Increasing Our Commitment to Mental Health

We are pleased to share with you that we will be significantly increasing our commitment and capacity for meeting the mental health needs of our patients and participating nationally in addressing the broader problem of providing diagnosis and treatment of children’s mental health issues.

Back in 2011, Dr. Yellin participated in a mini-fellowship given by the REACH Institute, a national nonprofit led by leaders in child psychiatry, psychology, and pediatrics. The fellowship was intended to equip pediatricians with the knowledge and skill needed to address more of their patient’s mental health needs, consistent with the best evidence-based therapies, to improve the mental health of children and adolescents. The fellowship was delivered in collaboration with CAP-PC NY (Child and Adolescent Psychiatry for Primary Care) and had three primary goals:

1. to train pediatricians and other primary care providers to correctly identify and differentiate among pediatric behavioral health problems such as anxiety, depression, ADHD, aggression, mood disorders, and psychosis; 
2. To provide the fellowship participants with training in effectively managing psychopharmacology: selecting medications, initiating and tapering dosages, monitoring improvements, and identifying and minimizing medication side effects; and  
3. To provide the participants with ongoing real-time consultation and mentorship by child psychiatrists at five university-based Departments of Psychiatry at the University at Buffalo; University of Rochester; Columbia University Medical Center/New York State Psychiatric Institute; SUNY Upstate; and Hofstra Northwell School of Medicine. 

After Dr. Yellin completed the mini-fellowship, we were able to expand our capacity here at The Yellin Center for meeting more of our patients' mental health needs, including psychopharmacology. This is an important aspect of the support we provide to families, especially in light of the continuing shortage of pediatric psychiatrists.

Recently, Dr. Yellin applied and was accepted to become a member of the Faculty of the REACH Institute. This weekend he began that journey by participating in the REACH Institute’s two day Train the Trainer Program: Patient-Centered Mental Health in Pediatric Primary Care. Over the next six months, as Faculty-In-Training, Dr. Yellin will be participating in various activities to complete his training, more fully contribute to this important initiative, and continue to build his clinical expertise to better serve our families.

Parachute Teachers

Every student has had the experience of coming to class to find a substitute teacher who struggles to present the lessons the regular teacher has left behind and who may have difficulty keeping the class engaged -- or even under control. Let's stop right here and acknowledge that there are many, many excellent substitute teachers. They have the difficult task of walking into someone else's classroom, with a lesson plan that may not be sufficiently detailed, and for which they have had no time to prepare. They are often underpaid - the national daily rate is about $105, although in New York City, substitute teachers receive $168.54 per day.

The Winter 2017 issue of Ed., the magazine of the Harvard Graduate School of Education, looks at a program designed to improve the lot of both substitute teachers and the students in their care. It notes that as of May 2015, some 625,750 substitute teachers were hired annually to fill in when regular teachers were out and that during a school year of 180 days, on average, teachers are absent between 9-10 days. Districts differ in how they match substitutes with open classroom slots, but no matter what the system, it doesn't always work, which can leave classes uncovered and result in disbursing students to other classrooms or having administrators needing to fill in to cover classes.

Enter Parachute Teachers, a Boston based initiative described as Uber for substitute teachers. As founder Sarah Cherry Rice noted, "Boston has an incredible ecosystem of people who have expertise and who want to be in schools, but there hasn't been a clear pathway to come into schools." What Parachute Teachers does is match individuals who have their own expertise and interests with open classroom spots. The substitutes present their own material -- music, computer coding, food and nutrition, just to name some examples -- often using experiments and practical lessons. Parachute Teachers does background checks, offers training, and does the scheduling for participating schools, with the added flexibility for regular teachers of having someone available to cover for just part of a day, if needed, something that is not generally available in the traditional substitute teacher model.

Presently, Parachute Teachers is in its second year of operation in Boston with about 150 participating substitutes. It will be interesting to see if and how this program expands.

Money Management Tools for Young People

Kids and teens of all ages need to be able to manage money. Whether it is understanding how far the modest allowance of your six-year-old son will go, or whether your teenage daughter wants to save up for a car, a trip, or a video game, understanding money and how to keep track of it is a crucial skill that will be even more important as young people move on to college and the workplace.

Some children and teens may find that they have difficulty keeping track of what they have and what they spend. These difficulties can be the result of problems with the underlying math and calculations involved, or impulsivity and lack of attention to detail. As with adults, kids' skills with money management vary widely and will likely improve over time, as math skills and judgment develop with age.

Parents and teachers can help children and teens build the skills they need while making money management easier and more enjoyable. The Wisconsin Media Lab provides a series of videos with lessons for students from K-12 that cover seven different aspects of financial literacy, including money management, saving and investing, and managing risk.

There are also numerous apps that kids will find fun and educational. We've listed some below:

Piggybot - free for iOS devices
This app is designed for 6-8 year olds and allows users to track allowance spending and savings.

Motion Math: Cupcake! - $5.99 for iOS devices.
Here at The Yellin Center we are big fans of Motion Math to build general math skills, and their Cupcake! game is another winner. This app, for ages 8 and up, helps teach proportions, word problems, coordinates, mixed numbers, and chart-reading by setting up and running a cupcake store.

Savings Spree - $5.99 for iOS devices
This award winning game helps children understand the consequences of their decisions to spend, save, donate, or invest. Designed for ages 7 and up, it introduces the concept of earning money and making choices about what to do once it is earned.

Mint - free for Android and iOS devices
This is a tool that allows teens -- and their parents -- to track their spending and savings by linking their bank accounts and credit cards to present a simple, unified financial picture.

Spendee - basic app is free for Android and iOS devices
Another tool for older teens and adults, Spendee helps to track expenditures, using very clear graphics.

Helping Children in a New Era

Exactly 55 years ago today, I sat in front of a black and white television set in my parents' basement and listened to John F. Kennedy ask us to think about what we could do for our country. I can't remember why I was not in school that day; I must have been home sick, since my parents would never let me stay home for any other reason. And my memory of that day has been conflated with the much clearer memories of November 22, 1963, when I was several years older and all of us were transfixed by the horror of JFK's assassination.

There is a very different kind of individual being sworn in as president today. This is not a political discussion. The facts of the election speak for themselves and the results of the popular and electoral votes are well known. Whatever your political views, it is good to see that our nation's strong history of peaceful transition of power has held sway, and that the checks and balances of our democracy will likely help balance out the impact of a new approach to governing.

The  most important thing that parents can do in this time of change is to be aware of their own state of mind, especially any anxiety they may be feeling, and to help their children cope with the different tone and policies of our new national leadership.

One excellent tool to help parents address a wide array of issues with their children - from respecting the views of others to social change and civic engagement -- is a book list created by the American Academy of Pediatrics and Reach Out and Read. The list is broken down by age groups and was created specifically to deal with issues families might face after the contentious election.

There are also a number of practical articles and blogs that look at how parents can help their children deal with a different political climate and with the anxiety that might trigger. One blog, from The Huffington Post, includes a suggestion from psychologist Dr. Nancy Mramor common to many commentators, who often characterize it as "Put on your own oxygen mask first."

Dr. Mramor notes, "Making peace with uncertainty and finding ways to temper your own stress levels may be the most important key to being a good parent ... “If parents get the care that they need for themselves,” she added, “then they’re going to be able to be better parents for their children.”

Teachers may find resources from Teaching Tolerance helpful in their classrooms and these may be useful for parents as well. And parents may find that some of the tips in a CNBC post-election blog, based on research supported findings, can help them to be less anxious, and thus more able to help them help their children.

Supreme Court Hears Case on Educational Benefit

Last June, we wrote about a case that was being considered for hearing before the United States Supreme Court, Endrew F. v. Douglas County School District. The Supreme Court subsequently agreed to hear this case and oral arguments before the Court were held this past Wednesday. As we had discussed, the case was brought by the parents of a child with autism who were seeking reimbursement for private school tuition from their public school district in Colorado, and is focused on the level of educational benefit that a school must provide to a student with a disability eligible to receive special education under the Individuals with Disabilities Education Act (IDEA).

 

The IDEA requires that a student receive an "appropriate" education, often referred to as "FAPE" - a free, appropriate, public education -and if a district program does not provide FAPE, then the district may be required to pay for the student to attend a private school that does provide such benefit. The "appropriate" standard was first formulated in 1982 and over the years there has been a divergence among  states as to what that standard really means, with terms like "more than de minimus" and "meaningful" being applied by courts in different states in different ways. Resolving this different interpretation of a federal law is one of the key roles of the U.S. Supreme Court. 

In the Endrew case, the student's parents were not satisfied with the very minimal progress he had been making in his public school program, both academically and behaviorally. By not adequately addressing his emotional and behavioral needs, the public school  program did not enable him to advance academically. The Endrews decided to enroll him in a private school and to seek reimbursement for the tuition they paid. Notably, once removed from the public school and receiving support for his emotional and behavioral needs, young Mr. Endrew made real academic progress; no one disputes that the new program offered him substantial benefits. 

In what Justice Alito described as "a blizzard of words", the attorneys representing the school district, the parents, and the U.S. government sought a clear standard for the benefit to be achieved under FAPE, one that would meet the needs of students, recognize that students with severe disabilities might not be able to make the same kind of progress as other, less disabled students, and not place undue financial burdens on school districts to pay for private school tuition. The goal, as noted in the brief filed by the Solicitor General, representing the U.S. government, should be to have the Supreme Court "clarify the proper FAPE analysis and establish a uniform standard to guide courts, state educational agencies, and parents across the country". We will see if the court is able to do so. 

ThriveNYC Gears Up for Improved Mental Health Care

Recently, the American Academy of Pediatrics (AAP) released a report that restated the importance of family-focused therapies for young children experiencing emotional and behavioral problems. This means that the best way to provide young children with support is to treat the whole family; parent training, family therapy, and access to social services are still the best medicine for problems in early childhood. That same report, however, also discussed the barriers that many children and families face when seeking help. 

In 2016, New York City began working to eliminate those barriers, and open the door to mental health care for all of our eight million neighbors. Here at The Yellin Center, we always look at the big picture for every child, and we know that learning is extra hard when students are also carrying the added weight of mental health challenges, which one in five New Yorkers do. We think this initiative has the potential to do some real good for our neighbors, and we’d like to tell you about these exciting plans and how you can get involved.

ThriveNYC, spearheaded by NYC’s first lady, Chirlane McCray, is a city-wide initiative to raise awareness about mental health and increase access to services around the city. This comprehensive mental health plan is based around a five-step plan. First, we have to change the culture. In other words, ThriveNYC wants to make mental health everyone’s business. One in five New Yorkers experiences a mental health problem at some point in their lives, but the topic is something that many families are uncomfortable talking about. You may have noticed the ThriveNYC ad campaign that debuted around the city last summer. It features photos of New Yorkers talking openly about their mental health concerns: “Addiction does not define me. Today I Thrive.” By opening up the conversation with our families, our teachers, our children, and our neighbors, we can make it easier to ask for help.

One of the most exciting parts of this first step is Mental Health First Aid – a free eight-hour course for any New Yorker to learn how to identify, understand, and respond to signs of mental illness. The city hopes to train 250,000 New Yorkers with this course, offered in both English and Spanish. One version of the course is specifically geared towards community members who work with young people.

The second piece of ThriveNYC demands early action. Echoing the AAP, the comprehensive plan is focused on identifying children from birth through college who are experiencing adverse life events (e.g., divorce, financial strain) or reporting feeling sad or hopeless – two predictors of mental illness later on. Identification is the first step to early intervention, and the earlier a child or family can find help, the better the outcome. To do this, ThriveNYC is hoping to put mental health clinics and consultants in schools across the boroughs.

ThriveNYC’s third step is to close the treatment gap by expanding care to under-served pockets across the city. The goal is to not just increase service availability but to also bring treatment provision up to expert-recommended standards. That means working with clinics, hospitals, and other professionals to locate residents in need and provide them with the care they deserve.

Partnering with communities is the crucial fourth step in the ThriveNYC initiative. For example, Connections to Care (C2C) will integrate mental health services into other programs that are already serving communities so that more people can find help. Most importantly, ThriveNYC believes that by teaming up with local organizations, which are trusted in their communities, they can help people feel comfortable enough to reach out and access care.

The fifth piece of the ThriveNYC program involves the way our city government collects, shares, and uses data. As an educator, your blogger has always known the importance of collecting data and using them in a way that makes sense. ThriveNYC plans to open a Mental Health Innovation Lab, which will allow the city to coordinate its data-gathering effort and analyze that data in a way that leads to providing the services that New Yorkers want and need.

Finally, ThriveNYC puts the onus on the city government to hold up its end of the bargain. Mayor DeBlasio and the Department of Health & Mental Hygiene are going to be working over the next few years to create an organized system of mental health care in our city. NYC WELL, for example, launched this past October. This is an anonymous, free, 24-hour call center that offers mental health support. They go beyond the classic emergency mental health hotline to also provide trained peer support, short-term counseling, assistance setting up appointments with a clinician, and follow-up calls to check in with callers and make sure they were able to connect with a professional in their community.

If ThriveNYC sounds as inspiring to you as it does to us, you may be interested in the following resources linked below for getting involved and potentially making a difference for a family in your community.

• Get involved in the mental health call center

• Get trained in Mental Health First Aid

• Work for ThriveNYC

And, of course, check out the website and let your family, friends, and neighbors know it’s time to start talking openly about mental health.

News Literacy Project

There’s been a concerning juxtaposition emerging over the last few years. As adolescents and young adults increasingly turn to social media for news and information, there has been a concurrent rise in the creation and widespread distribution of fake news. Much of this fake news is, not surprisingly, spread through the intricate webs of social media, like Facebook and Twitter. Students are not, however, routinely taught how to fact-check what they see and determine what is real news and what is meant to “persuade, sell, mislead, or exploit.” 

Fake news has come a long way from those magazine ads that look like real articles but say “Advertisement” in tiny print on the top. Now, there are whole sites dedicated to producing and distributing fake news, and many of them have names modeled after legitimate publications. Have you ever heard of the Denver Post, a reputable local paper? What about the Denver Guardian – sneakily named but completely fake (it was recently shut down after the Post exposed it)? Do you think a fifteen-year-old could tell the difference?

A recent podcast on National Public Radio (NPR) tracked down one fake news mogul and found out some very interesting and surprising information about one of the biggest fake news distributors out there. Even though it may seem easy for some to see the red flags – the missing byline, the lack of sources, the single-outlet coverage – millions of students are currently lacking the skills they need to discern real from fake on an ever-expanding internet. And when that means that young adults show up armed at local pizzerias that happened to be the unfortunate target of a fake news virus, it’s time to think about integrating fact-checking into the K-12 curriculum.

The News Literacy Project (NLP), which partners with reputable sources like The Associated Press, Los Angeles Times, and NPR, is hoping to help students change course. NLP’s education programs, including its "checkology" virtual classroom, is helping teachers, administrators, and students learn more about the rise in fake news and how to spot it. A typical three-week literacy course includes interactive lessons with journalists, student projects, and teacher-led lessons based on NLP’s curriculum. NLP believes that “knowing the standards of quality journalism empowers students as consumers and creators.” The coursework covers print, broadcast, and online reporting. Students are taught how to search for credibility, analyze primary and secondary sources, think critically about incoming information, and seek out different points of view. In the age of the echo chamber, where we typically surround ourselves with news that fits our own values and beliefs, learning to seek out valid, reputable sources that disagree with our own ideas is increasingly crucial.

We think The News Literacy Project has the right idea in mind, but talking about credibility with children can start with one discussion at the breakfast table. Consider sharing an age-appropriate article you’re reading with your pancakes and see if you can challenge your family to brainstorm why the article was written, what it hopes to achieve, and who it includes as credible sources. Then practice finding the holes, and see if you and your family can fill those holes with other credible information. Learning how to integrate lots of sources to get the full picture is a useful skill not just for reading the news, but also for navigating the complicated social world of childhood and adolescence.

Common Core - Unique Ways of Thinking

During a recent vacation visiting a friend, your blogger decided to go out with her one night to a PTA meeting. The topic at hand was Common Core math. The speaker, a math specialist at the school, acknowledged that helping kids with homework can be challenging and potentially frustrating for parents who were taught math in a different way. Borrowing and carrying the one, for example, may be the obvious way to solve a subtraction problem to a parent, but not to his/her child.

The speaker emphasized that students, such as my friend’s daughter (already a mathematician and doing fractions with Belgian waffles at breakfast), will be taught a variety of strategies for solving math problems, so they will be equipped with an arsenal from which they can select what works best for them. For example, without automatic recognition of the answer to 4x3, it could be solved by:

• Adding 4 three times
• Knowing that 4x2=8, and then adding 4 more
• Drawing 4 circles, with 3 dots in each
  
• Using graph paper, or a sketch with dots on regular paper, to make a rectangle with a length of 4 and width of 3, and finding the area
  

A problem such as 43-7 could be solved in various ways, such as:

• Identifying that 40-7 is 33, and then adding 3 more
• Mom and Dad’s good old fashioned borrowing and carrying method
• Representing 43 by sketching bars-of-ten and the leftover ones
  

Then breaking a bar up into ones and crossing out the number of dots being subtracted

Clearly, some problem-solving methods will be more efficient than others, and efficiency is ultimately encouraged. However, the teaching of various strategies allows for:

a) options for students who are struggling with other methods

b) conceptual understanding rather than just rote memorization of procedures

c) foundations to turn to when thinking about more challenging problems in the future

For my friend’s daughter, and for breakfast enthusiasts such as myself, the world makes most sense in terms of waffles. For others, this might not be the best methodology. Exposure to various ways of viewing and analyzing problems creates doors where there might otherwise be walls. We may be entering from different angles, but it is important that we each enter in a place from which we can have the personally clearest view, while ultimately seeking out the most efficient route to get there.