In the final session of the workshop, two presenters reflected on the main messages that they heard over the course of the day.
Victor Medrano, division director of the Division of Program Development and Operations in the Office of Adolescent Health (OAH), Office of the Assistant Secretary of Health, U.S. Department of Health and Human Services (HHS), began by pointing to the importance of community. Community is at the heart of change, he said, yet the concept of community can be interpreted very broadly. “There are different avenues in terms of looking at the community, not just one way,” he explained. Resiliency was a second key takeaway for Medrano. He noted that it is critical to look at the positive and protective factors at work for these youth.
Medrano also drew attention to what he called “evidence-based and evidence-informed programs.” The department periodically evaluates promising programs to add to the evidence base.
Of particular importance for a program is addressing sustainability. He explained that over the years “we have gone into communities, developed programs, provided funding, and we leave, and the program ends.” All programs, he added, need to learn about ways to be sustainable over the long term, he said. His office has developed a sustainability framework, with an accompanying assessment tool and resource guide. Training has been provided to all OAH grantees on how to develop a sustainability plan in their communities.
Medrano works for OAH, which was established in 2010 with the broad mandate to coordinate all adolescent health issues across HHS. The programs his office oversees are the Teen Pregnancy Prevention Program and the Pregnancy Assistance Fund (PAF).
The former program is currently evaluating interventions to add to the list of evidence-based programs. Once interventions have been rigorously evaluated, and have met the evidence-based standards, they can be added to the list of evidence-based programs and used more broadly.
The PAF program has made including fathers and families as well as mothers a priority. “We added the word ‘fathers’ so that our grantees who were funded would address the issues facing young fathers and . . . retain them in their programs,” he added. Programs or curricula designed to engage young fathers are “very limited,” said Medrano, as are programs for Native American youth. “We need to develop more programs that are culturally relevant and appropriate for Native American youth,” he said.
Another program directed toward fathers and men is the recent White House initiative known as My Brother’s Keeper. The program is designed to address some of the gaps that exist between the needs of boys and young men and the programs available for them. They lack educational attainment, resources, and job opportunities. The initiative is designed to bring together the federal government, philanthropies, and community partnerships to address the issue. It is organized around early learning, college and career readiness, opportunities for working with young men who are in the criminal justice system, and ladders to jobs and support networks, with a multitude of strategies under each of these four pillars.
Participation in the workshop provided a way to inform and guide these programs, Medrano concluded. He indicated that he would use the information shared during the workshop with other federal partners. He also said that the dialogue fostered by the workshop needs to be continued. “We need to move from dialogue to action to outcomes,” he noted.
“We need to move from dialogue to action to outcomes.” —Victor Medrano, U.S. Department of Health and Human Services
In a response to Medrano’s comments, Nina Wallerstein, professor in the Department of Family and Community Medicine at UNM, supported the idea of making systemic changes in policies to support specific interventions. However, she expressed some concern about limiting research to
the search for evidence-based interventions that can be easily translated or scaled up. As a community-based participatory researcher, she said she is very interested in changing how prevention science and translational science are addressed. But evidence can take many forms in different communities, varying even among Pueblo, Apache, and Navajo communities. For example, forms of communication can differ among these communities, and research cannot use an evidence-based protocol that is simply picked off the shelf. Randomized controlled trials are not the only source of evidence, she said.
Her research team uses the phrase “cultural centering,” with adaptation occurring in every community. This builds in ownership and sustainability. “How can we build those institutional systems that can own something themselves?” she asked. Academic evidence and cultural beliefs have to be bridged to create and find interventions and policies that work effectively.
Finally, Catherine Malone from the Human Capital Diversity project of the Robert Wood Johnson Foundation observed that many of the issues discussed at the workshop are in accord with the foundation’s vision for a culture of health. Foundations are not just funders, but collaborators in social change, she said. The Robert Wood Johnson Foundation’s vision is to advance a national culture of health in which people value being well, physically and mentally, and staying well. All sectors can collaborate to achieve this vision, including sectors that are not traditional partners, such as businesses, other nonprofit organizations, and educational institutions.
Many factors other than health care influence the health of Native American youth, including the environment, income, safety, housing, and employment, she said. Culture, connectedness, and communications across communities and families can direct these factors toward better health for all. For example, youth have the power to influence their own health and the health of the future by building the demand for physical and mental wellness. “All of these factors are coming together,” she said.
Addressing the many health disparities that plague the nation requires honoring and reflecting the nation’s diversity, Malone observed. “The problems that health and health care face today can’t be solved without a diversity of perspectives. That is where the solutions are,” she said.
Native American communities are closely aligned with this culture of health, Malone emphasized. These communities have developed a variety of ways to strengthen this culture. Now, help is needed to multiply and distribute such efforts. “How can we get the information out there so that a program developed in one area will be widespread across the board?” she concluded.
“The problems that health and health care face today can’t be solved without a diversity of perspectives.”—Catherine Malone, Robert Wood Johnson Foundation
“Anyone has the ability to create for themselves a good life from their hands and thoughts—now, go do it.”—Jaron Kee, quoting his grandfather