Angela	Diaz: My	name	is	Angela	Diaz,	and	I	would	like	to	speak	to	you	today	about	the	need	

for	adolescents	and	young	adults-centered	care	and	how	they	can	be	wrong	

effectively.	I	want	to	start	by	acknowledging	that	the	healthcare	system	in	the	

U.S.	was	created	by	adults	for	adults.	And	then	we	try	to	fit	young	people	into	

the	system	and	when	it	doesn't	work	we	call	them	non-compliant	and	hard	to	

reach,	when	in	deed	what	is	hard	to	reach	is	the	system	itself,	the	way	those	

services	are	designed.

Angela	Diaz: Adolescence	and	young	adulthood	are	really	critical	stages	where	the	

responsibility	for	healthy	behaviors	start	shifting	from	the	caregivers	to	the	

young	people	themselves.	It	is	a	stage	when	people	are	becoming	more	

independent.	There	is	a	lot	of	experimentation	and	experimentation	is	not	bad.	

Young	people	need	to	experiment	and	try	new	things	in	order	to	really	gain	the	

skills	to	be	able	to	be	independent.	And	what	we	need	to	do	as	adults,	is	really	

creating	environment	where	young	people	can	experiment,	try	things,	learn	in	

an	environment	where	they	are	not	going	to	get	into	difficulties.	So	that's	really,	

really	important.

Angela	Diaz: And	the	behavior	of	young	people	affect	their	health	status	during	adolescence	

and	during	young	adulthood,	but	also	establish	their	health	status	over	the	life	

course.	So	if	you	are	not	healthy	as	an	adolescent,	if	you	get	engaged	in	

behaviors	they're	not	particularly	healthy,	that	is	really	going	to	affect	your	

health	as	an	adult.	It	is	really,	really	important	for	providers	to	really	encourage	

young	people	to	engage	in	healthy	behaviors,	to	modify	their	behaviors,	to	

become	great	healthcare	consumers.	And	when	you	provide	services	in	a	way	

that	is	adolescent-friendly,	and	youth-friendly	in	general,	the	young	people	are

much	more	likely	to	change	their	behaviors.	So	we	really	can	have	a	tremendous	

influence	in	that	age	group.

Angela	Diaz: At	the	Mount	Sinai	Adolescent	Health	Center,	we	serve	over	10,000	young	

people,	ages	10	to	24	every	year	and	their	children,	if	they	have	children.	We	

welcome	all	the	young	people	within	our	young	age	range	of	10	to	24	but	we	

cater	to	low	income	disadvantage,	disconnected	young	people,	because	we	

know	that	they	do	not	have	access	to	care.	The	young	people	that	we	serve,	

98%	of	them	are	low	income.

Angela	Diaz: Some	of	those	young	people	have	loving	families.	They	are	going	to	go	to	

school.	They	aspire	to	go	to	college.	They	gave	in	for	work	and	some	of	them	are	

homeless,	some	of	them	are	foster-cared,	some	of	them	have	been	sextrafficked,	some	of	refugees,	and	the	beauty	is	that	they	all	feel	comfortable	

coming	to	our	center.	No	one	knows	where	they	are	coming	because	our	

program	has	no	stigma.	It	is	not	a	program	for	family	planning	or	HIV	or	

substance	or	...	It's	just	a	teen	center	and	they	all	feel	very	comfortable	coming	

and	all	10,000	of	them	sit	next	to	each	other	in	the	waiting	room	and	is	only	

behind	closed	door	that	actually	we	find	out	what	they	are	there	for.

Angela	Diaz: Something	that	is	really	important,	we	always	take	care	of	whatever	the	issue	

that	brought	them	in.	In	addition	to	having	all	these	services	under	one	roof,	we	
also	know	that	it	is	important	to	provide	as	many	services	as	possible	during	one	

visit.	So	the	young	person,	when	they	come	to	see	me,	I	will	do	their	history	and	

physical	exam,	I	will	connect	them	to	the	health	educator	so	they	learn	more	

about	their	body	and	decide	on	family	planning,	if	they	need	that.	I	will	have	the	

mental	health	persons	see	them	if	I	discover	that	they	are	depressed	or	could	

benefit from	that.

Angela	Diaz: So	if	we	see	the	acne,	we	take	that	very	seriously.	We	make	sure	we	treat	the	

acne,	but	then	we	asked	them	all	of	these	questions	to	get	a	sense	or	how	they	

are	feeling,	their	type	of	behaviors,	the	type	of	family	relationship	that they	

have,	and	for	example,	if	we	identify	that	they	are	depressed	or	they	have	a	

need	for	mental	health,	we	provide	that	there.	So	we	have	really	all	the	services	

integrated;	physical	health,	sex	and	reproductive	health,	dental,	optical,	

behavioral,	and	mental	health,	from	dental	to	mental,	from	head	to	toe,	

everything.	And	the	more	that	you	can	have	under	one	roof,	the	better	it	is.	And	

it's	not	just	about	being	co-located,	it's	really	about	being	integrated.

Angela	Diaz: All	these	people	are	working	together	and	the	young	person	will	know	that	

there's	a	team	taking	care	of	them.	Over	the	years,	people	come	from	around	

the	globe	to	see	the	way	we	work	at	the	Mount	Sinai	Adolescent	Health	Center.	

And	they	often	ask,	"Why	are	10,000	young	people	coming	to	you	every	year?	

They	come	to	you	asking	for	help.	What	is	it	that	you	do?	What	is	it	that	you	are	

giving	them?	They	are	making	line	before	8:00	in	the	morning	usually	to	get	

healthcare."

Angela	Diaz: So	with	the	support	from	the	New	York	State	Health	Foundation,	we	created	a	

blueprint	about	our	philosophy	and	our	approach.	And	this	blueprint	gives	a	

roadmap	of	how	people	who	are	interested	in	either	adapting	or	replicating	our	

services	or	modifying	what	they	are	doing	can	find	that	in	this	blueprint.	So	this

particular	blueprint	was	designed	to	be	used	by	people	depending	on	their	

context,	depending	on	their	needs,	depending	on	their	resources,	depending	on	

what	they	want	to	do.

Angela	Diaz: You	can	use	any	of	the	principles	that	we	have	there	and	shape	it	to your	

context	and	what	is	allowable,	what	is	doable	for	you,	in	your	context.	And	in	

addition	to	that	learning	that	we	are	doing	as	we	serve	them,	in	our	program	is	

also	very	important	to	us	to	have	the	voice	of	young	people.	So	they	really	

inform,	formally	like	we	have	advisory	boards	of	youth,	we	do	surveys	of	them	

asking	them	what	is	working	for	them	in	the	program,	what's	not	working,	what	

else	would	they	like	to	see,	so	the	whole	work	that	we	do,	everything	that	we	

do	,is	in	form	and	shape	by	the	need	and	the	voice	and	the	desire	of	young	

people.	So	they	are	our	partners	in	the	work.	We	are	not	serving	them,	our	

approach	is	that	we	want	to	empower	them	but	we	work	in	partnership	and	

everything	that	we	do	is	informed	by	them	and	what	they	need	and	what	they	

would	like	to	see.

Angela	Diaz: Hi,	my	name	is	Angela	Diaz,	and	I	would	like	to	talk	with	you	about	why	it's	so	

important	to	have	another	lesson	in	young	adult	friend	culture	in	your	
healthcare	systems.	When	people	hear	the	word	culture,	they	usually	think	

about	place	of	origin,	language,	and	things	like	that.	But	after	working	around	

the	globe	with	youth,	with	young	people,	I	really	have	come	to	understand	that	

there's	a	culture	of	other	lessons.	And	the	lives	that	they	live	today	are	very	

complex	and	there's	tremendous	stress	in	many	of	their	lives.

Angela	Diaz: So	we	really	need	to	understand	and	appreciate	that	when	we	work	with	them	

and	we	need	to	help	them	feel	comfortable,	we	need	for	them	to	feel	that	we	

are	not	judging	them,	that	we're	there	really	to	try	to	help	them,	that	we	are	in	

this	together	in	whatever	it	is	that	they	want	to	achieve,	we	are	trying	to	

facilitate	that	process	in	the	context	of	their	development.

Angela	Diaz: So	it's	very	important	to	understand	the	culture	of	adolescents.	The	research	

also	shows	that	when	you	provide	services	in	a	way	that	is	teen-friendly,	that	

increases	the	use	by	young	people	of	your	services.	They	come,	much	more	

likely	to	come,	when	you	provide	teen-friendly	services.	The	Mount	Sinai	

Adolescent	Health	Center	is	a	learning	organization,	we	are	never	static.	We	are	

around	for	50	years	and	we	are	always	evolving,	always	changing	based	on	the	

needs	of	young	people	or	what	they	tell	us,	or	what	is	happening	in	the	

environment	that	affects	them.

Angela	Diaz: For	example,	when	we	began,	we	were	not	working	with	transgender.	We	had	

kids	who	were	gay,	lesbian,	bisexual,	question	in	youth,	but	now	that	there	are	

many	young	people,	they	have	come	out	saying	now	because	they	are	

transgender,	so	now	we	have	a	program	about	transgender	youth.	So	we	have	

to	learn	how	to	work	with	them.	We	have	to	learn	about	their	needs.	We	have	

to	learn	how	to	work	with	their	parents.	And	then	now	we	really	have	

tremendous	expertise	in	that	area.

Angela	Diaz: The	young	people	make	our	program.	We	are	about	them,	but	the	other	very	

important	piece	is	the	staff.	So	we	can	teach	them	the	content	and	how	to	work	

with	the	young	people,	but	they	really	have	to	be	passionate.	They	have	to	

understand	that	population,	that	we	are	there	to	serve	them.	That	is	really,	

really	key.	The	other	thing	that	I	think	is	important	for	young	people	is	to	sit	and	

self-reflect	it	in	the	staff.	So	we	try	to	really	have	a	very	diverse	staff,	not	just	in	

term	of	race,	ethnicity,	language,	but	also	we	have	staff	who are	gay,	who	are	

lesbians,	who	are	transgender.	We	have	staff	with	disabilities.	We	have	staff	

that	really	almost	any	young	person	coming	to	us	can	see	themselves	in	that	

person.

Angela	Diaz: And	the	reason	that	I	think	is	so	important	is	because	a	young	person	can	look	

at	themselves	in	that	staff	and	see	possibilities	for	them.	It's	not	just	about	the	

connection	and	getting	the	services,	but	they	see,	"I	can	be	a	social	worker.	I	can	

be	a	doctor.	I	can	be	a	health	educator,"	because	a	person	that	looks	just	like	

them	is.	And	sometimes	they	had	not	had	those	life	experiences	before.

Angela	Diaz: At	the	Mount	Sinai	Adolescent	Health	Center,	we	have	like	17	different	

disciplines.	You	know,	as	a	physician,	among	adolescent	medicine	person,	I'm	
not	able	to	meet all	of	their	needs.	We	need	all	these	people	with	differing	

expertise	to	work	together	as	a	team	and	it's	not	enough	just	to	have	multiple	

disciplines.	The	services	have	to	be	delivered	interdisciplinary.	People	have	to	

work	together	around	the	young	person.	And	even	when	we	do	the	treatment	

plan,	we	bring	all	the	different	disciplines	and	then	we	work	together.	And	for	

certain	group	of	young	people	that	we	know	have	very	complex	needs,	the	staff	

may	regularly	and	discuss	the	cases	and	do	treatment	plan	together.	It's	really,	

really	important	to	do	that.

Angela	Diaz: Since	we	provide	services	from	age	10	to	24,	around	age	22	or	so,	we	start	

working	with	young	people	about	transition.	We	tell	them	that	when	they	turn	

24,	they	will	age	out	of	our	services	and that	they	will	need	to	go	to	an	adult	

system	hopefully	in	medical	home.	So	at	age	22	we	start	working	with	them	to	

prepare	them	for	that	transition.	And	as	we	get	closer,	we	make	sure	for	

example,	if	they	need	a	physical,	they	gather	their	physical.	If	they	need	an	IUD,	

they	get	their	IUD.	If	they	need	immunization,	we	just	make	sure	they	get	

everything	that	they	need	and	then	we	help	them	connect	to	young	adult	

system.

Angela	Diaz: And	often	they	want	to	keep	coming	back,	but	we	encourage	them	to	stay	

there.	And	we	just	don't	say,	"You	need	to,	you're	aged	out,"	we	actually	find	

places	and	connect	them	to	those	places,	help	them	make	the	appointment	to	

make	it	easier	for	them	and	give	everything	to	them	in	writing	or	so	just	to	

facilitate	that	transition	because	it's	not	so	easy	to	transition	for	young	people.

Angela	Diaz: Hi.	My	name	is	Angela	Diaz,	and	I	would	like	to	talk	today	about	why	it's	so	

important	to	integrate	medical	and	mental	health	services.	Research	shows	that	

only	20%	of	adolescents	and	10% of	young	adult	that	have	a	mental	health	

needs	get	services.	So	there's	a	tremendous	scarcity	of	mental	health	services.

Angela	Diaz: Developmentally,	young	people	do	not	necessarily	know	how	to	label	their	

needs.	They	may	be	depressed	but	they	may	not	know	that	they	are	depressed,	

so	it	is	very	important	to	integrate	services	and	to	work	the	way	that	we	work	

with	them	because	by	us	asking	and	screening	them	for	different	things,	then	

we	find	out	that	they	need	mental	health,	and	we	are	right	there	working with	

the	medical	people	and	the	mental	health	people	so	that	person	can	benefit	

from	that.

Angela	Diaz: Having	the	integrated	primary	care	and	mental	health	services	really	remove	

barriers.	It	is	hard	for	any	person,	including	adult	to	be	going	to	different	places,	

different	sites	for	different	types	of	services.	There	are	issues	about	

transportation,	geography,	learning	the	different	policies	or	the	different	

systems,	learning	that	they	have	to	show	up	at	this	time	or	that	time.	So	really	

this	integrative services	make	it	easier	for	the	young	person	to	be	able	to	get	all	

those	services	that	they	need.

Angela	Diaz: When	you	are	doing	intake,	let's	say	for	mental	health	in	many	places,	people	

have	this	really	rigorous	process	and	assessment	that	they	have	to take	all	these	
information.	And	sometimes	when	people	are	spending	all	that	time	trying	to	

gather	the	information,	the	young	person	feel	that	they	are	not	paying	attention	

to	them,	they're	not	being	engaged.	And	when	you	work	with	teenagers,	the	

number	one	thing	is	engaging	them.	So	you	really	need	to	balance	the	needs	to	

collect	whatever	information	you	have	to	collect,	but	at	the	same	time,	keeping	

in	mind	and	making	sure	that	that	young	person	is	really	and	truly	engaged,	and	

feel	that	they	are	the	most important	thing	right	now	for	you,	that	you're	paying	

attention	to	them.	Because	the	first	purpose,	the	purpose	of	the	first	visit	is	to	

get	a	second	visit,	and	then	a	third,	and	then	a	fourth.	You	really	want	to	engage	

the	young	person.

Angela	Diaz: So	whatever	you	need	to	do	to	achieve	that,	that's	what	you	need	to	do.	And	

maybe	the	form	can	be	completed	in	multiple	visits	or	something	like	that.	I	also	

work	with	young	people	who	are	homeless,	who	have	been	sex-trafficked	and	

when	I	know	that,	I	know	that	it	will	be	hard	for	these	young	people	to	

necessarily	come	regularly.	So	we	have	to	...	Or	to	come	back	if	I	say,	if	they	go	

to	a	place	where	they	say,	"You	need	an	appointment	for	mental	health."	We	

know	that	these	young	people,	it's	really,	really	hard for	them	to	return.

Angela	Diaz: So	we	need	to	give	them	as	many	services	as	possible	and	they	will	see	the	

mental	health	person	right	then	and	there.	And	the	mental	health	person	has	to	

be	very	flexible,	not	only	in	term	of	balancing	whatever	information they	need	

while	trying	to	engage	the	young	person,	but	also	understanding	that,	that	

young	person	is	not	necessarily	going	to	come	back	on	a	regular	basis.	That	they	

may	come	back	sporadically,	that	they	may	come	back	for	medical	services	and	

then	they	will	need	to	see	them,	all	those	things	are	really	important.

Angela	Diaz: Hi,	my	name	is	Angela	Diaz,	and	I	would	like	to	talk	about	trauma	in	particular,	

sexual	trauma.	At	the	Mount	Sinai	Adolescent	Health	Center,	we	see	young	

people	that	come	for	a	number of	services.	And	something	that	people	may	not	

be	aware	of	is	how	common	trauma	is	in	the	life	of	the	young	people	that	come	

to	us.	The	young	people	that	come	to	the	Mount	Sinai	Adolescent	Health	

Center,	about	70%	of	them	has	significant	trauma,	sometimes complex	chronic	

trauma.	Our	young	people	may	have	been	traumatized	by	a	history	of	

childhood,	neglect,	physical	abuse,	sexual	abuse,	incest,	rape,	tender	age	

violence,	domestic	violence.

Angela	Diaz: So	we	also	see	young	people	who	are	being	sex-trafficked,	and	there	are	other	

things	that	can	be	quite	traumatic.	Like	when	you	have	community	violence,	

when	you	are	a	victim	of	discrimination,	whether	it's	racism	or	because	of	your	

gender	or	sexual	orientation.	So	we	work	with	a	highly	traumatized	population.

And	it	is	very	important	when	you	work	with	traumatized	population	to	

understand	and	be	aware	of	how	common	trauma	is,	the	negative	impact	that	

trauma	has	in	the	victims,	and	what	are	those	signs	and	symptoms	that	they	

present	with.

Angela	Diaz: The	Mount Sinai	Adolescent	Health	Center	is	a	trauma	in	form	center.	

Everything	that	we	do	is	without	trauma	lens	because	we	know	how	prevalent	
trauma	is	in	the	life	of	our	young	people.	So	just	by	having	a	teen-friendly	

system	where	people	are	warm,	welcoming,	respect	for	the	young	person,	feel	

connected,	all	those	things	are	very	important	for	a	trauma	victim.	Because	they	

usually	have	been	living	in	isolation	with	their	history	and	what	happened	to	

them.	So	when	you	help	them	feel	connected,	when	they	know	that	they	are	

not	alone,	that	help	them	also	heal,	is	extremely	important.	And	more	

specifically	we	actually	do	services	for	trauma.

Angela	Diaz: So	we	have	the	mental	health	staff,	all	are	trained	on	doing	trauma	focus,	

cognitive	behavioral	therapy,	and	many	other	modalities	of	therapy	that	work	

for	this	population.	We	provide	individual	therapy	around	the	trauma.	We	do	

groups	that	are	specific	for	the	trauma.	For	example,	we	run	groups	for	young	

people	who	are	victim	of	incest.	And	the	entire	support	group	and	

psychotherapy	group	is	about	dealing	with	a	trauma	and	help	to	heal	and	do	

that.	We	also	know	that	especially	if	the	trauma	is	happening	at	home,	you	need	

to	work	with	the	entire	family	to	understand	what's	happening	and	help	the	

family	heal.

Angela	Diaz: And	we	need	to	have	those	staff	to	be	very	accessible	to	young	people,	to	really	

be	able	to	be	reached	when	the	young	person	need	to	talk	to	someone	because	

maybe	something	is	coming	up	about	the	trauma,	what	happened	to	them	as	a	

child,	they	really	need to	feel	that	they're	not	alone.	There	is	a	place	where	they	

can	come	with	whichever	way	they	are	feeling.	They	can	call	us,	they	can	come	

in	and	all	that	is	part	of	the	healing	process	for	a	young	person	with	a	trauma	

history.

Angela	Diaz: We	also	have	lawyers.	Part	of	our	services	are	legal	to	help	them	with	if	there's	

anything	that	they	need	a	lawyer	for.	So	we	have	legal	services	to	do	that.	We	

are	very	involved	in	advocating	on	their	behalf.	For	example,	if	they	were	raped	

in	their	school	and	they	don't	want	to	go	back	to	that	school	because	of	what	

happened	to	them	and	they	remind	her	of	that	or	because	they	are	worried	or	

afraid,	we	also	help	them.

Angela	Diaz: So	if	we	need	to	talk	to,	whether	it's	the	police	or	Child	Protection	or	anyone	on	

their	behalf,	we	help	them	with	all	those	things.	If	they	need	to	bring	their	

parents	to	tell	them	or	to	disclose	what	happened	to	them,	we	say,	"Bring	your	

parents,	we	will	sit	down	with	you	to	help	you	disclose."	Because	sometimes	it's	

very	hard	for	them	to	do	this	by	themselves	and	they	may	be	worried	or	they	

may	not	know	how	to	do	it.	And	in	the	safety	of	the	clinic,	the	young	person	is	

able	to	do	sometimes	things	are	they	will	not	be	able	to	do	on	their	own.

Angela	Diaz: At	the	Mount	Sinai	Adolescent	Health	Center,	we	are	mandated	reporters.	So	if	

we	see	a	young	person	who's	being	abused,	whether	it's	physical	abuse	or	

sexual	abuse,	we	have	to	report	that.	We	also	provide	confidential	services.	So	

the	way	we	do	it	is	that	when	the	patient	comes	to	us	and	if	the family	comes	

with	them,	we	tell	everyone,	"Here,	we	provide	confidential	services	except	if	

there	is	ongoing	abuse	or	if	there	is	abuse	or	if	the	life	of	the	young	person	is	in	

danger,	like	they	are	suicidal	or	if	they	know	that	somebody	else's	life	is	in
danger.	Like	they	know	that	a	gang	may	be	about	to	do	something	to	somebody	

else.	We	cannot	keep	those	things	confidential."

Angela	Diaz: When	the	young	person	discloses	that	they	are	being,	for	example,	sexually	

abused,	we	explain	to	them	because	we	said it	before	we	took	the	history	that	if	

there's	any	issue	of	abuse,	we	need	to	actually	need	to	call	Child	Protection.	We	

need	to	be	able	to	tell	Child	Protection	about	the	abuse	and	that	in	our	clinic	we	

work	closely	with	the	mental	health	people	including the	social	workers	to	be	

able	to	do	that.

Angela	Diaz: Hi,	my	name	is	Angela	Diaz,	and	I	would	like	to	talk	about	trauma	in	particular,	

sexual	trauma.	Sex	trafficking	usually	happens	when	a	young	person	is	used	by	a	

third	party	sexually	for	gains.	It	could	be	financial	gains.	And	what	happen	with	

this	is	that	a	young	person,	and	this	is	domestic.	Sex	trafficking	in	the	U.S.	

happens	in	every	single	state	under	the	history	of	Columbia.	Sometimes	when	

people	hear	sex	trafficking,	they	think	about	other	countries	or	people	being	

brought	to	the	U.S.,	I'm	talking	about	our	own	kids.

Angela	Diaz: Domestic	sex	trafficking	happens	all	the	time.	And	this	young	people	are	

approached	and	groomed	by	traffickers.	And	then	they	could	just	be	seeing	the	

young	person	in	the street	and	so,	"You	are	so	beautiful,"	and	start	talking	with	

them	and	offer	to	buy	them	a	hamburger	or	something	and	just	start	chatting	

with	them,	and	eventually	they	may	say,	"I	want	to	be	your	boyfriend."	And	

then	when	they	try	to	develop	that	relationship,	one	day	they	will	say,	"If	you	

really	love	me,	you	should	have	sex	with	my	friend."	And	if	the	young	person	

does	it,	then	that	continues	to	increase	with	different	type	of	people	that	they	

are	having	sex	with.	And	this	person,	this	boyfriend	is	being	paid	or	has	some	

gains	from	this	interaction	of	the	young	person.

Angela	Diaz: And	sex	trafficking	can	be	through	a	trafficker,	it	could	be	through	sometimes	a	

gang,	maybe	involving	sex	trafficking	and	sometimes	it's	an	individuals	and	

sometimes	it's	a	gang.	Sometimes	the	families	maybe	trafficking	the	young	

person	and	having	gains	such	as	money	or	drugs	or	something	like	that.	There	

are	a	number	of	things	that	put	young	people	at	risk	for	sex	traffic.	The	most	

immediate,	the	proximal	risk	to	sex	trafficking	of	young	people	in	the	U.S.	is	

being	homeless	or	having	unstable	home.

Angela	Diaz: Another	risk	is	having	a	history	of	abuse,	especially	sexual	abuse.	Young	people	

who	are	gay,	lesbian,	and	transgender	are	at	a	higher	risk	to	be	sex-trafficked.	

Young	people	who	are	system-involved	such	as	foster	care	or	the	criminal	

justice	system	also	are	more	likely	to	be	sex-trafficked.	So	these	things	are	

complex,	but	we	need	to	understand	that	there	are	multiple	risk.	Some	are	

individuals,	some	are	family,	some	are	community,	some	are	more	societal.	But	

they're	at	sometimes	because	we	ask	them	directly	if	they	ever	exchange	sex	

either	for	shelter,	for	money,	for	food,	for	drugs,	we	find	out	if	they	are	

engaging	in	any	of	those	behaviors.
Angela	Diaz: Also,	sometimes	if	you	see	a	young	person	that	comes	to	the	clinic	sort	of	that	is	

not	dressed	according	to	the	temperature	for	example,	or	they	have	certain	

tattoos	in	the	neck	that	says,	"That	his	car,"	or	something	that	sort	of	identify	

them	as	property	of	somebody	else,	you	sort	of	think	that	there	is	a	possibility	

of	them,	then	you	ask	the	young	person	directly.

Angela	Diaz: Something	else	to	be	very	aware,	sometimes	the	trafficker	and	may	come	with	

the	victim	and	they	want	...	When	you	are	taking	a	history,	you	should	always	

see	any	patient,	any	teenager	should	be	always	seen	at	least	for	part	of	the	

history	by	themselves.	But	especially	when	you	suspect	that	they	are	being	sextrafficked	because	the	trafficker	tend	to	take	over,	they	want	to	be	giving	all	the	

history	because	they	don't	want	the	young	person	to	say	anything	that	may	

compromise	them.

Angela	Diaz: So	we	always	say	to	everyone,	the	way	that	we	work	here	is	that	at	some	point	

we	ask	the	parents	or	the	friends,	whoever	comes	with	a	young	person	to	wait	

outside	and	we	will	continue	the	conversation	and	do	the	physical	exam.	So	we	

have	that	opportunity	to	work	with	the	young	person	and	ask	any	question	that	

we	may	need	to	ask	and	give	the	young	person	the	opportunity	to	share	

anything	that	they	need	to	share.

Angela	Diaz: But	we	know	that	they're	not	just	going	to	pack	up	and	leave.	It's	complex.	They	

may	be	afraid	of	the	trafficker,	they	may	not	know	what	to	do,	where	to	go,	so	

we	have	to	start	that	conversation	and	we	really	encourage	them	to	keep	

coming	and	every	time	they	come	we	continue	the	conversation	and	continue	

to	give	them	another	dose	of	mental	health.

Angela	Diaz: But	they	are	not	going	to	be	able	to	leave	the	life	unless	they	have	outside	in	the	

community	connections.	Whether	it's	connection	to	family,	they	have	a	place	to	

live,	they	have	a	place	to	let's	say	get	money	to	eat	or	...	They	need	to	survive.	

The	need	to	do	that.	Those,	you	need	to	start	working	with	them	as	they	

prepare	to	leave	the	life	to	what	system	of	care	are	they	going	to	come	to,	what	

resources	in	the	community	are	going	to	be	available	to	them?	And	only	after	

that	...	And	sometimes	it	takes	like	six	tries	or	more	for	them	to	try	to	leave,	for	

them	to	then	stay	out	and	be	able	to	get	reconnected.	They	need	to	be	

reconnected	to	society	and	to	the	different	elements	of	society.	That	is	very	

important.

Angela	Diaz: So	we	provide	these	trauma-informed	services	to	these	young	people	who	had	

been	sex-trafficked,	but	we	also	work	with	a	different	system	in	their	behalf.	

Sometimes	they	are	brought	by	police,	sometimes	they're	referred	to	us	by	

court.	I	guess	I	said	through,	FBI,	Homeland	Security	and	sometimes	just	other	

services.	But	we're	also	very	involved	in	advocacy.	We	have	many	different	

groups	in	New	York.	People	work	together	because	these	young	people	were	

not	only	been	victimized	in	the	trafficking,	but	they	also	were	being	arrested,	

they	used	to	end	up	with	a	criminal	record	and	they	used	to	be	re-victimized	by	

the	different	system.
Angela	Diaz: And	after	a	lot	of	advocacy,	New	York	actually	changed	the	law.	And	now	they	

see	any	young	person	as	a	victim	rather	than	a	criminal.	A	victim	who	needs	

services,	who	need	to	be	connected,	who	need	to	really	be	helped.	And	this	

have	been	really,	really	important.	And	this	is	key	because young	people	are	

much	more	likely	now	to	even	disclose	and	they	know	that	they	can	be	helped	

and	we	can	work	with	The	Child	Welfare	System,	Child	Protection,	everyone,	the	

different	type	of	system	to	really	help	this	young	person	do	well	rather	than	

consider	them	a	criminal	and	making	it	harder	for	them	to	leave	the	life.

Angela	Diaz: At	the	Mount	Sinai	Adolescent	Health	Center,	we	provide	free	services	to	the	

patient,	and	no	cost	to	them.	On	average,	we	spend	about	$1,000	per	year	for	

all	the	services	that	they	receive,	all	those	comprehensive	services.	We	also	buy	

their	medication	and	we've	even	metro	cards	so	that	there	is	no	barriers.	And	

because	only	30%	of	the	teenagers	that	come	to	us,	the	young	people	that	

come	to	us	have	Medicaid,	if	they	have	Medicaid,	we	bill	Medicaid,	but	we	have	

to	raise	a	lot	of	money.	So	our	budget	for	the	year	is	$10	million.	So	we	raise	the	

money	to	be	able	to	provide	all	the	services	that	they	need	integrated	and	not	

worry	about	the	fact	that	they	do	not	have	money	or	insurance.

Angela	Diaz: The	Mount	Sinai	Adolescent	Health	Center	has	had	a	long	history	of	partnering	

with	schools	and	we	partner	in	differing	ways.	One	is	that	we	have	within	six	

high	schools	in	Manhattan,	we	have	full-time	clinics.	So	right	inside	the	school	

building	we	have	clinics	where	we	provide	medical,	mental	health,	sexual	

health,	so	all	the	components,	and	we	also	can	go	to	the	classroom	if	a	teacher	

request	us.	So	very	strong	working	relationship	with	schools.

Angela	Diaz: We	also	have	young	people	that	we	train	to	be	leaders.	We	have	the	Peer	

Health	Education	Program	that	work	in	different	types	of	schools	in	New	York.	

And	they	go	into	the	classroom	and	work	with	young	people	on	a	ray	of	issues	

including	how	to	prevent	HIV	infection,	how	to	make	good	decision	about	

trauma.	And	they	go	with	the	staff	and	is	very	effective	because	it's	young	

people	talking	to	young	people.	Well,	also,	many	schools	send	young	people	to	

us.

Angela	Diaz: We	feel	that	parents	are	really	key.	Young	people	have	the	right	to	confidential	

services	and	we	honor	that,	and	that's	very	important	to	us,	and	that's	why	so	

many	young	people	come,	but	we	also	understand	that	young	people	do	much	

better	when	their	parents	love	them,	when	their	parents	are	involved	in	their	

care,	when	they can	communicate	with	their	parents.	So	we	actually	encourage	

parents	to	come	and	bring	their	children,	we	encourage	young	people	to	talk	to	

their	parents.

Angela	Diaz: And	sometimes	the	young	person	might	say	to	us,	"Well,	I	cannot	say	that	to	my	

mom	or	my	dad.	They	will	kill	me."	And	we	say,	"No,	no,	no,	they	will	not	kill	

you.	Bring	them	here.	We	will	help	you	tell	them	whatever	the	issue	is."	And	the	

young	person	has	that	option	to	bring	the	parents	to	the	clinic	and	then	we	help	

them	tell.	But	we	really	are	major	partners	with	parents,	we	also	do	family	

therapy.	Usually	the	family	therapy	involve	the	adolescents	that	we	serve	and	
also	whoever	is	there	in	their	families	could	be	a	mom,	it	could	be	a	dad,	it	could	

be	both	parents,	it	could	be	a	grandparent,	or	the	siblings.	So	we	really	think	

that	family	is	very	important	and	the	healthier	the	family	is,	the	healthier	the	

young	person	will	be.

Angela	Diaz: We've	reached	the	most	vulnerable	and	disconnected	young	people.	And	the	

reason	that	we	are	able	to	do	that	is	because	of	the	way	we	design	our	services.	

We	make	it	easy	for	everyone	to	be	able	to	come	in.	Public	School,	private	

school,	and	the	specialized	high	schools	and	the	teachers	and	guidance	and	

counselors,	and	other	professionals	in	the	schools	send	patients	to	us	all	the	

time	because	they	understand	that	a	young	person	will	be	more	ready	to	learn	

in	school	if	their	needs	are	met,	whether	they're	physical	needs	or	they	are	

mental	health	needs.	They	know	we	will	not	judge	them.	Whatever	is	happening

in	their	life.	We	meet	them	where	they	are.	We	know,	we	come	with	plants	and	

things	like	that	we	make	sure	that	we	meet	their	needs.

Angela	Diaz: Well.	We	have	learned	working	with	young	people	is	that	we	need	to	ask	them	

direct	questions.	And	if	we	do	and	we	ask	them	in	a	sensitive	way	that	they	

know	we	are	there	just	to	help	them,	they're	like	an	open	book	and	they	will	tell	

us.	And	what	we	do	is	that	before	I	even	take	the	history	after	I	explained	that	

everything	is	confidential	to	the	young	person	and	their	family,	if	the	family	

came	with	them	I	would	say	something	like	you	know "I	will	be	asking	you	a	lot	

of	different	questions.	We	ask	those	questions	from	everyone.	Just	in	case	any	

one	of	our	patients	has	experienced	that	so	it’s	not	that	we’re	picking	up	

anything	from	you	and	that's	why	we	are	asking	those	questions.	So	just	be	

aware	that	we're	going	to	be	asking	you	lots	of	different	types	of	questions."	But	

we	ask	every	single	patient	the	same	thing.	It's	just	to	make	sure	that	those	that	

have	experienced	those	things	really	will	be	able	to	share	that	and	then	get	help	

for	that.

Angela	Diaz: We	really	need	to	strive	for	equity?	You	need	to	really	give	this	young	people	

the	steps	that	they	can	climb	to	get	to	where	they	need	to	be.	And	the	way	you	

do	that	is	by	providing	teen-friendly	services,	youth-friendly	services,	and	

providing	all	the	different	trauma-informed	service	or	that	they	need	a	mental	

health,	everything,	and	working	with	them	in	a	way	that	they	heal	from	their	

trauma	and	they	are	able	to	deal	with	the	different	disparities.

Angela	Diaz: Another	challenge	that	we	face	is	the	lack	of	awareness	of	the	needs	of	young	

people	in	term	of	the	type	of	services	are	they	need.	People	try	to	send	them	to	

a	biomedical	type	of	approach,	and	that	just	doesn't	work.	And	the	funding	

often	doesn't	incorporate	prevention.	And	really	doing	the	type	of	work,	the	

intensity	of	the	work	that	is	needed	to	address	some	of	those	disparities	and	to	

really	achieve	equity.	And	it	is	really	important	because	those	funding	itself	is	

silo,	and	at	some	point	it	will	be	important	to	try	to	figure	out,	"How	do	we	

develop	maybe	a	youth-specific	funding	mechanism	that	incorporates	all	the	

things	that	we	see?"	Because	it's	in	those	same	kids	that	we	are	seeing	all	the	

things,	"but	also	the	go	from	wellness	to	prevention,	health	education,	risk	

reduction	and	treatment?"
Angela	Diaz: So	the	full	range	of	scope	that	I	think	is	needed	because	these	young	people	

really	can	do	very,	very	well.	We	need	to	really	think	about	those	social,	

political,	economic	context	that	leads	to	the	disparities	and	then	figure	out	how	

to	fix	it	so	that	people	can	really	maximize	their	outcome	and	do	well.

Angela	Diaz: Another	issue	is	training.	When	people	go	to	medical	school	or	psychology	

school	or	nursing	school	or	social	work	school,	they're	not	necessarily	learning	

how	to	work	with	young	people.	So	training	is	a	major	issue.	And	just	to	give	you	

the	example	in	medicine.	In	adolescent	medicine	people,	it's	only	like	a	hundred	

of	us.	So	there	are	about	26	programs	in	the	country	and	every	program	puts	

one	or	two	people	who	graduate	every	year.	So	that	is	not	enough	adolescent	

medicine	people.

Angela	Diaz: There	are	wonderful	pediatricians	and	family	physicians	and	actually,	the	

majority	of	youth	are	seen	by	those	other	disciplines,	but	even	them,	I	think	

they	need	additional	training.	I	think	we	all	should	be	receiving	training	on	how	

to	work	with	young	people.	There	are	the	ministers	will	be	receiving	training	on	

how	to	set	up	a	program	that	are	appropriate	for	young	people	that	is	going	to	

make	it	easy	for	them	to	come	and	utilize	those	services.	The	financial	

mechanism	needs	to	be	re-thought	and	maybe	integrated	the	same	way	the	

services	are	being	integrated	and	I	think	with	all	these	things,	the	system	would	

be	much	more	efficient	and	the	outcomes	will	be	much	better.

Angela	Diaz: We	use	different	lenses.	One	is	a	social	justice	lens.	Another one	is	a	positive	

youth	development	lens.	We	actually	see	the	young	people	as	full	of	promise.	

They	have	many	assets.	These	young	people	are	smart,	they	are	creative,	they	

are	working	and	even	when	they	have	such	challenging	lives,	they	are	really	

trying	to	do	the	right	thing.	Sometimes	I	work	with	patients	that	I	wonder,	"How	

does	this	kid	get	out	of	bed,	much	less	go	to	school,	much	less	help	with	the	

chores	in	the	house?"	They	work,	they	do	really	help	people	in	...	They	

volunteer,	so	they	have	tremendous	assets.

Angela	Diaz: And	we	need	to	really	start	stablish,	we	need	to	reframe	young	people	and	start	

seeing	them	by	the	positive	assets	that	they	have,	use	positive	youth	

development	principles	and	deal	with	all	issues	and	the	challenges	and	address	

them.	But	really,	they	should	be	more	about	wellness,	about	how	these	young	

people	maximize	their	potential.