Civic Warriors Episode 29 with North Shore Child & Family Guidance Center

North Shore helps children from 0-24 years of age. Standing in solidarity with not only the children, but the families as well, Elissa and Kathy talk with the Warriors about the vast impact a network of support can have. Techniques and tactics provided to families and children to ground and center, as well as what parents should look out for was shared. This organization’s focus on support, education and the family ecosystem was evident and brought a narrative of hope. At North Shore Child & Family Guidance Center, no one walks alone. As they say, “We are in this together”.

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This podcast was transcribed through a third-party application. Please disregard any misrepresentations.
Brad Caruso (00:00:10):

Alright. Hello, everybody. Welcome today to today’s episode of with them civic warriors, uh, we have some very special guests talking about a very important topic today, um, with us today from the north shore child and family guidance center, uh, in long island, uh, is Kathy Rivera, executive director and CEO, uh, and, and Elissa Smilowitz. It’s director of triage, emergency services and suicide prevention. And then from the wisdom side, we have, uh, myself, Brad Caruso, as you know, Ashley Krompier. And we have a very special guests are ahead of our not-for-profit tr group here, Jen Stewart, who also serves on the, on the board audit committee of, uh, the guidance center. So very special guests. So welcome everybody. And we are going to, uh, dive right in, uh, into the discussion and, uh, welcome to the show. Uh, Kathy, Jen and Alyssa.

Kathy Rivera (00:01:04):

Thank you for having me. I’m excited to be here.

Brad Caruso (00:01:07):

We’re excited to have this conversation. Um, so, so, um, Kathy, Melissa, maybe if you want to just spend a minute, tell us, um, a little bit about yourself, about how you, uh, got to be working with the organization and, uh, and we’ll go from there.

Kathy Rivera (00:01:20):

Great. Um, I’d love to go first if that’s okay, Lisa. Um, so I am Kathy Rivera. I am, uh, the new, I do want to just highlight that the new CEO and executive director of north shore child and family guidance center, we’re also known sometimes as the guidance center in the community. Uh, and I’m really excited to be here, um, because not only am I a part of an amazing organization, but I am really connected to the mission. Uh, so just to segue back to myself, I am a licensed clinical social worker by profession. I have been in the field if you will, since 1995. Uh, so yes, I started very young for the listeners. I actually didn’t stumble into the field. I actually needed to be in the field, uh, through my own personal experiences, uh, with, uh, mental health issues. Uh, within my immediate family, I knew that, uh, not getting the right services at the right time could really have long lasting effects. So I went into the social work field many, many moons ago. I have a wide portfolio of experience working with adults in the HIV world, mental health world, substance use world. And actually for the last 15 years, working primarily with children and families in mental health, uh, and also without a community placements in foster care, which was my previous life before coming here. So the children and family population is my absolute passion, and I am really proud to be part of an organization that supports that within, uh, throughout actually all of Nassau community.

Elissa Smilowitz (00:03:00):

Okay. So, uh, I’ll, I’ll tell you a little bit about myself. Um, I have been in the north shore child, family guidance since 2001. I actually joined the agency right after nine 11. Um, at that time I was a psychiatric social worker in the intensive support program, which is a, uh, a mental health program with the [inaudible]. And what we worked on is seriously, emotionally disturbed children and adolescents. Um, from there I worked there five years. I was promoted to coordinator of the high school program, which is also the intensive support program. And then, uh, five years after that, I was asked to start a triage program in, uh, north shore child, family guidance in their outpatient division. And I’ve been there ever since. Um, uh, the need was significant. Um, we started with just myself and one other social worker, and now we have five clinicians and a psychiatrist that works, uh, intensively with children that are significantly, um, uh, have emotional issues on our need, the more intensive care, rather than just a regular outpatient.

Brad Caruso (00:04:20):

Got it. Thank you for sharing that. And, and Kathy, from your perspective with the guidance center itself, I guess, you know, maybe take us a little through the history of it and how you got to where you are and, you know, some of the things you’re, you’re you’re working on today.

Kathy Rivera (00:04:32):

Absolutely. So I, um, you know, I came actually, I didn’t even describe, I came in June of this year, so I ex I succeeded, uh, the previous CEO and executive director and had been with the organization for 45 years, collectively serving last 15 years, um, in my current role. And, um, I knew that I was in a pivotal part of my career where I wanted to do more. I wanted to influence more. I wanted to be able to be in a position where I could continue to advocate, but also, um, keep a pulse on what’s happening within nonprofit, not not-for-profits, which is definitely my passion. I’ve spent my whole career in this area. Um, and really making a difference in meeting the community meet needs as well as the needs of families. Uh, so I came across, um, the guidance center opportunity, uh, through LinkedIn.

Kathy Rivera (00:05:25):

So I laugh and I share that because, um, a lot of, um, gen X-ers as myself, don’t use it as much, but the, a lot of the younger people do. So that’s really a funny way that that segwayed me here. And when I saw the mission of the guidance center to restore and strengthen the emotional wellbeing of children and families zero to 24, it was a calling, if you will. Um, when I did my research and I saw, um, this is this, uh, almost 70 year old organization, um, and in the non-for-profit world, that’s darn impressive. Um, you know, who the guidance center was, uh, back in 1953 is not only true to who they were back then, but they’ve grown astronomically as the needs of the organization have changed. Uh, so we continue to serve as children and families, zero to 24. We have three offices, although we do serve all of Nassau county, we are located in Manhassett Westbury and Rosalyn.

Kathy Rivera (00:06:24):

We also work in, uh, uh, the school district. So we have an intensive support program, uh, three specific schools, um, middle school, elementary and high school. So we do provide a lot of specialty work. Uh, we have a Latino girls program. We have a suicide prevention program, maternal depression, grandparents’ program respite. Um, and then obviously our big, heavy hitter, um, uh, services are surrounding outpatient, mental health. We do do it all. We do individual group family in person virtual services based on the need and safety of our families. Uh, we do drug and alcohol treatment as well. And actually the, um, emergency triage and a suicide prevention, Elissa will probably go into a little bit more, but this is what I want our listeners to really understand. Uh, we turn no one away for their inability to pay. We are committed to equity and access.

Kathy Rivera (00:07:22):

It doesn’t matter how you showed up on our doorsteps. It doesn’t matter what your zip code is. It doesn’t matter what your bank account is. We will treat everyone the same way and provide services if they need help. So if you know someone, if you, um, are in a situation yourself where you need services, please, we are a phone call away. We’ll provide that information at the end of the segment and show you, keep listening. And we ask that, um, you know, everyone just, uh, you know, listen with an open heart and understand that we are all in this together.

Brad Caruso (00:07:55):

Yeah. And I think that’s a very important point. Um, I know, I know in my own personal experience, it, it is very hard, especially when you’re dealing with insurance and you’re dealing with trying to identify, uh, organizations or individuals or, um, clinicians that have time and availability, um, you know, do the due to volume. Um, I remember trying to, you know, get help at one point in my life and you would call, and it would just be like, hi, we’re not accepting new patients, or you would call, and it would just be a voicemail, leave a voicemail. And then someone would call you back three weeks later. You’re like three weeks is a long time when you’re going through. And, you know, especially if you’re having an extreme circumstance, you know, maybe not, you know, just general symptoms, but you’re having a, you know, um, some type of extreme circumstance.

Brad Caruso (00:08:36):

And so I think that’s a very important point for people to understand. And I appreciate you bringing that up, Kathy. Cause I, I really do see a lot of value in that of turning no one away because I mean, that’s the reality of how you really help people, right? If you’re in it for profit and you’re in it as a business, you know, you’re going to turn people away based on what works best you. Sometimes I’m not putting words in anyone’s mouth, but if you’re have that model where you’re very inclusive and very accepting, I, you know, I think for anyone that’s going through a struggle in life, just just know there’s people out there and that they’re willing to help you. And, um, I think it gives people comfort, you know, even though that you’re very responsive too. So I think that’s a great point that you made on that. Thank you.

Kathy Rivera (00:09:15):

And thank you for sharing.

Elissa Smilowitz (00:09:18):

I can tell you that I have heard that many, many times since this pandemic, even before the pandemic, but more so that th between, um, private, uh, counseling centers, not accepting any patients or doctors not accepting any patients, uh, this is a conversation that our intake department has many, many times. Yeah.

Brad Caruso (00:09:46):

And I guess Elissa and Kathy, from your perspective, you know, we, we talk a lot about, um, you know, this, if this gets listened to five years from now, you know, we’re going through a pandemic, COVID-19, everyone is aware of it that we talk about with, but when you look at your, um, you know, the impact that’s had on, I’ll just say in general, you know, uh, the population you serve, you know, individuals from zero to 24, what do you think the, the, the mental health impact? What have you experienced, I guess, in some, in, in your practice, um, with that, as far as how, you know, how have you seen any new effects? Have you seen any changes in, in effects or any new trends that, you know, are somewhat alarming that people should be on the lookout for what, what are you start? What are you seeing with that? I guess now having 18 months, I guess it is now experience, uh, we’re working with individuals.

Kathy Rivera (00:10:34):

Yeah. I’ll actually let Elissa speak to that because I think that, uh, you know, she’s in the trenches, um, you know, she supervises a fantastic team, but in true guidance center fashion, we roll up our sleeves when we have to. And, uh, we ensure that, especially those emergency situations, Brad, that you’re describing that has not been created by the [inaudible], but has been enhanced by it. I want our listeners to understand that the pandemic did not create this crisis in our children and our families and even adults. It has enhanced what was already in existence and gave us permission to naturalize it a little bit more and talk about it. Um, so Elissa, you know, on top of, you know, supervising a fantastic team of clinicians and administrators has herself, you know, provided treatment. So I think Alyssa, you can take it away as the expert.

Elissa Smilowitz (00:11:24):

I, I, the, uh, the pandemic, you know, in the beginning, you know, there was a down within days, we were online virtually with our, our, uh, families. And they were so thankful that they had us to help support them during this time. But, you know, the families that are dealing with warm society, depression, uh, their are family members that are the, that they have lost due to COVID. Um, parents also are dealing with financial insecurities. So it has ramped up the, uh, the amount of families that are coming for treatment. We saw a tremendous surge, uh, the spring and, uh, from what I was hearing from a lot of the families, because I also work with the emergencies that come in, uh, the intake department calls me, and I have a conversation with the intake department and with the families when needed. And I, you know, there, you know, a lot of places we’re not taking any new clients because they were at maximum capacity and that’s not just for just the, uh, children and outpatient, but also hospitals and urgent care people were calling us because they had nowhere to, uh, service the children that were under their care.

Elissa Smilowitz (00:12:41):

So, you know, their search was really intense. And, uh, thank goodness that we had the Douglas S Feldman suicide prevention project, uh, funding, because that enabled us to increase our triaged. So we went from, uh, five clinicians. We have an extra clinician. Now we have more, more, uh, availability for these children that are really struggling with not just the pandemic, but now also returning into in school. And, uh, the feelings of anxiety and depression and suicidal ideation has significantly increased, especially in middle school children, which is a phenomenon that we did not see as much as we are right now. And, you know, there, the research has shown that when our social rhythms are, uh, interrupted as children, they lead to more, uh, major depressive episodes, which means children are being impacted. They’re being impacted with depression, anxiety, suicidal ideation, because they don’t understand the permanence of suicide. They just want to escape what they’re feeling. And so, um, you know, the intensity of this pandemic is ongoing, and this is not going to go away tomorrow. This is going to be an ongoing thing, just like when we got through, you know, with 9/11, we had that trauma, this is a trauma. These, these families are dealing with the trauma and it’s not just New York, it’s, it’s the entire country. So, um, this is going to continue.

Brad Caruso (00:14:17):

Absolutely. And, and, you know, I think it’s a very important point. And I guess when you say, when you say social rhythms, you know, is that, is that just, you know, being exposed to, uh, I’ll call it other people, you know, what, what do you mean by social rhythms when you say that?

Elissa Smilowitz (00:14:32):

Right. So, you know, during the beginning of the pandemic, there was a lot of isolation and the children had to stay in these, in these family dynamics. And, you know, I’m sure a lot of families are very supportive and caring and, and want to protect their children. But there are families where there’s a lot of conflict, a lot of substance abuse, lot of domestic violence, a lot of child abuse. These children were not being served. And they were they were in this environment for a long period of time. Um, you know, that people, parents think that socialization is a luxury, but for children, for the developmental, well-being, it’s more of a needed, it’s a necessity to have children have that influence of being with other children, having that social component, having that escape from the family dynamic, which might be toxic, and being able to go into a school and get that support.

Elissa Smilowitz (00:15:26):

And, um, for a long time, that was missing. Another thing we were dealing with also with, with college college students, chil, uh, seniors, there was a lot of loss with seniors. You know, they didn’t have their prom, they didn’t have their graduation, they couldn’t go away to college. You know, so we were also having a lot of, uh, 19, 18 and 19 year olds coming into the center also with, you know, uh, what’s the point, what am I going to do? Some had suicidal ideation. Um, so, you know, it has impacted, uh, not just the adults, but also the young adults, the children, um, even, even, uh, elementary. So, and like I said, this is going to continue.

Kathy Rivera (00:16:13):

Yeah. I want to just add, you know, I think, you know, to what Elissa’s talking about, you know, the world, if you will, you know, and we can make it a little bit more granular and talk about Nassau county, but, you know, we’ve experienced, what’s known as a collective trauma. Um, and the simple definition of that is it’s basically a psychological and emotional turmoil that shared by a group of people, right. Who’ve all experienced an event, um, and that’s created some kind of trauma. Um, and, and, you know, this pandemic has affected us all. I think everyone who’s participating today, uh, can probably say, I know someone who, or I may know of someone who’s the one that died right. From, from the pandemic and, you know, with, you know, with everything that’s going on, it’s really jolted us as human beings, you know, putting mental health aside for just a moment and just kind of like, let’s, you know, level-set this, you know, we have, um, our DNA has been altered, right.

Kathy Rivera (00:17:07):

In terms of looking at the world and safety, uh, and, and the future, right. There’s a big question mark about it. Now, if you insert the population of children into that, as well as their caregivers, uh, it’s been really hard to navigate. And so when I re referenced, you know, mental health and wellbeing, even, you know, it’s, it’s not, um, it doesn’t always have to be organic, right? It doesn’t have to be hereditary. It doesn’t have to be this sort of long lasting, you know, generational thing. It could be something significant that’s happened. Um, and we’re just not okay. And we don’t have the strength and tools to get through whatever it is that we’re going through. Um, and that’s inclusive of again, of our and our children. And we’re seeing more and more of that fragility in our families who are new to us, right?

Kathy Rivera (00:17:57):

These are not sometimes even children that have cycled in and out of the hospital. These are children that were relatively okay before the pandemic and now are in a very different place and that’s inclusive of their families as well. Um, so I just, you know, I just wanted to sort of share that and really also, uh, share that we treat the family ecosystem. We don’t just say, okay, you brought the child in and we’re going to treat that child. We expand that to the family and anyone else who’s in that child’s life that needs the support, uh, because it’s, you know, it takes a village, right. You know, to raise a child. And we, and we really support that village. So to speak, like literally the Nassau county villages, as I’ve learned as a queens gal, there’s villages and towns,

Brad Caruso (00:18:42):

You know, that, that shaking her head. She seems to know that many, many

Kathy Rivera (00:18:47):

Villages and towns,

Elissa Smilowitz (00:18:50):

No. Um, Kathy’s right, because we have a lot of parents coming in with anxiety, depression, and we do a lot of family work, and we do a lot of family work to help the parents recognize that they’re owning anxiety or their own, uh, way of, uh, coping, uh, the children absorb that they absorb the anxiety, they absorb, uh, the disconnect or the depression. So, you know, part of what we do also is we try to work with the, uh, family unit. And even, even if they’re living with grandparents or aunts and uncles or siblings, we will bring them in also, um, because that’s exactly what we’re trying to do, trying to improve the family unit to be able to support each other in this, in this pandemic.

Brad Caruso (00:19:40):

I think that’s so important. Um, you know, just, just, just knowing from, from my own experience, I know that, um, yeah, there’s a lot, there’s a lot of, you know, you’re, you know, as a parent, I’m a parent of a three and five-year-old, um, I fear that they feed off my anxiety in times like this, and they probably do. They see it. Um, you know, there’s an extra anxiety with, with, you know, we’re not used to always being around our kids and having professional life and trying to delineate the two of those. I think that’s a real challenge for everybody. I know, even with myself, my office is literally like a, Stone’s throw away from my daughters and sons like bedroom, and, you know, literally I can walk there, you know, it’s, it’s, it’s scary and they can hear everything you say and all those things.

Brad Caruso (00:20:21):

So I think, I think just, just, you know, educating parents I think is, is super important. And on that topic, I guess what I’ll ask with that is, you know, what, what do you feel are some important things as a parent, um, to look for social cues, to look for how, uh, you know, any behavior that, that, you know, maybe it’s time that we do talk to someone outside of our house that is a professional, you know, w what are some things that I guess our listeners could glean from that, that you’ve found are kind of successful educational strategies or strategies that you’ve employed?

Elissa Smilowitz (00:20:52):

Well, you know, a lot of times what we tell parents is that if they are, if they’re seeing their child be isolative, like isolating thing in their room, uh, not coming out of their room, staying on their, uh, devices for eight hours a day, that’s, that’s a red flag. Um, if they’re not eating, if their appetite is off, um, if they’re not able to, um, have a conversation without having significant turmoil, either anxiety or, or depression or anger, sometimes children will display anger rather than depression. Um, you know, you know, your child best, but there are certain situations if, if your child is not willing to do any social, um, outlets, you know, cause now children are starting to do that. Um, you know, those are the red flags that I would look at, um, you know, as a parent, you know, your child best, but if you’re seeing any of these behaviors and they’re escalating these negative behaviors, um, that’s when you really have to talk about whether, you know, the child needs a little more, uh, mental health, uh, care.

Kathy Rivera (00:22:07):

Yeah. I would just probably, I think Elissa hit the nail right on the head. I would also probably say, look, it also sleep patterns, right. I think that this pandemic has really shifted the sleep patterns of our children. And I think with especially teenagers, you know, it’s easier to sort of, uh, you know, minimize and say, oh, you know, it’s just the teen who just constantly sleeps as in the morning person loves to wake up in the middle of the day, you know? Um, but you know, really, again,, you’re always in the driver’s seat when it comes to your child and you know them best, as Elissa said, and you should be looking out for those things. And just simply, you know, if you had to ask yourself as a parent, is everything okay with my child that is already the first kind of indicator, right?

Kathy Rivera (00:22:48):

If you’re asking your own self, that question, imagine what they’re going through. Um, I also think communication is key, right? Words are very strong. Language is very strong. I think sometimes as adults, we get scared to use words because of the stigma. Uh, so we get scared to ask our child, are you depressed? Right? We, we, we, we sometimes as a parent and I, I’m a parent myself, and I’m a clinician, we get scared that if we introduce a term to them, oh dear, oh dear, is that going to be a problem? Are there, you know, am I going to scare them? Are they going to think, oh my God, are they asking me if I’m, I’m crazy? You know, think things of that nature. And I think the more we, I never used the word normalized, naturalized language, naturalized discussions, make it okay to say, are you not okay to do need help?

Kathy Rivera (00:23:40):

You know, do you need somebody to help you besides me? Did you want to talk somebody else besides me, if that’s the case, it’s all right. How do we, how do we make you start to feel better? Um, what do you know, what can make you feel better? No. Do you think maybe we could try talking to someone else to feel that, you know, to see how we can make things, um, turn around. I think with depression, especially, um, we make the mistake of thinking that the opposite of depression is happiness and that’s not accurate, right? The opposite of being, uh, of depression is not being depressed. Um, nobody walks around being happy all the time, but if we can help the child or the family, wherever is going through it, not have those feelings on a daily basis so that they, so that they can enjoy things or that they can get through the day. That is what, you know, treatments. And that is what we aim to do, right. To help helping families define what wellness is for them, what it looks like. And more importantly, how to get a taste of it, how to achieve it, how to gain it back if they’ve lost.

Jen Stewart (00:24:46):

Okay. To Kathy’s point, I think too, I think it’s how you approach it as a parent. Right. So you have to be open with them and have the conversation what’s going on and, and make it a point that it’s not, they’re not being weak if something’s wrong. It’s okay. It’s okay. That’s normal. And it’s okay. If, if I, as a parent can help you, we’re going to find someone that can help you. Right. I think that’s really the key,

Elissa Smilowitz (00:25:13):

I think, I think absolutely. I totally agree. Um, but you know, also if you have children or especially adolescents thing, what’s the use, you know, um, having some kind of passive, suicidal, uh, conversation, like, you know, um, not seeing a future for themselves, you know, have that conversation. I think it’s important. It’s your right. Not to look weak, but also let them know. They’re, they’re not in trouble because sometimes children feel like they’re feel guilty that they’re having these feelings and emotions, and they’re concerned that they’re going to get in trouble, especially when you’re dealing with elementary school. Um, so, you know, having these conversations are really important.

Ashley Krompier (00:25:57):

Yeah. And I feel like too, as, um, you have these conversations with the families and children, they do go so hand in hand because, I mean, I’m just thinking the likelihood of the parents, even maybe hearing these things when they were children potentially could have been extremely small or not there. So it’s, it seems like it would change the trajectory of everything. And even the conversations down line that these kids have with their own children, just the openness. Right. Right.

Kathy Rivera (00:26:24):

And I think with, you know, with Elissa who does phenomenal work with her team around her, um, her teams, excuse me, around, you know, suicide prevention, um, and just sort of pivoting back to caregivers, asking the questions or just adults. Right. Because you don’t put all that pressure on the power, right. If you’re someone in a school that seeing something, that’s, you scratch your head, get involved, don’t ignore it. You know, you could be saving someone’s life by even just opening up the dialogue and giving permission to say, I, it looks like you’re in pain. You know, you need to talk about it. Right. Don’t bottle it all up. You know, I think even sometimes questions that adults shy away from of saying, do you like, do you sometimes feel like you want to hurt yourself? You know, is, is the pain very strong? And are you thinking of hurting yourself?

Kathy Rivera (00:27:11):

I think that, again, it’s all sometimes get scared to ask that because they think they’re introducing a concept to the child. And I assure you, if a child is feeling a certain way and battling these emotions, they may be thinking about it, whether you introduced it to them or not, wouldn’t, you want to have that dialogue and understand, you know, what it is that they’re going through and what that they, you know, what they’ve been thinking about because when you have that knowledge, you can make different choices. Um, you know, for years I worked with, um, adolescent and adult male youth staff in residential settings. And I always said to them the most, the most important thing you can do as an adult is to use yourself in that, in your relationship with that child, uh, to, to make a difference. And what you do is what you do do as an adult or what you don’t do as an adult could really make or break what happens next.

Kathy Rivera (00:28:05):

Um, you know, not to be confused with, you know, I’m not, I’m not finger pointing and saying, you know, it’s an adult’s fault if something goes awry, but you know, really their children at the end of the day, we’ve got a model for them. Right. Um, we also have as, um, adults and caregivers have to keep a pulse on ourselves in terms of if our tank is on empty, we’re not, we’re not able to give to the kids. Um, so, you know, as, as those listeners who are adults who may be going through this and have children, um, please, you know, take a barometer barometer, reading of yourself, and also just be more aware of how that may be impacting, you know, um, the child that’s in your children that are in your life.

Elissa Smilowitz (00:28:48):

Absolutely. And you know, something, I use that analogy when I work with parents and you know, when they’re having this conversation and I say to them, if I use a barometer on myself of what I’m feeling, I’m feeling anxious, just the fact of how you’re talking to each other, imagine how your child feels. So, you know, we do use that as a, an analogy to help them under parents understand what they do matter. You know, what they do with each other as a, as a family unit becomes very important. These children need that security. They need to know that their parents are going to be there and support them. And if they see parents that are not doing well themselves, it scares the child, you know, and that’s where the suicidal ideation comes, where they, they don’t know how to deal with it. They don’t have the ability developmentally to deal with that. So, um, being more cognizant of where the, as adults, where you are as a parent is becomes very important for these children.

Brad Caruso (00:29:51):

Well, yeah, and it it’s complicated because how many factors impact it? You know, how many different, you know, you have genetics, you have social ex you know, isolation, you have, um, what you eat, how you eat. I mean, you have family environment, you have past history, you have, you know, a whole host of disorders that could have arosen, you know, it could be genetic, uh, there’s so many factors that affect it. It’s, it’s so hard to tell, you know, which, which one is more important than the other, how you approach it.

Elissa Smilowitz (00:30:20):

Right. And so, yeah, and the, and the pandemic has increased that tremendously, you know,

Brad Caruso (00:30:27):

I imagine it’s amplified it. Yeah. And I, I feel it personally, it’s amplified it, um, I guess on this topic and kind of talking a little bit more detail about some of the work that you’re doing around, you know, suicide prevention and, and how you’re approaching that. And, and also, I want to just, I guess if you have this information or, you know, it puts context to it, you know, what, what does the data kind of show right now? I mean, are there, is there an increase in, uh, I’ll call it, you know, your, um, inpatient or outpatient activity, uh, but then more globally, you know, statistically, is there an increase in suicide just in general, I’ll say either in your local area or in the United States. I mean, are you seeing any, any trends from a data perspective either at your local level or a more of a global level?

Elissa Smilowitz (00:31:11):

Um, well, yeah, I mean, um, you know, suicide from, uh, has increased dramatically. There’s been a 50% increase in suicide in, uh, young adults and, uh, from 2008 to 2018. And with this pandemic that has increased also, you know, we are seeing a lot of 11 and 12 year olds that are coming in from urgent care with suicidal ideation, depression, and anxiety stemming from the lack of the isolation, the inability to self-sooth, um, having troubles tolerating what’s going on with the environment and also the impact of how their families are handling these situations. So, you know, we’re definitely seeing an increase where we, we are seeing a tremendous increase in the younger adult population, which is very unusual and very concerning, you know, um, and, you know, uh, there’s like a 50% increase in children, girls, specially going into the ER with suicidal ideation, uh, from 2019 to now there’s a 50% increase.

Elissa Smilowitz (00:32:23):

So yes, we’re seeing many more, many more children, um, that are coming into our agency as you know, all ages. But, you know, lately it’s been the younger children with all these issues that have, um, really amped up their anxiety and depression, you know, as far as working with the families with the triage clinician does is first of all, we get them in immediately between 24 and 48 hours after if they have an intake and they’re saying their child is having suicidal thoughts or self-harming or cutting, we get them in within 24 to 48 hours. Um, and we do this with the triage clinician who works with the entire family, not just with the child, because there’s a safety factor. You know, we have to make sure the child is able to express themselves with their parents and, and feel comfortable doing so we have to make sure that the environment is safe for them.

Elissa Smilowitz (00:33:23):

At this moment, we give the parents a ways of learning, how to monitor the child, make sure the child’s safe while we continue treatment. And we can continue treatment immediately, um, with the children, um, helping them, learning, coping skills, helping them learning to be able to verbalize when they’re having a triggering event or a triggering thought who to go to, where to go to which, you know, those are the safety plans that we put in place, and we do it in writing and we make sure the family has a copy of it because we want the families to feel, uh, that they are able to handle it. We want to make sure the family understands that, you know, here, here is a list of things that you could do to help monitor your child. It makes the parents feel better because then they feel like they have some kind of a plan, right, moving forward.

Elissa Smilowitz (00:34:19):

And we work with, uh, the schools, we work with the family that can call the triage clinician anytime they need to. Um, and, uh, usually this is, this is the process. We see them two to three times a week, sometimes depending on the severity. And if we feel that the child is really struggling, um, and we want to have another pair of eyes diagnostically, or we feel that there may be need for medication. We have psychiatry, our psychiatrist that will see the child. So, you know, we do group, we have parent groups, we have groups for the children. We have individual, we do family. And, and this is like a really, um, it’s outpatient, but it’s more intensive. And we do this and we monitor the child until we feel the child is in a better place. And, and usually within a few months, we usually can tell, um, w you know, there’s usually improvement, especially if it’s environmental, we can usually, you know, get some improvement within the first few months. Um, but yeah, it’s, it’s very intense work that we do

Kathy Rivera (00:35:33):

Just wanted to add, you know, Brad, I was actually part of a webinar with the New York state commissioner for the office of mental health. And some scary statistics were thrown out, um, in, uh, 2020 in New York state alone, there were about 44,834 suicides. Um, New York state saw an increase by 30% of emergency visits, uh, with adolescents with mental health needs, um, and an increase of girl and an increase in the female population. Um, engaging in suicide, went up by 51%. Um, and I think that those numbers are scary and should be scary. And, um, the adult, you know, it’s a call to action for, for the communities to really open their eyes and make them realize that this isn’t going to go away. Uh, you know, COVID, it’s not going to end, and that’s not, those numbers are not going to probably go down. And, and I, I believe they will actually go up.

Kathy Rivera (00:36:28):

Uh, and so, you know, programs like our Latino girls program, which really provide a wide array of mental health services and respite support to that very vulnerable population. You know, many of these young girls are, um, young ladies of immigrant parents. And so they’re navigating between an American society and their cultural society, and trying to also find their way in transition to adulthood and be okay and try to develop what are, I mean, dare I use the way, the word norms anymore. What are the norms anymore? There are no more rules if you will. And so our services, you know, I think are really needed more than ever. They’ve always been lifesaving, uh, but the, the, you know, the amount of services and support that’s needed for communities are greater than ever. Um, so for listeners, you know, we welcome any kind of support from the general public.

Kathy Rivera (00:37:20):

You know, we, we have very, um, a very generous board. We get a lot of donations. We work with a lot of foundations, but this, the, the, the need for support is going to have to go up. Um, and, you know, we also have a great drug and alcohol program because, you know, there are a lot of what’s described as co-occurring disorders, right? So there are mental health needs and their substance use needs. And often the question becomes what came first, the chicken or the egg, but it doesn’t does it really matter. You have these two great needs, um, that are present amongst our young people, um, and you know, are intergenerational. And so, um, you know, very often, you know, we find that, you know, the increase in those kinds of needs for services are also growing. Uh, so it’s, it’s, it’s a perfect storm, if you will, right now with COVID and, uh, please know that we are ready.

Kathy Rivera (00:38:14):

We’ve always been ready. We’ve never closed our doors. Um, and so what, so this is point are high risk cases are high risk, right? The higher, your need, all your needs are, you know, the more treatment and support we’re going to provide. We’re not gonna, you know, uh, pivot you to other places. We, we, we try to be the one-stop shopping, um, all the time for families, because we know how difficult it is to navigate. But, you know, when you’re in the middle of a crisis, you don’t have time to, to search, you know, to search, you know, you need to go to a place where you are going to feel safe and okay. And that’s who we are.

Brad Caruso (00:38:53):

Yeah. The number 44,000. I mean, the number one is alarming, the number 44,000, you know, it makes your head explode a little bit because you have to think, I mean, and these are, these are, you know, young folks, these are people starting off in their life. There’s so much to live for, but yet, you know, when you’re in that place, it’s very hard to see otherwise, you know, the biggest thing I see in, in life is just a, you know, people need some level of hope. They need to, they need to have a belief that something can get better at some point, right. As opposed to, as opposed to that bleak outlook, which is really probably the driver on top of a host of other things. But, you know, with, with not only is it yourself, but your family struggling, and a lot of things around you, it’s hard to see that hope when you’re going through it, or it’s hard unless you have someone tell you, uh, that this isn’t normal or that there’s, uh, there’s something else outside of this.

Brad Caruso (00:39:40):

I think that, you know, where, when, when I hear some of the things you talk about and, and kind of just research in your organization more that I, I feel is so valuable as people just need to understand that you can’t solve it yourself. If you think you can solve it yourself, then you wouldn’t have a problem in the first place. That’s, that’s my opinion on it. Just from personal experience, you’d need someone to tell you, like, this is a normal, or there’s, there’s so much more than what you’re thinking. You’re thinking very narrowly and rightfully so. I mean, listen, I’m not, I’m not judging anybody either. I think there are certainly places for people to think that way, but, um, you know, from my perspective, I really, you know, I really value, um, that input and, and, and just knowing that, you know, there’s the work that you’re doing and how important it is and how important it’s going to be.

Brad Caruso (00:40:22):

Right. So, you know, thinking about fundraising, I mean, you know, organizations are seeing increases in activity, not decreases, and it’s only gonna continue. You know, we’re, we’re probably at the, we’re probably just at the beginning of all of this, you know, it takes time for people to be isolated and now we’ve been isolated for 18 months. So, you know, it’s only going to get increased the level of, of need, uh, you know, of your health and your services. So, um, very important to put context to that, in my opinion. So I, I thank you for sharing that.

Kathy Rivera (00:40:51):

I also, you know, I just also want to let the listeners know, you know, the earlier the intervention occurs, the more successful you’ll find, right. You know, uh, an upstream investments, uh, creates long-term prevention, uh, for the little guys, right. You know, the, the quicker you, you can see signs and intervene, the better outcomes. And, you know, we have, uh, the Nancy Marx right from the start program in our map Manhassett office. So we work with the little guys it’s zero to three, but, you know, really we target zero to eight there. Um, we have the, you know, maternal depression program because, you know, the healthy start and beginnings for a babies start in utero. Um, we all know that right. Healthy developments, uh, you know, is, is the springboard for, um, you know, physical wellbeing as well. So, you know, we have, we work with mothers, you know, perinatal postpartum, and we provide that support and services to ensure, again, you know, you treat the mom, you’re treating the child as well, um, and giving them the right start. So, you know, I, I, you know, I’m really proud to be part of the guidance center. You know, we, we treat the family ecosystem. We S we really do. We also have a grandparents program. So, you know, it’s a life cycle of a family I often refer to, which is key,

Elissa Smilowitz (00:42:08):

Right? Yeah, you’re right. And, you know, maternal depression, um, I’m part of that program. And I must say this pandemic has really triggered a lot of anxiety for these mothers, uh, mothers that are, we actually work, not just with maternal depression. We also work with mothers that are pregnant, that are really struggling with the environment and, and feeling safe. And what do I do to I get the vaccine? Do I not? I mean, all of these, uh, all of these questions and concerns and worries, um, in regards to having the baby in the hospital, who’s going to be there, what are they, you know, as my husband going to be allowed to be in there, you know? So, you know, we do deal with, um, that, that surgical. So we’re seeing, uh, a lot of maternal depression and pregnant women coming and saying help. I need help.

Jen Stewart (00:43:03):

I think, yeah. Postpartum, I think, I mean, I have an 18 month old. I had a baby in the middle of COVID, so I, which was the hardest thing I’ve probably done in my life to your point. I mean, I didn’t know if I would have someone with me when I was giving birth. I luckily did. Um, but afterwards I ha I had to be isolated. So my husband could not stay. I was by myself other than obviously people in the hospital. And that was really, really, really difficult. Um, and I think the postpartum piece resonates with me personally, because dealing with that in the middle of COVID you’re by yourself. And now looking back on it, I can say I probably had a mild, mild version of postpartum depression. And I think that’s one of those really important causes that people don’t really talk about a lot or, and mothers don’t understand what can happen after, after giving birth. And, and that’s scary. It was scary for me and scary for people. I know. And I just tried to you try and speak up as much as you can and tell people it’s okay to get help, because there are a lot of women that experienced postpartum depression. I think the statistic is much higher than people realize, and it’s important to make sure that they’re aware of that. So I, I, that’s one of those programs that is close to my heart and I really appreciate it. It’s definitely needed.

Elissa Smilowitz (00:44:33):

Yeah. And we do well, we do virtual groups with the mothers and the babies. We do virtual sessions. If they’re not comfortable, well, we’re doing virtual sessions right now for them because we want them to feel comfortable. We want them to feel safe with their babies. Um, so, and we do psychiatric services for that population too, when needed. So yeah, it’s all part of triage.

Kathy Rivera (00:44:59):

And I appreciate you, Jen, you know, sharing that because I think again, you’re modeling, uh, what we’re hope, you know, our hope is as we educate and raise, um, you know, the need for mental health support, uh, with the mental health needs are, um, and just really de-stigmatizing it, you know, it, it has, you know, um, it has no boundaries, right? It doesn’t, it doesn’t target one community it’s really across the board. And I think that the more and more we see a comfort level with discussing it and disclosing it and not judging it and saying, you know, it’s okay, any one of us at any point of our life just need that help in that support and just be comforted by the fact that places like the guidance center are here for you and we don’t turn you away and we’ll get you through this. Uh, you know, I learned very early on in coming here that I am now part of a family that treats families. And I say that with pride, and I’m very excited about that. And I actually feel very lucky.

Jen Stewart (00:46:02):

Yeah. I think what’s so great too, is we, we all know someone who’s had a mental health struggle or some other struggle, right. Or we’ve had it ourselves. So it really is a universal issue for everyone. And that’s why this organization and others, like it are so important to our communities.

Elissa Smilowitz (00:46:24):


Brad Caruso (00:46:26):

Yeah. And the more and more you have discussions like this, the more and more you’ll, you’ll find out that I think a lot of people have, you know, you’re not alone. I think that’s other, another concept that we’ve kind of talked a lot about, but you know, most people out there, like you’re not alone. Like, so if you’re listening to this and you’re like, man, I feel you’re not. And you could think the most together person, I mean, people think I’m together. And if I told you my history, you’d be like that. Guy’s not together, but at the same token, you, you go through a lot of, a lot of help. You therapy people, people along the way really save you and help you. And I think there’s a lot to be said about that. You know, don’t just think that you see someone on social media and they’re so perfect.

Brad Caruso (00:47:00):

Well, they’re only showing you the pictures that they want you to see, you know, social media opened up all the pictures, which it couldn’t, it would, they would explode if it did, you know, you would, you would literally, you know, your mind would spin. Cause you’d realize that you’re not alone. You’d realize that, you know, everybody needs help in some capacity help and people that don’t are probably just denying it or they’re trying to put on a front that they’re, you know, everything is fine. And sometimes there are sometimes people are, but I think it’s just important for anybody that listens to this, in my opinion, I think one of the most important discussions with anybody it’s just, you know, just know that you’re not alone and know that there’s a lot of, a lot of organizations. There’s a lot of individuals, professionals, family that, you know, you have to, you have to reach out or in, in your case, you know, you, I imagine you do a lot of outreach as well. So, you know, you’re also, you’re also extending that arm to say, you know, you may not feel comfortable reaching out, but we’re going to reach out to you. And I think that’s the other, you know, very important part about what you do is kind of that outreach education, um, you know, being in the right place at the right time component. Uh, I think, I think it’s very integral to really helping people,

Kathy Rivera (00:48:05):

Absolutely. Brad, we are out there, right. Because the more there’s you can never do enough when it, when it comes to, uh, raising awareness, um, making, you know, giving people permission to be able to talk about it and without judgment or stigma, you know, we just did a fantastic webinar for incoming freshmen at, uh, the Schreiber school in port Washington, uh, because, you know, talk about a really critical age, right. And, and a pivot, um, to, you know, moving toward adulthood and, and Brad, you said it, you know, the social media and, and how that really impacts a young mind as it developed, you know, the science behind it and what’s normal and Hey, I don’t fit into that. So there must be something wrong with me. Right. And, and worrying about, you know, the impact of that while that, you know, those are the informative years that really lay the foundation for their future, right.

Kathy Rivera (00:48:54):

That that’s, you know, the, the time that the parents are cracking whips and saying, you know, come on, you know, you gotta gear up for college, got to get yourself ready for that. And they’re just trying to get through the day. Um, so we are making sure that we are in the schools, not only through our intensive support program, which we partnered with posies. We also, um, you know, we are, we have pupil personnel, which is an upcoming webinar where we invite, uh, all the school districts, uh, to be a part of whether you’re a guidance counselor, a teacher, a parent, the principal, anyone, um, to partake, you know, participate in that. And, uh, just listen to what we have to say have become more aware of our programming, but it’s also our way of educating ourselves of getting a pulse on what’s happening in the community.

Kathy Rivera (00:49:41):

What are you seeing as, um, folks in the education system? You know, did you know we were, uh, around if so, and you see something where you feel a child or a family could use some help and support, send them our way, reach out to us, ask questions. We partner with the community every time that we can. Um, and our hope is to, uh, continue working in collaboration with the different schools, uh, to ensure that we raise awareness, um, educate parents and young people, uh, and, and staff, um, leverage, support, community support and say, you know, we’re going to get through this together. We are.

Elissa Smilowitz (00:50:27):

I think it’s really important that, that, you know, children and, and, and, uh, adolescents know that you know, we’re human beings we’re going to be set. Sometimes we’re going to have anxiety. Sometimes, sometimes we’re going to be happy to, to just have the conversation that yes, you’re going to have these emotions and it’s okay. And if you need help, we’re here to help you. I think that’s really important to, you know, let, let the children know that you’re not going to be happy all the time and that’s okay. Right.

Brad Caruso (00:51:04):

I think that’s a very real understanding. People need to have is that things are not, I mean, the world is not rosy and green and happy, you know, 99% of the time. And if it is, you know, God bless you, but I don’t think most understand. And that doesn’t mean that you’re living a bad life, but, you know, I mean, listen, nobody likes pressure and anxiety, but it’s a natural part of life. I mean, you’re always going to face conflict, whether you’re a professional or, you know, in your job, you know, you can be a professional sports athlete, you face injuries, you know, you’re in our professional services world, you’re going to face conflict. You know, you’re in your world, you’re going to face trauma and you’re going to face tragedy. And, you know, I think, I think those are all it it’s taking the good with the bad, but understanding that the good outweighs the bad and understanding the bigger picture, which is, I can accept this. I can accept that today’s not a good day, but it doesn’t mean my life’s over. It just means I had a bad day. And if I have a positive attitude, tomorrow is going to be a better day. And I that’s all I can do. Now, if you have 365 consecutive bad days and you know, it might maybe change.

Kathy Rivera (00:52:08):

Yeah. I mean, oh, sorry. I was just going to say, you know, Brad, I think, I think you hit the nail on the head. Right. You know, look, everyone’s going to, uh, everybody in their lives. And also regardless of their age, um, is going to encounter some amount of stress in life. Stress is, is, is difficult, right? Adulting is difficult. I would trade it. I’d be happy to, um, but it’s when it becomes toxic stress is where your spidey senses go up and you say, you know what, this isn’t normal. Um, and so not horrible, but this isn’t okay. Right. And it’s not okay. Uh, I mean, it’s okay to not be okay. Right. You know, when the level of stress in your life or what’s happening in your life now causes you to not function in school in your personal relationships, whether it be romantic or friendships, uh, with your children, with your inter job at your school. That’s when, you know, I have to get, I have to get help. Right. I have to, I have to talk to someone and I have to get help. And you have to know that you have permission to do so.

Elissa Smilowitz (00:53:15):

Absolutely. And you know, I think a lot of the work that we do, they’re life skills, you know, they’re life skills that you don’t learn in school. You don’t learn about this high school, elementary school, how to, self-soothe how to get through a day, how to, how to handle the stresses in a healthy way, or how to deal with, uh, you know, thoughts of, of, um, not wanting to exist anymore. You know, this is when you really have to reach out, reach out and get the help you need. So you can learn how to handle situations that are difficult in your life.

Jen Stewart (00:53:53):

Yeah. And it doesn’t mean you always get better. Right. Sometimes you just need to be able to cope and that’s okay.

Elissa Smilowitz (00:54:00):

Exactly. Exactly. Absolutely. Absolutely. And, and, you know, the, the positive attitude, the self-talk, it’s all important skills to learn, to help you through those moments

Kathy Rivera (00:54:15):

And the reasoning. It’s okay too cause Elissa, you know, you talk about rhythms, right? Your circadian rhythms, right. Your breathing techniques. Right. You know, I, I think anyone of us has ever, um, I’m sure you can relate to having sort of the racing heartbeat, the temperature change, right. All these, um, you know, physiological changes in you that really cloud the way you think and feel, and you just can’t function. You know, really just being able to take again a barometer reading of yourself and where you are. Right. And just doing anything you can to just sort of get back to sort of, you know, a comfortable level. I don’t even want to say baseline, but just like a comfortable level, um, is so key. Right.

Elissa Smilowitz (00:54:58):

I call it grounding, you know, to ground yourself, to get yourself in a place where, you know, you could think clearly it’s that you’re not, uh, overcome by everything going on around you. Um, I think that’s key. And that’s why a lot of, a lot of the, uh, clinicians, especially triaged, they do a multiple of different techniques. They do the, the mindfulness learning how to breathe, learning how to just sit and be. Um, and then, then they do the CBT looking at the cognitive way of how you look at things. What are your perceptions, how does that impact, how you feel, how do your thoughts impact your mood and your behavior? You know, these are the things, these are the skills that are really important to try to understand, not just for children, but for everybody.

Brad Caruso (00:55:47):

Yeah. Sometimes it never goes away. So it’s about how you cope with it or what strategies you can employ or what kind of techniques you have in your pocket that can get you out of a state,

Elissa Smilowitz (00:55:57):

Uh, toolbox. Sometimes we actually do still box, you know, emotional toolbox.

Brad Caruso (00:56:05):

I’m gonna start selling one. It’s a great idea. Yeah. Trademark, or right now this, this podcast is trademark case. Anyone decides to steal that great idea.

Brad Caruso (00:56:20):

Great. Well, we, you know, we, we’ve just been, um, it is a great conversation. Um, I think we’re going to have another conversation in the near future and, and kind of keep reinvigorating this, but w what, um, you know, what I wanna kind of wrap it up with and, and, and bring it home with is, you know, from, from your perspective, Kathy and Elissa, you know, w w where do you see, you know, your organization itself needs help from the public? Um, it could be in a variety of fronts and, and, you know, what do you want to leave our listeners with kind of as a, as a, uh, uh, final segue?

Kathy Rivera (00:56:49):

Um, again, I think two key areas I would like is, uh, you know, her forever for anyone who’s listening. I really want them, um, to just really take away the two notions of, um, you know, if you see something say something, right, you know, it’s all, we’re all in this together. Um, and what you do do, and, and helping someone get help can really save a life at the end of the day. So I think, you know, a call to action, uh, not only for the listeners, I just think as human beings is, you know, again, raise awareness, educate yourself. Um, if you yourself, or, you know, someone has gone through something really difficult, whether it be mental health issues, substance use issues, whatever, be comfortable talking about it and give permission to others. Um, so I think, you know, the more we educate each other and raise awareness and minimize, uh, the stigma of mental health, I think it will be better in the long run.

Kathy Rivera (00:57:47):

Um, and then of course, you know, um, I would be remiss if I didn’t talk about, you know, also, um, being able to support organizations like us, you know, we’re, we’re, we’re small, but we are mighty. Um, and, you know, look, a lot of our funding comes from different streams. We’re about 34% government, 49% in, in, uh, program fees and 17% in fundraising. Right. So, you know, whether you can, um, uh, support, uh, provide support in a financial way, that would be fantastic. Um, I’m looking at Jen, you know, Jen is a part of, one of our board committees, um, hint, hint, maybe a board member to one day. I don’t know, but that, you know, there are different ways to give back to organizations and level of support. Um, and for those who are listening, if we resonated for you in any, any type of way, and you connected to us reach out to us, you know, if you don’t know how to support us, reach out to us and ask we’ll we’ll, we’ll give you a laundry list. Believe you, it probably be regretting you call it, but I promise you, you won’t wear a lot of fun. And we’re amazing. And we, our vision for our organization is to just, uh, expand our already amazing services, create more specialty services as, as the needs of the communities change as we’ve seen over the last 70 years, um, and really continue to advocate for mental health on behalf of all of our children and families.

Elissa Smilowitz (00:59:13):

Yeah. I think I would also like to take away and say that when you reach out for help, it’s not a sign of weakness. It’s a sign of strength. It’s a sign that you’re willing to get the help you need to change your situation, change your mental health, improve yourself, look at it more as a strength rather than a weakness.

Brad Caruso (00:59:41):

Love it. Well, thank you very much for that message. I hope everyone listening, uh, can take something away from this and, and, you know, honestly, I hope it saved someone’s life one day because it, it means a lot to have, you know, folks out there like you doing the work you do. It’s not easy work by any stretch of the means. And, you know, there’s, there’s constantly a, it’s constantly going to get more challenging. So we appreciate the work. You do appreciate spending the time with us and just having this conversation. And we hope, you know, certainly we’re going to have another, uh, another conversation in the future. So thank you so much for being here

Elissa Smilowitz (01:00:13):

And we’re delighted to be back.

Brad Caruso (01:00:17):

Thanks for in. Thanks for all of us. Have a great day.

Music (01:00:31):