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sections highlighted in green
pertains to an issue on MHANYS' Legislative Agenda, which can
be viewed by clicking here.]
Mental Health Housing Rally in
Albany on January 23rd:
Tuesday, January 23, 2007
In “The Well” (1st Floor) of the Legislative Office
Take action and fight for the Campaign’s plan to reform, preserve,
and develop community-based housing with support services for all
New Yorkers with mental illnesses.
Registration, Breakfast & Background Presentation on the Campaign
Rally Kick Off, Lunch
Day’s Event Will Include: Speakers—March Around Capitol—Petition
Drive—Legislative Visits—Packet/ Leaflet Drops—Pictures/
new Governor and the State Legislature need to hear from you about
the importance of ensuring that all New Yorkers with mental illnesses
have access to housing and services. Participants must register
by Monday, January 8 at www.campaign4housing.org,
call (518) 465-7330 or e-mail email@example.com.
MHANYS' position on Housing]
NYS EDUCATION DEPARTMENT SAMPLE STATE COMPLAINT FORM:
The Sample State Complaint Form to be used by parents is now available
on the New York State Education Department’s website. This
form, found at http://www.vesid.nysed.gov/
specialed/publications/policy/samplecomplaint.htm, can be used
when parents, individuals or organizations believe a school district
or public agency has violated a requirement of Part B of IDEA or
New York State laws or regulations related to students with disabilities.
PRESIDENT BUSH APPROVES LEGISLATION PROVIDING RESPITE:
is a December 21, 2006 press release from the National Respite Coalition.
SIGNS CRITICAL RESPITE BILL FOR FAMILY CAREGIVERS
Lifespan Respite Care Act of 2006 (HR 3248)
DC (December 21, 2006) - The Lifespan Respite Task Force, a coalition
of over 170 national, state, and local organizations, applauds the
signing of The Lifespan Respite Care Act of 2006 (HR 3248) into
law. The bill was introduced and championed in the US House of Representatives
by Rep. Mike Ferguson (R-NJ) and James Langevin (D-RI). A companion
bill in the Senate was cosponsored by Senator Hillary Clinton (D-NY)
and Senator John Warner (R-VA). The Lifespan Respite Task Force
includes a diverse group of national and state organizations: state
respite and crisis care coalitions; health and community social
services; disability, mental health, education, faith, family caregiving
and support groups; groups from the child advocacy and the aging
community; and abuse and neglect prevention groups.
caregivers are providing 80% of long-term care in the US, a level
of care valued at $306 billion a year, more than what is spent on
nursing home and paid home care combined. Even though most families
take great joy in providing care to their loved ones so that they
can remain at home, the physical, emotional and financial consequences
can be overwhelming without some support, such as respite. Respite
provides the much needed temporary break from the often exhausting
challenges imposed by constant caregiving.
new law would authorize $289 million over five years for state grants
to develop Lifespan Respite Programs to help families access quality,
affordable respite care. Lifespan respite programs are defined in
the Act “as coordinated systems of accessible, community-based
respite care services for family caregivers of children and adults
with special needs.” Specifically, the law authorizes funds
• development of state and local lifespan respite programs;
• planned or emergency respite care services;
• training and recruitment of respite care workers and volunteers;
• caregiver training.
the bill passed the House, Rep. Ferguson, whose own father was a
caregiver for his ill mother for 6 years said, “Today’s
action by the House of Representatives represents not only an important
victory for family caregivers nationwide, but it also sends America’s
caregivers a clear message: Your selfless sacrifice is appreciated,
and help is on the way.”
behalf of over nation’s family caregivers who desire to keep
their loved ones at home despite limited support, we commend Rep.
Ferguson, Vice-chair of the Health Subcommittee of the House Energy
and Commerce Committee, Rep. Langevin, and Senator Hillary Clinton
(D-NY) and Senator Warner (R-VA) for their leadership, and especially
want to thank them, their colleagues from both sides of the aisle,
and the White House for taking action to help the burgeoning numbers
of family caregivers,” said Jill Kagan, Chair of the National
Respite Coalition, and facilitator of the Lifespan Respite Task
Force. “Relatively minimal investments in respite help family
caregivers provide this care at home and in the community. At a
time when federal and state fiscal resources are limited, this is
the most compassionate and fiscally responsible thing we can do,
and a most welcome gift in this holiday season.”
NYS RELEASES FIRST REPORT
OF THE MOST INTEGRATED SETTING COORDINATING COUNCIL:
From December 18, 2006 NYAPRS Member Summary.
NYAPRS Note: Following are excerpts and highlights of the fist report
of the NYS Most Integrated Setting Coordinating Council. As NYAPRS
members may recall, we joined with our colleagues and friends in
New York State’s cross disability advocacy community in 2003
to win passage of the Most Integrated Setting Coordinating Council
Thanks to a law approved by the NYS legislature and signed by Governor
Pataki in November 2004, the state's Most Integrated Setting Coordinating
Council (MISCC) was established and, according to the Governor's
press release, "charged with implementing the Olmstead Decision
in New York State" in way that would enhance "New York's
commitment to developing an approach to providing services in integrated
settings that are appropriate to the individual needs of New York's
citizens with disabilities.”
accordance with the legislation, the MISCC would issue and monitor
the implementation of recommendations to "each state agency
which operates, licenses or funds programs, services, and supports
for people with disabilities" including the Department of Health
(DOH), the Office of Mental Retardation and Developmental Disabilities
(OMRDD), the Office of Mental Health (OMH), the Office of Alcoholism
and Substance Abuse Services (OASAS), the State Education Department
(SED), the State Office for the Aging (NYSOFA), the Office of Children
and Family Services (OCFS), the Department of Transportation (DOT),
the Division of Housing & Community Renewal (DHCR), and the
Commission on Quality of Care and Advocacy for Persons with Disabilities
(CQCAPD)." The legislation omitted the NYS Department of Labor.
The MISCC also included 9 advocates, 3 consumers, 3 providers and
3 individuals involved in the provision of services to seniors.
developing the plan, the Council, chaired by Thomas Maul, Commissioner
of the Office of Mental Retardation and Developmental Disabilities,
held public forums in New York City, Albany, Syracuse and Buffalo.
Through the forums, MISCC members and staff had the opportunity
to hear from more than 150 people with disabilities, family members,
advocates and service providers.
many months of deliberation and after a subset of the advocates
(later called the ‘Ad Hoc Committee”) found an initial
draft unacceptable, Commissioner Maul authorized the Ad Hoc Committee
to substantively re-draft the report. Ad Hoc Committee members included
consumer representatives Kim Hill (Assembly appointee), Constance
Laymon (Governor’s appointee) and NYAPRS executive director
Harvey Rosenthal (Senate appointee), provider advocates Pat Fratangelo
(Governor’s appointee), Karen Oates (Senate appointee), Cliff
Perez of the Independent Living Center of the Hudson Valley and
Tracy Crandall, then of the Center for Disability Rights.
last month, state released the first MISCC report. The report, which
will be available on the NYAPRS website later today, was greeted
by some of the advocates on the group "with some hesitation
and reservation," since we found that "this report does
not quite meet the requirements of the law that established the
MISCC" and "falls short of the hopes and expectations
of the thousands of New Yorkers with disabilities who are currently
in need of services being provided in a more integrated setting."
advocates ultimately supported the report's going forward, seeing
it as a "blueprint that, at minimum, sets the floor for Governor-Elect
Spitzer and his staff to build upon, rather than having to start
from scratch." They also pointed to "several provisions
that jumpstart activity (in that) "it creates consumer advisory
groups in each state agency to push for strong, measurable action."
and "require(s) the MISCC to continue to meet, at least quarterly,
where we can continually raise the bar."
Some Highlights From The MISCC Report
the direction of MISCC chair Tom Maul, who is credited by the advocates
with keeping the spirit of the MISCC law alive throughout a long,
circuitous process, MISCC members comprised five working committees:
• Assessment, which reviewed assessment processes utilized
by various agencies to identify individuals with disabilities who
could benefit from services in the most integrated of settings;
Community Services, which examined community-based services and
their funding streams, as well as ways to improve the system to
ensure that it is comprehensive and accessible, including public
information and outreach considerations;
Data, which endeavored to identify the numbers of individuals within
each service system in need of service within the most integrated
setting and ways to improve data collection efforts.
Quality Assurance and Improvement, which examined processes for
the evaluation of services to ensure that the provision of such
occurs in the most integrated setting; and
Transportation, which explored means to promote local human service
agency cooperation relating to an all important need for individuals
served in a most integrated setting: transportation services."
Highlights of, the “MISCC Operational Plan”
included provisions that:
Each state agency which operates, certifies, licenses or funds programs,
services or supports for persons with disabilities will adopt the
general principles and guidelines set forth in the report.
Each stage agency will review its services against the general principles
and guidelines and make changes in agency policies and operations
as warranted. Each state agency will also review the recommendations
in this report and implement those that are feasible and appropriate.
Using a format to be developed by the Council, each state agency
will prepare and annually update a Most Integrated Setting Implementation
Plan which details the actions taken over the preceding year and
those to be taken in the upcoming year. The plan will include measurable
standards by which the agency can demonstrate its accountability
to MISCC general principles and guidelines.
Each state agency will establish or identify an existing stakeholder
group, with strong representation of consumers and advocates, to
assist the agency as it develops and implements its Most Integrated
Setting Implementation Plan.
The Council will establish a standard format for the Most Integrated
Setting Implementation Plans to be submitted by the state agencies
as well as a timetable for submission of the plans to the Council.
The plan will address the state agency’s plans to address
recommendations set forth in this report.
The Council will continue to meet at least quarterly to review the
state agency Most Integrated Setting Implementation Plans, to assess
progress made by the state agencies and to advise the Governor and
Legislature regarding the state’s progress in providing services
in the most integrated community-based setting. These meetings will
be open to the public and will be held in a space large enough to
accommodate this requirement."
Recommendations to State Agencies
are some excerpts by NYAPRS from the report's 'bottom line', official
recommendations to state agencies whose implementation will be facilitated
by the stakeholder groups and monitored by the MISCC every 3 months.
of the recommendations are rather general, despite efforts to make
them very concrete and measurable. The advocates are expecting that,
in the first year of the new Spitzer Administration, much more specific
recommendations will be developed, similar to Virginia's report
• A review of assessment policies, practices and
instruments used by other states should be undertaken to identify
best practices for the population served by the state agency.
Institutionalized individuals should be assessed to determine who
could appropriately benefit from services and supports in a more
Assessment processes should be developed to ensure that, for individuals
who are appropriate for community-based services.., all such services
and supports are first exhausted before an institutional placement
As part of the State’s Point of Entry initiative, coordinated
by the New York State Office for the Aging (NYSOFA) and Department
of Health (DOH), an entity in each county should be identified to
conduct assessments of individuals’ service needs and to provide
information on and referral to local community-based services and
supports as an alternative to institutionalization. Once NYSOFA/DOH
implement a Point of Entry system, training should be provided to
stakeholders such as hospitals, nursing homes, home care agencies,
consumer groups and other interested parties....
• Community services should emphasize “self-determination,”
with personal choice and the dignity of risk considered throughout
the service system.
There should be regular and ongoing evaluation of the service system
with evaluation results used to make ongoing systems’ changes.
An evaluation should be performed to assess the extent to which
services promote “most integrated setting” outcomes.
The need for funding improvements, service reconfigurations, and
necessary enhancements should be assessed. The extent to which “money
follows the person” in service funding and delivery should
Each service type should be evaluated against the following criteria:
Accessibility and appeal to consumers, Appropriateness to consumer
needs and preferences, Person-centeredness, Cultural sensitivity
in the delivery of services, Empowerment afforded the consumers
served, The extent to which the dignity of risk is recognized, The
extent to which each service promotes independent living, employment,
socialization and education, The cost effectiveness of the service
and the availability of the service in all of the state’s
There should be an evaluation of the extent to which consumers,
providers, advocates and localities are engaged in identifying needs
and service planning.
The availability of information on services and supports should
be assessed with a determination made as to whether information
is provided in a variety of culturally diverse and accessible formats.
The extent to which service information is available to discharge
planners, service coordinators and others with placement responsibility
should be assessed and training should be undertaken, if necessary,
to increase and promote the education of discharge planners.
Each agency should demonstrate that people are being transitioned
into most integrated settings.
There should be local point of entry systems that provide outreach,
education and referrals so that individuals and their families can
easily access and navigate the service system.
Each affected state agency should evaluate the availability of direct
care and home care workers and develop policies to address this
The service system should be reviewed to identify the need for less-intensive
but critical community supports such as respite, and vehicle adaptations.
The service system should be examined to determine whether it promotes
a “medical model” rather than a system which focuses
on rehabilitation, consumer empowerment and employment.
The entire disabilities’ service system should be reviewed
for bias toward congregate and institutional living models with
plans developed to give people other more integrated and community-based
Meeting the needs of people with disabilities should continue to
be a priority in state-funded housing initiatives.
The state should continue to support local housing authorities in
their applications for funding, as well as pursue any such funding
that may become available to augment State public housing and State-administered
In the transportation area, state tax policy makers should consider
providing tax incentives to make private vehicles accessible.
Funding for expanded transportation services by not-for-profits,
including the State Education Department’s Independent Living
Center network, should be explored. This funding should be directed
to activities associated with daily life (e.g. shopping, leisure
time activities) in addition to transportation provided to and from
• Individuals residing in institutions (excluding
those committed in accordance with appropriate provisions of law)
who are eligible for community services should be identified and
Each state agency should establish and maintain data needed for
service planning that provides information about individuals in
institutions and those supported in the community (NYAPRS note:
the law explicit requires the establishment of waiting lists for
housing and supports necessary to help New Yorkers with disabilities
to live and work in the most integrated setting).
Data should be available to assess each state agency’s success
in assuring that individuals receive appropriate community-based
services at a reasonable pace.
State agencies should address the relevant areas of a person’s
life – for example, residential, social, employment and education-related
community supports and services as derived from individualized assessments,
preferences and goals and in accordance with the principles, guidelines
and recommendations included in the Assessment Section of this report.
Each state agency’s data should have information on the current
state agency operated, licensed or funded residential, social, employment
and education-related settings of those served and, the length of
time they have spent at current settings and dated goal statements
determining preferred settings.
Data should also track each state agency’s success at demonstrating
that people are being transitioned into the most integrated setting.
• Evaluation results should be analyzed at least
annually and used to develop quality improvement strategies.
Standards and benchmarks used to assess services should incorporate
the values of self-advocates.
Evaluation results, standards, and benchmarks and quality improvement
initiatives should be reported back to the MISCC annually. Affected
state agencies should seek advice from the MISCC in identifying
best practices in quality assurance for replication.
Formal processes should be developed which address the complaints
(if appropriate) of individuals served and which require corrective
action where care deficiencies are identified from evaluation results.
These “fixes” must be timely. Establishment of an ombudsman
should be considered as a possible way to meet this recommendation.
There should be a continuous improvement process in service delivery
which uses quantitative data and quality information obtained from
Information and/or training should be made available to the people
served to assist them in understanding their right to quality services,
along with information and/or training on how to identify abuse
Clear service provider standards should be developed which address
the rights of people served and which include fully developed appeals
and grievance procedures.
Self-advocates should play a role in monitoring the effectiveness
of programs and services.
The role of local government in quality assurance should be addressed.
All of the “General Principles and Guidelines” specified
above should be incorporated into the state agencies’ quality
• In administering the federal 5310 program which
provides buses to not-for-profit agencies, the NYS DOT should review
its rating formula to encourage coordination of local human service
providers’ transportation resources. Additional points should
be awarded to 5310 applications which show such coordination.
NYS DOT should review state rules and regulations, including those
associated with federal transportation funding streams, to identify
and overcome existing barriers to coordinated transportation between
and among state agencies. To achieve this end, the following approaches
should be considered:
Encourage pilots which pool public and para-transit, taxi and not-for-profit
van resources. The pilots should be implemented in various regions
of the state and should be based on existing best practices.
Collect data on the pilots to assess the extent to which they demonstrate
an increased number of people served, expanded hours of service,
and availability of transportation to additional destinations.
Use the success of the pilots to promote coordination for entities
receiving public monies.
Enhance efforts in applying for the U.S. Department of Transportation
Grant Programs including “United We Ride” funding.
Review ways to encourage faster response times by para-transit providers
to trip requests.
Review the state’s policy regarding accessible hotel shuttles
and transportation to airports and train stations.
Encourage the participation of people with disabilities on boards
of regional transportation authorities.
Encourage disability sensitivity training for transportation authorities.
Encourage the availability of accessible taxicabs throughout the
Where federal and/or state laws govern, the NYSDOT should advocate
for enforcement organizations to implement appropriate enforcement
Examine use of “ambulettes” and “medicabs”
in Medicaid-funded transportation. Use of accessible taxis, where
appropriate, should reduce costs.
Consider use of accessible ramps instead of lifts in fixed-route
and para-transit buses when appropriate.
Review the maximum weight for transporting people in wheelchairs.
To avoid discrimination against “people of size,” consider
increasing the load weight capacity of an access ramp or a lift
to one thousand pounds as vehicles are purchased.
Encourage the transition of people who are able from para-transit
service to less costly fixed route service, utilizing both incentives
(e.g. reduced fare) and public education.
Encourage joint planning between the transportation policy makers
and those from the NYS Division of Housing and Community Renewal
(DHCR). This will allow coordination of accessible transportation
and low cost housing resources. Promote this kind of cooperation
at the local level as well.
To heighten awareness of transportation barriers, give consideration
to the appointment of people with disabilities to regional transportation
MISCC Actions by State Agencies
the MISCC progressed, Chairperson Thomas A. Maul asked state agencies
represented on the council to report on “Most Integrated Setting”
actions undertaken since the MISCC’s inception.
are brief descriptions of some of them, excerpted by NYAPRS:
Implementing three federal Real Choice Systems Change Grants for
Establishing a state-wide, but locally-based, Point-of-Entry (POE)
System for long term care which will begin by providing information,
initial screening and assistance to all those interested in exploring
the available options for long term care in New York State or who
are already receiving medical or other supportive services through
NYSOFA programs, Medicaid or private pay providers
Establishing a new Nursing Home Transition and Diversion Medicaid
Waiver to enhance the opportunity for individuals eighteen years
of age and older, who would otherwise be cared for in a nursing
facility, to receive needed services in their community.
Establishing a voluntary Rightsizing of Nursing Home Demonstration
Program designed to promote the development of alternative levels
Building on the initial success of the Self-Determination project,
OMRDD has reached its original target for people served and is planning
a further expansion. The project allows individuals to self-direct
their services through a portable individualized budget which they
manage through a Fiscal Intermediary (OMRDD);
Expanding use of person-centered planning and self-determination
to identify needs and personal goals. This includes a special OMRDD
Commissioner project with the Self-Advocacy Association of New York
State (SANYS) in which self-advocates meet with Developmental Center
residents to provide information on community living options (OMRDD);
Developing individualized housing options under the New York State
Options for People Through Services (NYS-OPTS) initiative, including
non-certified residential opportunities with individualized supports
and services (OMRDD);
Implementing and expanding the “Access to Home” program
to provide local program administrators with grants of up to $200,000
to make environmental renovations to the homes of persons with physical
disabilities and sensory impairments. To date, $15 million in program
resources have been made available (DHCR);
Implementing New York/New York III, the $1 billion supported housing
initiative announced in November 2005 which builds on the success
of prior housing initiatives (and provides new housing to 5,500
units of supportive housing for individuals and families with serious
mental illnesses who are chronically homeless or at risk of homelessness;
Implementing the Home and Community Based Waiver Program (a $62
million annual investment (provided in SFY 2006-07 State Budget)...which
enables seriously emotionally disturbed children at risk for institutional
placement, to remain at home and in school while receiving a comprehensive
and well-coordinated array of services appropriate to individual
Implementing the closure of Middletown Psychiatric Center, permitting
$7 million realized by the closure ito be reinvested to expand State-operated
services in Middletown’s previous catchment area of Orange
and Sullivan Counties (OMH);
Implementing Personalized Recovery Oriented Services (PROS), a comprehensive
recovery oriented program for individuals with severe and persistent
Enhancing the vocational rehabilitation process through the use
of peer mentors and supports aimed at improving employment outcomes
Working with Independent Living Centers, implementing a new model
for training staff that work directly with individuals who are at
imminent risk of nursing home placement. The training teaches staff
to use community resources to keep people at home (SED);
Fostering inter-agency use of accessible vehicles by awarding bonus
credits to vehicle grant applicants who agree to coordinate vehicle
usage with other not-for-profit agencies that are not grant recipients
IN THE NEWS:
Law Gives Hope to Mentally Ill
The Journal News, December 31, 2006
By Len Maniace
10 days at an upstate hospital, Victoria Scott's youngest of four
children suddenly found herself Thursday at the Rockland Children's
Psychiatric Center in Orangeburg.
13-year-old girl, who loves drawing and painting, had been hospitalized
so physicians could find the right mix of medications to manage
her bouts of depression. But when her health insurance coverage
ran out, there was no choice but to transfer the girl to the state
psychiatric center, said Scott, a 40-year old Spring Valley resident.
they're going to have to start over with her," said Scott,
referring to the new team of physicians treating her daughter.
hospitalization of Scott's youngest child coincided with a major
change in health care for the mentally ill in New York state. On
Dec. 22, Gov. George Pataki signed a law that attempts to eliminate
restrictions on insurance coverage for psychiatric illnesses that
don't apply to other health insurance coverage.
legislation is named Timothy's Law, after Timothy O'Clair, a 12-year-old
Schenectady boy who committed suicide in 2001.
for the mentally ill have long maintained that the disparity in
treatment is unfair and that New York state was part of a minority
of states failing to address the issue. An estimated 39 states have
laws that attempt to deal with the gap in coverage for the mentally
someone had cancer or heart disease, they would be allowed to have
full coverage, but we are talking about people who have brain disorders,"
said Jeanne Toovell, a Mahopac woman who has an adult son with a
mental illness. "It's not a lack of motivation or that they
can simply pull themselves up by their bootstraps."
of coverage limits, the family faced huge hospital and outpatient
care bills, said Toovell, co-chairwoman of the Putnam County chapter
of the National Alliance for the Mentally Ill, or NAMI, a grass-roots
organization representing the mentally ill and their families.
typical health insurance that may require a $10 or $20 co-payment
for outpatient care, those seeking outpatient care for mental illnesses
usually face a $40 to $50 co-payment and strict limits on hospital
on coverage often lead to patients being forced out of hospitals
too soon, disrupting progress in their treatment, mental health
known families whose children have been hospitalized for two weeks
and then the insurance ran out. The child wasn't ready and had to
go back into the hospital and start all over again," said Ann
Loretan, co-president of NAMI's Westchester County chapter. "For
some families, this happens a number of times."
benefits of Timothy's Law will not be felt uniformly, though.
is health coverage offered by companies that are self-insured, those
that pay for health coverage themselves rather than rely on payments
from an insurance company. This type of insurance coverage is regulated
by the federal government rather than states. Large companies often
provide this type of coverage.
exempt from the parity requirement are businesses with fewer than
50 employees, though these companies can provide equal mental health
benefits if they choose. Small businesses do not escape untouched
by Timothy's Law, however, which sets a minimum standard of mental
health benefits if these companies provide standard health insurance.
bill also excludes coverage for drug and alcohol addiction, though
many of these individuals may be covered if a mental illness also
exceptions were part of the compromise that led business organizations
to drop their opposition to Timothy's Law and paved the way for
its passage. That opposition was based on the fear that the requirement
to provide expanded mental health benefits would increase business
is not everything we sought, but it gives us an opportunity to show
that the bill is not going to break the bank," said Shelly
Nortz, deputy executive director for policy with the Coalition for
the Homeless, one of the groups active in negotiating the law.
though federal law exempts self-insured companies from state requirements
such as Timothy's Law, Nortz said many large companies such as IBM
voluntarily provide such mental health benefits. The companies find
that improved mental health benefits reduce absenteeism and boost
overall productivity, Nortz said.
Breaks, Other New Laws Greet New York's New Year
Staten Island Advance, December 31, 2006
By Michael Gormley
N.Y. (AP) — It will be less taxing to be married with children
York's tax law is changing Jan. 1 to eliminate the "marriage
penalty" by increasing the standard deduction for married couples
compared to the exemption provided to two single taxpayers. The
move, which has been phased in over several years, is expected to
save taxpayers $41 million in 2007 by raising the standard deduction
for married couples filing jointly to $15,000, up from the $14,600
they were allowed on their 2006 filing.
change will eliminate disparities between married and single people,
tax department officials said.
taxpayers with children at home will also start to benefit from
the Empire State Child Tax Credit, worth about $300 for a taxpayer
and saving parents $600 million statewide. The requirements to get
the credit reflect its stormy trip through the state Legislature.
George Pataki had proposed a $500 education tax credit for moderate-
and low-income families in poorly performing public school districts.
It could have been used for tutoring, SAT test preparation, or tuition
for religious and other private schools. It would have cost the
state $400 million annually and was backed by Catholic, Jewish and
Lutheran educators and parents.
that proposal didn't sit well with the Legislature, especially the
Democrat-controlled Assembly. Public school advocates and teachers
unions objected that the measure could encourage transfers to private
and religious schools at a time when public schools need more funding.
later, it was passed into law as a $330 "child tax credit"
for taxpayers with children 4 to 17 years old. There is no mention
of education and it will cost the state $200 million more in revenue.
going to be helpful to parents, but we don't think it's the best
policy that could have been implemented," said Dennis Poust,
spokesman for the New York Catholic Conference. "We don't need
people buying Nintendo Wiis when they should be paying for their
state's minimum wage will rise to $7.15 an hour from $6.75. For
those whose wages are complemented by tips, the minimum wage will
be $4.60 an hour, up from $4.35. It's the last bump in a 2004 law
that phased in the increase over three years.
may also see more of New York beginning Jan. 1. That's when a $7
million tax credit "pool" starts to encourage production
companies to do radio and television commercials in New York City
and throughout the state.
kicking in on Jan. 1 will be Timothy's Law, which will require insurers
to provide more mental health coverage. Although most health insurance
companies already provide the care to varying degrees, the law requires
offering it to workers even in small businesses.
bill requires insurance companies to cover 30 inpatient and 20 outpatient
days of treatment for mental illness. Companies must fully cover
"biologically based mental illnesses" including major
depression, obsessive compulsive disorder, anorexia and binge eating.
Law also requires coverage for children with attention deficit disorder,
disruptive behavior disorders or disorders that include suicidal
state would pay the premium increase for companies with 50 or fewer
measure is expected to increase premiums about 3 percent and no
more than 10 percent, while providing a much wider array of mental
of delays in passing the bill in both houses, the law was signed
by Pataki just two weeks ago. So the insurance industry may need
more time to adjust to the new mandate, stalling its implementation
for a few months, Pataki said at the bill signing.
Timothy’s Law Increases Mental Health Coverage
WNYC, January 1, 2007
01, 2007 — Among the laws set to take effect in New York on
New Year's Day is Timothy's Law, which requires insurers to provide
more mental health coverage.
most health insurance companies already provide the care to varying
degrees, the law requires offering it to workers even in small businesses.
bill requires insurance companies to cover 30 inpatient and 20 outpatient
days of treatment for mental illnesses, including major depression,
obsessive compulsive disorder, anorexia and binge eating.
Law also requires coverage for children with attention deficit disorder,
disruptive behavior disorders or disorders that include suicidal
state would pay the premium increase for companies with 50 or fewer
employees. The measure is expected to increase premiums about 3%
and no more than 10%, while providing a much wider array of mental
Grateful for Enactment of Timothy's Law
Albany Times Union, Letter to the Editor, January
you, Governor Pataki, for signing Timothy's Law.
suffering from mental illnesses will now have access to equal health
coverage, thus reducing a common barrier to treatment. This bill
also will help alleviate the stigma of mental illness in our society,
another such barrier. In addition, this bill will bring hope to
the thousands of New Yorkers who have lost a loved one to suicide,
survivors like me who know this legislation will help prevent other
families from suffering from the same tragic loss.
is a national public health problem that results in the death of
one American every 16 minutes (more than 32,000 per year). In New
York, deaths by suicide surpass 1,100, according to 2004 statistics.
than 90 percent of suicides are the result of a mental illness,
not always treated or diagnosed. We know that there is a great deal
more that needs to be accomplished as we work to prevent deaths
by suicide, but the passage of Timothy's Law is a huge step forward
in this fight. Insurance coverage for mental health care is an essential
also is extended to the O'Clair family for their passion, tenacity
Brings Some N.Y. Legislation that is Easy to Applaud
The Journal News, Editorial, January 2, 2007
the spirit of new starts, we share a few pats on the back to the
state Legislature and now-former Gov. George Pataki for drafting,
passing and signing a host of new laws that took effect yesterday
or will do so soon:
HEALTH CARE, WATCHING MEDICAID DOLLARS
Insurance parity for mental and emotional disorders, which took
more than 20 beyond-frustrating years of advocacy to become law,
took effect yesterday. It's admittedly early, but so far the sky
has not fallen, as long-time opponents predicted.
Law, named after an ill upstate 12-year-old who took his life in
2001, mandates better, but still not comprehensive, insurance coverage
for people with mental illness. Other health-related laws new to
New York include a measure that clarifies the definition of autism
spectrum disorders. Why is that important? It will expedite the
diagnosis of autism and stop insurance companies from refusing to
cover treatment. Another new law provides for increased Medicaid
reimbursement rates for the treatment of medically fragile poor
Legislature in 2006 also woke up to the extent of Medicaid fraud
and waste, even as low-income patients struggle for adequate treatment,
and too many small providers can't get reimbursed for providing
services. The new Office of Medicaid Inspector General is mandated
in 2007 to draw up and put into effect new checks and balances on
the system, including efficient ways to resolve payment discrepancies
and detect inaccurate billing.
'MINIMUM' MONEY AND SOME TAX RELIEF
New York's minimum wage was raised to $7.15 an hour from $6.75,
making it one of 18 states to raise the bottom yesterday. Also,
for those New York workers whose wages are supplemented by tips,
the minimum wage will be $4.60 an hour, up from $4.35.
with or without children, will be a little less taxing. Effective
yesterday, the standard deduction for married couples was adjusted
to put them on a fiscal par with single taxpayers. Most taxpayers
with children at home will also see a new benefit from the Empire
State Child Tax Credit, a $330 per-child tax credit, for children
aged 4 to 17.
tax news: There are roughly 130,000 volunteer firefighter and emergency
personnel in New York; to encourage more New York residents to join
their ranks, the Legislature provided a $200 personal income tax
credit for volunteer personnel who are not receiving local property
fire districts, by the way, now will be mandated to hold public
meetings on their proposed budgets on the third Tuesday each October.
The change should shed more light on what taxpayers are being asked
to pay for.
PROTECTING WELFARE OF CHILDREN
A host of new laws, several spearheaded by lawmakers from the Lower
Hudson Valley, enhance the rights of children, and require local
child protective agencies and law enforcement agencies to do a better
job. This year, minimum qualifications and training requirements
for CPS supervisors go into effect. Effective Feb. 12, the state
Office of Children & Family Services must create child advocacy
centers in every region of the state to handle cases of child sexual
abuse and serious physical abuse. The same state office must this
year conduct a public information campaign emphasizing zero tolerance
for child abuse. In conjunction with the state Education Department,
the office also must, by Sept. 1, develop and disseminate model
policies and practices for reporting and investigating educational
for children, an increase of $30 million to $60 million has been
appropriated to finance construction and renovation of residential
programs for children, background checks on prospective foster parents
will now be required and there will be a new statewide immunization
registry on children to verify they have had required immunizations
and to avoid duplicating unneeded ones.
as Therapy for Child's Mental Disorders
The New York Times, December 22, 2006
By Benedict Carey
school he was as floppy and good-natured as a puppy, a boy who bear-hugged
his friends, who was always in motion, who could fall off his chair
repeatedly, as if he had no idea how to use one.
at home, after run-ins with his parents, his exuberance could turn
feral. From the exile of his room, Peter Popczynski would throw
anything that could be launched -- books, pencils, lamps, clothes,
toys -- scarring the walls of the family's brick bungalow, and leaving
some items to rattle down the hallway, like flotsam from a storm.
Popczynskis soon received a diagnosis for their son, attention-deficit
hyperactivity disorder, or A.D.H.D., and were told that they could
turn to a stimulant medication like Ritalin. Doctors have ample
evidence that stimulants not only calm children physically but may
also improve their school performance, at least for as long as they
are on medication.
like most other parents, the couple preferred to avoid drug treatment,
if possible. Instead, with the guidance of psychologists at the
University of Buffalo, they altered the way they interacted with
Peter and his younger brother, Scott. And over the course of a difficult
year, they brought about a transformation in their son. He still
has days when he gets into trouble, like any other 10-year-old,
but he no longer exhibits the level of restless distractibility
that earned him a psychiatric diagnosis.
are so stressed out, and it's so much easier to say, 'Here, take
this pill and go to your room; leave me alone,' '' Lisa Popczynski
said on a recent Monday after work. Peter sat on the couch, hunched
over his homework, while her husband, Roman, occupied Scott, 8.
what I would say is that if you are willing to take on the responsibility
of extra parenting, you can make a big difference,'' said Ms. Popczynski,
an interior designer. ''I compare parenting to driving. We all learn
pretty quickly how to drive a car. But if you have to drive a Mack
truck, you're going to need some training.''
recent decades, psychiatry has come to understand mental disorders
as a matter of biology, of brain abnormalities rooted in genetic
variation. This consensus helped discredit theories from the 1960s
that blamed the parents -- usually the mother -- for problems like
neurosis, schizophrenia and autism.
defining mental disorders as primarily problems of brain chemicals,
the emphasis on biology also led to an increasing dependence on
psychiatric drugs, especially those that entered the market in the
1980s and 1990s.
the science behind nondrug treatments is getting stronger. And now,
some researchers and doctors are looking again at how inconsistent,
overly permissive or uncertain child-rearing styles might worsen
children's problems, and how certain therapies might help resolve
those problems, in combination with drug therapy or without drugs.
psychotherapy techniques intended for the improvement of interactions
between parents and children have been used mostly for children
who suffer from attention disorders or who exhibit aggressive or
defiant behavior. But recently, mental health professionals have
been studying their use for families whose children suffer from
depression or other mood problems.
a comprehensive review, the American Psychological Association urged
in August that for childhood mental disorders, ''in most cases,''
nondrug treatment ''be considered first,'' including techniques
that focus on parents' skills, as well as enlisting teachers' help.
in its just-completed guidelines, even the American Academy of Child
and Adolescent Psychiatry, an organization whose members strongly
favor drug treatment, recommends that children receive some form
of talk therapy before being given drugs for moderate depression,
a very common complaint.
are at a point where families who bring in a child ought to get
a Chinese menu of treatments that are backed by some evidence, including
not only medication but psychosocial or family interventions,''
said Dr. John March, a child psychiatrist at Duke University. ''Not
to do so when we know some of these therapies work is, in my opinion,
simply unethical. Then let the family choose which one they want.''
argument over which is better, medication or psychotherapy intended
to change the behavior of parents and children, is irrelevant in
many cases. A child paralyzed by feelings of severe despair or anxiety,
for example, often cannot begin to engage in any type of therapy
without a period on medication to break the disabling mood. And
many studies suggest that the combination of medication and talk
therapy is significantly more effective, and safer, than either
THERAPY OR BOTH?
''It's obvious that medication has been more effective than behavioral
modification in treating the core symptoms of A.D.H.D., but behavioral
treatments can produce real improvement, and for certain kids the
combination of the two treatment appears to be best,'' said Dr.
Oscar Bukstein, a child psychiatrist at the University of Pittsburgh
School of Medicine who is helping the American Academy of Child
and Adolescent Psychiatry write treatment guidelines. ''Children
with other behavior problems in addition to A.D.H.D., for instance,
seem to do best with both treatments.''
Popczynskis found that a brand of family therapy by itself was sufficient
to put Peter on track at school and at home. Their experience helps
illustrate how a family can, in effect, treat a child's psychiatric
disorder -- and for whom such an approach can be practical.
thing the family had going for it was location. When Peter's mother
began scouring the Internet for resources in the spring of 2003,
she quickly learned that they lived only a few miles from the University
of Buffalo, which runs one of the country's most comprehensive behavioral
a study involving 128 families, psychologists at the university
had found that about a third of parents who completed the program
saw enough improvement in their children that they had decided that
medication was unnecessary. The other two-thirds put their children
on stimulant medication at school but at doses significantly lower
those typically prescribed, said William Pelham, a psychologist
who is director of the Center for Children and Families at Buffalo
and the senior author of the study. Eighty percent of the families
who participated in the program, with follow-up parent training,
decided that their children did not need medication at home.
parents seeking help for a child with a psychiatric disorder never
hear about programs like this,'' Dr. Pelham said. ''The only option
they're given is medication. Now, it may be that the best treatment
for that child is medication. But how do you know if you never try
modification for A.D.H.D. and for related problems, like habitually
disruptive or defiant behavior, is based on a straightforward system
of rewards and consequences. Parents reward every good or cooperative
act they see: small things, like simply paying attention for a few
moments, earn an ''attaboy.'' Completing homework without complaint
might earn time on a Gameboy. Parents remove privileges, like television
and playtime, or impose a ''time out,'' in response to defiance
and other misbehavior.
they learn to ignore annoying but harmless attempts to win attention,
like making weird noises, tapping or acting like a baby.
These skills are hardly unknown to seasoned parents. But most also
know that stress or anger, even when dealing with a child who has
no serious problems, can sour the best instincts. That is why family-based
programs insist that parents try to maintain a clear, neutral tone
when instructing their children, or penalizing them.
for example, is a virtue. Saying to a child, ''Would you put your
toys back in the box, please?'' turns a command into a question.
Saying, ''Let's put your toys back in the box,'' implies collaboration.
An unadorned ''Put your toys back in the box'' is clearer for everyone,
psychologists say, especially so for a child who is highly distractible.
it is dressed up, family therapy like this teaches parents to provide
what many critics say children these days are missing -- discipline.
But therapists make a careful distinction between corrective action
and cruelty, between firmness and frostiness. Overly punitive parents
increase the likelihood that a child will develop mood problems,
some studies suggest. So parents learn not to become scolds, but
to bring their children into line without demeaning them.
some programs, parents play-act situations in front of their peers,
who critique the performance for emotional tone and the clarity
of parents' statements. As a result, the parents say, they become
immediately more deliberate at home. ''You end up constantly saying
things like, 'That's not an appropriate behavior,' using this unnatural
language,'' said Ms. Popczynski. ''But the point is you don't get
into it with them. The first thing I noticed was that I wasn't yelling
all the time. The house got a lot quieter right away.''
instructions to Peter and Scott became more precise, as well. Saying
''Clean your room'' is too vague and covers a half-dozen tasks,
Roman Popczynski, the boys' father, said. Peter might wonder where
to start, or just decide it was too much to worry about, and give
up, his father said. ''Put your laundry in the hamper'' is much
more likely to get results, he said, and lead to the next clear
step, like ''Put your toys where they belong.''
commands are also confounding: ''Put away your crayons, clear away
the table, and organize your homework, please'' leaves a child wondering
which to do first, and whether it is too much work to finish. ''It
overloads a kid, and then he feels like he's failing, which only
makes it worse,'' said Mr. Popczynski, who is a UPS driver.
Like most who try to use behavior modification techniques, the Popczynskis
relied on a daily report card to keep a running tally of Peter's
specific problem behaviors, like wandering attention, ignoring commands
or defiance, and his efforts to correct them.
instance, at the beginning, Peter, then 7, would get a check mark
every time he ignored more than two commands to do his homework,
put away his toys or brush his teeth, but he would earn immediate
praise if he got started. He received check marks when he slid off
his chair at dinner, and earned approval if he stayed seated.
bedtime he accumulated marks if he pulled delay tactics. A tantrum
resulted in instant punishment: a timeout of 5 to 10 minutes, shortened
for good behavior. The report card was posted on the refrigerator.
Popczynskis started slowly. They measured how many marks Peter recorded
in a normal day, and at first rewarded him if he reduced the number
by even one: with an extra 15 minutes on Game Cube, for example.
If he had more good days than bad ones over the course of a week,
he got to choose from a bag of toys from the $1 store.
and Ms. Popczynski continued to raise the standard, one checkmark
at a time, until Peter hit zero consistently.
want them to be able to succeed,'' Mr. Popczynski said. ''If you
make it too hard, they'll just give up, and so will you.''
Buffalo program is more comprehensive than most: psychologists run
a summer camp here, employing the same principles, and, during the
school year, regularly visit the teachers of every child in the
program. Those teachers who agree to cooperate -- most do -- keep
daily behavior report cards for the child too, in effect providing
full coverage for a child's every waking hour.
then, the therapy is far from a silver bullet or an automatic replacement
for treatment with Ritalin or other drugs that are routinely prescribed
for attention disorder based on many studies showing their effectiveness.
The constant tallying and reminding is too exhausting for some parents,
especially those raising children on their own and juggling outside
jobs. The Popczynskis did well in part because Peter's difficulties
were not severe, he was a capable student and his most disruptive
behavior came out at home, Mr. Popczynski said. And the couple were
able to share the many duties.
most parents in the program have found that their children do best
with a combination of the medication and family treatment, albeit
with significantly lower doses of the drugs than typically prescribed.
Van de Wal, a single mother of three in Buffalo, said that over
the last six months she has learned to contain and redirect the
behavior of her exuberant 9-year-old, TJ, who has received a diagnosis
of attention-deficit disorder. TJ can still become extremely frustrated
when required to sit for long periods and concentrate on schoolwork,
in the absence of his mother.
still give him medication for school, because the fact is that right
now he needs it to get through the day, but it's a low dose,'' Ms.
Van de Wal said while TJ practiced headstands on the couch. ''He
doesn't take it at home, though, and I plan to reduce the dosage
in time as much as I can.''
added, ''I don't want him to look back and think the successes he's
had are all due to a drug.''
surveys and in dozens of interviews, most parents of children with
psychiatric diagnoses say that they prefer to avoid using medications,
if possible. It is not so easy to do. Insurers as a rule do not
fully cover behavior modification therapies because they cost substantially
more than drugs.
therapies require an enormous commitment from already overloaded
parents, and some children are too severely troubled to respond.
Many clinics do not even offer the programs.
pediatricians and family doctors also tend to be more comfortable
writing prescriptions for psychological reasons.
''It's a tremendous relief for the physician to prescribe something,
because these kids are very tough, and it feels horrible to sit
there and not be able to help,'' said Dr. Jennifer Mary Harris,
a child psychiatrist practicing in Arlington, Mass., who has argued
for more caution in using medication. At every level, she said,
the mental health system strongly favors drug treatment.
the increasing number of studies that support family-based behavioral
treatment is shifting perceptions. The largest study comparing medication
with behavioral modification therapy for attention deficit problems,
released in 1999, found that drugs were more effective in improving
children's ability to focus and keep still. But more than three-fourths
of those treated without medication did well enough that their parents
were able to keep them off drugs. And behavior therapy significantly
improved children's reading performance and their relations with
parents and teachers when combined with medication, the study found.
have also studied a different approach to behavior treatment, called
cognitive behavior therapy. This approach engages children directly,
and signs up parents as helpers. The children meet in groups to
speak with a therapist, and learn elementary ways to identify and
manage their anger, frustration and hopelessness. The parents learn
in sessions how to reinforce those lessons at home.
find that up to three quarters of children who suffer from depression,
anxiety or obsessive-compulsive disorder find relief of their symptoms
with the help of this kind of therapy, which usually involves once-a-week
sessions for a few months or so.
Brzycki, a freelance editor who lives in Lawrenceville, N.J., said
she noticed several years ago that her son was struggling more than
usual with Tourette's syndrome, a neurological disorder that causes
involuntary facial tics and limb movements.
condition did not stop him from making friends or doing well in
school, Ms. Brzycki said, ''but I think it was first grade, I realized
that he was stifling the tics at school, and it created this boomerang
effect, and they came out like mad at home.''
the urging of a doctor, she took the boy, by then 9, to a program
at Temple University in Philadelphia that specializes in treating
childhood anxiety, which can exacerbate Tourette's. Therapists teach
children to identify the thoughts that amplify their worries, and
then defuse or moderate them. Ms. Brzycki and her husband attended
sessions, too, and Ms. Brzycki learned she was unwittingly contributing
to her son's anxiety. ''The main thing that came out for me was
that I was being overprotective,'' she said.
added: ''As a parent you want to protect a child from stressful
situations, but by doing that you're creating an avoidance mechanism
that can turn a minuscule anxiety into the big, bad wolf. I had
to loosen my grip'' and let him face his fears.
in fourth grade, her son has helped make a DVD about Tourette's
syndrome that he has shown to classmates. He has a close circle
of friends, his mother said, and his tics seem to have diminished
lately. But he sometimes still feels self-conscious and will talk
himself through it, with his parents' help if needed.
therapy for a difficult childhood disorder is in almost all cases
a way of life, not a weeks-long or months-long cure. If parents
are serious about finding alternatives to drug treatments, experts
say, they have to be willing to make difficult, and long lasting,
changes to their behavior and the home environment, and to allow
the child to progress at his or her own pace.
can't let your foot off the accelerator with something like behavioral
modification for A.D.H.D., for example,'' said Dr. Gabrielle Carlson,
director of child and adolescent psychiatry at Stony Brook University
School of Medicine, who used the treatment for her own son. ''It's
like making changes in diet and exercise to lose weight: you don't
lose 20 pounds and then you're home free and can eat ice cream and
cake again. No, it's a complete lifestyle change, and when you have
a child with any of these psychiatric difficulties you have to stay
on the program, for as long as it takes.''
This is the last in a series of articles about the increasing number
of children whose problems are diagnosed as serious mental disorders.
The earlier articles examined one family's experience, the uncertainty
of diagnosis, the use of combinations of psychiatric drugs and the
transition to adulthood.
and previous articles are online at nytimes.com/children.
December 23, 2006, Saturday A front-page article yesterday about
parents' influence in helping their children overcome psychiatric
disorders misstated the age of TJ Van de Wal, whose attention problems
have improved in response to parental techniques. He is 7, not 9.