Portal de Periódicos da CAPES

Can We Put Our Hoodies On and Get to Work?

2019; Elsevier BV; Volume: 65; Issue: 1 Linguagem: Inglês

10.1016/j.jadohealth.2019.04.016

1879-1972

Maria Trent,

Youth Development and Social Support

Thank you, Deborah, for that lovely introduction and the excellent example of leadership you have provided over the last year. Before beginning my presentation today, I would like to acknowledge how busy and exciting this year has been for our Executive Team. I want to start today by acknowledging Tamera, Tanya, Ryan, and the other members of the board and the management company for facilitating a collaborative and collegial experience as a volunteer leader in SAHM. I'll share that the weekly work seems escalated in our current sociopolitical context. In the last year, we have responded as a team to more than 25 major political and social issues in organizational letters, amicus briefs, and media statements. We are working and responding in real time to adolescent public health and policy issues and using our strategic plan to guide our actions daily. As such, I am especially grateful for the work of Krishna, Abigail, James, and other members of the Advocacy Committee who are watching closely as policy unfolds and raising the red flag through effective advocacy and partnership. This meeting has been a serious undertaking and so I need to recognize Manuel for his leadership of program committee, the principles of fairness and inclusion that guide his work. Finally, I'd like to recognize my husband, children god-parents, friends, and family who have and continue to support my professional development. A few of them have joined us here today. Today I will share a bit about my journey to this place, discuss the topic of heroes and why adolescents need them, and share some things I know for sure that will transform our work. I would like to dedicate this talk to my mom. I know she'd be here if she could. She was one of those adolescents who defied the odds after being orphaned at 16, to become valedictorian of her high school class. She put herself through college and graduate school, traveled the world and achieved great things at a time when people wouldn't have thought it possible for any African American young woman. She touched many lives over her 30-year career as a middle school guidance counselor and planted seeds of compassion and justice for young people within me that continue to bloom with each passing year. Her story is complex, but it reminds me that every adolescent is worth saving. Like an adolescent coming of age story, my relationship with SAHM has evolved over the years. As a fellow and junior faculty member, I was awed by our senior leaders striving to show us the way. I joined committees, took on leadership roles, and planted my professional seed here. About a decade ago, I had my first adolescent moment with SAHM—you know—when you start to see holes in something you had previously idealized. It's something that feels like the moment you learn that Santa Claus was your mom and dad. An unarmed African American adolescent boy wearing a hoodie—Trayvon Martin—was gunned down in Florida carrying nothing but a cell phone and a bag of skittles. As a victim, he was vilified by the media for being a teen, and it was effective because his killer would not come to justice. As the parent of an amazing African American boy and a physician working in a practice primarily serving low-income African American youth, I was incensed because nothing really happened afterward. Our team at Hopkins wrote an open letter to SAHM members asking our SAHM community to “put our hoodies on” to prevent the deaths of unarmed black teens in the U.S. Maybe two people sent us notes in response. I later wrote again on a similar issue asking colleagues to “help me” as a parent and a member of a historically aggrieved group, but received silence. I decided then to find alternative ways to contribute to the conversation and become a better advocate for young people. I became chair for the Section on Adolescent Health for the American Academy of Pediatrics and our team of mostly SAHM members worked together to support and pass resolutions on everything from protecting underrepresented minority youth from violence to expanded adolescent access to contraception. Our section designed a course to train people in general adolescent and young health, continued to produce a journal to impact adolescent education and care through the 68,000 pediatrician members in the U.S. I became a member of the task force on bias and discrimination and though we are behind SAHM, I recently wrote a policy statement on the impact of racism on child and adolescent health. I also continued to contribute to SAHM's mission—chaired the research committee, served on the board, co-facilitated the mentoring forum, supported our Hopkins trainees to grow in SAHM, and settled into a period of bliss with the organization. Last year, I had another flashpoint as your new president-elect. We were all about Marching for Our Lives, having moments of silence, and really tackling the issue of gun violence after the Parkland shooting. I'll admit I was hanging on to a bit of my Trayvon Martin baggage. I had also just seen a patient who was unable to sleep at night after witnessing the death of a close friend and whose tattooed body displayed his trauma experiences, the associated grief, and dwindling optimism for his future—a key spark necessary for him to thrive. When I looked at the data around gun violence in Maryland and compared the deaths and injuries due to gun violence in a 1-mile radius around my job in Baltimore to my own neighborhood just 16 miles south, our silence about chronic gun violence and trauma was deafening. It became a justice issue for me. As a person who rarely seeks to engage speakers at the microphone, I was perplexed when my question about whether the speaker thought that urban youth experiencing chronic gun violence might be retraumatized when we ignore them by normalizing their dismal reality in favor of sensational yet tragic school shooting events in well-resourced communities, was ignored. Honestly, I thought, “how can I lead this organization when I can't get a question answered?” My good friends in SAHM took me to lunch, filled me with food and cheer, and while disappointed, and I soldiered on. I left SAHM to attend a leadership forum for the Academy. The last speaker of the meeting focused on the problem of gun violence, its complexity, and its impact on children globally and nationally. His parting call to action, however, was simple. As adults and organizational leaders, we had to become more powerful on behalf of children. He asserted that in these tough times we must essentially become heroes. Young people are naturally drawn to fictional heroes, characters who are often flawed but somehow find the greatness within themselves to use their gifts to help others. I am mindful of the work of Stan Lee whose work on the “other” has not only entertained us across generations but has served as a catalyst for change by leveraging pop culture. As I watched my own teens enthralled by Black Panther and commiserate with the new Afro Latino teen Spiderman as he gained mastery of his superpowers (symbolic of the pubertal process), it reinforced the notion that young people are looking for inspiration, reassurance, and opportunities to contribute to the world in a meaningful way. My first act toward becoming more powerful was to actually March for Our Lives with the Parkland youth, and they showed us—like a younger generation of the Avengers—that they understood what had pained me for many years. That day they became heroes by expanding their platform to share their stage with those very young people that I have been fighting for from places like Washington, DC, Chicago, South Central, Los Angeles, and Baltimore. While people think about the dozen students who are in the media each day, one hundred public school buses also left Baltimore carrying youth desperate for heroes to change the fact that gun violence is eating away at the sparks they need to survive and leaving them traumatized. I saw my own suburban teen change from being annoyed about the early wakeup call and the fact that the coffee shop messed up her order to become a true protester for change before my very eyes. We saw that with scaffolding and resources young people are effective change agents. But we knew that already, right? We saw that with the Little Rock 9; the college students at North Carolina A & T University who sat at the lunch counter in Greensboro; the diverse group of Freedom Riders who rode from the North to help change the South; the students leaders in the Chicano movement; students from Ferguson, Missouri who helped inspire the Black Lives Matter Movement, and those at Standing Rock who have resisted changes in governmental de-regulation that ignore the promise made to Native Americans and increase the risk for hazards that have the potential to undermine the health of their people. What I've seen is that they also mobilize the US to act. Over the last year, I've given presentations, testified before government agencies, cared for patients in practice, conducted research designed to reach the most vulnerable, worked within key professional organizations, am collaborating with international partners to address sexual health in low resource countries, and am trying to truly become a more powerful voice for young people. I worry, however, that we cannot always solely rely on young people to take the lead. We have to step up and ask them to transform the discussion as we lead from the rear. If adults had really mobilized around gun violence after the shootings in Columbine, Sandy Hook, or even after the Trayvon Martin shooting—Parkland may not have ever happened. Even so, those young people's deaths have not been in vain. Almost exactly 1 year after the Parkland tragedy and just around Trayvon Martin's 24th birthday, we've seen a substantial decline in the national rifle association lobby's influence and resources and gun legislation was just passed in the US House of Representatives to require background checks—moving us in the right direction. There's still work to do since 46 children and adolescents are injured or killed by firearms each day in the U.S., but we must be careful to celebrate every win to gird ourselves for the next challenge. The question becomes “what will we do together to change the health and well-being of young people moving forward?” How will the most diverse group of globally connected young people survive and thrive physically and emotionally when some adults seek to divide them? We also have significant health issues such as (1) a rise mental health disorders, (2) direct marketing of illicit drugs as the solution to our problems, (3) substance use, (4) sexually transmitted infections, (5) direct attacks on the public funding of the family planning infrastructure, (6) educational inequity leading to suboptimal vocational outcomes (a key developmental milestone), (7) obesity, (8) family strife, (9) discrimination, (10) regressive immigration policies, (11) cyberbullying, (12) sex trafficking, (13) decline in well visits, (14) low adolescent immunization rates, and (15) firearm safety. Parents are also raising adolescents in a world in which the value of truth, morality, and justice are no longer the standard. Our global society has taken a step back and a fifteen-year-old today appears as likely to experience adversity due to isolation or direct attack due to “difference” as I did 35 years ago. An experience that is further exacerbated by easy access to hateful and harmful words and actions through social media. As such, young people today need heroes. Ordinary individuals who find the strength to persevere and endure despite facing overwhelming obstacles and who are intent on making the world a better place for everyone, but especially those who have not yet been empowered to stand up for themselves. In adolescent health, we don't wear a mask and cape, but an invisible “A” on our chests to advocate for young people moving through adolescence and into young adulthood while they may face disdain and misunderstanding by adults both inside and outside complex health, educational, and community systems. We embrace the beauty in the natural transformation presented by puberty and adolescence and are willing to face the challenges that often emerge in the struggle for autonomy. Be it the boy who riots because he feels is disrespected and unheard; joins a gang because he feels alone; has become addicted to drugs to cope with the chronic emotional and physical pain of cancer; the girl who has a baby because she needs to feel loved, is starving herself to death because it is the only thing in her life she feels she can control; or worries about what will happen to their family if her parents are deported. Even well-resourced adolescents who appear to have it all together need heroes. Parents are the real heroes in adolescent health. They sacrifice to ensure their child has what they need and often what they want. They spend time driving and waiting through practices, games, performances, and after-school jobs as adolescents hone their gifts into something meaningful while practicing autonomy; care for their adolescent with special needs without respite; and wait up at night closing their eyes just as the front door clicks shut as their teen driver finally arrives at home. While society mobilizes around parents with small children, the parents of adolescents also need support. Adolescent health professionals do not separate youth from the protections of family, but rather know how to help youth navigate the transition to autonomy, carefully mobilizing resources in the SafetyNet so that there are no gaping holes that fail to catch them if they fall. The challenge is that the adolescent health workforce is declining. This is the organization that can inspire a new generation of adolescent health professional across disciplines. We don't have to look far for inspiration. The path has been laid out before us, and our resources are tremendous. If I just look at my own professional mentors. There are people like Larry D'Angelo and Judith Ratner who first modeled Adolescent Health and Medicine for me. Denise Cora Bramble who supported me to attend my first international scientific meeting in Mexico City to present work with teens here in South East Washington, DC. After visiting Teotihuacan and sitting on the sun, I caught a travel bug then that will never be cured. Jean Emans who has been a mentor and SafetyNet for over 20 years. She can tell you that at this moment I'm actually now fulfilling the final piece of my fellowship individual learning plan to give a talk for more than 500 people at a professional meeting. Sara Forman, Jessica Daniel, Cathryn Samples, Bryn Austin, and Catherine Gordon also wrapped me in southern style warmth in the New England winter of fellowship to begin my journey as an adolescent health professional. I have other heroes closer to home. Hoover Adger whose quiet guidance, honest discussions, and friendship has created a safe space for me to evolve as an academic faculty member at Hopkins. Jonathan Ellen who took me and many others under his wing with a generosity of time and resources to show us the way to become independent scientists. Alain Joffe the father of Adolescent Medicine at Hopkins who placed me in positions to lead and whose counsel remains among the most trusted in my network. Iris Litt whose elegant “mother of the church” nod saw me through my toughest interview at the Robert Wood Johnson Foundation and then who mentored me through my first big grant. Then there's the positivity of Mychelle Farmer who started adolescent clinics in Mondawmin Mall--the site of the 2016 Baltimore riots—and who now has an Adolescent Health footprint that extends around the globe. Renee Jenkins who has paved the way, helping me navigate complex bureaucracies with grace while maintaining my commitment to justice. Dennis Fortenberry for reality checks and extending my professional research network. Charlotte Gaydos who has connected me to laboratory science so that I can bring novel diagnostics to my efforts to reduce STI disparities in urban youth. Finally, Bob Blum who expanded my public health platform through the School of Public Health. Then there are those external to SAHM that pulled me into their circles. Folks like Deborah Arrindell from the American Sexual Health Association, Debra Hauser from Advocates for Youth, and Harolyn Belcher at the Kennedy Krieger Institute. Through these interactions, I've met amazing people doing adolescent health outside of my usual sphere and mentor some fantastic young people in college and graduate school to consider careers in public health and medicine. Through them, I've also had the opportunity to meet and engage with my professional heroes such as Jocelyn Elders. She is a former surgeon general, fellow pediatrician, and sorority sister who embodies what it means to put service above self. The time is now for us to have a transformative moment and become heroes for adolescents and young adults. There are seven things I know for sure:1.There are 1.2 billion adolescents across the globe. While this means that we should never be out for work, it also suggests a need to expand our field. Adolescent Health and Medicine is a field mostly concentrated in North America, we need to strengthen our international activities and relationships to connect folks working with adolescents worldwide to facilitate an adolescent health movement to address the many preventable causes of morbidity and mortality for adolescents worldwide.2.We need to find those gifted souls who are poised to accept their superpowers, lead, and ask them to lean into those roles. People like Ryan Pasternak who stood with New Orleans when the city and his new job were flooded during one of the most significant humanitarian disasters in North America to rebuild a clinical program that young people count on. Steve North who uses telemedicine to connect young people to care in my home state of North Carolina. Tina Simpson who travels to meet young people where they are in Birmingham, Alabama. Robert Garofalo who is transforming the lives of sexual minority youth while also using his scientific and clinical skills creatively to design interventions that work. Vo Dzung whose work on mindfulness is helping youth and families across the globe tap into their inner selves to become more peaceful. Megan Moreno and Michael Rich whose work on technology and Kenneth Ginsberg's work on strengths-based communication are transforming what positive youth development means.Then there are what I refer to as the “ballers.” These are leaders like Angela Diaz who inspire me by their ability to reframe Adolescent Health and convince others to invest in her vision. She has built something in New York City that young people truly consider their own. Claire Brindis and Abigail English whose work keeps adolescent health issues at the forefront of health policy and the law and Pierre-Andre Michaud who trains Adolescent Health professionals across the world through EuTeach.3.As adolescent health leaders and innovators like Trina Anglin and Seth Ammerman retire, we need to recruit new people into the field. If we look at the discipline of medicine alone, not even one half of 1 percent of individuals from over 1300 eligible residency programs choose a career in adolescent medicine. Of our thirty or so spots, training programs still go unfilled in the national residency matching program. We are countered by the notion that even if interest were to skyrocket---where would they train? While it is harder to wrap numbers around the other disciplines as there is no direct path to adolescent health nursing, mental health, and nutrition---the workforce disparities data suggest that we are behind. I am grateful for members like Jason Nagata who is leading initiatives with an amazing council within SAHM to recruit new members into the field. We need each committee chair to meet with their members and creatively think about how they can contribute to our mission and keep people active in our organization.4.We need to reframe adolescent health from a risk-based model to one of wellness. While there are definitely issues for us to address, young people are mostly healthy. Research by the Frameworks Institute has demonstrated that the media coverage of adolescents is mainly negative and focused on issues such as crime, being-at-risk, and accidents. We must not have the only time that adults love teens is during the Olympics. Risk is a natural part of adolescence, but we mustn't forget the positive risks they take every day that have nothing to do with “sex, drugs, and rock N roll.”I look at my own teens and see their vulnerabilities. I can read my daughter's body language from the other side of a room or stadium. I also have witnessed her bravery, intellect, and skill be transformative for herself and others who count on her. I am also acutely aware that while she loves her doctor, there are other adults in her life such as teachers and coaches who have a more significant impact on who she is becoming. We need alignment across the places where young people come in contact with adults every day, to more positive messages in the media about adolescence, and to ensure that national and international policy does not undermine their human rights or ability to enter young adulthood with sparks that they need to thrive. To do this, we must not abandon the conduct, presentation, and publication of cutting-edge adolescent/young adult health research as a part of our strategic plan. We undermine our efforts to advocate without data.5.We need to take better care of ourselves. We handle some of the most complex and challenging cases often with limited resources and provider burn out is real. We must put our oxygen masks on first so that we can be there for our patients to do the work as Ken and Merrian described on day 1. We should also carefully negotiate for sufficient resources to do our job in a way that makes sense for adolescents and that shows the value of our contributions.6.We must have fun. What I have loved about SAHM is that we are able to tackle the tough issues in adolescent health, but that I almost always have fun at these meetings. The wonderful thing about our 50th Anniversary celebration last year was that we infused fun into our work. While we may not have another party like that one until we reach another major milestone, we should be thoughtful about how to consistently infuse enjoyment into this meeting, our daily work for adolescents and young adults, and with each other whenever and wherever we can.7.Finally, we must all become more powerful on behalf of adolescents and young adults. We must see their power and scaffold all of them to harness it in ways that matter. We need to be sure that our objectives and actions are not only for them but also with them. We must lead from behind whenever possible as they become the heroes they were always also destined to be, cognizant that there are times that we must stand alone to create opportunities and shield them from harm. I've asked you once before, but I'll ask you again. Can we put our hoodies on and get to work? Thank you.