in the above areas frequently co-occur, contributing to health care inequities and disparities.

• Routine screening for risk factors and unhealthful behaviors that emerge during adolescence is not available or accessible for most adolescents.

• Many health care providers who treat adolescents fail to adhere to recommended prevention guidelines, to screen for appropriate risk factors and unhealthful behaviors that emerge during adolescence, and to provide effective counseling that would reduce risks and foster health promotion.

• Disparities and biases affect the quality of health services for adolescents and deserve serious consideration in any efforts to improve access to appropriate services and reduce inequities in the health system.

• Evidence shows that health services that are confidential increase the acceptability of services and the willingness of adolescents to seek them, especially for issues related to sexual behavior, reproductive health, mental health, and substance use.

• Existing state and federal policies generally protect the confidentiality of adolescents’ health information when they are legally allowed to consent to their own care.

This chapter introduces a framework for examining the strengths and limitations of current health system approaches for adolescents. This framework comprises five major objectives—accessibility, acceptability, appropriateness, effectiveness, and equity—that serve as criteria for assessing the use, adequacy, and quality of adolescent health services. The chapter then reviews the current array of mainstream and safety-net primary care services, as well as specialty services, that respond to the adolescent health needs identified in Chapter 2; a brief discussion of inpatient hospital services for adolescents is also presented. This review is followed by a discussion of what is known about adolescents’ use of health services.