Adams enumerated some of the key health issues that affect the girls they serve: pregnancy prevention, sexually transmitted diseases, and reproductive health care; abuse, neglect, and violence; and substance use and abuse. Issues related to body image—anorexia and bulimia—and stress, affecting girls as young as eight or nine, are also of particular concern for clinicians who work with adolescent girls and young women.

Looking at the system for providing care through the lens of adolescent girls and young women’s needs, familiar issues arise. Lack of insurance or inability to afford available insurance or care; language barriers; transportation; and parental support all affect the young people served by Girls, Inc. Confidentiality can also be a particular concern for adolescent girls and young women when they need reproductive health care. For all these reasons, health education is a prime concern for the organization, although it does not provide health services. Adams noted that neither health education nor physical education is included in the requirements of the No Child Left Behind legislation, and as a result both are being significantly cut back in many jurisdictions. Girls, Inc., has begun advocating for the inclusion of these programs when the legislation is reauthorized and also focuses on programs that provide these opportunities outside school.

The role of parents is a key issue. Adams noted that often parents of vulnerable adolescents lack information about health and health care. Those who are not experienced at advocating for themselves or their children have not been able to teach their children to advocate for themselves. To address this problem, Girls, Inc., has developed the concept of the health bridge for adolescent girls and young women—a means of both linking them to the health services they need and teaching them to advocate for themselves. On a very practical level, Girls, Inc., staff work with adolescents as they practice looking through the telephone book to find a practitioner, calling for an appointment, and visiting a clinic before becoming a patient to assess the environment and establish a comfort level.

At the same time, Girls, Inc., works at the community level to educate providers about the perspectives adolescents bring and to identify ways they can do more to reach adolescents and provide them with what they need. Girls, Inc., has organized adolescent forums to spread their messages among adolescent girls and young women, parents, and community leaders, as well as parent-daughter workshops to provide education about health issues, health fairs, and other activities designed to reach as many people as possible.



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