poorly coordinated, and delivered in multiple public and private settings.

The committee also found that many adolescent health services and settings take a limited, problem-oriented approach and focus on care for certain health conditions or specific issues, thus failing to meet the broader needs and behavioral challenges that characterize adolescence. Because of this narrow focus, many providers of health services are poorly equipped to foster disease prevention and health promotion for adolescents. This is especially true in the areas of mental health, oral health, and substance abuse, as well as services that address sexual behavior and reproductive health.

Overall Conclusion 4: Health services for adolescents are poorly equipped to meet the disease prevention, health promotion, and behavioral health needs of all adolescents. Instead, adolescent health services are focused mainly on the delivery of care for acute conditions, such as infections and injuries, or special care addressing specific issues, such as contraception or substance abuse.

Adolescent Health System Supports

The committee was asked to explore the policies and mechanisms of support that promote high-quality health services for adolescents, as well as the barriers that impede optimal service provision. In doing so, the committee considered issues related to privacy and confidentiality, as well as health insurance.

Privacy and Confidentiality

Concerns about privacy and confidentiality may be a significant aspect of many adolescents’ interactions with health services. During screening and assessment, for example, sensitivity to stigma and bias may affect the adolescent patient’s willingness to trust and communicate with health professionals or return for follow-up care. As well, while professional guidelines for the practice of adolescent medicine stress the importance of privacy and confidentiality in interactions with adolescent patients, parents frequently receive information about their children’s health services. Many medical professionals recognize the importance of parents’ involvement in their adolescent children’s health care decisions. At the same time, however, privacy concerns influence adolescents’ willingness to seek services at all, their choice of provider, their candor in giving a health history, their willingness to accept specific services, and other important aspects of access to care. The committee found evidence showing that confidentiality increases



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