CHALLENGES IN ADOLESCENT HEALTH CARE
Workshop Report
THE NATIONAL ACADEMIES PRESS
Washington, D.C.
www.nap.edu
THE NATIONAL ACADEMIES PRESS
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NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.
This study was supported by Contract/Grant No. 14356 between the National Academy of Sciences and The Atlantic Philanthropies. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the views of the organizations or agencies that provided support for the project.
International Standard Book Number-13: 978-0-309-11269-7
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Suggested citation: National Research Council and Institute of Medicine. (2007). Challenges in Adolescent Health Care: Workshop Report. Committee on Adolescent Health Care Services and Models of Care for Treatment, Prevention, and Healthy Development. Board on Children, Youth, and Families, Division of Behavioral and Social Sciences and Education. Washington, DC: The National Academies Press.
THE NATIONAL ACADEMIES
Advisers to the Nation on Science, Engineering, and Medicine
The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences.
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COMMITTEE ON ADOLESCENT HEALTH CARE SERVICES AND MODELS OF CARE FOR TREATMENT, PREVENTION, AND HEALTHY DEVELOPMENT
ROBERT S. LAWRENCE (Chair),
Bloomberg School of Public Health, The Johns Hopkins University
LINDA H. BEARINGER,
School of Nursing, University of Minnesota
SHAY BILCHIK,
Center for Juvenile Justice Reform and Systems Integration, Georgetown University
SARAH S. BROWN,
The National Campaign to Prevent Teen Pregnancy, Washington, DC
LAURIE CHASSIN,
Department of Psychology, Arizona State University, Tempe
NANCY NEVELOFF DUBLER,
Montefiore Medical Center, New York
BURTON L. EDELSTEIN,
College of Dental Medicine, Columbia University
HARRIETTE FOX,
Maternal and Child Health Policy Research Center, Washington, DC
CHARLES E. IRWIN, JR.,
School of Medicine, University of California, San Francisco
KELLY J. KELLEHER,
Columbus Children’s Research Institute, The Ohio State University
GENEVIEVE M. KENNEY,
Urban Institute, Washington, DC
JULIA GRAHAM LEAR,
School of Public Health and Health Services, Department of Prevention and Community Health, The George Washington University
EDUARDO R. OCHOA, JR.,
Section of General Pediatrics, Arkansas Children’s Hospital, Little Rock
FREDERICK P. RIVARA,
Department of Pediatrics, University of Washington, Seattle
VINOD K. SAHNEY,
Blue Cross and Blue Shield of Massachusetts, Boston
MARK A. SCHUSTER, RAND,
Santa Monica, California, and Departments of Pediatrics and Health Services, University of California, Los Angeles
LONNIE SHERROD,
Department of Psychology, Fordham University
MATTHEW STAGNER,
Chapin Hall Center for Children, The University of Chicago
LESLIE R. WALKER,
Children’s Hospital and Regional Medical Center, Seattle
THOMAS G. DeWITT (liaison from the Board on Children, Youth, and Families),
Cincinnati Children’s Hospital Medical Center
BOARD ON CHILDREN, YOUTH, AND FAMILIES
BERNARD GUYER (Chair),
Bloomberg School of Public Health, The Johns Hopkins University
BARBARA L. WOLFE (Vice Chair),
Department of Economics and Population Health Sciences, University of Wisconsin
WILLIAM R. BEARDSLEE,
Department of Psychiatry, Children’s Hospital, Boston
LINDA MARIE BURTON,
Sociology Department, Duke University
P. LINDSAY CHASE-LANSDALE,
Institute for Policy Research, Northwestern University
BRENDA ESKENAZI,
School of Public Health, University of California, Berkeley
CHRISTINE C. FERGUSON,
School of Public Health and Health Services, The George Washington University
WILLIAM T. GREENOUGH,
Department of Psychology, University of Illinois
RUBY HEARN,
Robert Wood Johnson Foundation (emeritus), Princeton, NJ
BETSY LOZOFF,
Center for Human Growth and Development, University of Michigan
SUSAN G. MILLSTEIN,
Division of Adolescent Medicine, University of California, San Francisco
CHARLES A. NELSON,
Laboratory of Cognitive Neuroscience, Children’s Hospital, Boston
ELENA O. NIGHTINGALE,
Institute of Medicine, The National Academies, Washington, DC
PATRICIA O’CAMPO,
Centre for Research on Inner City Health, St. Michael’s Hospital, Toronto
LAURENCE D. STEINBERG,
Department of Psychology, Temple University
ELLEN A. WARTELLA,
Office of the Executive Vice Chancellor and Provost, University of California, Riverside
MICHAEL ZUBKOFF,
Department of Community and Family Medicine, Dartmouth Medical School
ROSEMARY CHALK, Board Director
WENDY KEENAN, Program Associate
Preface
The Committee on Adolescent Health Care Services and Models of Care for Treatment, Prevention, and Healthy Development was formed by the National Academies in May 2006, with funding from The Atlantic Philanthropies, to study adolescent health care services in the United States and develop policy and research recommendations that highlight critical health care needs, promising service models, and components of care that may strengthen and improve health care services for youth and contribute to healthy adolescent development. This report summarizes the presentations and discussion at two one-day workshops organized as a part of the work of this committee. These workshops were an effort to take stock of the current knowledge base on adolescent health care services, settings, and systems; to incorporate personal experiences; and to help inform the work of the committee.
In November 2006 the committee convened a community forum to elicit the views of those who use and those who provide adolescent health care, with the goal of revealing gaps in current delivery mechanisms through perspectives from people who work with vulnerable populations of adolescents, individuals who work in different settings and systems that deliver health care to adolescents, and young adults themselves. In addition, the forum invited public stakeholders to present their views. In January 2007 the committee convened a workshop to examine the research base on the organization and delivery of adolescent health care services by (1) reviewing the state of adolescent health care systems, (2) identifying quality features of an adolescent health care system, (3) reviewing
the evidence base on specific service delivery models or systems of care, and (4) identifying the evidence base of health care delivery to vulnerable populations of adolescents.
Given the limitations of both time and scope, the workshops could not address all issues that are certainly critical. It is our hope, however, that this report helps illuminate important issues in adolescent health care and begins unraveling this challenging and multifaceted area of study. Individual presentations from both workshops are available at http://www.bocyf.org/.
We are grateful for the contributions of the expert presenters, speakers, and discussants who contributed to the meeting (see the appendixes for the workshop agendas and list of participants). Special appreciation also goes to the committee members who volunteered their time and intellectual efforts to shape the workshop programs and identify themes and contributors. In addition, we give special thanks to Alexandra Beatty, who prepared a comprehensive draft of the workshop report, Leslie Sim and Jennifer Gootman, who directed the planning and workshop preparation and the production of the final publication, April Higgins and Wendy Keenan, who assisted with preparation of meetings and workshop, and Matthew McDonough, who assisted with running the workshops. Although the workshop report was prepared by the committee, it does not represent findings or recommendations that can be attributed to the committee members.
This workshop report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the Report Review Committee of the National Research Council. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We thank the following individuals for their review of this report: Trina Anglin, Office of Adolescent Health, Health Resources and Services Administration, Rockville, MD; Claire D. Brindis, National Adolescent Health Information Center, Institute for Health Policy Studies, University of California, San Francisco; Denise Dougherty, Child Health and Quality Improvement, Agency for Healthcare Research and Quality, Gaithersburg, MD; Jack C. Ebeler, Ebeler Consulting, Reston, VA; Elizabeth Feldman, Pediatric/ Adolescent Coordinator, UIC/Illinois Masonic Family Practice Residency, University of Illinois College of Medicine; Alan Shapiro, Community Pediatrics and South Bronx Children and Family Health Center, Monte-
fiore Medical Group, New York, NY; and Joshua M. Sharfstein, Health Commissioner’s Office, City of Baltimore, MD.
Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the report nor did they see the final draft of the report before its release. The review of this report was overseen by Robert Graham, Department of Family Medicine, University of Cincinnati College of Medicine. Appointed by the National Research Council, he was responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the author(s) and the institution.
Robert S. Lawrence, Chair
Committee on Adolescent Health Care
Services and Models of Care for Treatment, Prevention, and Healthy Development