diabetes and hypertension in older populations (which involve chronically relapsing and remitting disorders with major challenges of adherence to treatment regimens).

At present, aftercare for adolescents with substance use disorders remains inadequate, and comorbid mental health problems receive insufficient attention. One review of 53 studies found that fewer than half of adolescents discharged from treatment programs (38 percent) remained abstinent from substance use after 6 months, even when aftercare plans were in place (Williams, Chang, and the Addiction Centre Research Group, 2000). Data reported by Godley and colleagues (2007) for some aftercare models, such as “assertive” continuing care (in which the clinician rather than the patient has responsibility for linkage and retention), suggest that these models can improve linkage to aftercare for adolescents who have received residential drug treatment. However, while the authors found that substance use decreased as expected when these models were employed, the results were not significant (low statistical power, which limited conclusions). A recent (as yet untested) approach is for aftercare programs to implement “adaptive” interventions, which vary in focus and intensity in response to changes in individual needs (McKay, 2006).

Summary

Evidence-based therapies are available for adolescents in the specialty areas of mental health, sexual and reproductive health, oral health, and substance use treatment and prevention. Yet these interventions are commonly not integrated into routine health care practices, particularly for those who depend on public financing for their routine care. Many adolescents have difficulty gaining access to specialized services because of financial restrictions, shortages of skilled personnel, and the lack of appropriate or convenient settings that are suitable for their stage of development. Adolescents with comorbid conditions (such as mental health, sexual, and substance use conditions) are especially difficult to serve within the current fragmented array of health care services and settings.

Findings:

  • Evidence shows that specialty care services for the adolescent population are not accessible to most adolescents. Existing specialty services in the areas of mental health, sexual and reproductive health, oral health, and substance use treatment and prevention are generally insufficient to meet the needs of many adolescents. While evidence-based therapies are available in a number of these areas, they are not integrated into many practice settings.



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