Last Day Presents: “Helping the Most Vulnerable Teens” (Squeezed Ep 4)

Lemonada It takes little to be big. To learn more, volunteer or donate, go to BeBigNow.org. It's 5.30 in the morning. After two snoozes, I am awake and ready to get on the rowing machine. That's Shopa. She runs a world-class therapeutic school and rehabilitation program for teens in New York. And clearly, she's a morning person. Okay. Now, I'll spend about 20 minutes on the acupressure mat, which really helps to relieve built-up tension in my neck, shoulders, and upper back area. And while doing that, I'm going to listen to The Power of Now by Eckhart Tolle. Chapter 3. Moving Deeply into the Now. Shopa's 52, grew up in New Jersey, and now lives just across the border. She lives across the river in Chelsea with her husband, Simon. All right, time to put away the mat and head into the shower. So, what's your agenda today? Meeting, meeting, teaching. We're meetings. Are you teaching? Yes. So, I'm probably going to need the laptop. She's a cat mom. We're getting a lovely chicken pate. With a nice sprinkling of freeze-dried chicken on top. And a human mom to her 11-year-old son, Zubin. Seven o'clock, time to wake up, Zubin. Good morning. It's time to wake up, Bubba. You ready? Five more minutes. Five more minutes? You can have five more minutes. I'm going to go start your breakfast. I'll meet you in the kitchen. Okay. Every morning, Shilpa, Simon, and Zubin walk together from their downtown apartment to the subway. Then, the trio splits apart. Simon takes Zubin to school, and Shilpa catches the train uptown to her office in Harlem, where she cares for more than a hundred of the city's most vulnerable teens. All right, guys. See you later. I'll see you at 2.35. Love you. Just walk into the one train. Everyone knows a caregiver kind of likes your book. They keep everyone fed, wipe away tears, execute plans, all without breaking a sweat. And it might look easy for her, but don't be fooled. She's just had a lot of practice. Caring for yourself while caring for others is an important balancing act when you're doing it at home and at work. There's humanity on one side, the love and passion that draws you to the job in the first place. On the other side, there's systems, the programs, policies, and resources that make it all possible. Shilpa's been balancing these scales for decades, and she's a pretty big deal in her field. She works for a New York-based hospital called Mount Sinai, where she leads the psychology division and directs a program called CARES. Today, we'll hear how she helps teenagers work through challenges as they take that rocky road from childhood to adulthood. This is Squeezed. I'm your host, Yvette Nicole Brown. Episode 4, Meet Shilpa. We're looking at one wall in my office that has shelves that I made, by the way. Handmade those shelves a very long time ago. Shilpa is standing in her office at Mount Sinai. There's a lot of personality inside, almost like a living room. Stickers, stuffed animals, and framed student photos cover the shelves. Some of these puzzles with capturing balls in the little slots. a couple of valentines that i got from my son dear mom i love you love zubin with a stick the overhead fluorescent lights are off shilpa prefers warm lighting from some mismatched lamps she brought from home there's a round table and two couches the kind you want to sink into i hold a lot of meetings in here staff meetings or group supervisions and classes and i think it really is conducive to just kind of contemplation and exploration, and that's a lot of what I expect to do here. Next to her desk, bookcases stretch to the ceiling. The books she uses most are near eye level. Transcultural health care, young adult mental health, dismantling systemic racism in the workplace. Once I became director of CARES, I started a tradition of at Halloween, we all dress up in costumes, so we take a group photo, and then I get them printed on mugs for all the staff that are here. So one, two, three, four, five, six. There's a long line of mugs, each printed with a staff group photo. 13, 14, 15. I guess it's been 15 years. I was so excited to meet Shilpa, the director, who's been doing this for 15 years. But first, I wanted to know about Shilpa, the teen. I grew up in a very white suburb of New Jersey, and I'm not white. I feel like I was two different Shilpas. One was the Shilpa from Monday through Friday, who was at school as one of maybe three brown people in my entire school of about 800 people. There was always that feeling of, I don't think I belong here, but I'm here. So let me figure out what to do with this. But then the other Shilpa, who was in the Indian community, very sociable and lots of friends and family and all of that. It was just really like two different parts of my brain would get activated at different parts of the week. There was a lot around with friends and family of them struggling with mental health issues. And being the eldest, there is just kind of an inherent responsibility that comes with that, regardless of what your background is. When you naturally fill that kind of gap, it's hard to step out of it. And, you know, surprise, surprise, I ended up being a psychologist. Our team visited SHOPA at CARES, or the Comprehensive Adolescent Rehabilitation and Education Service. It's a clinical program in school for teens dealing with mental health, substance, academic, social, emotional, and family issues. Kind of like a one-stop shop for the most at-risk teens in New York City. It's passing period between classes. Dozens of students file in and out of classrooms. Joep was taking us on a little tour. It has the typical chaotic vibe of every high school. A teen digs through their purse for lip liner and fake eyelashes, then uses their phone camera to apply bone. Another sits quietly in a corner reading a book. One group crowds outside a classroom. At the math classroom, I think they're just going to wrap up class before they head over to the spelling bee. It might be a little biased spelling bee, just saying. They gave me the crown, so I'll be picking the words. You get an idea of what the students are like from their hallway decorations. This is a, today I am grateful for poster. Cats, puppies, 80s Spanish music, that is specific. We've got a Black Lives Matter flag, and then we've got our very inclusive Pride flag. Students typically stay for about a year. In some ways, CARES is like any high school. Students come from 9 a.m. to 3.45 p.m. every day for standard classes. They can graduate with normal diplomas. But in other ways, it's totally different. Think weekly drug tests to track progress and therapy most days. I have heard CARES described as a therapeutic school. What does that mean to you? It's a bit redundant in that school should be therapeutic. You better say it. You better say it. And it's not. I mean, we know that it's not. And so we do try to do that here. Teachers are teaching in classrooms while clinicians are literally right outside the classroom. Really trying to destigmatize the idea that I might need help in the moment. And it's okay. You can ask for it. Anybody can ask for it. And we can just do it immediately. Students between 14 and 21 get referred to CARES from all over. other schools, therapists, child protective services, the legal system, even their own families. It's open to anyone who can pay out of pocket or through insurance, even through Medicaid. Some care students have rough transitions from middle school to high school. Others were bullied or have learning difficulties. There's also abuse, family trauma, and issues with substances. - In most cases, unless they've already tried very intensively Intense. levels of outpatient care, we will give them a shot because one of our goals is to prevent hospitalization. CARES is preventative. They support teens now, so they're less likely to have a crisis later in life. And they don't just work with students. They see their families, too. There is no way to treat a child or a teen in isolation from their family system. The young people that come to us, the families that come to us, seem to have just been eroded down by discrimination or misdiagnosis or racism. Dealing with things like inequality and systemic racism and poverty can be really, really painful. And Shilpa and her team are there to help. All of these layers keep getting added on that I think has led to this disconnect from who am I and what am I and what's my purpose and what do I do? After the break, we'll listen in on a family therapy session to hear how this works in real time. I recently picked up the bamboo sheets from Quince, and I'm just so impressed. They are incredibly smooth and comfortable. And honestly, getting into bed at the end of a long day has become something I'm looking forward to even more. It's such a simple upgrade, but it makes my whole bedtime routine feel a little more luxurious. Quince prices everything 50 to 80 percent less than similar brands by working directly with ethical factories and cutting out the middlemen so you can give luxury quality without the need for luxury. The luxury price tag. Give the gift of quality this holiday season. Download the Quince app for app-exclusive offers or go to quince.com. Get free shipping on your order and 365-day returns. Now available in Canada and the UK, too. And when Quince asks where you heard about them, let them know it was last day. It's the best way to support the show. The drug landscape has changed, and most parents are working from information that's out of date. Fake prescription pills made with fentanyl. And other dangerous chemicals are promoted on social media. Pressed to look like Xanax or Adderall. THC vapes can hit 90 percent. Nothing like the cannabis we remember. Kratom sits on the counter at the gas station. Marketed as natural. And it can be habit-forming. You don't have to be an expert to start this conversation. Lead with facts, not fear. Teens can tell when you're exaggerating and they tune out. Ask questions. Listen. It's not one big talk. It's a series of small ones. And morning teens' what not to use doesn't teach them what to do instead. Helping them build healthy ways to handle pressure gives them better options. The New Drug Talk is free, science-backed, and made to help parents start these conversations. Visit thenewdrugtalk.org. There's only so much healing a young person can do alone. And usually, the people closest to them need help too. So students at CARES go to therapy at least once a day. They do individual, group, and family therapy. And there's a team of psychologists, nurses, doctors, social workers, and training staff who work with them. We listened in on a family session with 17-year-old Shai and their mom, Shayla. They've been working with therapist Emily for a year and a half since Shai first came to CARES. I would invite Shai to talk more. I think I talk plenty. There is maybe a tendency towards a dynamic for Shayla to talk more. Shai was referred after being hospitalized for a mental health crisis. Emily helped Shai and their mom work through past trauma, like what Shai went through at their old school. There was like a stabbing and there was gun violence and stuff. Yeah. So there's concern about going back into an environment like that? Yes. Emily says Shai is bright and funny. And when they have a hard time sharing feelings with Emily or their mom, Shayla, they communicate through sarcasm and facial expressions. In my past, people have crossed boundaries. So when people cross boundaries after I set them, it pisses me off. And it makes me feel unsafe because of past trauma. How does it feel for you to hear, Shayla? Scared. Softness. What do you feel, Shai? Numb. Frustrated. Mm-hmm. I'm sorry. No. I don't need to be sorry. What's the sorry part? Stop bringing this shit up, Emily. We are talking about you, sweetie. We are not talking about. I know, but you're funny. So your, Shai, feeling is like, I would prefer to be isolated. Yes. CARES students have been through a lot. Some are. Are really traumatized. And at times, adults haven't taken their experiences and feelings seriously. They've been let down and labeled as difficult or ungrateful. So some have built up emotional walls or lashed out at people around them. Sadly, many adults go to extremes to try and change a teen's behavior. It happens at home and in our social systems. Just look up troubled teen industry. You'll see what I mean. But at CARES, it's different. They're determined to get to the bottom of the trauma that teens face. So it's very rare for students to get kicked out of CARES, even when they skip school, fail a drug test, or yell at a teacher. Research shows that punishing traumatized children for things like acting out or withdrawing has a deeply negative effect that lasts a lifetime. At the same time, students aren't just let off the hook for their actions. The goal is to build a safe environment where young people learn to take accountability. That's different. That's different from punishment. Oftentimes, those get confused. Like, the immediate response is, oh, you're punishing me. I'm in trouble. Right. And we do a lot of work to help them recognize, no, it's not about being punished. Punished is not giving you a chance to respond and take ownership of what you've done. What we're looking for is for you to be able to slow down a bit and recognize, what was my role in this thing that happened? Right. And rather than keeping your locus of control external to you, you know, things happened to me, let's find the thing that you can be in control of. Right. And so let's work on that so that you can now have some agency. Agency, boundaries, relationships. These are big things for teens to work through. And Shilpa has spent decades building a system to help them. Students who couldn't see their future before CARES end up going to college, trade school, or other jobs. And Shilpa keeps in touch with many of them. Hey, Shilpa, how are you? Hey, how are you doing? I'm all right. Chris is one of those former students. He graduated from CARES in 2006 and still lives in the city. What are we talking, 15 years ago? Oh, my God. Okay, so start with your experience at CARES. This morning, there was always support around the corner. There was always someone to talk to if you needed it. At that age, that was a. I was a very rebellious, stubborn, emotionally illiterate kid. Whatever I couldn't figure out, whatever I didn't know what was happening with me and my personal family issues and my socialization problems back then, I would just get upset and I would act out constantly. Shilpa, what are you talking about in the corner? I was like, how are you doing, Chris? You want to talk about it? No, not really, Shilpa. Yeah, let's talk about it. You were always around. I definitely found some kind of peace here and there, whether I'd like to admit it back then or not. I did not want to admit it back then. But you were, to me, very easy to support. You would just show up all the time, every day, and that was it. That was all I needed, to know you want something more for yourself. Yeah. Things definitely turned out better than they could have. That's for sure. You worked tremendously hard, and I know you would never believe me when I would tell you that, but you did. After graduation, Chris went on to the Marines, then to other jobs. Now, as an adult, he wants to pay it forward. He's planning to mentor current CARES students. It's making me emotional now. It's a lot, you know, when the kids let you in. They don't really have to do that. I'm always telling my staff, as long as they're walking through the door, that's all they need to do, and then the rest is now on us. Shilpa manages 30 staff members in the program. She also oversees 175 more in the psychology division. She handles finances and hears from her bosses about the demands of the health care system she works in. Whew! No wonder Shilpa needs the power of now and those beautiful self-care rituals every morning. Advocating for the students, supporting her staff, and satisfying the system to keep the show on the road can be a lot. People talk about, do you change the system, or do you just accept it? And I think it's both and neither. Me being taken over by the humanity and forgetting that we work within a system is, - Yes. oh, so what? Doesn't matter what our demands are. We're just going to do whatever we want. We will all be out of jobs. And then the kids that we're treating will have nowhere to go to be treated. So it's just a very big reality that we're constantly having to strike a balance between these two things. I think the trick for us is to maintain our humanity and not let the humanity go. I imagine that this work can be very emotional at times and heavy at times. How has it changed you over the years? And how do you look after yourself? I had a day that ended feeling physically and emotionally painful and draining. And I know I have those days when I almost automatically start to feel those thoughts of why are you even doing this work? Why don't you just do it? And I think that's a really important part of the process. And I think that's a really important Just go and get that farm you want upstate and only deal with animals, not people. You know, those are the typical go-tos for me. Then I go home and my son and my husband, and they can just take one look at me and say, what happened today? And then I tell them and I offload and I come back to my core. It's difficult to be that human set of scales. There are days when all you want to do is the work that feels more human and connect with the world. And I think that's a really important thing. Other things, and I've got a little holiday wisdom for you. Hosting during the holidays means lots of cooking, and that means your trash is going to be full of smelly, rotting food. Yuck. So here's the wisdom. Get a mill food recycler. I did. We've had ours for years, and it has totally transformed our kitchen. It's unbelievable how much less waste and less odor there is now. Plus, it's so easy to use. 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BetterHelp is an online platform that gives you space to talk about what's taking up too much of your insurance. Insurance is a big deal. Shilpa says a lot of mental health programs prioritize access for very low-income people on Medicaid. And that's important. They need the help. Their access should not be taken away. But people that also need the services are middle class with commercial insurance. Leaders like Shilpa are at the mercy of insurance companies who challenge who can get access to which services. It's always changing and hard to predict. It's just a very strange setup here of like who's going to be allowed to access the multitude of programs that are designed. I can imagine, don't ask me how I know, that there aren't nearly as many women of color in prominent roles. Yeah, how did you know that? Isn't that shocking? How did I know this? What are some challenges that you've faced and how do you cope on those difficult days when it's exhausting and you just wish there were more of us? So for the longest time, I wouldn't recognize the challenges. And so I would just kind of go for what I wanted and get it. And if I didn't get it, then I'd try again until I got it. It's not until fairly recently, really, with the surge of DEI movements and recognition and this and that, that it started to dawn on me that, huh, maybe this has gotten in my way. And I don't know it. I think as I moved higher up in the ranks, it came up more and more from both women and men. And so I would then challenge things and I would put myself in a position of probably getting in trouble or risking things. Shilpa's drive to challenge the status quo actually started in childhood. That came directly from my dad. I remember once we had a family friend came over and made some comments to my parents about, oh, so sad. You have two daughters, you know, in Indian culture. Oh, that's, you know, you have to give them away and then you'll be left with nothing. That's so sad. And that really struck me because I'd never heard that before. And so I went to my parents saying, is that true? And my dad just looked at me so calmly and smiled and he said, oh, that's ridiculous. No, we actually feel blessed that we have two girls and girls can do anything they want. So why would that be a problem? And I was like, oh, okay. How do your memories of being a teenager shape how you deal with the young people now? I think at the core, we're talking about, you know, finding oneself. And that's what teens are going through across the board, across the spectrum. And caregivers, when they're adults, get caught up in thinking, I know better. You need to just listen to what I say. And I think it comes from a good place. You know, it comes from a place of care and concern and worry. But I think most times they have completely forgotten what it was like to be a teenager. I think it exists somewhere in their being. And that's why they're going to such a polarized opposite approach because of the turmoil that may still be unresolved for them. And so I think if we can take on that responsibility of saying, do I remember what I went through? If I can connect on that level, then I think that just magic can happen. The questions Shilpa's talking about, where you belong, who you fit in with, what to do with your future, those are the big mysteries of life. I'm in my 50s and still haven't figured it out. For teenagers, it's a lot more intense. It takes years, plus a few wrong turns to start to figure it out. Remembering that journey of finding yourself helps you transcend time to connect with the teens in your life. But you can't avoid all the arguments and door slamming. You actually need to have that. I have conflict, especially with teens. Part of what they're developmentally wired to do is to push up against adults. So if we can allow them to do that safely, we have a much better chance of lending them some trust and saying, you will tell me when there is something I need to know. Then we as adults have to let go a little bit. I imagine that's the challenge of parenting. You have to teach them to be an adult and to contribute positively to the world. But you don't want to be a parent. You have to teach them to be a parent. You need to support their process of growing into their own person. So how does Shilpa do it with her own son, Zubin? When I'm talking with him about just the realities of the world, so things like addiction that hit me both close to home and out there, I have to get myself into like a non-preachy place because I don't need to be a textbook for him. I need to be a human being. But also recognizing I'm still his mother. I told him things when he was four about addiction because I had to. Now it's more appropriate for an almost 11-year-old. I don't need to overload him, but I also don't need to fully shield him. Many parents of teens will tell you this constant tension feels like riding a roller coaster. But Shilpa's got a different take. I like to think of addiction as a way to get out of it. I like to think of the roller coaster in another way. It's kind of riding a wave. You know, when you're in the ocean, waves are coming at you. You can either be really stiff and strict, and that wave's going to hit you, and it's going to be so painful. Or you can see that it's coming, it's going to overpower you, it's just going to be bigger than you are. And you can acknowledge that and anticipate it, and it will come, but it's also going to pass. The more you try to fight it with this rigidity and this, I'm right, you're wrong, it just gets harder and harder. But if you can acknowledge that, okay, this is big, and it will also ease up, then you can tell yourself, I can ride this wave, and I will still be standing here. I love that analogy. And if I think about my own life, you know, I don't have teens, but I know that caring for my dad comes with a whole lot of waves. Shilpa's right. There's no point in fighting those waves. They're going to hit whether we like it or not. So we might as well just learn to ride them out. After meeting Shilpa, I'm thinking of the caregiving system for teens as a big set of scales, with teens on one side and adults on the other. When parents, therapists, or teachers drop fixed opinions and rigid systems on their side of the scale, teens get launched right off the other. But when caregivers set their own teen memories and mistakes. They move slowly toward harmony. And when mental health systems and leaders support that balance, that's when real change can happen. I'm Yvette Nicole Brown, and this is Squeezed. There's more Squeeze with Lemonada Premium. Subscribers get exclusive access to bonus content like previously unheard clips from all our voices in this series. Subscribe now. On Apple Podcasts. Squeezed is a Lemonada Media original. Crystal Genesis is our senior producer. Julia Yort, Tess Novotny, and Hannah Boomershine are our producers. Ivan Kurayev is our engineer. Feeble production by Tess Novotny, Crystal Genesis, and Ivan Kurayev. Our theme music is by Andy Kristen's daughter with additional music by APM Music. Jackie Danziger is our VP of narrative content. Executive producers are. Jessica Cordova-Kramer and Stephanie Whittles-Wax. This show was created in partnership with the Robert Wood Johnson Foundation, a leading national philanthropy dedicated to taking bold leaps to transform health in our lifetime and pave the way, together, to a future where health is no longer a privilege but a right. 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