Parents, Teens Know This Family Physician Is There for Them

Svetaz completed medical school in her native Argentina and was in her third year of an internal medicine residency when she came to the United States for an internship in family medicine and adolescent medicine in Chicago. She returned to Argentina to serve a year as chief resident, but she moved to Minnesota in 1996 to complete a two-year fellowship in adolescent medicine at the University of Minnesota while earning her master’s degree in public health.

This time, she stayed in the United States for good.

“My dream was to work with teens and families,” she said. “When I decided to stay, I didn’t have any doubt I wanted to be a family physician.”

With more than a decade already invested in her medical training, Svetaz opted for even more and completed a family medicine residency in Saint Paul. She joined a federally qualified health center there after graduating in 2001.

Immigrants account for 20% of St. Paul’s population and more than 60% percent of the city’s population growth in recent years. Latinos accounted for 5.5% of Minnesota’s population in 2018, a 115% increase since 2000 in a state that is 85% white.

Svetaz said immigrant parents often have extremely different life experiences than their children who are growing up in the United States, and those disparate upbringings can lead to conflict. Her health system completed a community needs assessment during her residency training that identified three top concerns among Latino adults: diabetes, back pain and communicating with teenagers.

“That blew my mind,” Svetaz said. “That was a need, and we knew that parents were ready for our help.”

Soon after residency graduation, Svetaz secured an Eliminating Health Disparities Initiative grant from the Minnesota Department of Health that allowed her to design and launch Aquí Para Tí/Here for You. The clinic-based development program for Latino youth and families provides bilingual and bicultural medical care, mental and sexual health coaching, health education and referrals.

“I was seeing a lot of teens and children with adverse childhood events and the effect that racism and poverty were having on them — the ‘expanded ACEs,’” said Svetaz, who serves as a clinician and medical director at the clinic. “I thought, ‘What’s the difference between confronting this and a chronic condition?’ In order to address this, we need team-based care, and that’s how we wrote the grant. We mapped all the unmet needs and gaps in health care for Latino teens and families, and then we created a program that could deliver interventions using the cultural values of our community.”

The Aquí Para Tí staff is 80% Latino and 100% bilingual.

“All of us have lived in Latin America, even those who are not Latino,” Svetaz said. “We know that one of the largest inequities is around mental health because of trauma, so everyone is trained in trauma-responsive care.”

She also leads Between US, an initiative funded by the Minnesota Department of Health, that safeguards teen patients’ confidentiality. That teen-friendly effort is balanced with efforts to engage parents directly in Aquí Para Tí, where community health workers meet with teens and their parents separately. Those staff members then meet with a clinician, who develops a plan for the family.

“I deliver the intervention for that teen,” Svetaz said, “and I tell the CHW working with the parent as a parent coach, ‘This is what the parents should be doing.’ So, when the parent and the teen go home they have a mirrored intervention because we give them the same guidance. We provide teen care in a one-stop visit where we fulfill the needs of a parent and the teenager in a separate but congruent way.”

A 2016 survey of parents and teens at Aquí Para Tí found that 100% of teens trusted their clinicians and felt listened to, and nearly 90% said their care at that clinic was better than what they had experienced elsewhere. Parents gave the clinic high marks for its parallel care, confidentiality, family-centeredness and cultural inclusivity.

“We know that parenting teens is one of the most stressful things a family can go through if you are not prepared because it changes the dynamic for the whole family,” said Svetaz, who has authored or co-authored dozens of peer-reviewed articles regarding minority and immigrant health with a focus on child and adolescent issues. “You need to know that, embrace that and be ready to change your parenting style.”

Svetaz said although there are a lot of books, resources and information for parents of newborns and small children, there are fewer helpful resources for parents of teens. She wrote a chapter of the book Congrats — You’re Having a Teen, which was published last year.

“I don’t think we do enough to prepare residents and faculty to work with families in transition, although family physicians, and pediatricians do that a lot,” she said. “Here we are filling that gap.”

Her clinic also has staff dedicated to communicating with schools when teens are experiencing issues like depression or trauma.

“We elevate the student for the school to see that the teen is struggling and needs a different type of care,” she said. “When you do that, the possibility of bias sometimes decreases.”

Although the clinic was originally grant funded, it has since been certified as a behavioral health home by the Minnesota Department of Human Services. That distinction means the clinic is eligible for federal funding that will provide $350 dollars per patient per month for those who have monthly contact with the clinic.

Svetaz said there are about 120 teens and families in frequent contact with Aquí Para Tí and another group of up to 1,000 teens and families who come for more routine care, such as annual visits. New patients are screened for social determinants of health and complete a general comprehensive questionnaire about teen health called “Check Yourself.” Both parents and teens are brought up to date on vaccinations and screened for depression. Visits can last hours.

“There was a snowstorm recently, and we only had two patients that day,” she said. “We managed to stay late anyway. There’s so much to do, and they need help.”

That includes care coordination.

“My colleagues are constantly working with parents,” Svetaz said. “We bypass the whole maze involved with calling the hospital. They leave a message, and we reply to them within an hour.”

Svetaz said that after more than 20 years at Aquí Para Tí, she could remember only one parent who couldn’t be convinced about that way the clinic operates.

“Everyone knows about us,” she said, “but the No. 1 source of referrals is still our parents who tell other parents, ‘You need to bring your child to Aquí Para Tí.’ We build a true partnership with parents. We explain why we are going to be doing certain things, like respecting confidentiality. But we make it very clear that is not against the parents. It’s about us supporting them and them allowing us to be the other significant adult in their child’s life. I think that’s where our success lies.”

Svetaz serves as faculty at the Hennepin Healthcare Family and Community Medicine Residency and in the Leadership Education in Adolescent Health program in the Department of Pediatrics at the University of Minnesota. She also is an associate professor in the Department of Family and Community Medicine.

Svetaz also has taken on national leadership roles with the Society for Adolescent Health and Medicine. She led SAHM’s efforts when it became the first medical organization to publish a position paper on racism and health in 2018. She later served as chair of SAHM’s Diversity Committee and was elected to its Board of Directors in 2021. She also has created content and is currently working on translations for the Center for Parent and Teen Communication.

Finally, Svetaz’s success is leading to expansion. Aquí Para Tí has excelled in improving mental health outcomes and in delivering preventive services, including long-acting reversible contraception, she said. Svetaz to launch a similar clinic, Radical Healing Initiative, which will provide parallel care for African and African American teens and their families in Minneapolis-Saint Paul, which has a large Somali immigrant population.

“We are going to disrupt the system by bringing in these oases of care in a way that is truly centered around patient needs and not centered around insurance,” Svetaz said. “Socioecological models that look at intergenerational care with a healing lens to support families is the way to go, and we have proven that once again.”