We asked AMCHP members: How has the adolescent health framework changed over the time that you have been doing this work/been in your position?
Robert Nystrom, MA
Section Manager, Adolescent, Genetics & Reproductive Health, Center for Prevention & Health Promotion, Oregon Public Health Division
When I first arrived at the Oregon Public Health Division in 1994 as school-based health center program coordinator, one of the first people I met was a seasoned professional working on "teen pregnancy prevention." The conversation was a typical one at that time – we talked about "risk," "negative outcomes" and "dangers." Fast forwarding to 2013 finds Oregon contributing to Public Health Reports Special Supplement Number 1, Understanding Sexual Health, with an original article titled, Shifting the Paradigm in Oregon from Teen Pregnancy Prevention to Youth Sexual Health. Instead of talking about what youth should "not do" or avoid to "stay out of trouble," the dialogue has shifted to "how can we best support all youth to be safe and realize their human potential." For someone who has worked in various educational, clinical and public health settings for more than 30 years, it is the perfect illustration of the profound movement over the last several decades in how we have reframed our work with adolescents. When I ask "how have we made this shift?" I see four overarching movements that have influenced adolescent health policy and practice.
- Positive youth development (PYD) – PYD is both a philosophy and approach to policies and programs that serve youth. It represents a fundamental change in thinking that moves away from negative risk paradigms and focuses on physical, emotional, social and environmental factors that support all youth.
- Authentic youth engagement – Intrinsic to PYD philosophy is the notion that youth should be co-authors and decision makers on programs and practices that impact them. Authentic engagement moves adolescent involvement beyond asking their opinion to empowering them as agents of change in their own community.
- Adolescent brain development – Advances in neuroscience have allowed us to see ‘adolescence’ and adolescent behaviors through a new lens; and more fully understand the developing brain as it continues to mature well into early adulthood. It underscores the need for experiences and opportunities for each adolescent to exercise and prune neural pathways to develop, among many things, refined decision-making capacity.
- Inclusiveness and equity – Keeping youth safe and healthy requires that all youth be engaged in a culturally competent manner; LGBTQ youth, disenfranchised youth and emergent concepts, such as gender fluidity, necessitates assurance that all youth can see themselves in programs and practices like sexual health education and culturally/gender competent health care.