more serious challenges. Specific kinds of vulnerability bring somewhat different health challenges that frequently overlap. In general, vulnerable adolescents are at risk from substance abuse, risky sexual behavior, family dysfunction and abuse, and violence. Many programs exist to help and support them, and considerable ingenuity has gone into planning and adapting these programs. Government at all levels plays a critical role, as do a host of other institutions and private funders. Schools can be important partners in building community health resources. Expertise from a wide range of disciplines is incorporated into the care that is available, and countless individuals in every community are working hard to make the most of the resources they have to offer this vulnerable group.

But all this is not enough. Just as the discussion revealed that the needs are generally consistent across communities, the workshop speakers consistently also revealed significant gaps in the care that adolescents are receiving. In short, while these workshops were not exhaustive examinations of the issues, together they strongly suggest that both the system through which care is delivered and ways of reaching individual adolescents are insufficient to meet the need. The committee will return to these issues, but the areas of agreement evident at the workshops will be a valuable foundation for its work.

SYSTEM CHALLENGES

Gaps in the health care system serving adolescents were mentioned repeatedly at both the community forum and the research workshop. They are straightforward and generated no controversy:

  • Too many adolescents have either no health insurance coverage or inadequate health insurance coverage.

  • The programs, both volunteer-run and publicly sponsored, that attempt to serve adolescents have insufficient funding to adequately serve all those who need them.

  • The public and private programs that exist provide fragmented coverage that is disconnected and poorly coordinated. Excellent programs are available—although not in every place where they are needed—but the burden is often on adolescents and their families to identify the problem that needs treatment, identify a place where they can get help, get themselves there, and figure out how it might be paid for. Moreover, providers must often treat adolescents without access to medical histories or opportunities to collaborate with professionals from other relevant disciplines who can address other elements of their patient’s situation.



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