The World Health Organization has identified five characteristics that constitute objectives for responsive adolescent health services:

  • Accessible. Policies and procedures ensure that services are broadly accessible.

  • Acceptable. Policies and procedures consider culture and relationships and the climate of engagement.

  • Appropriate. Health services fulfill the needs of all young people.

  • Effective. Health services reflect evidence-based standards of care and professional guidelines.

  • Equitable. Policies and procedures do not restrict the provision of and eligibility for services.

These five objectives provided the committee with a valuable framework for assessing the use, adequacy, and quality of adolescent health services; comparing the extent to which different services, settings, and providers meet the health needs of young people in the United States; identifying the gaps that keep services from achieving these objectives; and recommending ways to close these gaps.

Approaches to the Provision of Adolescent Health Services and Organizational Settings and Strategies

The committee was asked to explore the range of approaches to the provision of adolescent health services and elucidate their respective strengths and limitations. In doing so, the committee was to highlight efforts aimed at promoting linkages and integration among adolescent health care, health promotion, and adolescent development services, and at offering primary care, prevention, treatment, and health promotion services for adolescents with special health care needs and for selected subpopulations. This study was also focused on settings and strategies that influence the use and outcomes of different services by the diverse adolescent population.

Adolescents receive both primary care and specialty care services. They receive these services in various settings, including private physician and dentist offices, community outpatient departments, school-based health centers, emergency departments, and even mobile vans, and from various providers, including doctors, nurse practitioners, dentists, psychologists, and social workers.

Evidence shows that while private office-based primary care services are available to most adolescents, those services depend significantly on fee-based reimbursement and are not always accessible, acceptable, appropriate, or effective for some adolescents, particularly those who are uninsured or underinsured. Such young people often have difficulty gaining



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