• able to provide effective disease prevention and health promotion services while also addressing issues related to risky behavior. However, such centers often can become unstable during times of fiscal uncertainty and may experience frequent personnel transitions. They also face unique challenges associated with financing of prevention and health promotion services that cannot be reimbursed.

  • important mechanisms for resolving the disparities and inequities that exist within private office-based primary care.


The preceding section reviewed knowledge of and experience with an array of programs and centers that offer primary care services for adolescents. This section focuses on specialty services in the areas of mental health, sexual and reproductive health, oral health, and substance use treatment and prevention. While some of these specialty services may be integrated into comprehensive primary care programs, they are more frequently located in separate sites and systems, which makes it difficult to blend them with primary care.

Mental Health

As noted in Chapter 2, mental disorders are common among adolescents and may impose a tremendous health burden for this population.2 Emotional and behavioral symptoms often co-occur with other health problems seen in the health system and in the juvenile justice and foster care systems (see Chapter 2). Traditionally, the mental health sector has been responsible for treatment of adolescents with mental disorders. This sector comprises a diverse workforce of psychiatrists, psychologists, social workers, and other, lesser-trained individuals organized into loose networks of providers. The reimbursement system for mental health services has traditionally focused on the severely and persistently mentally ill, and has limited capacity to address emerging mental illness and adolescents who are functioning but not healthy. In case studies in four major cities, mental health providers reported that insurers rarely covered telephone calls to parents, teachers,


Although an appreciation for the importance of mental disorders in adolescence has emerged over the past two decades, changes made to enhance mental health services for adolescents have been modest at best. For the purposes of this report and brevity, discussion of this subject—which can involve the use of various terms, including “mental health problems,” “mental disorders,” “emotional and behavioral disorders,” “psychosocial problems,” “emotionally disturbed,” “mentally ill,” and the like—is limited to mental disorders and related services.

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