Ken Ginsburg, MD, MS Ed LTC Keith Lemmon, MD, FAAP

1. Tell Us What's Really Going On - A Strengths Based Approach to Connecting With Military Teens and Special Populations Ken Ginsburg, MD, MS Ed LTC Keith Lemmon, MD, FAAP

2. Department of Defense Disclaimer • The opinions or assertions contained in this presentation are the private views of the presenter and are not to be construed as official or as reflecting the views of the Department of Defense

3. Participant Outcomes • Be able to discuss the fundamentals of a strengths based approach to psychosocial health screening in military adolescents • Discuss the most common causes of injury and death in the adolescent population and describe effective connection and communication strategies that are most likely to mitigate these risks. • Identify the unique challenges that sexual minority youth face in their military family, educational, and health care environments. • Discuss effective ways to support sexual minority youth in developing a healthy sense of identity that will lead to successful adult lives.

4. The Military Adolescent Experience

5. Keeping the Promise • Caring for warrior families • Creating an environment for military kids to see military service as a viable stepping stone or career • Preparing military kids to be successful as adults • Children from military families are 2x more likely as their civilian counterparts to serve in the Armed Forces as Adults

6. The Military Adolescent Experience • Over 2 million children of service members in the Active Duty, National Guard and Reserves • Almost 4 million children and youth including those of post 9/11 Veterans • Over 2 million children have a parent who has served in Afghanistan or Iraq – many have served multiple times

7. The Military Adolescent Experience • Military-connected children move 6-9 times during their K-12 education. • 27% of both Active Duty and National Guard and Reserve Forces children are between the ages of 12 and 23 • Available research suggests that current military service and recurrent deployments are stressful to military families and have at least some short term adverse effects on mental health and functioning

8. The Military Adolescent Experience • Military youth live the concept of service and sacrifice every bit as much as their military parent • Expected to take on more advanced family roles when family members are away • May live in environment where parent is absent – physically or emotionally

9. Toxic Stress and Adverse Childhood Experiences • Young children who experience toxic stress are at high risk for a number of health outcomes in adulthood, including cardiovascular disease, cancers, asthma, and depression • Recent developments in the understanding of the neuroendocrine-immune network, how its function is altered by early life adversity, and how these alterations then increase vulnerability to disease.

10. Toxic Stress and Adverse Childhood Experiences • Early environments shape and calibrate the functioning of biological systems very early in life • Even in the most extreme cases of adversity, well-timed changes to children’s environments can improve outcomes • Youth serving professionals are in a unique position to contribute to explain how factors that seem distant from child health may be the key to some of the most intractable public health problems of our generation.

11. American Academy of Pediatrics Center on Healthy Resilient Children • A national effort coordinated by the AAP and strategic partners to support healthy brain development and prevent toxic stress • Focus on prevention efforts as well as identifying children who have experienced adversity and toxic stress and insure they have access to appropriate interventions and support

12. American Academy of Pediatrics – Resources for Military Teens and Youth Serving Professionals • Reaching Teens – America’s Children Chapter • Deployment and Military Youth Medical Home Resource Website - http://www.aap.org • Health and Mental Health Needs of Children in US Military Families – 2013 Clinical Report

13. The Military Child and Adolescent Deployment Support Video Program View the videos at : www.aap.org/sections/uniformedservices/deployment/index.html

14. MilitaryKidsConnect.Org

15. Left Handed People

16. Left Handed - Then • Dave was born in 1954. His parents assumed he would be just like them – right handed. It wasn’t something they ever even thought about. Everyone was right handed. They knew there were left handed people, but they had never met one. They were just people that needed to be made to stop using their left hand and start using their right hand.

17. Left Handed - Then • If his parents had ever thought about it, they would have noticed he favored his left hand. When he started school, the teacher noticed, but she made him write with his right hand, use right handed scissors, and paint and color with his right hand. It wasn’t acceptable to use your left hand – it was just wrong. No one could say why, that’s just how it was.

18. Left Handed - Then • Dave knew he was different, before he even knew why. He could tell there was something about himself that was different, that everyone said was wrong. • He learned to use his right hand around other people, but it never felt – right. • When he was alone he would use his left hand, but he would always feel guilty, and sad

19. Left Handed - Then • Eventually, he met other left handed people. When he was with them, he didn’t have to pretend anymore. He finally understood that it was OK to be left handed. That he was OK. He didn’t have to be ashamed. • He finally told his parents what they already knew, but didn’t want to admit. He was left handed.

20. Left Handed • 1988 study found 7 to 10% of the US adult population is left handed • Left handed negativity: • In ancient Hebrew and other cultures, the left hand symbolized the power to shame society, and was used as a metaphor for misfortune, natural evil, or punishment from the gods • Persisted and integrated into Christianity *Wikipedia

21. Screening for risk . . . . . . but always while recognizing strengths

22. Strengths School Home Activities Drugsand other Substances Emotions and Eating Sexuality Safety

23. JonahMowry Video

24. The Era of Changing Social Constructs Regarding Sexual Minorities • "Don't ask, don't tell" (DADT) was the official United States policy on service by gays and lesbians in the military instituted in February 28, 1994 lasting until September 20, 2011. • The policy prohibited military personnel from discriminating against or harassing closeted homosexual or bisexual service members or applicants, while barring openly gay, lesbian, or bisexual persons from military service.

25. Changing Social Constructs • Legislation to repeal DADT was enacted in December 2010 • Training focused on treating all service members equally with dignity and respect. • President Barack Obama, Secretary of Defense Leon Panetta, and Chairman of the Joint Chiefs of Staff Admiral Mike Mullen sent certification to Congress on July 22, 2011, which set the end of DADT to September 20, 2011.

26. Defense of Marriage Act (DOMA) • The Defense of Marriage Act (DOMA) (Pub.L. 104–199, 110 Stat. 2419, enacted September 21, 1996, 1 U.S.C. § 7 and 28 U.S.C. § 1738C) is a United States federal law that allows states to refuse to recognize same-sex marriages granted under the laws of other states. • Until Section 3 of the Act was ruled unconstitutional in 2013, DOMA, in conjunction with other statutes, had barred same-sex married couples from being recognized as "spouses" for purposes of federal laws, effectively barring them from receiving federal marriage benefits.

27. Defense of Marriage Act (DOMA) • The Obama administration announced in 2011 that it had concluded Section 3 was unconstitutional and that although the administration would continue to enforce the law while it existed, it would no longer defend the law in court. In United States v. Windsor (2013), the U.S. Supreme Court declared Section 3 of DOMA unconstitutional under the Due Process Clause of the Fifth Amendment.]

28. Marriage Equality • California • Connecticut • Delaware • Illinois • Iowa • Maine • Maryland • Massachusetts • Minnesota • New Hampshire • New Jersey • New Mexico • New York • Pennsylvania • Rhode Island • Vermont • Washington • Illinois • Hawaii • D.C.

29. American Academy of Pediatrics Policy Statement – March 20,2013 • Committee on Psychosocial Aspects of Child and Family Health • Promoting the Wellbeing of Children Whose Parents are Gay or Lesbian • The AAP supports access for all children to (1) civil marriage rights for their parents, (2) willing and capable foster parents regardless of their sexual orientation

30. American Academy of Pediatrics Policy Statement – June 24th,2013 • Committee on Adolescence • Office Based Care for Lesbian, Gay, Bisexual, Transgender, and Questioning Youth • Acknowledging resilience but health disparities • Encouraging Sexual Minority friendly spaces • Setting the expectation that SMY should be able to have healthy, happy transitions through adolescence and young adulthood

31. Caring for Sexual Minority Youth in the Military and Military Families

32. What is Healthy Sexuality? • Sexual development and growth is a natural part of human development • Healthy sexual expression is different than sexual risk • Same-sex behavior is included in the realm of healthy sexuality

33. Determination of Sexual Orientation • Sexual orientation is not a choice • Most likely determined by combination of influences: • Genetic • Hormonal • Environmental

35. Confronting Personal Biases

36. Depression • Rejected by society • Rejected by family • Rejected by friends • Internalizedhomophobia and self-hatred

37. Suicide • Suicide is the leading cause of death among gay & lesbian youth • Approximately 30% of all adolescent suicides are gay and lesbian youth • School victimization correlates with suicidality • Most attempts are during Identity Confusion stage

38. Suicide • Mean age at attempting is 15.5 years • 50% of all gay and lesbian youth have made at least one attempt • Loss of friends increases risk 3 to 7x

39. School Harassment • GLSEN 2011 National School Climate Survey • 81.9 % of LGBT Students have been verbally harassed • 38.3% physically harassed (18.3% assaulted) • 63.5% report they feel unsafe in school • 31.8% miss school due to safety concerns in the last month (6.7% school average)

40. School Harassment • LGBT youth who report significant verbal abuse at school have lower GPAs and are less likely to report plans to go to college • When students can identify supportive staff members at school, the number that plan to go to college increases significantly

41. Accepting school environment • Gay-Straight Alliance in the school resulted in fewer homophobic remarks, less victimization, less absenteeism, greater sense of belonging • Supportive staff results in feeling safer, fewer absences, greater academic achievement • Accepting Families !!!!!!

42. How Can We Create a Safe Space?

43. Resilience of GLBTQ Youth • Many GLBTQ teens lead normal, healthy and productive lives • Usually develop resilient adaptations to social biases and mistreatment • Many develop and possess remarkable strength and self determination

44. Resources for Sexuality Minority Youth, Their Families, and Youth Serving Professionals • TheTrevorProject.org • “It gets better” campaign • The Gay, Lesbian & Straight Education Network GLSEN.org • Family Acceptance Project: www.familyproject.sfsu.edu/ • PFLAG – Parents and Friends of Lesbians and Gays – www.pflag.org • Outserve.SLDN.org

45. Behavioral Change 101 (What they’re missing)

46. The Five Steps of Behavioral Change • 1. Awareness • 2. Motivation • 3. Skills • 4. Trial and Error • 5. Maintenance

47. Confidence gets it started… …and shame paralyzes all efforts

48. Finding Competence……Building Competence X X X

50. Help youth know how much they matterRecognize the credentials they bring to the world