intro: Welcome to Pediatric Voices, Duke Children's podcast about kids' healthcare. Now, here's our host, Dr. Richard Chung.

Richard J. Chung, MD (Host): Hello and welcome to Pediatric Voices, expert insights about timely topics in children's health, brought to you by Duke Children's Hospital and the Department of Pediatrics at the Duke University Medical Center. My name is Dr. Richard Chung, a physician at Duke Children's and a co-host of this show. Today, we will explore the youth mental health crisis, specifically through the lens of the experiences of Latino youth and their families.

Mental health challenges among youth were exacerbated by the COVID-19 pandemic and continue to cause substantial suffering and impairment among youth. The Surgeon General and multiple national professional societies have called this a true public health and healthcare crisis. In prior CDC data, we saw 42% of high school students reporting experiencing persistent feelings of sadness, and nearly one in three high school girls reported having seriously considered suicide. Importantly, not all youth are the same, nor do they all have the same experiences.

Today, we will hone in on the experiences of Latino youth to understand how their experiences differ and what members of our community are doing to support them. To help us understand this topic better, I'll be speaking with three remarkable guests. Lauren Goslin is a licensed clinical social worker with over 20 years experience. Her approach is rooted in clinical experience with cognitive behavioral therapy, solutions-focused therapy, and mindfulness-based stress reduction. She also serves on the crisis intervention mental health response team for Duke University Hospital. Welcome, Lauren.

Lauren Goslin, LCSW: Thank you, Richard.

Host: Gabby Maradiaga Panayotti is a clinician advocate in Durham and previously a member of our Division of General Pediatrics and Adolescent Health here at Duke. She is originally from Honduras and grew up in Central America and the Caribbean. She has immersed herself in advocacy work for children in immigrant families working both locally and nationally with elected officials to influence policy and previously co-founded Latin-19, the Latinx Advocacy Team and Interdisciplinary Network for COVID-19. Welcome back to the show, Gabby.

Gabriela Maradiaga Panayotti, MD: Thank you, Richard. Buenos días.

Host: And finally, last but certainly not least, Dr. Luke Smith is a Child, Adolescent, and Adult Psychiatrist and Executive Director and Medical Director of El Futuro, a non-profit in Durham, North Carolina, providing comprehensive, bilingual, and culturally responsive mental health services for Latino families. Welcome, Luke.

Luke Smith, MD: Thank you very much. It's good to be with you.

Host: All right. So, this is, in my view, the A team. If I were thinking about how do we care well for Latino youth with mental health concerns, this is the team I would call. And if we were having a conversation like we are having today, to understand the experiences of youth and families in the Latino community, these same people are who I would call. And so, thank you, all of you, for being here.

Now, we have a lot to discuss, so let's just jump right in. Gabby, as our repeat guest, maybe I'll start with you. Can you describe for us the Latino community here in North Carolina and maybe specifically in the Triangle, the size and the diversity and maybe the evolution of the community over time?

Gabriela Maradiaga Panayotti, MD: Yeah. That's a great place to start, Richard. I'll say that the Latino population in North Carolina has been growing steadily over the last 20 years, and there are now more than 1 million Latinos in the entire state. Here in our county, Durham County, 15% of its residents identify as Latino or Hispanic. So, it's quite a sizable population.

Another really important thing to know is that Latinos are very heterogeneous. It's not easy to pigeonhole us into one category because we come from many different countries and have many different cultural experiences, educational backgrounds, and economic situations. And it's important for listeners to be aware of that because even though there is one label, Latino, it really encompasses a large and diverse group of people. And so just as a tangible example, one of the local Catholic churches here in Durham has three separate Sunday masses all in Spanish, for one small town that we like to call Durham.

And then, the last thing I'll say is that the Latino community contributes in many diverse ways to our society and to our economy here in the state and, obviously, to the country as a whole. For example, of the migrant farm workers in North Carolina, 94% of them are native Spanish speakers, which we can consider a proxy for immigration status. So when you're enjoying your sweet potato pie the next time, thank a farm worker. They are also teachers, doctors, nurses. They are many of your children's classmates at school and the people who drive the bus. They're all around us. So, it's really important to remember that Latinos are in some ways very well integrated into the fabric of society. And at the same time, many are newly arrived immigrants who are searching for that integration and welcome into our lives here.

Host: Thank you, Gabby, for sharing those insights. It's really helpful to remember that, as you mentioned, we talk about the Latino community, but there's such rich diversity within that community. And also, your other point that even if you're not a member of that community or you're not caring directly for them, you are a part of the broader community, right? That includes Latino members in a variety of different ways. And so, the conversation today is highly relevant to all of us to really understand those key experiences. Luke, did you want to jump in there?

Luke Smith, MD: Yeah. I'd like to just point out a couple things in addition that I see actually coming to you from one of our clinics, which is a little more rural this morning. And it's been said that rural America would have dropped off in population if it hadn't been for the Latino immigrant influx in the rural areas that small towns are really seeing a big shift in the numbers in schools and coming into the medical facilities. So, that's something that I'm seeing. And a lot of them, the parents don't necessarily work in those cities, but they live there. And part of that is because of some of the migration effect where a family will come and kind of anchor and then call up other family members. And so, you'll see these really dynamic pockets of people from a certain state in Mexico or a certain city in Honduras. They come together because there's a lot of mutuality. And a lot of community is reinforcing good things and they like to be together. And so, that's something that I do oftentimes see is that families and little pockets will develop in cities or in the rural areas.

Host: That's really interesting and helpful to know, Luke. I think it's common for us as clinicians in a healthcare setting to think that just a patient just kind of arrives at the clinic and they're in some sort of vacuum, but they are a part of a community, a household, a local fixture. And really understanding those experiences outside of the clinical setting is really critical. And when we think about the teenagers that we'll focus in on in the conversation today, those household members and those community members are particularly important. And if you think about a teenager growing up in the center of an urban venue or in a rural community, those are very different experiences. And so, definitely worth making note of.

I do want to kind of get a window into the clinical experience of this A team as I mentioned. It's often hard to really, frankly, believe the statistics that we see and hear about. And Lauren, I would love to kind of hear about your perspective in terms of what you're seeing day to day in the clinic where you work. Are teens really struggling this much? Is it truly the crisis that it's been made out to see? What are you seeing day to day?

Lauren Goslin, LCSW: Yes. Unfortunately, we're seeing a lot of mental health crisis day to day. This has certainly been, you know, a mental health crisis that covers all ages in our country and in North Carolina and in our community. But with the teenagers, this has been coming on for about 10 years. And like you had said earlier that, you know, the pandemic and the nature of all the stress it caused made kind of almost a pressure cooker for mental health concerns that may have been brewing.

 I mean, for my role here in the clinic, I've been here for five years now and we've seen, you know, a huge increase in the need as my role has shifted to, you know, more than 50% of direct contact with children and adolescents for mental health reasons. And I think the number I was told was that the workload in general for social work has, you know, increased to 150% of what it was in 2019. So certainly, especially with adolescents, there's just been so much more demand for that support.

Host: Thank you for sharing that, Lauren. And I think the role of the social worker within this fabric of care is so critical, and it's interesting to hear you talk about kind of the shift of the balance of the work that you do. I often think of social workers as kind of the Swiss Army knife of the clinical team, because you do so many different things. But it sounds like there's a particular set of skills and a particular role that you're playing even more so during this crisis. Is that right, Lauren?

Lauren Goslin, LCSW: Yes, definitely. And I appreciate that. That's a great image. I'm going to just adopt that. We are the Swiss Army knife. Of course, a lot of our providers are too. But this is such a critical place to be able to meet with kids and adolescents, the teenagers who just come in for a well-child check, and then we have adopted so much more screening for depression and anxiety, which may be new information to that family that their child adolescent loved one is struggling, and then being able to have that conversation with their primary care provider who they trust and then bring in, you know, social workers so we can be a collaborative part of the team. That's often what I tell people when I'm meeting them, you know, "I'm here to be part of your team and help get you support while you're going through this. You know, your family is your team, your primary care provider, and we're all here together."

Host: I'd love to kind of hone in on the distinctions of the experience of Latino youth specifically, since that is the focus of today's conversation. And Luke, I would love to maybe start by getting your thoughts. You know, at some level, the mental health crisis impacts all youth, certainly. But what's different about the experiences and needs of Latino youth, both in terms of maybe risks or vulnerabilities as we talk about them clinically, but also in terms of strengths, things that their experiences might lend to them that might make them more resilient despite all the stress going on?

Luke Smith, MD: I'd like to start and end with the strengths, that there's something there that is powerful, draws me into the work and encourages me. And I think it's because I'm in an intensely independent and driven society that I've grown up in here in the United States. And what has refreshed me and brought me into this work has been seeing the rich culture and the community that is in the Latino community. When I meet a mom who comes in, who has on a colorful blouse that shows her heritage, I just go, "Wow, I want to know more about that." And then to see a kid proud of that, celebrating a quinceañera perhaps, that's something that I just step back and go, kind of privately, "I wish we had more things like that oftentimes here in America." I wish when we go somewhere and they say, "Well, sing your songs from America and do your dance," and I would know exactly what those are. So, I love that quality that the community brings to us.

But the other side of that is that in the migration experience, people are taken away from a lot of those traditions and moments, and they don't have the availability anymore because maybe parents are working several jobs, and people feel out of place, fish out of water. And I think there's right there a lot of what's going on, that the family starts to disintegrate in this context of an independent drive, a success drive, do well in school. And on what are some of the wrinkles of that, that fall out, are if you aren't able to succeed, there is a significant questioning that happens, "Well, why did we come here in the first place?" Or shame that, "I don't want to tell my parents about my grades, because I know how much they prioritize that." Those are things that I see and holding them in contrast to that wonderful attribute that starts to kind of happen on the flip side, that people start to worry and second guess the very reasons people come, they start to think, "Oh no, we came here for dreams" and those dreams now are muted and dimmed, and it's very dispiriting for people to feel that. That's one of the things that we look at, and we start to think about is how can we support community? How can we support people who are feeling fish out of water and feeling like they're struggling in this new environment?

Host: Thank you, Luke, for sharing those insights. One thing that I always wonder about, in terms of adolescence in particular, you know, when we talk about teenagers just generally from a developmental standpoint, identity is just so key to what's going on and what they're wrestling with and what they're stressing about. And many teenagers have multiple identities, right? It's not just that they're Latino. It's not just that they live in X town. It's also maybe aspects of their identity and how they interact with others.

And Lauren, I'd love to draw you in here. You know, we talk about these intersections of identities from a clinical standpoint and how that really enriches who an individual is, but also sort of complicates matters in terms of how they experience things. What have you seen in terms of those intersections among teenagers?

Lauren Goslin, LCSW: Well, I can go forward with what Luke was just talking about, too, of this kind of our society being more independent. And then, you know, a lot of the Latino culture being more interdependent. So, you know, whether migrating here from another country or maybe moving to this community away from family, that puts a lot of stress on the parents, like Luke said, who may be working multiple jobs. And then, if there are multiple children, that, you know, the family members that may have been in the community previous aren't there. So then, that falls often to the teenagers to be, you know, in charge of a lot of roles in the household. You know, and then having this background of the culture from their country and their also wanting to take on and be a part of the culture of America and then how does that intersect both in their identity, but also, you know, going to school, being with other students and then being considered a person of color and not maybe looking at that before or dealing with their own, you know, awakenings into who they kind of identified gender and sexuality. And all of this comes up at some intersections for all teenagers. But then, there are multiple ones that may be layered as we were talking about.

Host: And it can be sort of a bewildering experience for many young people. And I know as a clinician, it's tempting for me to assume that one identity is predominant, but it's not necessarily the case. I found that many young people, you know, their gender or their sexuality or their cultural backdrop may be secondary to something else that they're really focused in on and thinking about and wrestling with at that particular moment in time. And so, it's helpful for us to not assume, right? That something is necessarily the main thing, but to ask and to really understand.

Lauren Goslin, LCSW: Right, absolutely. And then, to be able to understand that the last time we saw this person in the clinic may have been two or three months ago. And then, the identity, like you said, that's more prominent may have shifted even from then. It is such a time of rapid growth and development and change.

Host: Gabby, I'd love to come to you and actually ask you about access to care and sort of in view of your work with Latin-19 and all of the advocacy you've done around structural and systemic barriers, but also thinking about the preferences and comfort of individual youth and families. You know, there are a lot of different reasons why a Latino youth with actual known mental health issues may not be getting the care that they need. And I'm looking at Dr. Smith on my screen. And I'm thinking, if we could just clone him and put him on every street corner, then maybe that would solve the issue, but maybe not, right? Even if Luke were right down the block, some youth still might not get the care that they need. And so, can you sort of tease out some of those wrinkles in terms of what are the barriers to care, both sort of within the young person in their household as well as in the system within which we work.

Gabriela Maradiaga Panayotti, MD: Yeah. As you alluded to Richard, it's a layered complexity of a problem for all youth and in particular, in immigrant families. It takes on yet another challenge, because these young people are living in a very "American" environment at school and in society where they're expected to be a certain way. And then, they have to code switch when they arrive home and face the other way and then become more traditional to their family's history and culture. And while that is certainly a skill that is valuable to grow up with and feel the discomfort with, put that alongside the challenges of puberty and growing into adulthood, it's very hard.

And the conversation I have with parents often is your kid may be your kid with your values, but they're growing up in an entirely different society that expects something else of them. And the parents don't often know how to help them or to even acknowledge that that's happening because they're thinking back to their adolescence and how they handled it, and they want to use the same strategies that helped them without really coming to terms with the fact that their kid is not going through adolescence in the same way, in the same place, with the same kind of people.

And so, the barrier to access to your question that that presents is, one, the kids don't often even know that that's what's happening, so it's hard to put a label on the anxiety or stress that they're feeling. It often manifests in a pain that they feel in their body, stomach discomfort, headaches, chest pain, and they're not necessarily aware of those dots connecting, and neither are the parents. So, one barrier is even understanding that that's what's happening. The second barrier is feeling comfortable communicating that to your caretaker who can take you to a medical provider. Then, you have the parents' experiences with healthcare and how they experienced it in their country, which may have been good or bad; how they've experienced it in this country, which may be good, bad, or in between. And so, going from a young person feeling a certain way to "I need help," to "Who can take me to the person who can help me," and then having that adult feel enough comfort and trust in the provider to say, "Please help my child with this," that's a lot of steps to get through.

As Lauren was saying, and Luke was saying, the way our society places value on independence and assertion and fighting for your own rights and making sure your kid gets what they need is very contrary to a society focused on the good of the community. So, really raising the flag for your one child about this one thing is uncomfortable for a lot of families. And a lot of the work we do in our clinic is really validating each one's experience, right? To the parent, we validate your leadership role in this family, where you come from, and your part in this, and then turning around to the adolescent and saying, "We know you're going through something really weird that your parent probably doesn't get, and how can we help them talk to each other to help the young person and the parent navigate these turbulent waters of teenagehood."

Host: Thank you, Gabby, for sharing those really interesting perspectives and it really underscores how complicated this is and how essential it is for somebody like you, as a primary care provider who has known this young person and this family over time to help walk them through the process, right? That it isn't a simple yes no.

 I think it underscores the importance of this other person right in the mix, somebody with trust between the young person and the clinician, as well as between the clinician and the parent, somebody with expertise of some sort in terms of the healthcare issues that are going on that could kind of broker that conversation and bridge the gap of understanding between the kid and the caring adult, so that we can kind of move forward. Luke, do you want to jump in there?

Luke Smith, MD: The whole tenure of how to live as an immigrant is don't draw attention to yourself. And a lot of people will ask me about stigma. Are people looking to come to you? I mean, I thought it was stigma in the community and there is stigma, but there's also this huge thing about don't draw attention to the family. Don't air your laundry out in public. And we especially see this in schools when people want to go for supports for their kids, they will not want to raise a hand and say, "Wait a second. What about my kid?" It's "Just blend in." Just blend in and let it all pass and things will take care of themselves.

And then, the additional thing is that of feeling like I'm not doing a good job as a parent. I'm not doing a good job as a kid. The shame that enters in is a barrier and causes people to hesitate, not want to speak up. It's compounded, unfortunately, by then the layer around the family, the mother-in-law, I always say the suegra, who's living with the family. There's a lot of jokes in Spanish about the suegro or suegra, the in-laws, just like we have in English, who is very judgmental and comes in and says, "Well, it's your fault that you're not raising your kid the right way," because these families are stacked together living in tight quarters. Or it could be the well-meaning person at church who says, "Well, it's because you're not faithful enough." Or it could be a school counselor at an IEP or a 504 meeting or something that says, "Well, you didn't speak English with your kid at home when they were growing up, and that's why they're having this learning challenge." Just like this constant barrage of, "You're not good enough, you didn't do a good job. And why are you making a big deal of this?" So, those, even if it's just anticipated or perceived that that's going to be the message, causes people not to raise their hand and say, "What about me? Can I get some help here?" And that's tragic to watch that. It's hard because when you're the person trying to offer help and you see those little messages enter in, it's hard to undo them because they're so in the fabric.

Host: Lauren, did you want to follow on there?

Lauren Goslin, LCSW: Yeah. I certainly have seen that as well with the formality of families and also the wanting to protect a family from a teenager if there's a mixed migration household, wanting to be careful about vulnerability. With that, wanting to have protective factors can also become another barrier.

Host: That's super helpful. All of these insights are sort of flummoxing me as I think about caring for the young people I'll see tomorrow in clinic, right? Just because I'm always asking myself, "Wow, I didn't know that, and yet I've been practicing for X number of years." I've been through medical school, and I just don't remember that there was a course on what you guys just said, right? Maybe the curricula have improved since then, but it's just really Interesting and important to note that to be clinically effective, to be useful to the kid in front of you and their family, you need to know much more than what is typically taught in healthcare curricula, right? You need to have some degree of understanding of who they are and where they come from and what their day to day life is, not just what you're talking about in the clinic setting. And this might be a good time to segue, Luke, and give you an opportunity to share a little bit about El Futuro, because I think that certainly from my perspective is a huge part of your team's contribution to our broader fabric. And so, can you share a little bit about El Futuro and the work that you do and your view of the role that it plays within our community?

Luke Smith, MD: Yes. I'm amazed at where it's come to, seeing how it started, because it started with me, just recognizing that there were few services. And then, jumping in with awful Spanish that was only improved by watching a lot of telenovelas in Spanish and reading Harry Potter in Spanish. Like, that was my training by and large at the first. And then, I just listened to the patients and heard what they were saying and then would almost repeat back. I feel like I script back what people say. But at the very beginning, we started recruiting people and I recruited some people who were insightful, able to do work. But the community that we built was really a little nidus of energy. And it fed each other. We started bringing in social workers, other psychiatrists, other professionals who do therapy, substance use counseling. And it grew over time into something that now provides a lot of services by video and in person. And we have a lot of staff. What I'm always impressed by is that we go back to some basic principles when we're doing this work that resonate through the type of care we provide. I wish there were more people that we could call employees working at El Futuro, but we don't have that capacity. So, we have to then go out and spread the message and say, "You can do this too," even if you don't have the Spanish. Watch some novellas if you don't. Try it out. It works.

But in the meantime, here are some things you can do that maybe are beyond language and beyond some of the things that you may think you need to do this work. Actually, you can do it right there. And a couple of the principles we talk about are one of trust, or in Spanish it's confianza. The trust that has to be there for people to open up, to be able to disclose things that are really hard and then to continue to walk with you, that means everything. That means so much that in that first session, if we're unpacking something and we think we're going to need to get to a treatment intervention, the treatment intervention actually is the trust at first. We have to have that ground-level trust before people will actually use the service we're offering.

The other one that follows that closely is one of what we say in Spanish-- what they say in Spanish-- but I now say also as calor humano, warmth. I had a staff member one time come to me and teach me this. And it was only because a doctor who was from Cuba came to work in our clinic. And she came in and I thought, "My goodness, I'm not going to be able to teach her." She was a resident at the time. And I said, "I don't think I can teach her. My Spanish isn't good." But within a couple minutes, the front desk staff came in, closed the door to my office and said, "She can't work in this office." And I said, "Why not?" And she said, "Because she doesn't have calor humano." She doesn't have human warmth. She just walked through a waiting room full of people and didn't say, "Hola! Buenos días!." The simple Spanish that you know, Dr. Smith, she didn't do any of that. She didn't look them in the eye and smile warmly. That's not going to work here. And it was a lesson early on that, along with that trust that we have to build, it comes through having that warmth and calor humano. I thought that was a wonderful lesson that has stayed with me and stayed with our staff so that within every orientation of a staff member, I say, "This is important. I don't care what credentials you bring, what Spanish, what evidence-based practice."

And the final one that we often talk about is that of respect or respecto, where we say, "Listen to people. Listen to who they are." They're from some upbringing, some migration journey, something that has brought them here to you today. Don't miss it for what you think you're about to give them. But listen to them first. We've talked about that already today some, in just the ways we need to understand the complex heterogeneous community that comes to us. And it's nowhere more important than our individual interaction with that person right when they walk in. We're respectful, we call them by name, we listen first. And those things build the trust. Those things are the calor humano that we have to embrace. And just with a couple of those principles, El Futuro has gained a name and a reputation now that we have a lot of contacts in the community. We're reaching out and providing services, but we know we can't do it alone. So, those things are what we take out and we say, "Do this, and it will be very helpful for helping..." And actually, it's true that it doesn't just help your Latino patients and their families, but it helps all your families when they come in. Those are just basic principles of care. But I think in this experience, we've seen them really brought to light in a different way, and now they've crystallized in a different way, and it just enriches our care truthfully across all of our patients.

Host: That's beautiful, really well-stated, and really encouraging to my heart as a clinician caring for members of this community, because what you just articulated is that, yes, there is an approach that is particular to the Latino families that you care for, but undergirding that is you're sort of core humanity and engaging individuals and families and households and cultures at that level with a sense of, I'm guessing, humility and just kind of curiosity and earnestness. And so, you don't have to necessarily be Dr. Gabby and have years of lived experience as a part of this community. You don't have to be Dr. Luke and have watched thousands of telenovelas in order to be prepared for that next appointment. Or you don't need to be Lauren and have 20 years of experience in this field. You can actually, even tomorrow, do somewhat better for the next patient that you see. And I think that's a really encouraging message.

Luke Smith, MD: You know, one other thing, Richard, that occurs to me that it's worth mentioning is we do feel strapped at El Futuro with the number of referrals we're getting, and it's only gone up since the pandemic. And during that time, we've entered into a really amazing relationship with a group called NC-PAL, which you can search online. It's at nc-pal.org. And it's a collaboration of experts around North Carolina who are helping to support pediatricians and pediatric practices to do a better job with mental health through a series of trainings, but also an access line that's available every day from 8:00 a.m. to 5:00 p.m. And Gabby and I both are working on this. We're really bringing trainings, and those are available through their website to help people know more about how to do culturally tailored healthcare for the Latino community. And I just think it's a great resource. I know that oftentimes we see resources like this and we put it down, do something else and we forget to come back to it, but they're there, they're free and available. And it's tremendous to see this kind of expertise available to pediatric providers. I think it's great to mention that right now. It's definitely been something that we want to support and see continue to grow to help empower people

Gabriela Maradiaga Panayotti, MD: Yeah. And as a pediatrician who, like every other pediatrician in this country, has had to absorb a large amount of the mental healthcare that used to only go to people like Luke, NC-PAL has really been an invaluable resource. I usually call them once a week because they help me triage the situation, hear my plan, give me some feedback, and then I can continue managing most of those patients on my own without having to refer them to a specialized agency, which really allows space in clinics like El Futuro for those higher needs families who can then access folks like Luke. So, it's a great resource for pediatric providers across the state of North Carolina.

Host: I do want to try to round us out here. And Gabby, I might come back to you. And you sort of alluded to this at the top. You know, for our listeners who are not a member of this Latino community, who aren't directly engaged in behavioral healthcare services, but just care about teenagers, and want to understand what they need to understand, want to feel the way that they should feel and want to do whatever they can do to help. What is your message to them?

Gabriela Maradiaga Panayotti, MD: I would say to the other parent that I meet at a school function or at a soccer game, if they'd like to contribute, is to put down whatever work you're doing and engage with the person sitting next to you, as Luke said, in an earnest and meaningful way. Because your curiosity and your eagerness to integrate other parents will help the parents of those young people slowly feel part of their child's community.

And when the children see that, and they see their parents slowly becoming more and more comfortable, understanding things more, becoming friends with people outside of their Latino culture, it will help that relationship of integration. And so, that's what I would say. Make friends, be friendly. If you see someone who may be struggling with something, again, you don't have to understand Spanish. It's about slowing down, taking an interest, and listening. Again, you don't have to be best friends forever, but when that parent sees you again, they'll remember, "Wow, this person took their time, they laid down their book, they looked me in the eye, and listened attentively for five minutes about whatever. I have this question. I feel safe enough to go ask them for help."

Host: That's beautiful. And it's so doable too, right? If we can just kind of muster the courage and overcome our human inertia of looking down or looking away or minding our own business as Luke had mentioned, as we're kind of raised up to do here in the United States. Maybe that's too broad a generalization, but I do see it happen and I feel it myself. And so, thank you, Gabby. And that can make all the difference, in terms of that one relationship and maybe that one youth who's connected within that relationship. So, thank you for sharing that.

My last question before we kind of round things out, and this is the hypothetical magic wand question, as we like to say. And so, I'll start with you, Lauren, maybe, but I would love to hear from the three of you. If you today wanted to improve the health and well being of Latino youth, and you had a magic wand, and cost were no object, and political will were no barrier, what is the one change you would affect in our community, if you could? Lauren, do you have any initial thoughts?

Lauren Goslin, LCSW: Oh, my goodness. It's that trick of childhood magical thinking. I think I would use my magic wand to create more magic wands.

Host: Good one.

Lauren Goslin, LCSW: I mean, that's tough. Just based on our community, I would love to see more El Futuro and Latin-19. I mean, it's just amazing, the work that's being done to support our Latino youth. And the school system itself can be very stressful with getting an IEP or trying to figure out where delays are, what needs extra support, and where accommodations need to be. And some of that communication just gets lost from school to parent in English and certainly when, you know, with translation too, for not a native English speaker. So, really working with them and then with the school and then with the mental health agency to connect and feeling so encouraged.

You know, at first I was thinking, "Well, I would want bilingual counselors in all the schools," and that would be great too, but especially with the warmth and the calor humano. You know, working with that team at the school just over the last few days, they were really showing up for this family and making sure that the student got connected, making sure the parents understood when the meeting would be, and what all this paperwork meant that they were sent in English. And, you know, I think just having some really good starting points in school, you know, that can be such a factor for increased stress and anxiety on families and then, you know, on the students and teenagers themselves. It just makes such a big difference.

Host: That's a great example. Thank you, Lauren. What about you, Luke? Your magic wand is active. The fine print says you cannot create more magic wands. And so, save for that, what would you want to do?

Luke Smith, MD: Wow. Well, I'm not going to say that I would open the border so that people could go home and refuel every once in a while with cultural heritage, though that would be really good. I'm not going to say I would empower every parent to be able to speak up, not feel shame and not discrimination. I'm not going to say that, though that would be really good. I'm not even going to say enforce mandatory pause on all electronics every day for a certain amount of time and obviously shut off at nighttime so they can actually sleep and that kids couldn't get telephones until they're 16 years old. I'm not going to say any of that.

What I'm going to say may surprise you. I'm going to say that I would like to see a little plaza or public square park with a little soccer, basketball, volleyball court put every so many miles in all of our cities and towns, so that those kids and those families can come together and just be family and enjoy each other's presence, because I think that we're missing that and we're missing those public spaces that allow people to connect in an authentic way. And if I think we did that, I would be out of business and I would be happy about that. I'd be out there trying to play some football or soccer even. So, that's what I would use with my magic wand.

Host: I love that, Luke. I think that's such a good idea. I liked how sly you were in sliding in a few different magic wand wishes. And I think we used to call that the third place, right? The third place in community where it wasn't home or school, it wasn't home or work, but there was actually another place where people would spend a large amount of time. And that's when you would have those kinds of happenstance moments, like Gabby was talking about, or actual human connection could happen and isolation could be broken. And what about you, Gabby? So, your magic wand is active, what would you want to do?

Gabriela Maradiaga Panayotti, MD: Gosh. If I had that wish, I would wish for universal healthcare for everyone. Because especially in our Latino community, such a large portion of those people are immigrants without access to any kind of healthcare. And so many of these youth, these adolescents we see are in blended healthcare access families. So, you may have one child who has health insurance and the other one who doesn't, and I've seen this many times where a mother might use one child's asthma treatment medicine for the other one because the other one doesn't have access to healthcare. Or the father, who may be the biggest wage earner, isn't getting the health services he needs and then may have a heart attack and be out of work and that family has no resources. Or even the mental health services the family needs at large, it's really hard to say there's some intergenerational trauma, and you all could benefit from help, but the only one who can get it is this child, and they're going to go back into a home where nobody else has benefited from those resources.

So, my magic wand would be to have universal healthcare, so that the whole family could really be as healthy as possible. And the healthier the whole family unit is, the higher the chance that that young person will thrive and be successful and be able to manage the challenges that inevitably come their way.

Host: Well said. Thank you for that, Gabby. Thank you to Lauren Goslin, Luke Smith, and Gabby Maradiaga Panayotti for sharing key insights regarding the mental health challenges and needs of Latino youth. More often than not, I find myself at a loss and feeling frankly overwhelmed when I consider the complexity and the enormity of this challenge. But then I think about you all, frankly, and have conversations like this one. And I feel deeply hopeful that we can actually make a difference, whether in the life of one young person each day or broader communities over time. So, thank you, all three of you, for sharing your time, your wisdom, and your expertise with us.

 Pediatric Voices is produced by the team at Doctorpodcasting. The show has been developed by my co-hosts, Dr. Angelo Milazzo and me. Thanks to Dr. Ann Reed and the administrative team at Duke Children's, particularly Debbie Taylor and Courtney Sparrow, for their support. Find our show and hit the subscribe button wherever you find your favorite podcasts.

And we want to hear from you. You can connect with us at dukehealth.org/dukechildrens, Facebook, X, and Instagram. Please send us your feedback about the show, including your suggestions for future topics. Thanks for being a part of the show. I look forward to talking with you again.