Susan Rabinovitz

It’s at least an hour before the school day ends, yet the waiting room in the teen walk-in clinic, part of Childrens Hospital Los Angeles, is busy. A handful of girls, waiting for counseling or medical care, idly twist strands of hair or play with their jewelry. Each seems lost in private thoughts or fears. A boy stares at the floor.

This is a place where the hazy adolescent nostalgias of Sweet Sixteens and beach parties yield to the hard reality of condoms, HIV testing and runaway hotlines, a place where Working Mother magazine shares space with back issues of HIV Plus.

Susan Rabinovitz is the quiet, unprepossessing presence overseeing the clinic at Sunset and Normandie, along with several other clinics and teen services around the city. Rabinovitz, associate director of the Division of Adolescent Medicine at Childrens Hospital, is a self-described “child of the ‘60s”

Bent on “making change,” she left the Midwest, where she grew up, for California in 1972. Nursing school at Los Angeles Community College followed, and Rabinovitz, 51, eventually found her calling with adolescents after a stint as an elementary-school nurse in Boyle Heights. There she saw, firsthand, how a bad fall from the monkey bars could plunge a family without insurance or much income into financial crisis. “It showed me that unless you have access, you don’t get the care you need.” At Childrens Hospital since 1983 and the division’s associate director for the last eight years, she has helped to bring medical and counseling services to the places where kids are.

Childrens Hospital now serves some 10,000 teens annually in a wide range of settings. The hospital operates clinics in three Los Angeles high schools and homeless shelters, along with services tailored to pregnant and parenting teens, gay and bisexual youth, teens who have experienced abuse and neglect, and those dealing with substance abuse and HIV.

Soft-spoken and quick to laugh, it’s easy to see how Rabinovitz builds trust with teens. Her experience parenting an adolescent behind her--she has a 26-year-old son--Rabinovitz now shares her Silver Lake home with her physician husband. She lists hiking, reading and going to the theater among her hobbies.

Rabinovitz was interviewed in her office near downtown.

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Question: Is it harder to be a teenager today?

Answer: About 80% of adolescents navigate their adolescence pretty easily. . . . One of the jobs of an adolescent is to develop a sense of identity and separate from their parents and . . . that’s why kids get involved in risk-taking behavior. What’s of concern nowadays is that risk-taking behavior can be so much more extreme--HIV, substance use and violence.

Q: Recent school shootings, including at Santana High School near San Diego, may have resulted from bullying. Kids have always been mean toward one another, starting at an early age. Is there something different happening now that kids pick up a gun when they feel they’ve been bullied?

A: One of the things that’s different [is] the availability of guns and [the fact that] guns are used in ways they weren’t used in the past. With bullying, with fights in the past, kids would use their fists. . . . But the use of weapons in interpersonal violence is a newer phenomenon and has increased.

Q: Why the resort to guns?

A: We have helped to make those guns available to young people and have created a society in which weapons are used against one another. It’s really not the fault of young people who [turn to guns.] It’s the failure of our society to keep [guns] out of the hands of children who shouldn’t be using [them].

Q: Is it just guns or are there more pressures on kids that are causing them to explode?

A: Adolescence is very different than it was 100 years ago. The whole idea of adolescence is very new. A hundred years ago . . . teenage childbearing used to be normative behavior because people’s life expectancy was so much shorter. . . . You got married early. You had children early. You had many children. . . . Now we have a whole prolonged adolescent period, where the age of menarche is even younger, 10 years old, when it was 12 1/2, 13 in the past. . . . We also have a very complex society in which it’s hard to be successful. There’s lots of uncertainty about the future. A sense of how are they going to make a contribution. It’s particularly true for young people of color and young people who are impoverished and disenfranchised. We have 30% of children in L.A. in poverty. That’s tied to all kinds of other serious negative outcomes. . . . Young people talk a lot about wanting to be heard and acknowledged, [yet] a part of our culture really demonizes young people. That’s one of the concerns about school shootings and that kind of school violence.

Q: We hear a lot about teen rage these days. How should we respond to that?

A: A lot of research shows that the thing that makes a difference in the life of a teen is a positive relationship with a caring adult. That’s something that has also changed in our society. Families are more spread out. They’re not in the same community. They can’t take care of one another in the way they used to. Multigenerational families don’t necessarily live together and support one another. So many young kids grow up in single-parent families in which parents don’t have time to spend with their children. . . . That leaves young people on their own a lot . . . It’s something we can do something about. We can all figure out how to make connections with young people. . . . It can be as a parent, an aunt, a teacher or as an after-school coach, as long as we find ways for teens to be in relationships where there are adults who can give them positive regard.

Q: Would you say that the biggest single problem that teenagers today face is lack of a connection with an adult?

A: I hate the single-bullet theory of adolescence. . . . The lack of support in our communities is important, and I think that kids do feel very disengaged from community. There are [also] family stresses and conflicts that make it hard for parents to provide their children with what they want--that’s a major issue for many of our young people.

Q: We talk about teens as being under a lot more pressure. Some people say teens are in crisis, yet the high school dropout rate is decreasing, the teen birthrate has fallen, even teen smoking has declined some. Are teens really in crisis?

A: Some things are definitely getting better, and I think some of that reflects what we’ve done. Adolescent birthrates are going down [and] everyone will claim responsibility for that success. I think a lot of it is that we have really invested resources in pregnancy prevention, in promoting contraceptive access for teens who are sexually active. Teens have more knowledge about contraception and family planning than they did when I started. A lot of it is related to HIV. In some ways, we have an easier time doing condom awareness and HIV prevention than we actually have with pregnancy prevention. It’s easier to talk about HIV than it is to talk about sex. So I think there’s more condom use among teens than there used to be, and that has made a really significant difference in teen birthrates.

Still, many of the reasons why teens don’t use contraception are reasons that have persisted. They don’t know where to go for care. They have enormous shame and exquisite sensitivity to somebody judging them and blaming them. All those barriers for why they don’t seek out services still exist. . . . I don’t think we have done enough in terms of promoting awareness of the services available to them. . . . There has been a lot of conflict about family planning and abortion services for teens, so when there is an unintended pregnancy, tremendous conflict on the part of teens in terms of sorting out what they should do.

Q: You’ve worked a lot with homeless teens. Does L.A. have a particularly big problem with homeless youth?

A: Homeless youth tend to congregate in a few major cities. L.A. being one of them, for obvious reasons--climate. Also San Francisco and San Diego.

Q: What should the county be doing for homeless youth?

A: Every year, about 35% of the young people who have been emancipated from foster care become homeless. And that’s consistent with national figures. The county is already putting a significant amount of energy into improving their emancipation planning, preparing young people to be productive. They’ve got new systems for training, looking at employment opportunities for kids when they leave foster care. . . . The Department of Children and Family Services is looking to expand transitional housing for young people leaving the foster-care system. . . . [It is] looking at setting up transitional living programs that would go as long as 24 months, so young people can continue to live there, continue to get support and services, help with school, financial aid, services like that.

Q: Are adult concerns about the messages conveyed about sex and violence in the mass media overblown?

A: I don’t think it’s appropriate to tag rap music and lyrics as really a major contributing factor to youth behavior. There is certainly much more explicit violence and sex in movies and television than we were exposed to growing up. And I do think there are concerns about young children watching that without the mediating influence of an adult. . . . Everything encourages kids to be titillating, provocative, to be sexually active. What we haven’t done is then balance that with the same messages about being safe and using protection. If you’re going to have sex, negotiate condom use. If you’re going to see people using drugs, we need to then have messages that are clear about the consequences of that. That’s an area where we have let young people down.

Q: Would you say that your job has gotten easier over the years? Are the messages being heard? Or do you feel it starts all over again with each new generation?

A: Some of the messages are getting through to kids. Certainly, when you look at condom use, if you look at knowledge about HIV transmission, [still] we have a long way to go in terms of making sure we have what kids need to keep them safe. There are concerns about violence. . . . When I raised an adolescent--I worked here from the time [my son] was 7 or 8--I’d come home every day and just say, “Don’t you ever have sex without a condom!” He had no idea what I was talking about but it was like, let’s just get that message out. But just to see what we were able to provide for him and being able to talk to him about issues--about college, making sure those college applications got in on time. I write recommendation letters for kids here that I have a chance to work with because they have so few people in their lives even who can do that for them.

Q: What is the single best thing that parents could do for their teen?

A: To negotiate with them around reasonable expectations and around rights and responsibilities. It’s a method we use sometimes when there’s family conflict. . . . [Teens] do have a right to privacy, and they do have a right to keep things to themselves. They do get to make decisions for themselves. There need to be arenas in which young people can [decide] for themselves, and parents can trust them to make good and safe choices. One thing is being willing to listen to what your kids want to say. One of the most critical things for parents, teachers and people who work with teens is that you have to be willing to hear it. Kids won’t tell you what you don’t want to hear, and they won’t tell you what they don’t think you can hear. And so, a lot of kids who say, “Well, I can’t talk to my parent,” know on some deep level that their parents don’t want to hear it. . . . Most young people want to talk to their parents. . . . And if we can really learn how to listen to young people so that it’s safe for them, then [they’ll talk to us]. Sometimes, you don’t know what to do, [and] you can acknowledge that you don’t know what to do, and you can get help.