You wouldn’t necessarily know it by the name, but Staten Island Mental Health Society (SIMHS) is all about kids. Its roots go back to 1895 – two years before Staten Island became part of New York City – when a group of women from the Dutch Reformed Church formed a day care center for poor working families. In 1956 the Port Richmond Day Nursery and Central Relief Fund, as it was known, merged with a children’s mental health program founded by Dr. Richard M. Silberstein and became SIMHS.
Building a Green Future for SI Kids
Mobilizing the Community
“Over the years we have started many different programs, but they are always children’s programs,” says Dr. Kenneth Popler, who has led the agency as President and CEO since 1981. “Serving Staten Island kids is our only mission and we have kept to it. We work with over 5,000 children every year in our various programs. That is about one in every ten families residing on Staten Island.”
While Staten Island is part of New York City, the borough is clearly unique. For one thing, it is physically and culturally isolated from the rest of the City in significant ways, with the $13 toll to cross the Verrazano-Narrows Bridge being just one example. “In some ways, Staten Island is more like an upstate county,” says Popler. “It is very large – twice the landmass of Manhattan – with a very poor transportation system.” At the same time, Staten Island has significant pockets of poverty. “We have all the problems of the inner city in certain areas,” he explains, “and we have a large, rapidly growing and very diverse immigrant population.”
This geographic and demographic profile has guided SIMHS’ expansion strategy over the years. SIMHS’ headquarters and its first Children’s Community Mental Health Center are based in a former orphanage adjacent to the Richmond University Medical Center. In order to fully serve children throughout the borough, the agency opened a second children’s mental health clinic on the South Shore in 1962. A third clinic was established in St. George on the northern side of the Island in 1986. “There is no realistic way for children and their families to travel across the Island to get mental health services,” says Popler.
In 1969, SIMHS opened a Day Treatment Center in partnership with the then-NYC Board of Education for students with severe emotional & behavioral challenges. “We provide the clinical staff and DOE provides the teachers,” says Popler. “These are all children whose needs could not be met in traditional special education classes in their home schools.” PS/IS 25, which is located on SIMHS’ headquarters campus in West Brighton serves 100 elementary and middle school students. South Richmond High School in Tottenville serves 50 high-schoolers.
SIMHS has expanded the reach of its services dramatically through School-Based Mental Health Programs. “We have one or two counselors based at 11 public schools -- six elementary, four intermediate and one high school,” says Popler. “These are the highest-needs schools in the borough. Our staff are right there, able to provide onsite mental health services for kids. We have the clinics as a back-up and our therapists can see parents and other family members in the schools or at the clinics in the evening after the schools close.”
In total, SIMHS’ school-based programs make mental health services readily available to over 200 students and their families each year.
Teen Substance Abuse
Substance abuse, while endemic everywhere, is particularly problematic on Staten Island. “Teen substance abuse is the number one issue on Staten Island,” says Popler. “Our borough leads the rest of the city and has one of the highest rates in the state in use of cocaine, inhalants and potent prescription drugs among teens and young adults. We have twice the New York City rate of oxycontin prescriptions per capita and twice the emergency room death rate from oxycontin overdoses. Kids get hold of prescription drugs because they are too available.”
SIMHS’ Teen Center is an OASAS-licensed chemical dependency treatment center that provides comprehensive services exclusively to teens and young adults who are abusing alcohol and/or drugs. Launched in the South Shore community of Great Kills in 1984, the program proved so successful in meeting its goals that SIMHS was able to open a second office in St. George to serve youth from the North Shore area. Services are offered between 3:00 and 9:00 p.m. when the greatest incidence of alcohol and drug abuse takes place.
In recent years, SIMHS has been expanding its range of substance abuse and treatment options in response to continued growth in the need for services.
Project for Academic Student Success (PASS) is a privately funded after-school “safe haven” for intermediate and high school students at risk of dropping out or using alcohol and/or drugs. “If your child is having trouble in school and his or her grades suddenly drop, research shows that 50% of the time it is because they have begun abusing drugs or alcohol,” says Popler. Funded by the Staten Island Foundation as a prevention program, PASS is now receiving additional support from the New York Community Trust. “This will allow us to work with the most seriously troubled kids in our teen clinic program,” says Popler.
In January, SIMHS also started a new DUI Program which serves young people arrested for driving while under the influence of drugs or alcohol. The program offers screening and assessment for individuals referred by the courts and can arrange for treatment at the agency’s Teen Center or other treatment programs as appropriate.
Transitional Services for Youth
The agency’s SafeTY.net (Safe Transitions for Youth) program serves adolescents and young adults with mental health challenges who are transitioning to adulthood, with a variety of services that address employment and career, education, living situations, and community life. Partnerships with the school district, colleges, businesses, and other not-for-profits provide support for clients’ educational and vocational goals, community living skills, and assistance in finding housing alternatives, Popler explains.
In total, the Children’s Mental Health Center’s various programs – clinics, school-based mental health, substance abuse prevention and treatment and transitional services -- assist almost 2,500 unduplicated individuals and receive over 78,000 visits annually.
In the early 70s, Staten Island philanthropist Elizabeth W. Pouch helped SIMHS to begin providing health and mental health services for children with developmental disabilities. The SIMHS’s Elizabeth W. Pouch Center for Special People is an Article 16 clinic that provides outpatient clinical services, including comprehensive assessment, therapy, education and support services. The team also conducts interdisciplinary evaluations for children three-to-five-years-of-age who need specialized preschool services. “It is one of the last Article 16 clinics surviving,” says Popler.
The Pouch Center’s Training in Parenting Skills (TIPS) program serves families in which one or both parents are developmentally challenged. “The TIPS program started with parents who grew up in Willowbrook, met there, and had children,” says Popler. “Sometimes their children have developmental disabilities; sometimes not.” The parents meet weekly for group discussion, counseling and social activities while their children meet separately with Pouch Center staff.
Club Saturday is a therapeutic socialization group for children with autism spectrum disorders that encourages better social functioning through participation in structured activities and relationship-building exercises.
SUCCESS (Support, Counseling, Conversation, Education and Socializing Skills) serves individuals with mild developmental challenges who are transitioning into adulthood.
Early Childhood Programs
The Port Richmond Day Nursery was established in 1895 to provide child care for poor and working families and today, 117 years later, SIMHS remains committed to that mission. Together with its Head Start programs, it serves approximately 342 children at any given time in a network of programs and centers.
The Port Richmond Day Nursery itself – now funded by the NYC Administration for Children’s Services (ACS) – provides child care for 57 eligible children. The agency also has three Head Start centers – Dongan Hills, Osgood in Clifton, and Kingsley in New Brighton. “We received the first Head Start Grant on Staten Island in 1965,” says Popler. “President Johnson even spoke about our program in a speech in the Rose Garden.”
Over the years, SIMHS has developed a blended program model, combing resources from Head Start, Universal Pre-K (UPK) and ACS funding to offer high quality extended-day services for all children, regardless of their eligibility for individual programs. “It is seamless to the families and it should be. They shouldn’t have to worry about whether it is UPK, City, State or Federal funding. That is our job. We provide the services for the benefit of the kids,” says Popler, who does acknowledge that it takes a talented fiscal staff to manage the financing and billing throughout SIMHS.
Befitting its dual child care/mental health focus, SIMHS also has enhanced its programs by providing onsite mental health services in the form of licensed social workers, funded by the Robin Hood Foundation, who are able to offer assessments, counseling and treatment for all children and families. “Having social workers here as part of the program increases the chances that families will make use of the services,” says Beryl Clark, Vice President for SIMHS Early Childhood Services. “Parents get to know the social workers and find them less threatening than the thought of taking their child to an outside clinic.”
SIMHS is able to provide the on-site mental health services through a $350,000 grant from the Robin Hood Foundation.
The agency also operates integrated “inclusion” classrooms, in which ten mainstream children share a Head Start classroom setting with ten children with developmental disabilities, at the Dongan Hills and Osgood Head Start Centers. Special education teachers from the Pouch Center work together with Head Start teachers ensuring that all children receive appropriate personalized attention while interacting and learning from each other.
SIMHS’ early childhood programs utilize the High Scope Preschool Curriculum, a nationally-recognized, evidence-based program model which uses “active participatory learning” to achieve powerful, positive outcomes, explains Roseann Catania, Osgood Head Start’s Director of Education.
“We devote a lot of time, effort and resources to conducting outcome studies,” says Popler. “We want to find out how effective our programs are and what we can do to make them better.”
For example, SIMHS routinely administers Conners’ Rating Scales to all children receiving out-patient or day treatment services. The system evaluates the level of major behavioral issues exhibited by each child, including hyperactivity, conduct problem, emotional over-indulgent, anxious-passive, asocial, daydream-attention problems and hyperactivity.
In 2008, SIMHS determined that participants attending its specialized Summer Therapeutic Program (STP) for children with severe emotional and or behavioral challenges were not showing adequate improvement as measured by the Conners’ scores. In response, the agency implemented a new evidence-based curriculum developed by Dr. William Pelham at the Center for Children and Families at SUNY Buffalo. The SIMHS STP model Point System is based on a systemic reward/response program that includes verbal positive reinforcement, daily report cards and techniques to discourage inappropriate behaviors.
Following implementation of the new system in 2008 and 2009, pairs of pre- and post- ConnersTeachers Scales for 155 children showed significant decreases in six of the seven behavioral categories. “Families seeking services for their children with severe behavioral dysfunction rely on community-based providers of children’s mental health services,” says Popler. “While from the children’s perspectives, they are attending a fun-filled program with sports and crafts, using an evidence-based curriculum, the program has evolved into a highly effective community resource.”
As we went to press, SIMHS – along with all other ACS-funded day care providers – was awaiting results of the City’s new EarlyLearnNYC competition. EarlyLearn will be implementing a new “blended funding” approach similar to that already used by SIMHS and some other nonprofit agencies to combine ACS Day Care, UPK and Head Start monies into a single early childhood education program model. Unfortunately, the higher costs of the City’s new higher-quality program, together with reductions in overall funding levels, is leading to a significant reduction in the total number of children to be served by the new program. Citywide, the program is expected to have 37% fewer slots. Staten Island is being hit even harder.
“The Island is going to lose more than 50% of its total slots,” says Popler. “We now have about 500 slots among all Staten Island programs and we are going down to 242 for the entire borough.”
In addition to the likelihood that programs will shrink in size, EarlyLearn presents additional concerns in terms of both the adequacy of proposed ACS reimbursement rates and a new requirement for a 6.7% private share contribution to program costs, totaling approximately $250,000.
EarlyLearn, however, is not the only program area in which SIMHS will be facing significant changes in the way services are delivered and reimbursed. SIMHS, like all its colleagues, is in the midst of a major transformation of New York State’s mental health system – driven in large part by the Medicaid Redesign Team (MRT) process. Children with Severe Emotional Disturbance (SED) who had historically been “carved out” of Medicaid managed care programs will soon join virtually all other Medicaid recipients in a new – and yet to be fully determined – system of care coordination services including Managed Care Organizations (MCOs), Behavioral Health Organizations (BHOs), and Health Homes.
How all this will impact direct service providers like SIMHS -- and the children and families who rely on them -- remains highly uncertain. SIMHS is doing what it can to be an active participant in helping to shape the new system. It has partnered with more than 50 other health, mental health and human service provider agencies to form Coordinated Behavioral Care Inc., a new NYS Department of Health-approved-Health Home that will provide care coordination.
And, while concerned about the potential implications of changes to come, Popler remains optimistic and focused on SIMHS’ overriding mission. “We can’t look out two years and say all is doomed,” he explains. “In the 31 years I have been here, we have never had a day where we weren’t worried about funding issues. It is always this way. Now there are just new names and new challenges. Our goal is position ourselves for the future and remember that every day we are helping thousands of kids and their families.”
For information visit www.simhs.org.