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Adolescent Health Services: Missing Opportunities
it is clear that a number of potential impediments to quality health services for adolescents exist, including a lack of financial support, insurance, physicians and other health professionals who are trained in adolescent health, and transportation; cultural and language barriers; discomfort with or lack of understanding of who provides adolescent health services; and concern about the confidentiality of health services (Hock-Long et al., 2003; Kodjo, Auinger, and Ryan, 2002; Perloff, 1992; Sanci, Kang, and Ferguson, 2005; St. Peter, Newacheck, and Halfon, 1992).
Another barrier to quality adolescent health care is the fact that adolescents do not fit easily into current models of health care. There are two prevailing models of health care: one focused on children and the other on adults. In a pediatric approach to medicine, the parent is the responsible agent, and the focus is on nurturing the patient in a family context. In an adult-centered approach, the patient is the responsible agent; the provider offers information with which the patient makes decisions; and the focus is on the individual, not the family. The treatment of adolescents does not fit well into either model, and their needs change as they progress through adolescence. While some practitioners focus on caring for adolescents, their numbers are few. A third model—family medicine, in which the family, including children, adolescents, and adults, is cared for by a family physician or nurse practitioner—may offer another alternative, but the number of family medicine practices is limited.
Over the past decade, numerous published studies have addressed particular aspects of adolescent health (Ozer et al., 2003; Park et al., 2005, 2006). Much of that research, however, is focused on specific health domains, injuries or illnesses, special interests, or problem behavior—such as mental health, teen pregnancy, sexually transmitted infections, substance abuse, tobacco use, violence, diet and exercise, or oral health. Often neglected is a more comprehensive strategy for adolescent health services that integrates behavioral, psychological, physical, and social aspects of health. Moreover, much of the research available to help understand different types of services, organizational models, service settings, and provider skills that influence the health, safety, and well-being of today’s adolescents is scattered among different disciplines and literatures, including pediatrics, reproductive health, social work, mental health, and education (The Center for Development and Population Activities, 2003; Chung et al., 2006; Committee on Adolescence, 2008; Kopelman, 2004; Lear, 2002; National Association of Social Workers, 2002; Rand et al., 2007).
Experimentation with different models for providing health services to adolescents has occurred at the local, state, and national levels, and the health, safety, and well-being of adolescents are receiving attention from diverse public and private agencies. Fundamentally, however, the research being conducted is not always comprehensive, the health service approaches