Mikayla Bozym

Director of Urgent Crisis Center and Evidence-Based Practices Child and Family Agency of Southeastern CT, Inc. 

Contact: bozymm@childandfamilyagency.org 

Links: https://www.childandfamilyagency.org/programs/urgent-crisis-center/

Resume

Can you share some details about yourself, background, education and relevant training you've received?

Grew up in Ledyard, New London County, CT. Obtained Undergraduate degree in Speech Pathology and Audiology from St. John’s University, Queens, NY. Master's in Mental Health Counseling from Texas A&M University. Worked with Corpus Christi Police Department as a Family Violence Counselor. There I supported children affected by homicides and suicides, often related to intimate partner and gang violence. This focused on connecting families to ongoing care. Moved back to Connecticut and started working with Child Family Agency (CFA) in an evidence-based cognitive behavior type therapies, home-based programs addressing intimate partner violence (IPV). Supporting entire family systems with both victims and perpetrators involved with Department of Children and Families (DCF).  Involved collaboration with family navigators to address basic needs (housing, food, transportation) to enable trauma therapy. Partnered with Safe Futures to support women and children leaving abusive relationships. Transitioned into working in CFA outpatient office as a clinician for youth ages 4 -18. Promoted to coordinator of the Groton Outpatient site, overseeing clinicians and evidence-based therapy practices. Specialized in evidence-based therapies like Attachement Regulation Competency (ARC), Trauma Focused Cognitive Behavioral Therapy (TFCBT), Eye Movement Desensitization and Reprocessing (EMDR), Child-Parent Psychotherapy (CPP), and Modular Approach to Therapy with Children (MATCH). Went per diem and worked with Effective School Solutions for at-risk students in maintaining placement in their home schools with therapeutic support. Later, I opened a private practice in Gales Ferry, CT, specializing in victims and perpetrators of IPV with referrals from DCF. 

Can you describe your current position and main responsibilities? What initially attracted you to your current role or profession?

When I got to my senior year of college, I was looking at grad schools for speech path, but I had one client in our clinicals that his mental health drew me to be interested. He was a veteran with a TBI and I was working with him on how to swallow and how to talk again. But his story was just really compelling that I was like, maybe I want to be a therapist I then wanted to move back. My family is still here, so I wanted to move back. So, when I graduated with my masters, and I sat for my licensing exam, the NCE, the National Counseling Exam.

And then just recently in January, I was promoted to the director of the Urgent Crisis Center. Then I also am an adjunct professor at CCSU, and I teach the internship class, it's full year fall to spring, and then in the spring, I teach counseling families.

And when it comes to the families that we see, we are an open-door policy. We're open Monday through Friday, 8:00 A.M. To 10:00 P.M. And then we're also open on Saturdays from 10:00 A.M. To 6:00 P.M. And we are hoping to eventually one day be 24/7 facility. We are just working on increasing numbers on the weekend. We're most busy during the week. And those times are not hard stop times, so somebody can walk in at 9:45 P.M. at night and they will be seen, and they will be supported by the team. And we also offer ambulance drop offs.

The clinician goes in, and we like to say it's a really big intake with a pretty extensive safety plan piece. The safety plan includes an individual safety plan for the child or adolescent and a family safety plan. We really value the family systems approach and having an adult part And the clinician also diagnoses. Then we do a psychiatry consult. We call that a round. And that is where the clinician and the nurse sit with our provider. The team is presenting the issue, presenting problem, what's going on. Important historical information, family history of mental illness, and or substance abuse, abuse history, all of that. Then they go into diagnosis and then referrals. So, a big part of our treatment here is connecting the families to care.

How do you incorporate cultural sensitivity into your practice when dealing with mental health issues in diverse populations?

We are trying to stress the flexibility and what that looks like. It does not need to be birth mother or father, right? It could be a grandparent, it could be a safe neighbor, a coach. We do need to get obviously, you know, clear it by the legal guardian, of course. But if we get permission, again, that's something that we're working on for access to care. A teenager might ask a friend's parent to bring them, right? And trying to work through that right now that's current. 

I think every day we're learning, we are constantly trying to provide the most accurate evidence based support we can. In addition to the assessment and, you know, linking to care. We also include therapeutic intervention, whatever that looks like. Sometimes a family may come in and the child is extremely dysregulated. Let's say they're angry. Something happened, family conflict, something happened, and it may take an hour or two to de-escalate the youth before we even start our assessment. So, we truly meet the family where they are at. 

Vice versa. Maybe we're coming in, the kiddo is okay, but the parent is really angry. Maybe they caught their child exploring drugs for the first time, and they're really scared. And we really are trying to coach our staff to just remain curious about what that is and where that family comes from. We have a lot of immigrant families. And when they're trying to explain their story that wherever they have come from. This wasn't accessible to them. The parents are learning what this is and how this can help their youth. They might be timid. They might be shy. They might be confused and really spending the time to explain the process to the family. Because if we get buy in and we get the family system on board, the child is safer, right? So, all of these studies are showing the child could have a severe mental health diagnosis and have severe behaviors, severe symptoms. But if they have a supportive family, they're safer than a child with minimal to moderate mental health reasons and an unsupportive family, they're at higher risk. So that's why we really are valuing that family systems piece.

In addition to the de-escalation that we engage in where our staff are TCI trained. It's therapeutic crisis intervention. One of our staff member's is a trainer for that, which is awesome. We also engage in different skills. So, CBT based skills, DBT based skills, family therapy, trauma focus. We really try to have the youth leave with some regulation techniques and what works for them. We also do a whole lot of family therapy. A lot of the time, the families come in there in some sort of discord, and by the end of it, you know, they're giving each other a hug or they're talking or they're making eye contact when they had it for so long. And families leave in tears of just feeling so relieved that they're in a different place. Good tears, happy tears. That is just so different.

And then I think a lot of the time, there's parental education, or we call it parent psycho education, where we'll speak to the parent alone. And we don't want to shame. We have to be careful, there's a balance. But a lot of the time people are misinformed. Again, you don't know where they come from or what their story was. And a lot of these parents have generations of trauma. So, they come from their parents, grandparents, great grandparents, all of that. And we will connect the parents to support, too. We have connected lots of adults to therapy as well, because it's not just the child, right? So well, our agency sees kids and their family, we have lots of connections with the agency of people that support adults. And they've been really thankful for that, too. And I think it takes patience and it takes time.

We've had dads that don't believe in mental health. 'There's nothing wrong with me'--  because they've been shamed and told not to talk about feelings that masculinity. Toxic heavy stuff, and then they're leaving with “Wow, okay, I got to talk to somebody. Like, I can see how this will benefit”. And then that just shifts the entire family system when the kid sees that mom or dad is getting help. You know.

What community-based mental health interventions have you been involved in, and what outcomes have you observed?

Our goal here in the state of Connecticut has a huge initiative. We're one of four urgent crisis centers in the state, and we hold the contract for all of Region three. Region three includes not only New Lyndon County, but Windham County and Middlesex County, which is a crazy geographic area. We are the largest geographic area when it comes to DCF regions. Basically, the state is trying to keep children and adolescents ages 4 to 18 out of the local emergency rooms for behavioral health crisis or substance abuse reasons. So, the family or the ambulance can drop off here, and they are met with the RN who takes vitals and medically clears them to be able to be here. Our rule outs, if you will, are if someone self-harm to the extent of needing stitches from the ED. We do have basic first aid here where the RNs can clean the wounds or the burns or whatever, self-harm they engaged in, or if they need medical intervention due to substances, if they need their stomach pumped or something like that. So, once they medically clear, they do vitals, the RN also does a full review of systems from head to toe.

When it comes to transportation, the ambulances that have dropped off, the parent has gone separately in their car. I do have to give a major shout out to the Emergency medical services (EMS) personnel because they helped the family do that. They arrive on scene. The police officers like, this is a good use of UCC, right, behavioral health reason. The police officer actually called our triage nurse and asks is this a good referral? The triage nurse says, yes, absolutely. And so, the police officer and the EMS crew helped that family. We are trying to have conversations on how to help families that don't have transportation. We're working on that right now. We're trying to brainstorm ways to support that. We do also work very closely with mobile crisis. And, you know, if the families thinking what direction to go. Remembering that mobile crisis can go out to them, right so they can call and mobile crisis will show up their house or the park or wherever they're at versus having to come here and then needing that transportation back.

How do you collaborate with other community members or organizations to deliver mental health services?

We're currently really trying to strengthen our relationship with local EMS providers. There are 34 ambulance companies that can drop off to this location. And so, we're really working with New London, one of our big ones, Groton ambulance. Stonington ambulance. Waterford and East Lyme. We're really working on changing the system because right now for however many years, the ambulance companies have been around. They pick up a 911 call and they drop off at the ED.

The referrals that we use the most are linking to outpatient therapy, which our agency has four outpatient offices, one in New London, Groton, Pawcatuck, and Westbrook. We also refer to PHPs, partial hospitalization programs. Sometimes the child needs to go to the hospital to be inpatient. But we proudly say that it's percent now. We've been able to discharge the families back to their home in their community, which is amazing.

There's other referrals that we make too. We also have a school-based department here and home based with family therapy options. We will also get children connected to psychiatric care if medication management is indicated. Also specialized things like Hospital for Special Care, Institute of Living, certain ASD (Autism Spectrum DO) evaluations, those are less frequent, but we do it all.

If the family walks in and they're like, 'Oh, yeah, we see you know -- so and so out in the community for therapy'. Our community navigators are connecting to that provider to let them know. Obviously, with the release of information, let them know that the child's here and what we're doing, as well as internally too. And then they're looking for any of those I mentioned those Maslow’s hierarchy of needs. They're also doing that. So does the family need insurance? Does the family need access to a food bank? Do they need to reinstate their snap benefits? Are they homeless? Are they looking for shelter? What is going on and really managing that.

We like to say that the kiddo and the adolescents is our identified client, but the family systems are secondary client, right? So sometimes these parents, this is the first time that their hurt their 9-year-old is suicidal and wants to die. They're incredibly emotional, and that shows up in many different behaviors, right? So, our community navigators are really skilled in managing that family system piece. They have an incredibly hard job because parents are crying or they're angry, or there's just so many things that they're managing. At the same time that we're also trying to stabilize the youth. And then when they discharge with our recommendations, we give them a discharge summary. We are actually maintaining contact with the family every day until they're connected to care.

I have a case that comes to mind. It was one of the first ones. I was still really learning. I've been at the agency, but what is this department? It was a tween or teen. Parents were both addicts, not in the home. She actually with grandma. And they were homeless. They were actually living at one of the local hotels like night-by-night basis. And so clearly, trauma. Misses both of her biological parents, Grandma's doing the best she can. But has her own stuff. Because her kid is an addict. Trying their best, you know, only had the clothes on their back’s kind of thing. Poor school attendance because they would just hop from hotel to hotel. And there was something that we had to call 136 on. And we always try to do that with the family, so there's no surprise, and we really talked about that report and that relationship. Same with families. It's not just for providers. So, we told Grandma, hey, we have to call on this. She reported that she gave the child some medication. You can't do that. She was just trying to help. She had anxiety meds. But you can't do that. And the grandma actually was so thankful because she was like in tears thankful because she's like, I got help. We think in that judgment that we hold as a provider. Oh my gosh, this family is going to hate us. Oh my God, this family is going to be so mad. Oh, no. That we have to because we're mandated reporter. And we were met with thank you so much. And now we have a great relationship with the family. We got both of them connected to care. The DCF worker connects with us. And DCF is really trying to support that family system and get them into stable housing so that the kiddo can go to the same school and get the schooling that they need, and she's now an outpatient and has her own med provider that is specific to her, and grandma is supported. And they still keep in contact. And I think that one was really a life changing experience

How do you balance clinical and community-based interventions?

What makes us different than the ED is that we're calling every day we're checking in. We're offering bridge therapeutic sessions if the family needs it. So, for example, if we refer them to a local PHP program, but the intake isn't for two weeks, then we're calling that family for 14 days checking in on them, reminding them of their safety plan. Is there any alterations that you needed to make? Do you want to speak to the therapist? Do you want to speak to the RN? We've had some medically complex kids. We've had transgender youth that are on specific medications for their transition, and it impacts them medically. It's been really cool to have this multi-disciplinary team of the therapist, RN, and community navigator and site provider come at the child and the family system from such different approaches, but they all complement each other. And we've been able to save 312 cases to date (at the time of interview) which is really amazing. And that's just us, the state of Connecticut, including all of the Urgent Crisis Center has supported over 1,000 kids. And we are a year old.

If the family comes here and we are thinking the appropriate level, you know, they can't contact for safety. They are actively suicidal. They have a plan, they have intent, they have means, and inpatient is where they would be most safe. We would call the ambulance over here to transport them to the hospital to get them inpatient.

It's truly relationship building. I think thus long I've been in the field for nine years here, and it truly is the relationships that you make, the professional relationships. I have people at DCF that just working together, they respect me. I respect them. And we're here for the family. Right? And they will help me if a family is in need. You know, I have the people at DCF that I'm going to call. We have a wonderful relationship with L&M and the ED director. Doctor Mittleman. He has been wonderful. He is like, How can I help? And it's just, you know, every few weeks, making contact. It's easy. Time goes by really fast. So as a professional and you get stuck in your day to day, and you start to kind of spin that way. You have to remember that relationships are, what matter.

We invite people to see the space to take a tour to see what it looks like. I go out and I literally drive around and chit chat with people. I schedule, I talked about those PDs with the schools. But it's not a one and done, and we're constantly evolving and getting stronger. So, we're always learning new things.

And we will see families any insurance and even if they are under insured or uninsured, we will see them. It's connecting them to the ongoing care that might make it harder. And especially providers with specialties. So, if we're thinking an EMDR, private practice clinician isn't going to see someone who can't pay. That's the service that they need, right? They need that EMDR. And it's very hard to find. There are a few that will do some like pro bono or sliding scale, but they fill up quickly.

What resources do you find most valuable in supporting your work with mental health in the community?

So, I actually have an intern this summer, and we're looking forward to connecting with the Hispanic Alliance of New London. And meeting with them, and we just got our brochures translated into Spanish, which I think it would be amazing. So, helping us connect there.

How do you stay informed about the latest research and best practices in community mental health?

We have support from DCF to send to specific training. Right now, I'm actually in a class for suicide prevention. It is our leading referral reason -- suicidality and self-harm. So DCF has allowed us to have this training. Also, I mentioned the Child Health Development Institute (CHDI). They are wonderful for those evidence-based practices. They're located in Hartford. When it comes to this area, we are actively working to make contact with all different types of providers and just community professionals. The other nonprofit agencies. We're connected to UCFS with mobile crisis and that sort of thing. Area private practices. We also go into schools, and I've done so many PDs (professional development) for the teachers on what the urgent Crisis Center is, when to use it, and then also our larger agency, what we have to offer, talking with police departments, and what that looks like, trying to make contact with the youth officer, school resource officers, those types of things. We're also connecting to pediatricians’ offices and connecting to the nurse managers there, the pediatricians. Sarah's taken the lead on that and just trying to branch out when schools are biggest referral source.

What role do you see for preventative measures in community mental health?

Studies show that when the provider does it with the family, it's more apt to happen. So, our staff will sit with the family while making referrals as much as possible. Obviously, if somebody comes in at 9:30 at night, like the providers in the area, they're probably not there. But if they come in at 2:00 P.M. We are calling. We're looking through psychologytoday.com, and we're putting in zip code, where male versus female specialties, we're showing them how to use that website. Most people have never seen that before. We're picking top three, we're calling. We're leaving messages or we're getting them connected to that care. Because when you're in crisis, you're absorbing the information, but it's not going to right because you're flooded.

If we do have to send them to the emergency room, our providers, so Sarah and the nurse and the clinician are calling over to prepare the hospital for this, and we really value that provider to provider contact and we're trying to strengthen that every day.

I had mentioned the bridge sessions, and that's if we want to support the family until they can connect to that higher level of care. When it comes to our outpatient department, we have really outpatient and school based. We have strong connections to them to get kids in immediately. And when we do those follow up calls, it could be anything. It could be the parent venting. It could be a new stressor, and it's really just being that listening ear and having those conversations. And doing a little bit of psycho edu over the phone or reminding them of their regulation techniques that they learned to practice. And if it's acute enough, we will invite them back in. They can come as many times. There's no limit to use us. There's nothing like that. So, if we are open, the families are welcome to come in. We've had siblings come in at the same time. We've had a sibling come first, and then the second one comes a few months later. It really is we try to access anybody we can

What role do you think technology can play in improving mental health care in the community?

We have an advancement team, and there's a few interns, and we're trying to push-- Instagram, Facebook. Wellness page on Facebook. It's like for like therapists in the area. We post on that. So, we really are trying to think outside of the box. But again, I mentioned our geographic location is so big. We have a lot of work to do like Norwich and North. Around here, like, here, New London, Groton and, Stonington, Waterford, East Lyme, Ledyard. They all know about us, right? And they are well versed and sending kids here. The schools are great partners. But when it comes to towns that are farther away, it's harder. They deal with the transportation issue. But we are their catchment area. So, it's just really supporting people that way and brainstorming with the team how to make that work.

How do you advocate for mental health awareness and education in the communities you serve? Or What strategies do you use to engage community members in mental health interventions?

So, when summer happens, we're like, oh, my gosh, we have to brainstorm, like, where else to go. So, we've been hitting up parks and rec departments, summer camps, libraries. When we think kind of those community hubs for families, where are they in the summer. We just did a marketing thing at Ocean Beach, and we were passing out books and candy and talking about the UCC. Also, we're very fortunate that our agency is well known in the area and we have a lot of personal connections to things. And then, even just like supermarkets and post offices, the train station. Everywhere we can think of, we're trying to figure out the billboard, you know.

How did you come up with your team?

We team up with Master's level mental health clinicians, all disciplines, whether they're going for their LPC, LCSW, or LFT. And what's cool about CFA is we're a teaching agency. We do hire new grads. We have an internship program, and we also give them the supervision that they need to be able to sit to become licensed, which is really cool. We also hire RNs. And then we have community navigators, most similar to a case manager. And then we have our providers. And our providers are all either MDs or APRNs, and DO.

How do you measure the effectiveness of these programs/services?

I'm so open to feedback from what those community partners have to say. And I bring that feedback here and we try to strengthen it to the best that we can.

How do you ensure that your interventions are culturally relevant and sensitive?

We engage in hour long individual supervision on top of rounds and team meetings where everybody gets an hour of personal time with their supervisor to go through that and talk about counter transference, to talk about judgment, right? Because we're all human beings. And yes, we're in the work. You know, we've been called to this work for a reason. But we all hold our own stigmas, and our own judgments to really process through that in our agency as a whole, all departments were trained in a model called risking connection. And it's really to help us as the provider, as a support staff, be able to see human beings for who they are. And I think in the direction that the world just is right now, it's very chaotic, and there's a lot of uncertainties and things like that. That just the level of stress that our clients are under, we also have to check ourselves because we're also under stress. And we can wake up on the wrong side of the bed, and we can have a personal experience of whatever we bring to the table. And the agency does a wonderful job with reflective supervision, using the risk and connection model to help sort through that and remain curious for all.

What are you most excited about in your work right now?

I am most excited to help more families. Our focus really is marketing right now. So that's what I'm most excited for is to see our numbers grow so we can support more families.

Can you share any advice or tips for someone aspiring to enter your field?

Advice that I would give a new professional is it's really hard work. So, make sure that you balance yourself personally to be able to do the hard work. Whatever that balance is for you, it's different for everyone. Me personally. I like to travel and do activities that way. And I think days can be really hard, but it's so fulfilling when you know that you potentially saved a life and saved a family unit.

And stay curious. Yes. That is something that I'm working on ten years later. You can easily get in your own groove, and that's when you lose your clinical skills, nursing or therapy. Whatever people do, stay curious about the human that you're supporting and constantly try to figure out what's under it, because what they're presenting with is an adaptation to whatever is going on underneath. And it's really easy to get judgmental and just stay curious.