the acceptability of services and the willingness of adolescents to seek them, especially for issues related to sexual behavior, reproductive health, mental health, and substance use. The committee concluded that existing state and federal policies generally protect the confidentiality of adolescents’ health information when they are legally allowed to consent to their own care, and that it is critical that any efforts to improve health systems for adolescents ensure continued consent and confidentiality for adolescents seeking care.

The committee found that financial support for health services is fundamental to promoting adolescents’ engagement with, access to, and use of these services. More than 5 million adolescents aged 10–18 are uninsured. Uninsured rates are higher among the poor and near poor, racial and ethnic minorities, and noncitizens. As is true for all Americans, uninsured adolescents are less likely to have a regular source of primary care and use medical and dental care less often than those who have insurance. Having health insurance, however, does not ensure adolescents’ access to affordable, high-quality services given current shortages of health care providers and problems associated with high out-of-pocket cost-sharing requirements, limitations in benefit packages, and low provider reimbursement levels, especially in areas that involve counseling or case management of multiple health conditions. For example, the current system of health insurance coverage is often limited or nonexistent for treatment and prevention in areas that are particularly problematic for adolescents, such as obesity, intentional and unintentional injury, mental health, dental care, and substance abuse. Furthermore, uninsured adolescents aged 10–18 who are eligible for public coverage often are not enrolled either because their parents do not know they are eligible or because complexities of the enrollment processes deter participation.

The committee was asked to consider the elements of health provider training necessary to improving the quality of health services for adolescent populations. The committee found that whether providers report on their own perceptions of their competencies or adolescents describe the care they have received, data reveal significant gaps in the achievement of