Presidential Address: CAPture Belonging
2021; Elsevier BV; Volume: 61; Issue: 1 Linguagem: Inglês
10.1016/j.jaac.2021.10.011
ISSN1527-5418
Autores Tópico(s)Family Support in Illness
ResumoEvery great dream begins with a dreamer. Always remember, you have within you the strength, the patience, and the passion to reach for the stars to change the world.—Harriet Tubman, freedom fighter I am deeply humbled and honored to be your next AACAP President, daring to dream to meet the challenge of today. Let’s start with where we are, in the midst of a global pandemic and ongoing mental health crisis, not to mention everything else that has turned our world upside down. However, despite being spread out across the country and globe, in our homes or offices, through our computers, laptops, and phones, we are connected and together at this moment. The pandemic has challenged us in many ways, but we’ve found new ways to connect because we instinctively need one another and that sense of belonging. The title of the presidential initiative is CAPture Belonging, starting with CAP for child and adolescent psychiatry. My address has 3 parts: a reflection on AACAP, a little about me, and an introduction to the presidential initiative. Who better to understand the magic of connections than child and adolescent psychiatrists and mental health providers who co-create spaces for healing and change? What have been your most meaningful connections in the past 2 years? This has been an unbelievable time, and personally, I am grateful for my forever friends, family, and especially my AACAP family. The fearless leadership of our immediate Past President, Dr. Gabrielle A. Carlson, and Executive Director, Heidi B. Fordi, with our Executive Committee, Drs. Bennett L. Leventhal, Cathryn A. Galanter, and Melvin D. Oatis, and our AACAP Directors, has risen to every challenge. This AACAP pod, even virtual, has been a beacon of light and hope for me. Dr. Carlson’s visionary leadership helped us through the darkest days of the pandemic. She enlightened us with the warm wisdom of her Screenside Chats, reminiscent of U.S. President Franklin D. Roosevelt’s Fireside Chats. She led by shining light on the sickest children with her presidential initiative on emotion dysregulation. She championed our efforts toward health equity and combating racism with her presidential working group, among many other accomplishments. As we look back over the past 2 years and think about the silver linings and the lessons learned, we can see how important we are to one another and the importance of a sense of belonging. Mother Theresa said: “If we have no peace, it is because we have forgotten that we belong to each other.” The one thing we crave the most, especially in a year with social distancing, is our love and connection to family, friends, community, and home. AACAP has always been my professional home, giving me a sense of family, community, and belonging. I love our annual meetings when we can connect with friends and colleagues and meet new kindred spirits who share the passion of children’s mental health. AACAP, whether in person or virtual, is our home and community. In these challenging times with the dual pandemics of COVID-19 and mental health, we face a divided country with an overdue reckoning of racial injustice and inequity, economic uncertainty, and our own painful personal losses. We face the unfinished promise of our nation and our people. How are you responding to these times? Well, you are here, and we are here together to meet the challenges. In the words of 2021 AACAP Catcher in the Rye Humanitarian Award recipient, Secretary Hillary Rodham Clinton: “When we all help each other out, when we stand together, we are stronger together.” I had the privilege and honor giving this address to AACAP Annual Meeting attendees on the eve of becoming your next AACAP President. How does one lead in these times? I believe we should lead together, with a collective voice, to be truly inclusive and representative of all of us. I see myself as a servant leader, as coined by Robert Greenleaf.1Greenleaf R. The servant as leader.in: Zimmerli W.C. Holzinger M. Richter K. Corporate Ethics and Corporate Governance. Springer, Berlin2007: 79-85https://doi.org/10.1007/978-3-540-70818-6_6Crossref Google Scholar The core tenets of his philosophy include, among others, listening, empathy, healing, self-awareness, stewardship, and commitment to the growth of people and community. We all have a stake in this, and so the principle of stewardship engages us to share leadership. As your president, my role is to bring out our best and have you, our incredible AACAP members and staff, shine your light to lead the way. I think about the wise words of our Poet Laureate Amanda Gorman’s poem at U.S. President Joseph R. Biden’s Inauguration: “For there is always light, if only we’re brave enough to see it. If only we’re brave enough to be it.” As a gay Asian American first-generation immigrant child and adolescent psychiatrist, among other things, I am, first and foremost, a human being. My many identities enrich me, but don’t fully define me. What unites all of us as child and adolescent psychiatrists within AACAP is our shared mission and passion for serving children, youth, and families. It isn’t lost on me what this moment means. That I am standing here speaks to what AACAP represents and its commitment to championing diversity, equity, and inclusion. One doesn’t arrive in these moments without a heart of gratitude. Some say that gratitude is the heart’s memory. I’m grateful for the AACAP leaders and members who have been in the spotlight and those behind the scenes who have contributed to this moment and to me. Without those of you who were brave enough to be my light, I wouldn’t be here. You’ve paved the way through your courage and representation, championing justice and change. I am humbled and inspired by your vision, allyship, sponsorship, and generosity. I remember the passion and grace of our incredible former Executive Director, Virginia Q. Anthony, who would always stop by the Lesbian and Gay Child and Adolescent Psychiatric Association (LAGCAPA) reception with the presidential entourage to join the party. When I look back on our history/herstory, we have come a long way as an organization, but we have much work still to do. We are far from our promise and our destiny. We are making strides and we can build on that momentum to take the next steps. We have had transformational dreamers and innovators with diversity of thought and representation since our founding in 1953. Our first woman president was AACAP’s fifth president in 1959, Dr. Marion Kenworthy. She was a visionary who inaugurated our first journal editor, Dr. Irene Josselyn, in 1962. Both accomplished and inspired so many to dream and created incredible legacies in AACAP and child and adolescent psychiatry. Groundbreaking and pioneering work was also accomplished by Drs. Jeanne Spurlock and Ian Canino, who started the Diversity and Culture Work Group in 1994. They’ve inspired generations of child and adolescent psychiatrists and leaders to carry the work forward with open minds and hearts to one another’s diversities and cultures. To lead us into the new millennium in 2001, it was only fitting that Past President Dr. Marilyn B. Benoit’s initiative was titled Embracing the Opportunities in Child and Adolescent Psychiatry.2Benoit M.B. Embracing the opportunities in child and adolescent psychiatry in the new millennium.J Am Acad Child Adolesc Psychiatry. 2002; 41: 2-4Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar She focused on the underserved half-million kids in foster care at that time as well as the “wow” moments that inspire us to child and adolescent psychiatry. In 2014, Past President Dr. Paramjit Toor Joshi invited us to her presidential initiative, Partnering for the World’s Children, because we are one humanity and there are no borders in our hearts or dreams.3Joshi P.T. Presidential address: Partnering for the world’s children.J Am Acad Child Adolesc Psychiatry. 2014; 53: 3-8https://doi.org/10.1016/j.jaac.2013.10.009Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar All these leaders, plus all the individuals of all genders, races, ethnicities, and identities who championed them and advanced child and adolescent psychiatry, share in the accomplishments that led us to where we are today. I want to share a bit of my history in the hopes that you will see parts of yourselves in my story. I come from a family of dreamers, as immigrants often are. As I shared the wisdom of Harriet Tubman earlier, “every great dream begins with a dreamer.” With limited command of English, my parents courageously emigrated in search for a better life with their 3 young children from Hong Kong, China, to Canada. Neither of my parents had completed high school, so my father started work as a cook and my mother a seamstress, but that didn’t define nor limit them. I’m so proud of them and love them for risking it all to find a better world for us. I grew up working in my parent’s coffee shop and met all different types of people, each with their own story to tell over a cup of coffee. My parents told us that if we didn’t do well in school, we would have to continue working in the coffee shop. Needless to say, we all studied hard. I’m the youngest of 3 boys, a close second by 10 minutes with my identical twin brother, Ronman, the artist. Double trouble, or double good trouble, I hope, as I’ve always been inspired by the civil rights hero, Representative John Lewis. I went to medical school in Toronto during the late 1980s at the height of the HIV/AIDS epidemic, the other pandemic that has shaped my life course. It was another time in history when politics, society, and medicine collided. What I saw in hospitals were the painful effects of stigma, homophobia, marginalization, and shame. It shook my sense of humanity but galvanized my commitment to justice and compassion in medicine. Being a creature of my times and a gay man, I saw medicine through the lens of the HIV/AIDS pandemic and pursued HIV care within family medicine to answer that call to help. However, what captivated me the most, once again, was listening to the human stories of suffering, courage, and love amidst it all. It was while doing family medicine that I had my “wow” moment and fell in love with child and adolescent psychiatry. I had the privilege of emigrating twice, but this time it was my choice in becoming American. I was pursuing my dreams in New York City, the city of dreamers. I was lucky to do my child training at Bellevue Hospital/NYU and even luckier that I was introduced to AACAP through the regional organization, the New York Council on Child and Adolescent Psychiatry. I remember going to my first meeting. I was so intimidated as a trainee, feeling like an outsider, but once I walked into the room everyone welcomed me. So much for New Yorkers! They made me feel at home and like I belonged. So, when I attended my first AACAP meeting my home got larger and so did my family. New York also happened to be one of the epicenters of HIV/AIDS and pediatric AIDS, where visionaries like my mentors at Columbia University, Drs. Jennifer Havens and Claude A. Mellins, created incredible programs to serve women and children living with HIV/AIDS, bringing light to the darkness. I was able to combine two of my callings: HIV/AIDS and child and adolescent psychiatry. As I mentioned, I am a creature of my times, and the COVID-19 pandemic has revealed many ugly truths about our society and ourselves. The long-standing pandemic of racism has colored the tragedies of the COVID-19 pandemic, disproportionately affecting Black, Indigenous, and Latinx individuals, families, and communities. The tragic murder of George Floyd sparked a national reckoning of over 400 years of continuing anti-Black racism that has been baked into the fabric of our society. We have also seen other communities targeted by racism with the sudden increase in anti-Asian hate, reminiscent of post 9/11 Islamophobia. We have also witnessed the assault on the rights of transfolk, sexual minorities, women, and voters. In 1963, Reverend Dr. Martin Luther King, Jr., wrote: “Injustice anywhere is a threat to justice everywhere. We are caught in an inescapable network of mutuality tied in a single garment of destiny. Whatever affects one directly affects all indirectly.” Now to pull the threads together and share my vision for the Presidential Initiative: CAPture Belonging. As we move through our collective journey of diversity, equity, inclusion, (DEI) and justice work, it can hopefully bring us to a destination of belonging. Finally giving us a single garment worthy of us all. What do I mean by belonging? Belonging is the feeling of security and support when there is a sense of acceptance, inclusion, and identity as your authentic self. This was adapted from a definition by Baumeister and Leary.4Baumeister R.F. Leary M.R. The need to belong: Desire for interpersonal attachments as a fundamental human motivation.Psychol Bull. 1995; 117: 497-529https://doi.org/10.1037/0033-2909.117.3.497Crossref PubMed Scopus (10894) Google Scholar Instead of calling it my presidential initiative, I will be so bold as to call it our presidential initiative in the spirit of belonging. This isn’t about me; it’s about us. Our presidential initiative will build on the foundation of DEI work established under President Carlson’s leadership and take it to the next level. The tremendous efforts of the Working Group to Promote Health Equity and Combat Racism led by Drs. Oatis, Lisa M. Cullins, and Tami D. Benton, with Director Carmen J. Thornton, have highlighted the 4 priorities of awareness, advocacy, workforce, and professional development, as well as national partnerships and linkages. In addition, JAACAP’s leadership with Drs. Douglas K. Novins and Robert R. Althoff and Director Mary K. Billingsley has taken the important step of envisioning an antiracist journal with the first Deputy Editor for Diversity, Equity, and Inclusion, Dr. Wanjikũ F.M. Njoroge, and the first Assistant Editor for Health Equity and Antiracism, Dr. Eraka Bath. Important work has been accomplished, but we are far from done. I’ve asked Dr. Oatis to lead the presidential initiative, and he has graciously accepted to advance these efforts. What work do we need to do? We need to continue doing the work toward being antiracist as an organization. The goal is to have this work embedded within our culture, so it is who we are, what we do, and how we work together. The antiracism work never ends, nor the commitment to our values of diversity, equity, inclusion, and justice. As Dr. Camara Phyllis Jones, Senior Fellow at the Satcher Health Leadership Institute, teaches us, there are 3 levels of racism: personally mediated, institutional, and internalized.5Jones C.P. Levels of racism: A theoretic framework and a gardener’s tale.Am J Public Health. 2000; 90: 1212-1215https://doi.org/10.2105/ajph.90.8.1212Crossref PubMed Google Scholar Since systems and structures are often inherently inequitable, it requires active efforts to address them. To help us advance, we will be looking inward and outward to help identify systemic and structural solutions to these challenges. AACAP is our home and who we are, and that’s where we start. Two quotes come to mind:“Be the change that you want to see in the world.”—Mahatma Gandhi“Yesterday I was clever, so I wanted to change the world. Today I am wise, so I am changing myself.”—Rumi In taking the next steps in this DEI journey, we will expand the charge of the current work group to encompass more components of our organization with a broader agenda and input from our members. The working group will be renamed the JEDI (justice, equity, diversity, and inclusion) Workgroup, and its membership will be expanded to have the greatest impact within AACAP. Learning and unlearning will be critical, with annual DEI and implicit bias training for our Council members and other leaders. To know that we are making progress, we will measure a baseline for DEI and set goals. Systemic and structural racism and oppression requires us to review and update our governing documents, such as our AACAP Bylaws, mission statement, and operating documents, to reflect our commitment to diversity, equity, and inclusion. Evaluating current diversity and representation within our Executive Committee, Council, Assembly of Regional Organizations, committee leadership, and leadership of our publications will help us see ourselves in reflection. Transparency is critical in this process, so reviewing the pathways to leadership and opportunities within AACAP for everyone is key. I’m still learning on my own DEI journey, but I’ve learned that it’s not just the complexion that needs to change but the culture to truly embody inclusion and belonging. It is about all of us, not some of us, and that’s important to belonging. The second priority of our initiative is you, our membership. You are our lifeline, strength, and inspiration. Part of working toward being antiracist, diverse, equitable, and inclusive is developing a way to harness the power of our membership and our collective voice. Amplifying our members’ voices and developing a method of soliciting representative membership feedback on organizational decisions and priorities is critical to our future. We will explore developing a process to do this. By better understanding the diverse needs of our membership, we can benefit from the diversity of thought, experience, and perspective that our organization has to offer. We are making important decisions on behalf of child and adolescent psychiatry, and hearing your voices is critical to our success. The third priority is to support AACAP’s continued investment in the development of our members. We will explore developing a Leadership Academy to support child and adolescent psychiatrists throughout their careers in research, advocacy, education, and clinical services. As our professional home, AACAP is invested in your growth, development, and evolution. The practice of child and adolescent psychiatry is constantly evolving, and the development of a Leadership Academy would help equip our members, profession, and organization to solve the big problems with child and adolescent psychiatrists at the table. The last priority is one where President Dr. Carlson has already sounded the alarm: a response to the national crisis in mental health for children, adolescents, and families. This work requires us all. However, not all communities and populations are affected equally, and finding solutions, especially to address health equity issues and the underlying social determinants, is critical.6Fortuna L.R. Tolou-Shams M. Robles-Ramamurthy B. Porche M.V. Inequity and the disproportionate impact of COVID-19 on communities of color in the United States: The need for a trauma-informed social justice response.Psychol Trauma. 2020; 12: 443-445https://doi.org/10.1037/tra0000889Crossref PubMed Scopus (107) Google Scholar Many minoritized communities of color, who are disproportionately black and brown, are disadvantaged by decades of racism and neglect. It’s important for us to contribute to solutions for all children and families. Engaging in clinical practice transformation and harnessing the power of advocacy and partnership will be integral components of our response. As your home, AACAP will provide resources, strategies, and tools developed with the wisdom of our members. Partnering with all our stakeholders, pediatricians, mental health providers, youth, families, and communities, will be key. The American Rescue Plan Act of 2021 offers an opportunity to address neglected mental health priorities with initiatives such as integrated pediatric care, telehealth, suicide prevention, community mental health, and substance use disorders treatment.7H.R.1319—American Rescue Plan Act of 2021. 2021. Accessed September 27, 2021.https://www.congress.gov/bill/117th-congress/house-bill/1319/textGoogle Scholar Let’s do this together with an eye to our values of diversity, equity, inclusion, and justice for all. I invite you to join me in our collective presidential initiative: CAPture Belonging. Through our DEI journey and by investing in each other, our community, and our connectedness, we can dare to dream and meet the challenges before us. We will promote health equity and justice and combat racism and other forms of oppression and change the world in the words of Harriet Tubman. I want to thank my dear forever friends, family, AACAP family, and my patients and their families who have taught me and invested in me along the way. I am grateful for all the mentoring and support AACAP has gifted me, most importantly, to be myself and contribute to our collective passion for advancing children’s mental health and child and adolescent psychiatry. Finally, I want to thank my parents, who dared to dream, and I dedicate this to my mother, whom I lost suddenly this year. She taught me the transformative power of love. I hadn’t seen her in a year and a half, but we often spoke by Zoom. She would always ask me, “Are you happy?” I told her that thanks to her, “I am living my dream.” There is a word in Chinese, my mother tongue, for happy that is literally two words: “Open (开) + Heart (心) = (开心).” So, with an open heart, I invite you to join me in CAPture Belonging.•Be you•Be AACAP•Belong Thank you. https://www.jaacap.org/cms/asset/6109bca6-3da1-4c9d-afa4-f903a8d15286/mmc1.mp4Loading ... Download .mp4 (420.22 MB) Help with .mp4 files Supplemental Video 1
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