those who work with vulnerable young people recognize, seek, and take advantage of unexpected opportunities to reach, educate, and support them. Adults who have the best opportunity to reach adolescents could have significant impact if they are aware of both the circumstances that are likely to affect adolescent health and available resources that may be outside their area of specialty. As DeFlorimonte noted, every positive interaction with an adolescent is a success story that paves the way for him or her to feel comfortable seeking help when the need arises.

Moreover, if care provided in different contexts could be better coordinated, so that providers had more insight into the histories of their patients or clients, they would be in a better position to recognize and address the full extent of their patients’ pressing needs. However, participants noted that hierarchies within and among the professions can work against coordination among programs and even against collaboration among colleagues. Both nurses and social workers, for example, may have relevant educational credentials and experience, yet informal protocol may inhibit a nurse or social worker from making recommendations to a physician or documenting key points. Because no single discipline has made health care for adolescents a central focus, and because coordinating and collaborating strategies are seldom incorporated into training or institutionalized in other ways, programs tend to struggle on their own with the resulting vacuum.

Shapiro pointed out that his mobile unit is well equipped to address this issue because the staff can deliver care precisely at the sites where adolescents are getting other services, such as food, shelter, or needle exchange. His ideal program would be a mobile team that includes social service, mental health, and medical personnel, all working together every day. Yet the needs are so broad that a mobile team that could truly address them all would be cumbersome. Legal and educational counseling, as well as nutrition counseling for obesity, are part of the picture as well, so interagency cooperation is critical.

At the same time, Balcorta and others stressed that funding is tight for attempting comprehensive service such as this, and that programs and communities cannot afford to be completely dependent on federal funding—they have to find ways to magnify the benefits of federal resources with local support.



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