Shooting Trauma Rx: Fix Bureaucracy

Thomas MacMIllan PhotoHow can New Haven help people dealing with the traumatic effects of gun violence? More mentors, more focus on neighborhoods—and less paperwork.

Those answers emerged Wednesday morning during a “roundtable” discussion with U.S. Sen. Chris Murphy (pictured) at Clifford Beers Clinic in Science Park.

Murphy was in town to discuss the effects that gun violence can have, not just on immediate victims, but on families, neighborhoods, and communities. He spoke with a dozen mental health professionals and social service providers and the chief of police about the rippling mental health impact of shootings.

Murphy, along with other members of Connecticut’s delegation in Washington, has been focused on guns and gun violence since the Sandy Hook mass shooting in Dec. 2012 in Newtown. The senator has sought to bring attention not only to school shootings, but to the more quotidian gun violence that occurs in American cities.

“Urban gun violence goes unnoticed by the national press,” Murphy said. He said he holds monthly discussions with middle- and high-schoolers, and finds that nearly all of them know someone who’s been shot.

The trauma of a shooting spreads through communities, leaving mental health problems—stress, anxiety, post-traumatic stress disorder—in its wake. One of the obstacles to treating those conditions, according to Clifford Beers Clinic Executive Director Alice Forrester, is a billing model that fragments care and creates a paperwork burden.

A Bad Model

“The burden of documentation and billing is so high,” Forrester (pictured) told Murphy, that it “doesn’t allow for counseling.”

Forrester said Clifford Beers Clinic sees 2,000 children per year for counseling and therapy. The center relies heavily on Medicaid payments to meet its costs, which means the clinic is forced to conform to a “medical model.”

This creates several problems. For one, clinic staff have to write a diagnosis and a treatment plan for every new patient, both of which need to be updated with any change in the patient’s circumstances. A psychiatrist needs to sign off on all treatment plans every 90 days.

Second, the medical model prevents staff from treating entire families. If a family comes in and it’s clear that all members are facing a constellation of mental health problems, Clifford Beers staff nevertheless have to treat members individually. Each family member would have to have their own file, their own diagnosis and treatment plan. As a result, treatment is fragmented, atomized, Forrester said. “Nobody’s talking to each other.”

Also, Medicaid only pays for therapy sessions, regardless of the time clinicians spend outside of therapy—calling school counselors, pediatricians, talking to family members.

“If I go to school to monitor behavior” of a patient in class, “I can’t be reimbursed,” Forrester said.

What’s needed, Forrester said, is “payment reform.” The federal government should allow counseling centers to move from a medical model to a “rehab model,” which is more flexible, she said.

“I’d like to look deeper into that,” Murphy said, when asked about Forrester’s comments. He said he and others have been working to put mental health care “on parity” with other other medical care, but it sounds like counseling may have a higher bureaucratic burden than physical care.

Mentoring; Neighborhoods

The most moving statements at Wednesday’s discussion came from Maysa Akbar, head of Integrated Wellness, a psychotherapy practice in New Haven. She spoke about growing up amid gun violence in Brooklyn housing projects. She said she was affected by that environment, and spent some time homeless as a teenager. “I wasn’t supposed to make it.”

The “only ingredient” that allowed her to succeed: “mentors that were placed in my life.”

“People became important to me, and not letting them down became important,” she said. Mentoring is key to address gun violence and its effects, she said. “We have to be on the ground.”

New Haven Police Chief Dean Esserman (pictured) thanked Akbar for her comments. His advice to Murphy was to focus on neighborhoods. That’s how young people create a sense of identity and find connection, he said. “That needs to be reinforced and supported.”

“Kids go to places where they’re comfortable,” he said. They may not like the chief of police, but they like their neighborhood cop, just like they like their neighborhood store, their community center.

Asked after the meeting what he was taking away from the discussion, Murphy said, “The conversation at the end was fascinating.”  He said he wants to look into “the idea that services should be rooted in the neighborhood.”

Murphy said that while the federal government “shouldn’t micromanage,” there may be a way to encourage local organizations that receive federal dollars to tie their work to neighborhoods.


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posted by: anonymous on March 19, 2014  1:54pm

So instead of investing directly in the poor neighborhoods themselves—which is what most residents ask for, though perhaps not the ones invited to press conferences—we should continue to raises taxes on low-income families who rent, in order to hire more doctors, shrinks, and police officers who almost entirely live out of town?

posted by: Shaggybob on March 19, 2014  2:31pm

Anonymous - you got it. That’s how we do it in New Haven- why put the money where it needs to go to actually solve a problem. You should run for mayor.

Why try to get rid of the guns that would prevent the shootings in the first place. That might actually work.

I think a private study by people who live out of State to determine where the money can be best spent is another wise investment of taxpayer money. (sarcasm)

posted by: Pat Wallace on March 20, 2014  11:42am

We need to focus on creating multigenerational community centers in each neighborhood as a core strategy for building relationships.  Buildings alone won’t do that, but it is hard to do it without a place that is the place that is the place to which everyone comes regularly.  The 3 elements are these:  a place, a direct connection to the City budgeting process for each neighborhood, and a permanent, quality neighborhood leadership training organization so that neighbors can have a way to transfer knowledge, skills and shared values over time.  Everyone needs a real neighborhood, especially at both ends of our lives.  Kids in trouble can make it if they live in a great neighborhood where neighbors know, and care about each other.  Kids from a family in trouble that cannot support them day to day, that also don’t have a great neighborhood are in real trouble.  We have put a lot of emphasis on schools as the backstop, but as a City, we have not focused on neighborhood.  Q House holds the truth of the power of a positive place in the stories of people who grew up with it.  A community center that also is a magnet for grownups is even more powerful glue.  We think we can’t afford a community center in each neighborhood.  If we had the vision and commitment, we could do it.  Stitch together the school buildings, our fragmented array of non-profits, our city services, our colleges and universities—-we could get there.