oaks, NY 11004 South Oaks Hospital Behavioral Health 400 Sunrise Highway, Michael Dowling Michael Dwyer Amityville, NY 11701 President and CEO Associate Executive Director Northwell Health Zucker Hillside Hospital Manish Sapra, MD Maria Conforti Executive Director Director, Editorial and Behavioral Health Services Executive Content Northwell Health Northwell Health Public Relations Carolyn Sweetapple, RN, PhD Executive Director South Oaks and Zucker Hillside Hospitals

Focus on Behavioral Health is published by the Northwell Health Public Relations Department. The information within this publication is intended to educate readers about subjects pertinent to their health and is not meant to be a substitute for consultation with a personal physician. Produced by Onward Publishing, Inc., Port Jefferson, NY 11777, (631) 757-8300. Printed in the USA.

Northwell Health Hospitals: Cohen Children’s Medical Center • Glen Cove Hospital • Huntington Hospital • • Long Island Jewish (LIJ) Forest Hills • LIJ Medical Center • LIJ Valley Stream • Mather Hospital • North Shore University Hospital • Northern Westchester Hospital • Peconic Bay Medical Center • Phelps Hospital • • South Oaks Hospital • Southside Hospital • University Hospital • Syosset Hospital • Zucker Hillside Hospital Affiliates: Boca Raton Regional Hospital • Crouse Hospital • Maimonides Medical Center • Nassau University Medical Center • Western Connecticut Health Network Taking to telehealth Virtual programs are filling the gaps in face-to-face individual and group therapy. Here’s a sampling of what is available. For programs at Zucker Hillside Hospital, call For programs at South Oaks Hospital, call (347) 971-4153 for more information. (631) 994-3587 for more information. Adult outpatient services: Comprehensive treatment for a Intensive outpatient addiction services: Individual, group or wide range of psychiatric diagnoses. Includes individual and family therapy; medication management; medication assisted group therapy. therapy; and more. Three to five days per week for three hours per day, on a flexible schedule to fit each individual’s needs. PACE (Progressive Alternative Clinic Experience): Small, multidisciplinary groups that provide a team approach Outpatient addiction services: Evidence-based treatment for for patients who need greater intervention than the substance use disorders for individuals and their families. Day traditional setting. and evening appointments available six days a week (Mon-Sat). Geriatric psychiatry outpatient program: Mental health services Adolescent addiction services: For those between 13 and 21 for older adults and their families. who struggle with their own or a loved Partial hospital program: Short-term intensive therapy that one’s substance use. bridges the gap between inpatient services and the traditional Evening and weekend outpatient setting. appointments Child and adolescent services: Care for children and families available. managing an array of emotional and behavioral issues including Comprehensive ADHD, depressive disorders, gender dysphoria and more. outpatient behavioral Behavioral health college partnership: Individual and group services: Helping treatment for college-age young adults. children, teens, young Perinatal psychiatry services: Addresses the needs of new adults and families mothers experiencing postpartum depression, anxiety or understand and obsessive symptoms, as well as women struggling with manage challenges psychiatric symptoms during pregnancy, and those dealing in order to lead with unexpected pregnancy outcomes. productive lives.