Daniel Knoepflmacher, MD (Host): Welcome to On the Mind, the official podcast of the Weill Cornell Medicine Department of Psychiatry. I am your host, Dr. Daniel Knoepflmacher. In each episode, I speak with experts in various aspects of psychiatry, psychology, research, and other important topics on the mind.

In 2021, the American Psychiatric Association or APA released a resource document on approaches to youth in mental health crisis. In this document, when referring to youth in mental health crisis, the authors meant an emergency situation where a young person's emotions and behaviors become so agitated that there is significant concern about them harming themself, others, or their environment.

The APAs document was released a few months after an incident widely reported in the media where a police officer used pepper spray to subdue a seated, handcuffed nine-year-old child in Rochester, New York, whose parents had called 911 for mental health support. This disturbing incident recorded on video and several other similar stories sparked ongoing discussions of the systems we have for responding to mental health crises involving young people with proposals for solution-oriented recommendations.

Our guest on the podcast today, Dr. Wilfred Farquharson, has studied the factors associated with police bringing children into psychiatry emergency rooms. He's demonstrated how demographic factors such as race and social disadvantage are highly associated with police-involved youth, and he's done important work to address these disturbing trends in our communities. Our discussion today will examine the social, structural, and clinical factors that result in police involvement during youth mental health crises, and explore solutions for helping the families, schools, providers, and children involved in these emergencies.

Dr. Farquharson is Director of the New York-Presbyterian Center for Childhood and Adolescent Behavioral Health and is an Assistant Professor of Psychology in the Weill Cornell Medicine Department of Psychiatry. Will, thank you so much for joining me today on the podcast.

Wilfred Farquharson, PhD: Thank you so much for having me, Daniel. It's a pleasure and an honor to be here with you today.

Daniel Knoepflmacher, MD: Well, I want to jump right in and ask you to begin by sharing your own story. What was the path that led you to become a psychologist who works with children and adolescents?

Wilfred Farquharson, PhD: Well, the story's quite near and dear to my heart. Essentially, I've always loved working with youth and even when I was a youth. So, it started with being a camp counselor, then considering an education career, and a lot of different things really around community. There's a community orientation about everything that I've done.

Additionally, I got some really great mentorship when I was an undergraduate at Binghamton University, and met a Black psychologist who said, "This is the path to psychology. I think you'd be great," and really finding something that could meet my desire for a career that was meaningful and ways for me to connect with the community and really meet my passion for equity and justice. And so, now in the health field, obviously, it's geared mostly towards health equity and health justice approaches in the work that I do.

Daniel Knoepflmacher, MD: Well, mentorship clearly was a huge factor for you. I mean, have you also been a mentor to others in your career path?

Wilfred Farquharson, PhD: Yes, it's something that I take quite seriously. I think that's why I've found my home in academic medicine, just understanding that there's so many rich opportunities to connect with early career folks as well as folks that are still in training and willing to just hear about a variety of experiences. And so, I really loved what I've been doing, and I'm really excited to be here at NYP to continue this work forward.

Daniel Knoepflmacher, MD: And we're excited to have you here. And I'm hoping, as the training director and someone involved in education, I'm thinking about all the mentorship opportunities, which I'm excited about moving forward. I want to touch on the research you've done, which ties into the topic that we're discussing today.

So, your work focused on youth psychiatric emergencies involving the police. And I'd like to provide our audience with some background information on this topic. I mean, you spoke about the importance of health equity and justice. And this is obviously a topic that's right in the center of that. So, can you describe what typically happens during one of these crises involving children or adolescents where adults are seeking outside assistance?

Wilfred Farquharson, PhD: Yes. So, I want to make sure I set precedent too. I'll use the word a CPEP, which is the Comprehensive Psychiatric Emergency Program. That's for us, and it is also similar to the psychiatric emergency department. So, I'll be using those terms interchangeably throughout today's talk. Essentially, there are many options and ways that many young people can come to the emergency room with a psychiatric issue. You could imagine young people under 18 years old, having a variety of different concerns, emotional and behavioral outbursts, and families that are really stressed and overwhelmed by these incidents and unsure what to do.

Now, some families are able to get their child into the car and drive them to the emergency room. Some families are able to call a clinician that's been working with the family, and see if there's ways to deescalate them in the home. Other folks may make good use of resources that are available: crisis lines, calling 988 if folks are familiar. And then, there are other families that are very overwhelmed. And like most folks, when they're experiencing a crisis or an emergency, their first instinct is to call 911 or maybe they've tried other things and those other areas that we've talked about and still feel like there's an emergency happening that's beyond their control and they call 911.

At that point, and at least in the area where I did this study that we're going to talk about today, local law enforcement, in order to get young people to psychiatric care, had one option, which was our a CPEP at Stony Brook University. And so, the typical procedure though, regardless of the age of the person, is to arrive on scene, assess the need. And again, this is a law enforcement agent that's making this decision and they would determine that the person needs a psychiatric evaluation or an emergency psychiatric evaluation. And if the family could not otherwise safely transport the child to the emergency room, the police would take over. They would handcuff the young person and place them in the back of a police car and bring them to the emergency room. Now, if you're come in with your family, you're brought into the emergency room, and the families are separated, where the young person goes to the unit and the family waits in the waiting room. If they are brought in by the police, the police will escort you, and then transition your care over to the clinicians that are present.

But for me, what really brought me to really want to investigate this work further is I was thinking about the young people that were under the age of 12. And I know we're going to talk more about that. But you could imagine that same procedure for coming into the emergency room with the police handcuffed behind your back in the back of a police car, the messaging that that sends to a young person who's experiencing their own crisis too.

Daniel Knoepflmacher, MD: Yeah, not a therapeutic impact. And that's not what police are typically trained to do. I'll talk more about that as we go on. I just want to touch on one thing you said earlier, just to get some clarification, you mentioned 988. Can you speak to what that is?

Wilfred Farquharson, PhD: Absolutely. So, 988 is a nationwide toll-free number that anyone in the United States can access. It started around July of 2022 really. And the mission of it was to decriminalize mental health issues in the broad population. And so, finding ways for people to access care in a meaningful way and not having to use the police if there was an emergent urgency that people could access care. They're staffed by most of the time by social workers and clinicians that can help deescalate and will also help and make some of the tough decisions of when people need to be brought to the emergency room. It's available via call and text as well.

Daniel Knoepflmacher, MD: Really important to emphasize. Thank you for clarifying that. I want to turn to the study that you did, and you published the results of this in 2023. And this was examining the factors that were associated with police bringing children to psychiatric emergency rooms, or as you said, a CPEP. What led you to pursue this work? And what were your findings ultimately?

Wilfred Farquharson, PhD: As a child psychologist, of course, as I said before, I'm really caring and compassionate when it comes to young people. And I also shared with you that there's a health justice and health equity approach to all of the work that I do.

And so, preliminary, we looked at the results. And one of my colleagues came to me, and this was also in the context of the sociopolitical crisis of 2020, where there was a lot of concerns around police brutality and the murders of particularly people of color, black people. And so, we started to wonder what does that look like in children and how are children interfacing with law enforcement? And we can imagine that psychiatric emergencies is a big cause of that. And when we took a brief look at some of the data, there we found that Black and Latino families were calling the police for their young people at a disproportionate rate compared to the white families that were coming in with the law enforcement arrival to the psychiatric emergency room.

Daniel Knoepflmacher, MD: Thinking about the linkage to the adult population, I mean, this is maybe the first time that some of these kids have an interaction with the police during a time of crisis. And it's not a, again, comforting therapeutic encounter. It's something which is potentially traumatic. So, it seems like that would almost set up part of a cycle that could continue through life in terms of the dynamic between that individual and the police.

Wilfred Farquharson, PhD: Yeah. Thank you for bringing that up, Dan, because I think that's something that we have to echo when we even think about school-to-prison pipelines and people's experience with law enforcement. There is even data out there that shows that when black children are interfaced with the police, they have poor health outcomes when they are adults. You could also really probably have another podcast if we were to talk about the intergenerational trauma and things of that nature, and how that plays a role in these encounters.

So to your point, I think this is something that's a very serious concern. I also think it needs a community-wide approach. And I also want to be clear, while I'm critical of the policy that happens, when young people are brought in by the police to the emergency room, I also want to make sure it's echoed that any law enforcement officer that I've talked to about this research is not interested and did not join the role of being a law enforcement officer to arrest young kids. So, it's something that we all as a community need to take a look at and find a better way to approach it.

Daniel Knoepflmacher, MD: It's a systems issue, a public health issue. We're going to get into that, certainly as we continue our discussion. I want to talk about the reasons that people are calling 911 for these incidents that are involving children. Typically what is going on that elicits these calls?

Wilfred Farquharson, PhD: It is a great question. So again, my study really looked at ages five to 12. And so, in that age range, when you think of child psychopathology, what you're looking for is a lot of aggression, or what you'll see is a lot of aggressive behavior. In our study, we categorized aggression for verbal aggression, physical aggression, property destruction. At the same time, you will also see suicidal behavior and not necessarily suicidal ideation. So, not a young person that's contemplated suicide or even made a verbal suicide, but someone that is acting out or has taken some preparatory actions towards that. Then, we find that police are usually getting involved. And so, we could imagine a young eight, nine, 10-year-old that's aggressive, maybe they've thrown things they've maybe tried to hit or swing at the parents, that feels like an emergency to the family, and rightfully so. And then, without any other recourse or the recourse that they've tried has not worked, they call 911.

Daniel Knoepflmacher, MD: Can you speak more about the suicidal ideation? And in looking at the demographics that you examined in your study, what were your findings related to suicidal ideation and/or suicide attempts?

Wilfred Farquharson, PhD: Yes. So for suicidal ideation, much of the time if someone's made a statement. And we've also found that some of those young people tended to be either very depressed or anxious. And in those more internalizing disorders and those clusters of disorders, those young people are able to really talk about their feelings to some degree, and families are able to transport them safely. So, much of the time those young people are able to go to the emergency room, what we call standard arrival by their parents. It's the young people that are a little bit more aggressive, where families are concerned about their behavior, they're displaying externalizing behavior, again, they've made an attempt or started to do some preparatory work around taking their life via suicide. And so, that's a big concern. And oftentimes parents get worried about that. And again, call an emergency, maybe sometimes expecting an ambulance. And again, we know even if an ambulance is coming before an ambulance is coming, still a law enforcement officer is coming.

Daniel Knoepflmacher, MD: That's a really important point that people don't even know when they're calling, that they're not getting an ambulance. They're getting some police officers, and they're ending in handcuffs.

Wilfred Farquharson, PhD: That's why I think it's a public health issue and a public health or a public education issue that we all need to take up. Thinking in advance, crises will happen. We all know what to do when there's a fire in the home, but how often do we really have good sound conversations around crisis planning and psychiatric emergencies? I think it's when we wait for their person to be in care or we wait for things to overwhelm ourselves. And really, we don't always expect our house to catch on fire, but we know what to do if it does, but we don't necessarily know what to do if we're seeing and/or someone's demonstrating behavior that is concerning for us.

Daniel Knoepflmacher, MD: I'm going to go slightly off topic here because this makes me think about adult population and, as a residency training director, our residents are working in a clinic where part of the safety planning is to call 911. And for people of color, for people who may have had historic intergenerational trauma related to these issues, that may look very different, calling 911 than it would for another individual.

So, I'm wondering, I mean, I'm asking you off the cuff here, is that a situation where adults should call 988 rather than calling 911 in those situations? Or do you have thoughts about safety planning for adults as well in these situations?

Wilfred Farquharson, PhD: That's an excellent question as well. And Daniel, I think it's mostly about knowing options, right? And so, when I was at Stony Brook, we got wind of this video of the reference, that you referenced earlier of the 9-year-old girl. And I had a very strong reaction to that and was already looking at the data at the time. But I paused, our team and said, "We have to do something because if this happens to one of our patient's, it would be a devastating experience."

And so, we developed a document that goes over four categories of different scenarios that people may face and ties them to the options, because a lot of people think this is an emergency because it's scary. But from a psychiatric standpoint or from a clinician standpoint, it may not be an actual emergency. And so, we look at when can you call your physician and make an appointment, when can you call 988, when can you transport that person to the emergency room yourself as a family, and when do you absolutely need to call 911.

If someone is in imminent danger and I have these active conversations with patients, if a young person, let's say, picks up a chair in their room and they throw it up against the wall and it puts a hole in the wall, and then they sit down at the foot of their bed and they're hysterical, crying, there's no longer an emergency, there's no longer imminent danger. But if that young person's picked up the chair and is chasing their younger siblings around the house, that may be emergency that needs a 911 intervention.

But I think having that level of detail and explaining crisis situations and having that level of detail in crisis planning is where we as clinicians can continue to do a good job. And the same thing does exist for adult patients. You also mentioned intergenerational trauma. I think that that's something that we have to bring to the surface. It's an uncomfortable conversation as clinicians, and I think it's a very important one.

Daniel Knoepflmacher, MD: So, it's really about dialogue with the stakeholders, the people directly involved in this. And that's why I hope in us talking about this and people listening, this is part of the process of getting this out there. Going back to the work you did, the study shows clear signs of disparities between the incidents involving the police versus those where there was no police involvement. So, can you speak more about the socioeconomic and clinical factors too that are behind these disparities? You touched on some of this, but I'm wondering if there's more to add.

Wilfred Farquharson, PhD: Yes. We'll start with the race data that we looked at. Again, this is ages five to 12. Twenty-seven percent of the families that came in by police were black. Another 27% of the families that came in by police were Latinx. That would be a total for Black and Brown folks of 54%. This data was taken in Suffolk County, New York. Only 7% of Suffolk County new York is Black. Thirteen percent of Suffolk County, New York is Latinx at the time that this data was done. And so, you could see that there's a significant disproportion of families. At the same time, majority of the families that were brought in by police, up to 74% of them were on Managed Medicaid or Medicaid. And while that's not a direct reflection of their socioeconomic status, it's what we had in the medical record review. And it's usually used broadly.

Additionally, we also found that families that were able to bring their kids in by themselves were more likely to have two parents in the home. And there's a lot of reasons that we could think about that. Maybe it's logistics around transportation. Folks have multiple families. One parent can go, one parent can stay. There's a lot of different reasons. But it also does speak to these families being very strained for socioeconomics and social disadvantages, as well as intergenerational trauma and other items of marginalization.

Daniel Knoepflmacher, MD: What about the outcome? So, you looked at what happened to the children and adolescents in the emergency rooms where the police were involved, and also the outcomes with those. That weren't. So, can you speak to what happened after that touch point or not with the police?

Wilfred Farquharson, PhD: Yeah. So, most of these young people-- or I won't say most of the young people-- but they're more likely for sure to go into an hospitalization. And this data is also consistent with adolescents and adults. They're more likely to get more complex service utilization. So while someone that does not come in with the police, maybe with a similar presentation clinically, because the family brought them in, they're more likely to get connected to outpatient services. That's typical. So, weekly therapy, monthly psychiatric medication management, but that label of-- and sometimes we put it in our notes as BIBP, right? Brought in by police. That label in itself means something different opposed to when you say, "Child came in with the family," and there's more detail there.

And also, I think there's some bias that goes into what happens once young people are labeled with that. And we'll also see too, in the data that the younger age someone is interacting with the police for their psychiatric emergencies, they're more likely to interact with the police again in the future when we looked at our lifetime data. So again, we're setting these patterns and precedents in our young people's lives, really trying to get them connected to care, doing our best and having a harder time making the full connection.

Daniel Knoepflmacher, MD: Such a good point about the BIBP, brought in by police, because that is something that is recorded in the record and can have all these associations. So, it's important for us to kind of think about that as clinicians and acknowledge whatever inherent bias there might be when we read that and react to it. So, that's a very good point.

Wilfred Farquharson, PhD: Right. And clinically speaking, these kids are more likely to have a diagnosis of ADHD, ODD, conduct disorder. And so, those labels also play a role. Now, again, can we do a better job as treatment teams and getting families to help us in supporting us in treating some of these disorders? Absolutely. At the same time, it does beg the question of what do these tags mean when we give them out? And where does it mean for their trajectory of care?

Daniel Knoepflmacher, MD: Now, these kids are spending time at home, and we've talked about the home, but they're also spending a lot of time at school, and things happen at school. So, could you speak about the role of schools in these situations?

Wilfred Farquharson, PhD: The role of schools is a unique one. So, they're there to educate. There's limited resources in the schools, but we always want to name that. And at the same time, we know that you're more likely to find a security guard than you are to find a psychologist or a social worker in a school. And so, I do think that they have a role in maybe helping us and coming alongside us in changing the trajectory of these young people. I think that, at the same time, they're in a unique position where they don't have as much agency as parents do. So, you know, most schools are not going to physically restrain a young person. So, their threshold for emergency situations is a little bit different than someone that's at home. And while I do completely understand some of the nuances for schools, I do oftentimes when I get in front of schools, challenge them to think creatively. Meaning if they have a young person whose parents are not readily available to come transport them to the hospital, and they think that they need to go to the hospital, is their only recourse to call 911 or an ambulance? Or is there ever a way in which they could call a local school bus to come and grab that kid and bring them and have the family meet them at the emergency room? So, still thinking about ways to be creative, but then also culturally responsive, right? Where can we work to maybe not involve the police if the young person is otherwise safe?

Daniel Knoepflmacher, MD: So, adverse childhood experiences and repeated trauma that occur in many settings, but obviously what would be true of police involvement in cases are associated with mental health struggles that continue through development into adulthood and all of this, which you've demonstrated with this work disproportionately impacts populations that are disadvantaged socioeconomically. So, can you speak more about how youth psychiatric emergencies involving the police fit into this bigger cycle that impacts young people, especially in marginalized communities?

Wilfred Farquharson, PhD: Another great question. I think when I think of adverse childhood experiences, of course, we know that there's a list of them that go into the study and that have been studied to show poor health outcomes in adulthood. One of them that I think is important to highlight is parental incarceration. We also highlight-- and this came out in our study-- single parent homes. Those adverse childhood experiences, I always want to make sure that we call them out to be larger systems issues, right?

So oftentimes, when we think of them, we categorize them as this is just this family. There's usually a pattern of things that have happened long before, dating back to slavery, dating back to colonialism, imperialism that's impacted our nation's history. That often gets left out of the conversation. And so, when we fast forward those historical context into what's happening in current times, we can not only see a pattern of the way that we've treat people, but we can see a pattern of continuing and perpetuating the cycle of trauma. And so, when we involve young people with the police at these tender ages of age five to 12, we're setting up a pattern of them being wrong, of them being bad, of them being out of control and needing to be, again, restrained in the back of a police car, isolated, separated from their families. And so, when we think of the historical context of those messages, what are we implanting in the youth at age nine when they're going through these circumstances? And let's call it out too, right? We know I used to work in an office of mental health hospital in New York state, and we were unable to use both more than one method of restraint and seclusion.

And so, when we think about the 9-year-old girl that you were referencing when we opened up, she's in the back of a police car, she's handcuffed, and she's pepper sprayed, right? That is seclusion in the back of a police car, restrained with her arms behind her back, and a chemical use of a restraint form to subdue her. And she's nine. And so, what kind of messages again is she going to receive? And that is her entryway into care. So, this was the message of you're out of control, we adults know better, we're going to take control for you, we're going to control your body, and this is how you will get support and care, and this is how you will interface with the mental health system.

Daniel Knoepflmacher, MD: It is such an important way to look at this. And thinking about how those narratives are written for those individuals, those folks who are affected directly, and this cycle generationally, it's about rewriting that story and hopefully breaking that cycle. And with that in mind, I want to turn to some solutions, because this is a problem that we've outlined here. The factors involved are numerous and complicated. There are so many stakeholders. There's kids, families. We talked about schools, hospitals, clinicians, police, in this overarching system that you're talking about on all of these structural pieces. Can you break this down for us. And let's break it down into pieces. Let's start with helping the kids and their families. What steps, solutions can we use to break this cycle?

Wilfred Farquharson, PhD: I think the first thing that we always want to lean towards is care. Let's get them care. Let's get them care. Let's get them care. And I'm a licensed psychologist. I believe that wholeheartedly I will never abandon the benefits of psychotherapeutic interventions, psychiatric management. I believe in it all. I also think it starts with education. And so when we were talking about-- and not just education, it starts with really advocacy. That's the better word. It starts with advocacy. And in recognizing all the things that we just talked about and all the messages that people have been getting, and that messaging around how people enter care, showing and advocating for different pathways to care is really important and I think that is on the head and shoulders of clinicians in the healthcare industry.

And then, once we are able to think about ways for us to advocate, bringing that information to the community so it's digestible. I really want us to continue to partner with children and families, and then say to families, "We're going to your school to talk about crises. Here's some of your options. The way that you talk to your young people about how to handle a fire in the home, we want you to revisit this topic on a regular basis. Now, we've said that to you and we've partnered with your school, we've partnered with your pediatrician, we've partnered with your basketball coach. Everybody is now sharing with you different ways to advocate and different ways to enter care in a meaningful way."

And then, I think, obviously parent support is a huge component. It's the toughest job, right? There's limited to no training unless you get into care. There's no certification, right? So, you're out here trying the best you can. And it's a really difficult job that many people take very seriously. And so, I think finding ways for us to continue to partner with parents, make them feel comfortable accessing our services, really just even giving them labels for what they're experiencing. That outbursts, we can attribute it to ADHD, right? That's not just purely defiance. The difficulty that you're experiencing, that irritability when that kid comes home and doesn't want to talk to you, we can attribute that to anxiety that they experienced all day in school. And so, giving people those contexts would also be helpful.

Daniel Knoepflmacher, MD: Well, I know you do so much of that. I mean, you and I have met before to talk about initiatives to educate the public. And that is such an important piece of advocacy and education. You've done work with schools, so can you speak about that piece?

Wilfred Farquharson, PhD: Yes. The work with schools, again, they're in a nuanced position. They're caring for the young person. They also have serious education initiatives that they have to carry out. My hope and mission for schools is to continue with the partnership, continuing to find tiered levels of interventions that are working. So, what are the things that you all can handle as educators? What do you need to refer to your school mental health teams? And then, how can your school mental health teams take good advantage of partnerships with these larger health and hospitals and institutions? We have a variety of expertise that may extend to a little bit beyond what you're able to do in the school setting. But then, how do we have a partnership in a way that makes good sense? Is it an educational initiative where we come to you and give you some expertise, and then you call us when there's a bigger problem? I think that tiered approach is what's going to be best for schools.

And then, I really think it would be awesome for schools broadly to take a look at their workforce and what it looks like. And what I mean by that is for schools that have an overwhelming majority more of security officers versus mental health clinicians, can that be looked at? We are really working towards being culturally responsive, trauma-informed, and engaging with our youth. What messages does it send when there's more security officers and some of them armed in today's world? what does that say about how we trust our young people? And what stage are we setting up for them to feel like they can come and get support when it's needed?

Daniel Knoepflmacher, MD: What about law enforcement? You alluded to police not wanting to do this either and not being trained, obviously, in psychotherapeutic techniques. What steps can be taken to reduce harm and increase help?

Wilfred Farquharson, PhD: I think law enforcement has really been trying. So, I want to make sure I say that aloud too. I know that there's been initiatives that are nationwide around the crisis intervention training model. And I think the model is great and can really be beneficial. I also don't know that everybody in the departments are getting it. At the same time, I don't know everything about that curriculum, but I also don't believe that it's child specific. And so, what happens is child psychopathology looks very different than adults. And you'll hear this a lot from our child-trained folks, that they're not just mini-adults. So, when we take things that are meant and built for adults and try to bring them to children, they don't always work the same.

And really, when we're thinking about recognizing what symptoms mean, recognizing what's been communicated from a young person, and how to understand that differently, law enforcement does not have that training. And at the same time, can we revamp what they are getting to give them a little bit more cues and hints as to what's going on for young people.

And then, I think that their policy really needs an investigative overhaul, right? Again, threat assessment. Does a 10-year-old need to have their arms behind their back in the back of a police car? What can be done to think of alternatives? Many outbursts in children don't last very long. And so, when I shared with you that we did that study, we looked at 750 visits. Over 250 of those visits involved the police. Only five of those visits that we saw in the medical record was the young person actually aggressive with the police. So, what we're finding is can we do an assessment that not only goes based off of the child and the parent's report of what led to the incident, but where's the imminent danger? And if there's not imminent danger, can we find a different way to manage this?

Daniel Knoepflmacher, MD: That brings up a specific question to mind for me and you maybe encountered this when you studied this. Were there situations where the police would come, the situation was diffused, and the police say, "We're not needed here," and they walk away? Or is there kind of imperative for them to say, "Okay, we've been called, we got to take this person into the hospital"?

Wilfred Farquharson, PhD: In this study, it's one of the limitations that we noted because we're just not sure. We're not sure. And this is interesting too, because you could also imagine it's a game-time decision by the law enforcement agent that's there. There could be bias that goes into that decision. So, there's so many different factors.

We're not really sure what happens when the police arrive and don't take things further. What we do know is that they did take the kid further in the timeframe of our study. They had one option, which was the Stony Brook CPEP. So, they would bring them all throughout the county, they were bringing them to that one place. But we don't know how many times the police officer said, "Mom, dad, jump in the car and take this kid. This is not something that you need us for." We're just unsure. But it is something to really take a look at. And again, partnerships, so law enforcement agencies, let's get to the table. Let's look at that data. We know you have it, of how many times you've recalled and what your disposition and decisions were and how can we figure out, like I'm sure there's some patterns, right, that have worked well to identify when you need to intervene and when you don't. And then, we can even look at the electronic medical record and give you feedback about some profiles where you didn't necessarily need to transport.

Daniel Knoepflmacher, MD: And have you gotten to work with police departments?

Wilfred Farquharson, PhD: Yes. So when I was on in Suffolk County, we did a little bit of work with them, participated in some of their crisis intervention trainings. And here in Westchester County, it seems like there's a lot of great work, particularly in White Plains working with their own wellness initiatives, most of the time, it's specialized training units that are working with us. And most of the time, it's good because those are the folks that will typically be responding. But it has been really, really nice. And even when I've worked in the past with even local campuses, on college campuses, those law enforcement agents, most of the time, those conversations are very well received and encouraged. And there's a longing for partnerships. So, folks that are willing to extend themselves and stretch out over the aisle, law enforcement agents are really excited about those opportunities. They want to learn more, they want to do better. And like I said before, they definitely don't want to handcuff children.

Daniel Knoepflmacher, MD: There's so much nuance in this. As you said, not every crisis is the same, and we need to think carefully about the response. That's true for clinicians too. And you're an expert in this area, but I'm wondering what you can do to make sure that clinicians have the most sensitive approach to this.

Wilfred Farquharson, PhD: There are some big things that we can do and there are some small things. And I'll start with the small things, because I think they're really easy. We can change our voicemails to stop saying to only call 911 in case of an emergency. We can change our websites to reflect the same. When we do our safety planning, we can take our time and really ensure that people identify what to do in an emergency and really think about what's something that you're going to remember, just like if there's a fire, it stop, drop and roll. How can we make this so digestible that everyone in your family knows what to do and really thinking about what that means? Because if we're talking about a 12-year-old and they've got an 8-year-old sibling, 8-year-old siblings should be able to know what to do as well. Not to the level of detail as the parents, of course, but the 8-year-old sibling should know maybe what some of the early warning signs or when it's time to give that 12-year-old some space and how to alert mom and dad if there's something more concerning happening. So, I think that level of tiered active safety planning that thinks broadly and creatively to do so.

I would also encourage our clinicians to get involved with advocacy. Reaching out locally to policy makers, connecting with law enforcement, just introducing yourself, and saying, "Hey, I'm here. I'm taking care of the kids in your community, in your area. And I want you to know if you come across my kids, here's what I've explained to them. The kids that are in my care, the families that are in my care, they know A, B, and C. If they do reach out to you, you can trust that they've thought about X, Y, and Z." And so, then there's more partnership and there's more explanation, and really then letting the families know, "I've talked with the law enforcement," right? There's a tiered approach here.

And of course, if you want to have the maximum output of doing lobbying with policymakers broadly, ensuring that things like the 988 initiative is safe and accessible for all people. I think we really also want to make sure. The federal government has a lot of different changes coming, and one of them is around critically looking at 988. I think it's been a tremendous resource that we need to preserve, and again, we need to preserve it so that all communities can access it.

Daniel Knoepflmacher, MD: Well, I get excited hearing about public education And the work that we can do to educate Not just clinicians, but everyone else. And I'm looking forward to collaborating with you on that moving forward.

An important thing to talk about as we're speaking about solutions is your work leading the new Center for Childhood and Adolescent Behavioral Health here at New York-Presbyterian. I'm curious, because you came here from Stony Brook and you're leading this new important initiative, what's your vision of how this new center in our system will make a meaningful difference in the community?

Wilfred Farquharson, PhD: So, one of my dreams is to really make sure that everyone has access to care and everyone feels like they're towards the front of the line. And I think that's one of the things when we think of seamless access in our bridge to care service that we're building in the CCABH, that's one of the missions.

And so, we want to make sure that people can find their way to a rapid evaluation, and at least leaving that evaluation with an understanding of what's going on with their young person. Many times, people call, they get a bunch of wait lists, they're not really sure how to navigate the system. We're aiming to chisel that down, and find ways to evaluate kids and have case managers support the families in getting connected to the right resource. And that's a challenge. So, much of what makes Children's Mental Health unique is not just access, but it's systems navigation. And so, we have that program launching through the Bridge to Care.

We also have an intensive outpatient program and a partial hospitalization program, and our intensive outpatient program is accessible for virtual care, so anyone in the state of New York can access it. Our partial hospitalization program is by regulation, 100% in-person. But with those two programs, we're now developing here at NYP more acute care services. And so, the option to step down from an inpatient or to get out of the emergency department quicker is now available because we have more acute services for the children and their families.

And so, you could imagine how difficult it may be if we only had our outpatient clinics, our emergency departments, and our inpatient services, without these more acute kind of buffers and ways to keep kids out of the emergency room, or even a system where young people that are in their inpatient services, once they're stable and ready to go, they're really nice half step down into a partial hospitalization or an IOP where the family will feel comfortable, because there's still more touch points than typical treatment and as well as our clinicians that are on the inpatient team feel really nice that they're sending someone to a place where they'll be cared for just as well. And so, we're really trying to think of is how to create more events on our system so there's not as much backlog. And then, again, once you have places for people to go, you have doors where other people can come in. And that's really what we're trying to do here for the ambulatory side of the Center for Childhood and Adolescent Behavioral Health.

Daniel Knoepflmacher, MD: Amazing work. And I'm wondering for all of the stakeholders we talked about today, do you have any recommendations for resources, whether that's maybe through efforts of CCABH, which is the acronym of that center that we were just discussing or other places that you think folks should turn to to get more information.

Wilfred Farquharson, PhD: Yes. So, I think you can definitely look at our New York-Presbyterian website and look for the CCABH or the Center for Childhood and Adolescent Behavioral Health. It will highlight for you our acute care services, and also the work that we're doing on our inpatient services. Those things are accessible for folks.

We will also be looking at our safety planning mechanisms and putting out in the future some literature around just what I was talking about before, some of the different situations that you may face and the options that you have local to your area. And many people, I would encourage folks to take a look at their county level and local level, city level agencies to see what's available. I know Westchester County's got a lot of resources for Crisis and Care that are available, and we know that the city has the same. The Office of Mental Health also has field offices in your region of this state. So, we would encourage folks to take a look there.

I would also touch base with schools, right? And I want schools to know that we are here as partners for them. And a lot of times, we know that young people start with their schools and they start with their pediatricians, and those are great places to start. Those folks work with young people on a regular basis. They usually carry their own list of resources. And obviously, they're very accessible because your kids are there on a regular basis and you can talk with your pediatrician, set up an appointment. They have regular opportunities for that.

So, I think finding ways to start in where it makes sense. And then, a call out to other agencies, grassroots organizations, churches, youth leagues. Pick up the phone, reach out, call NYP, call us here at the CCABH, see what we can offer you. There may be an opportunity if you've already got a body of parents, and we've got agencies that we're working with already. They've got a body of parents that want to hear expertise around how to manage outbursts or they want to have some kind of knowledge around how to navigate our complicated mental health system. We're going out to the community to do this work. And I think it's inspiring, it's helpful, and it gets us ahead and gets us upstream of some of these concerns that we're seeing. So, maybe there's more that can be done on the front end that will help balance things just a little bit more.

Daniel Knoepflmacher, MD: Wow. Well, thank you so much. I'm just really impressed and inspired by all the work you've already done and now the work you're doing here. Running an important center, but also just all this work out in the community. I learned a ton from talking to you today. I know that's true for many people who listen to you, in all of these different capacities. So, thank you so much. I hope we continue to work on getting the message out there together. I just really want to thank you, given that you're doing all of these things, that you took the time out to sit with me and speak today. So, thank you so much for joining me.

Wilfred Farquharson, PhD: Absolutely, Daniel. It's a pleasure and an honor. And thank you for doing this good work of getting our expertise out there. It's so important and so needed.

Daniel Knoepflmacher, MD: It is absolutely my pleasure. I mean that. So, thank you. And I also want to thank all of you out there who are listening to On The Mind. This is the official podcast of the Weill Cornell Medicine Department of Psychiatry. And as many of you probably already know, our podcast is available on all major audio streaming platforms. That includes Spotify, apple Podcasts, YouTube, you name it. If you like what you heard today, and This is really important. If you liked what you heard today, tell your friends, please give us a rating and subscribe. We want to get the word out there, so please stay up-to-date with all of our latest episodes. And we will be back soon. Thank you.

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