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Adolescent Health Services: Missing Opportunities


 “Adolescence is a time when youth establish health habits, both good and bad, that often last a lifetime.  Yet the U.S. health care system today is not designed to help young people develop healthy routines, behaviors, and relationships to prepare them for adulthood.  Although most adolescents do make it through this turbulent period, some engage in risky behaviors that can jeopardize their health during these formative years and that contribute to poor health outcomes in adulthood.  The nation’s health services system is missing opportunities for disease prevention and health promotion during the period of adolescence.”

The National Research Council and Institute of Medicine (NRC/IOM) Board on Children, Youth, and Families received funding from the Atlantic Philanthropies to address the challenges facing adolescent health services in the United States.  Through this collaboration, the report, Adolescent Health Services: Missing Opportunities, was developed, which offers guidance to administrators of health care agencies, health care workers, guidance counselors, parents, school administrators, and policy makers invested in advancing a integrated health system for adolescents. 

Adolescent Health Services explores the health status of adolescents and reviews the separate and uncoordinated programs that currently exist in public and private health care settings. The report examines the current status of adolescent health and adolescent health services, settings, and providers and gathered seven conclusions from their research. 

  1. Most adolescents are thriving, but many engage in risky behavior, develop unhealthful habits, and experience physical and mental health conditions that can jeopardize their immediate health and contribute to poor health in adulthood.
  2. Many current models of health services for adolescents exist.  There is insufficient evidence to indicate that any one particular approach to health services for adolescents achieves significantly better results than others.
  3. Health services for adolescents currently consist of separate programs and services that are often highly fragmented, poorly coordinated, and delivered in multiple public and private settings.
  4. Health services for adolescents are poorly equipped to meet the disease prevention, health promotion, and behavioral health needs of all adolescents.  Instead, adolescent health services are focused mainly on the delivery of care for acute conditions, such as infections and injuries, or special care addressing specific issues, such as contraception or substance abuse.
  5. Large numbers of adolescents are uninsured or have inadequate health insurance, which can lead to a lack of access to regular primary care, as well as limited behavioral, medical, and dental care.  One result of such barriers and deficits is poorer health.
  6. Health care providers working with adolescents frequently lack the necessary skills to interact appropriately and effectively with this age group.
  7. The characterization of adolescents and their health status by such traditional measures as injury and illness does not adequately capture the developmental and behavioral health of adolescents of different ages and in diverse circumstances.

In addition, the committee offers recommendations on how to improve systems of adolescent health services; a workforce to meet the health needs of adolescents; and health insurance coverage and access to adolescent health services. The 11 recommendations relate to the following areas:

Primary Health Care:

  1. Federal and state agencies, private foundations, and private insurers should support and promote the development and use of a coordinated primary health care system that strives to improve health services for all adolescents.
  2. As part of an enhanced primary care system for adolescents, health care providers and health organizations should focus attention on the particular needs of specific groups of adolescents who may be especially vulnerable to risky behaviors or poor health because of selected population characteristics or other circumstances.
  3. Providers of adolescent primary care services and the payment systems that support them should make disease prevention, health promotion, and behavioral health—including early identification, management, and monitoring of current or emerging health conditions and risky behavior—a major component of routine health services.

Public Health System:

  1. Within communities—and with the help of public agencies—health care providers, health organizations, and community agencies should develop coordinated, linked, and interdisciplinary adolescent health services.

Privacy and Confidentiality:

  1. Federal and state policy makers should maintain current laws, policies, and ethical guidelines that enable adolescents who are minors to give their own consent for health services and to receive those services on a confidential basis when necessary to protect their health.

Adolescent Health Care Providers:

  1. Regulatory bodies for health professions in which an appreciable number of providers offer care to adolescents should incorporate a minimal set of competencies in adolescent health care and development into their licensing, certification, and accreditation requirements.
  2. Public and private funders should provide targeted financial support to expand and sustain interdisciplinary training programs in adolescent health.  Such programs should strive to prepare specialists, scholars, and educators in all relevant health disciplines to work with both the general adolescent population and selected groups that require special and/or more intense services.

Health Insurance:

  1. Federal and state policy makers should develop strategies to ensure that all adolescents have comprehensive, continuous health insurance coverage.
  2. Federal and state policy makers should ensure that health insurance coverage for adolescents is sufficient in amount, duration, and scope to cover the health services they require.  Such coverage should be accessible, acceptable, appropriate, effective, and equitable.

Research Agenda:

  1. Federal health agencies and private foundations should prepare a research agenda for improving adolescent health services that includes assessing existing service models, as well as developing new systems for providing services that are accessible, acceptable, appropriate, effective, and equitable.

Monitoring Progress

  1. The Federal Interagency Forum on Child and Family Statistics should work with federal agencies and, when possible, states to organize and disseminate data on the health and health services, including developmental and behavioral health, of adolescents.  These data should encompass adolescents generally, with sub-reports by age, selected population characteristics, and other circumstances.

Click here to read or order the full report, Adolescent Health Services: Missing Opportunities.

Read the AAP News article about the report from the perspective of the chair persons of the the AAP Committee on Adolescence and the Section on Adolescent Health.



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