and primary care providers; team conferences; or care coordination. In addition, these mental health providers reported that few insurers accepted diagnostic codes for psychosocial problems not yet considered diagnosable mental disorders (McManus, Shejavali, and Fox, 2003).

Treatment for adolescents with mental disorders generally involves the use of psychotropic medication and/or psychotherapy. Effective therapeutic interventions with fewer adverse effects have emerged in both areas over the last two decades. Unfortunately, despite the lack of effectiveness of usual clinical care, most routine community practices fail to incorporate evidence-based therapies for mental health problems into their delivery systems (Weisz, Hawley, and Doss, 2004; Weisz et al., 1995, 2005). In other words, community practices rarely incorporate effective care for mental disorders as assessed through randomized trials; therefore, the benefits of effective therapeutic interventions are not available to the majority of adolescents and families seeking care for mental health problems within their communities. In most communities, effective treatment is also hampered by severe shortages of trained professionals, limited coverage of useful care, and poor coordination among providers from different disciplines (Ben-Dror, 1994; McManus, Shejavali, and Fox, 2003). These factors have contributed to long waiting lists, low levels of satisfaction, and little evidence of effectiveness for routine community mental health services.

An analysis of 2003 data from the National Survey of Children’s Health reveals that a significant percentage of adolescents need but fail to receive mental health or counseling services. On a national basis, 36 percent of adolescents aged 12–17 with current behavioral problems that require treatment or counseling do not receive mental health services; this percentage ranges from 63 percent in Texas to 10 percent in Wyoming (Child and Adolescent Health Measurement Initiative, 2008).

Sexual and Reproductive Health

The American Medical Association and the American College of Obstetricians and Gynecologists, among others, recommend that adolescents receive guidance and counseling on responsible sexual behavior, including abstinence, methods of birth control, and prevention of STIs and HIV infection (American Medical Association, 1997; Committee on Adolescent Health and American College of Obstetricians and Gynecologists, 2006). Current guidelines recommend that adolescents who have had sexual intercourse be screened for STIs.

According to data from the 2002 National Survey of Family Growth, approximately half (49 percent) of all adolescent girls aged 15–19 had



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