services that meet these quality objectives; the scarcity of current services that consistently do so; and the lack of systems that provide coordinated health promotion, disease prevention, and behavioral health services for adolescents. Whereas Chapter 3 focused primarily on findings with respect to problems with adolescent health services, this chapter focuses on ways to address these problems and achieve improved adolescent health systems that embody the above quality objectives. The strategies recommended are informed by three of the behavioral and contextual characteristics presented in Chapter 1. First, participation matters: effective health services for young people invite engagement with clinicians by adolescents and their families. Second, family matters: at the same time that adolescents are growing in their autonomy, families continue to affect their health and overall well-being and to influence what health services they use; young people without adequate family support are particularly vulnerable to risky behavior and poor health and thus require additional support in health service settings. Third, community matters: good health services for adolescents include population-focused as well as individual and family services since the environment that adolescents live in as well as the supports provided in the community are important.

Efforts to improve the availability of health services for adolescents and the accessibility of those services are insufficient by themselves to meet the health needs of today’s adolescents. Those needs increasingly involve health problems resulting from behaviors that can best be addressed before the onset of obvious morbidity or during the early stages of experimentation in such areas as diet and exercise, substance use (including tobacco and alcohol), driving, and sexual behavior. Therefore, adolescent health services need to do a better job of incorporating prevention and health promotion, while also being more tailored to the developmental stage of adolescents.

Evidence is insufficient to suggest that one particular setting or practice structure for adolescents can achieve significantly better outcomes than other approaches. While a small number of comprehensive clinics and facilities focused on adolescents do exist, these service approaches are not easily applied to larger populations or most communities because of a lack of professionals specializing in adolescent health. However, the five criteria of accessibility, acceptability, appropriateness, effectiveness, and equity provided the committee with a framework for assessing the use, adequacy, and quality of adolescent health services, and comparing and contrasting the extent to which different services, settings, and providers meet the health needs of adolescents in the United States.

To meet these needs, improved systems of adolescent health services will be necessary. These systems must encompass (1) evidence-based and standardized screening tools and management and referral processes in adolescent-friendly primary care settings, including primary care provider



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