Index

A

Abortion rates, 92

Abortion rights, 180181

Acceptable health care, 5, 299

Access to care

access to adolescent medicine specialists, 145

adolescent perceptions, 38

challenges for adolescent subpopulations, 97

cost of care and, 267

dental care, 161

fragmentation of current health system as barrier to, 7, 300301

health insurance and, 8, 265, 266269, 274, 285286, 287, 288, 302

mental health services, 158

objectives for adolescent health system, 5, 299

population patterns and trends and, 6, 17

primary care, 135

provider participation in public insurance programs and, 285286

racial/ethnic disparities, 137, 177

recommendations for insurance system, 1213, 307308

right to confidential access, 180183

in rural areas, 3435

safety-net health services, 67, 136, 157, 300

shortcomings of current health system performance, 6, 299300

sources of medical care, 168172, 299300

specialty health services, 136137, 166, 300

Accidental injury

adolescent mortality, 53

health objectives for adolescents, 55

insurance coverage issues, 8, 302

mortality, 53, 6264

patterns and trends, 6

Adolescence, defined, 2, 23, 2527

Adolescent health status

adolescent self-perceptions, 54

adolescent subpopulations, 96115

current state, 1, 1718, 52, 54, 5560, 115, 296

definition, 89, 28, 52, 54, 302

determinants of, 34, 1819, 28, 4345, 5455

mortality and morbidity patterns and trends, 53

significance of, for adult health, 1, 34, 56, 1718, 44, 52, 54, 6061, 293, 297

socioeconomic status and, 35

See also Mental disorders;

Mortality



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Index A safety-net health services, 6–7, 136, 157, 300 Abortion rates, 92 shortcomings of current health system Abortion rights, 180–181 performance, 6, 299–300 Acceptable health care, 5, 299 sources of medical care, 168–172, Access to care 299–300 access to adolescent medicine specialists, specialty health services, 136–137, 166, 145 300 adolescent perceptions, 38 Accidental injury challenges for adolescent adolescent mortality, 53 subpopulations, 97 health objectives for adolescents, 55 cost of care and, 267 insurance coverage issues, 8, 302 dental care, 161 mortality, 53, 62–64 fragmentation of current health system patterns and trends, 6 as barrier to, 7, 300–301 Adolescence, defined, 2, 23, 25–27 health insurance and, 8, 265, 266–269, Adolescent health status 274, 285–286, 287, 288, 302 adolescent self-perceptions, 54 mental health services, 158 adolescent subpopulations, 96–115 objectives for adolescent health system, current state, 1, 17–18, 52, 54, 55–60, 5, 299 115, 296 population patterns and trends and, 6, definition, 8–9, 28, 52, 54, 302 17 determinants of, 3–4, 18–19, 28, 43–45, primary care, 135 54–55 provider participation in public mortality and morbidity patterns and insurance programs and, 285–286 trends, 53 racial/ethnic disparities, 137, 177 significance of, for adult health, 1, 3–4, recommendations for insurance system, 5–6, 17–18, 44, 52, 54, 60–61, 293, 12–13, 307–308 297 right to confidential access, 180–183 socioeconomic status and, 35 in rural areas, 34–35 See also Mental disorders; Mortality 2

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0 INDEX Adolescent perceptions and understanding standardized screening practices, 198 access to care, 38 strategies for improving adolescent data collection, 22, 38 health service system, 197–202, 203 demographic differences in, 38–39 substance use, 201–202 mental health services, 39 Asthma of parental involvement in health care, limitations in normal daily activities due 38 to, 66 privacy and consent for care issues, 38, prevalence, 53, 66, 67, 71 42–43 risk factors, 66–67 self-perceived health, 54 Attention-deficit hyperactivity disorder, 72, substance use treatment, 39 73, 74, 202 Alcohol use addiction risk, 90 B age at onset, 89–90 associated risks, 88, 89 Behavioral health in adolescence mortality, 89 advantages of safety-net health services, motor vehicle accidents and, 84–85 7, 136, 157, 300 outcomes of adolescent health- current adolescent health status, 53–54 compromising behavior, 54 developmental significance, 3–4, 17–18, patterns and trends, 6, 87–88, 89, 90 44, 52, 54, 60–61, 197, 211, 297 preventive interventions, 30, 212 goals for improving adolescent health risks among homeless adolescents, 102 services system, 196 significance of, in adolescent health, 53, health management strategies in primary 91 care, 202–204 treatment needs, 163–164 monitoring, 204 American Academy of Pediatrics, 198, 222 morbidity, 84 American Medical Association, 198 patterns and trends, 6 Anxiety and anxiety disorders, 53, 72, 73, primary care assessment, 144 77 primary care reimbursement, 143–144 Appropriate health care, 5, 299 protective factors, 212 Assessment of adolescent health rationale for early assessment and barriers for vulnerable subpopulations, intervention, 197 202 recommendations for adolescent care goals for improving adolescent health provider training, 12, 307 services system, 195–196, 231 recommendations for improving primary Guidelines for Adolescent Preventive health care, 9–10, 305 Services, 145, 198–199, 248 recommendations for monitoring health in primary care, 144, 199–201 care system performance, 14–15, privacy and confidentiality in, 202 309–310 public insurance coverage of screening risks, 24–25 services, 278 shortcomings of current health system recommendations for adolescent care performance, 5–6, 7, 301 provider training, 12, 307 significance of, in adolescent health recommendations for monitoring health system, 3, 43–44, 211, 297 care system performance, 14–15, See also Risky behavior 309–310 Bisexual adolescents. See Lesbian, gay, recommendations for research, 14, 309 bisexual, or transgender adolescents reimbursement, 201 Board certification in adolescent medicine, screening tools, 172, 174–175, 197–199 254 shortcomings of current health system, Body piercing, 84 8–9, 172–175, 303–304

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 INDEX Brain development, 25 Congenital anomalies, 64 Bullying behaviors, 87 Consent for care adolescent concerns, 42–43 adolescent utilization of health services C and, 178–179 current legal framework, 180–181 Cancer parental concerns, 42, 211 mortality, 64 policy formulation challenges, 42, 43 prevalence, 67–70 recommendations for, 11, 306 survival rate trends, 70 Consultation, specialty, 208 type distribution, 70 Contextual factors Case management determinants of adolescent health status, in community-based health centers, 3, 4, 18–19, 43–45, 54–55, 138, 297, 150–151 298 recommendations for health insurance recommendations for research, 14, 309 coverage, 13, 308 Continuing education for health providers, referral management, 208 255 Centers for Disease Control and Prevention, Contraception 253 adolescent patterns, 159 Chronic illness counseling, 159 associated conditions, 65 insurance coverage, 279, 280 causes in adolescence, 53 parental notification, 211 comorbidity, 65 right to access, 180 epidemiology, 65–66 Coordination of care implications for health care system, 66 adolescent primary care, 145, 146 mortality, 64 care management of specialty services, risks in foster care, 54, 98 206–207 See also Asthma; Cancer; Diabetes goals for improving adolescent health Community-based health centers services system, 194, 196 goals for improving adolescent health recommendations for improving, 9, services system, 195–196 10–11, 304, 305–306 innovative programs, 150, 226–228 regional approach to resource limitations, 151 management, 209 scope of services, 150 shortcomings of current system, 7, significance of, in adolescent health care 300–301 system, 150–151 strategies for improving adolescent Community-level public health interventions health service system, 206–207 disease prevention interventions in, 212 strengthening primary care–specialty recommendations for improving, 10–11, care linkages, 207–210 305–306 Correctional facilities, 35 significance of, in adolescent health, 4, Cost of care 44, 195, 298 access to care and, 267 youth development promotion, 218 chronic health conditions, 66 Comorbidity dental care expenditures, 266 mental disorders, 72 insurance cost sharing arrangements, patterns and trends, 6 285–286 special health care needs, 65 Medicaid cost-sharing requirements, 277 Competency domains, 249–251 mental health services, 282 Conduct disorder, 72, 73, 74–75 recommendations for health insurance Confidentiality and privacy. See Privacy and system, 13, 308 confidentiality

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2 INDEX D Development changes in adolescence, 24–25 Data collection developmental delays in foster care among homeless population, 99 children, 98–99 current health care system, 21–22 significance of adolescent experience recommendations for monitoring health for later development, 1, 3–4, 5–6, care system performance, 14–15, 17–18, 44, 52, 54, 60–61, 197, 211, 309–310 293, 296, 297 shortcomings of current health system, violent behavior risk, 85–86 8–9, 23, 294–295, 303–304 youth development promotion strategies, Definition of adolescence, 2, 23, 25–27 214–219 Definition of adolescent health status, 8–9, Diabetes 28, 296, 303 health outcomes in adulthood, 67 Dental care prevalence, 53, 67, 71 adolescent perceptions of access and Diet and nutrition quality, 38 adolescent consumption choices, 24–25 barriers to, 161 current adolescent intake, 94, 172 current adolescent health status, 53, current screening and counseling 79–82, 84 practice, 173 fragmentation of current health system food and beverage marketing, 31 as obstacle to, 7, 301 outcomes of adolescent health- insurance coverage and, 8, 265, 266, compromising behavior, 54 267–269, 271–272, 284–285, 302 risky eating behaviors, 94, 95 in juvenile justice system, 114 See also Obesity juvenile periodontitis, 83–84 Disease prevention linkage with primary care, 208–209 communication of behavioral health opportunities for health promotion in information, 211–213 dental practice, 161 fragmentation of current health system oral disease risk factors, 79 as obstacle to, 7, 300–301 parental educational attainment and, goals for improving adolescent health 162 services system, 196, 231 preventive interventions, 161, 214 insurance policies and practices and, 265 public insurance coverage, 277 in primary care settings, 145–146 recommendations for health insurance rationale, 172 coverage, 13, 308 recommendations for primary care, 10, recommendations for improving public 305 health system for adolescent care, in safety-net health services, 157 10–11, 305–306 shortcomings of current health system trauma risk, 84 performance, 7, 172–175, 301 trends, 82–83 strategies for improving, 211–214 unmet needs, 162 strengthening protective factors, 212 utilization, 161, 265, 269, 271–272 See also Health promotion; Preventive Depression interventions; Sexually transmitted among homeless adolescents, 103, 104 disease associated behaviors, 73, 74 current screening and counseling practice, 173 E pharmacotherapy, 202 Early adolescence prevalence, 72, 73–74 definition, 55 screening, 198 mortality patterns, 62 See also Mental disorders

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 INDEX Eating disorders, 75, 79, 110 recommendations for improving primary Education and training for health care care, 9, 304 professionals. See Provider education recommendations for research, 13–14, and training 309 Effective health services training grants, 251 family and adolescent participation and, Federal Interagency Forum on Child and 4, 298 Family Statistics, 14–15, 309–310 mental health services, 158 Fighting, 87 objectives for adolescent health system, Financial factors 5, 299 compensation for adolescent health care sexual and reproductive health clinics, specialists, 259 160 funding for adolescent care provider substance use treatment, 165 training programs, 12, 251, 253, 307 Electronic communication, 211–212, 224 funding for school-based health centers, Electronic health records 153–156 confidentiality, 223 recommendations for health insurance recommendations for, 10–11, 305–306 system, 13, 308 Emergency care recommendations for improving primary adolescent utilization, 6–7, 171, 300 health care, 10, 305 hospital-affiliated primary care and, 152 scope of, in adolescent health care, 4, shortcomings of current health system 44–45, 298 performance, 6–7, 300 strategies for improving immunization Equitable health care delivery, 5, 299 programs, 213 See also Cost of care Focus of adolescent health services, 7, 301 F Foster care system, adolescents in, 2–3, 35 abuse and neglect patterns, 97–98 Family health risks, 53, 54, 98–99 influence on adolescent health behavior, insurance coverage after departure, 272 38 mental health services, 73 one- and no-parent homes, 34 recommendations for health insurance parental involvement in adolescent care, coverage, 12–13, 307–308 confidentiality and, 221–222 recommendations for improving primary parental notification effects on health care, 9–10, 305 adolescent health care utilization, substance abuse risk, 163 178–179 See also Subpopulations of adolescents recommendations for adolescent Free time, 35–36 confidentiality and consent for care, 11, 306 role in preventive intervention, 212 G significance of, in adolescent health, 4, 44, 298 Gay adolescents. See Lesbian, gay, bisexual, Family medicine as model for adolescent or transgender adolescents care, 19 Gender differences Family planning services, 160, 279–280 adolescent health behaviors and Federal government attitudes, 38–39 confidentiality laws, 181–182 board certifications in adolescent recommendations for confidentiality and medicine, 254 consent policies in adolescent health demographic and population patterns, care, 11, 306 32, 35 recommendations for health insurance diabetes prevalence, 67 system, 12–13, 307–308 health care utilization, 171

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 INDEX mental disorder risk, 72–73, 74, 75 current models of care, 6–7, 19, 300 mortality patterns, 62 data sources on current state, 21–23 physical activity, 96 determinants of adolescent health status, seat belt use, 85 18–19, 28 sexual and reproductive health service family factors, 4, 298 utilization, 158–160 financial factors, 4, 298 sexually transmitted disease patterns, focus, 7, 301 77–78 objectives, 4–5, 138–140, 298–299 substance use, 76 perceptions and attitudes, 37–41 suicidal behavior or ideation, 77 policy factors, 4, 298 Group homes, 35 rationale for improving, 15, 310 Guidelines for Adolescent Preventive recommendations for improving, 10–11, Services, 145, 198–199, 248 305–306 recommendations for research, 13–14, 309 H research needs, 19–20, 294–295 safety-net services, 136 Health Insurance Portability and salient issues, 2, 20–21, 293–294 Accountability Act, 181–182 scope of settings and services, 3, 28–29, Health promotion 37, 299 conceptual evolution in adolescent sectors, 140–142 medicine, 37 shortcomings of current system, 1, 6–9, in dental and oral health care, 161 15, 18–19, 142, 293, 299–304, 310 fragmentation of current health system specialty care services, 136–137 as obstacle to, 7, 300–301 See also Improving adolescent health goals for improving adolescent health services system; Provider education services system, 196, 231 and training participants, 210 Healthy People 2010 objectives, 6, 55, 145, in primary care settings, 145–146, 147 196, 296 print and electronic resources for, Heart disease, 64 210–211 HIV/AIDS, 78, 101, 111 rationale, 172, 195 Homeless population, 2–3, 35 recommendations for monitoring health alcohol and substance use, 102 care system performance, 14–15, associated health risks, 99–100 309–310 data collection challenges, 99 recommendations for primary care, 10, mental health, 103–104 305 patterns and trends, 99 in safety-net health services, 157 physical and sexual abuse risk, 100 shortcomings of current health system recommendations for improving primary performance, 7, 137, 172–175, 301 health care, 9–10, 305 significance of intervention in risks for lesbian, gay, bisexual, or adolescence, 3–4, 17–18, 54, transgender adolescents in, 104–105 297–298 sexual activity and health, 100–102 strategies for improving adolescent See also Subpopulations of adolescents health service system, 210–212 Homicide Health system, adolescent care in access to weapons and, 86 behavioral and contextual framework, mortality, 53, 62, 64, 65 3–4, 43–45, 137–138, 297–298 victimization patterns, 87 community factors, 4, 298 Hospital-affiliated primary care, 151–152 conceptual and technical evolution, innovative programs for adolescent care, 36–37 228–229

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5 INDEX I mental health and substance abuse treatment insurance coverage, Immigrants, 2–3, 35, 105–107 281–283 access to care, 18 specialized units for adolescents, 167 insurance coverage disparities, 269–271, treatment teams, 167 272 Institutionalized adolescents insurance coverage patterns, 8, 302 population characteristics, 35 population patterns, 33 settings, 35 public insurance eligibility, 274 substance abuse risk, 163 recommendations for improving primary Insurance health care, 9–10, 305 age distribution of coverage patterns See also Subpopulations of adolescents among adolescents and young adults, Immunization. See Vaccination and 273, 288 immunization barriers to health care access, 8, 265, Improving adolescent health services system 266–269, 274, 285–286, 287, 288, care management of specialty services, 302 206–207 confidentiality protection, 223, 287 community role, 4, 195, 298 cost sharing, 285–286, 287 consideration of special needs and coverage patterns and trends, 8, 265, vulnerable populations, 9–10, 194, 269–272, 276–285, 288, 302 305 current sources and benefit plans, coordination of care, 194, 206–207, 276–278 231 definition of adolescence for, 26–27 family role, 4, 195, 298 dental services coverage, 284–285 goals, 194, 195–196, 231 eligibility, 272–273 health information technology, 223–225 employment characteristics and, health management strategies in primary 269–271, 272–273 care, 202–204 failure of eligible adolescents to enroll in immunization programs and policies, public programs, 8, 265, 273–276, 302 213–214 health risks related to lack of, 8, 265, implementation of strategies for, 266, 302 231–232 inpatient pregnancy expenses, 168 innovative programs, 225–231 mental health and substance abuse linkages between primary and specialty treatment coverage, 158–159, care, 207–210 280–284 participation and engagement for, 4, preventive services coverage, 278–279, 195, 298 286–287 personalized health services, 225 recent reform proposals, 42 prevention and health promotion, 194, recommendations for improving health 195, 210–212, 231 care system, 12–13, 307–308 privacy and confidentiality issues, 194 sexual and reproductive health services provider training, 255–258 coverage, 279–280 rationale, 1, 15, 18, 194–195, 293, 310 shortcomings of current health system, recommendations for, 9–15, 304–310 7, 18, 265, 276, 278, 287, 288, 300 referral practice, 204–206, 207–208 source of medical care and, 169–170 research needs, 232 strategies for increasing coverage, screening and assessment, 197–202, 203, 275–276 231 Internet youth development promotion, 214–219 harassment via, 87 Inpatient hospital care online health services, 224–225 adolescent utilization, 167–168 resources for medical education, 256–257

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 INDEX J M Juvenile justice system, adolescents in, 2–3, Managed care 35 adolescent utilization, 169 health risks, 53–54, 113, 114 carve outs, 205–206 mental disorder risk among, 113–114 confidentiality concerns, 287 mental health services, 73 recommendations for improving public population patterns, 113–114 health system for adolescent care, recommendations for health insurance 10–11, 305–306 coverage, 12–13, 307–308 Maternal and Child Health Block Grant, recommendations for improving primary 181 health care, 9–10, 305 Maternal and Child Health Bureau, 252, substance abuse risk, 163 258 victimization risk, 114 Medicaid See also Subpopulations of adolescents confidentiality of adolescent health care, 181, 287 coordination of care, 174 L cost-sharing requirements, 277, 285 covered services, 276–277, 278–280, Leadership Education in Adolescent Health, 281, 284 12, 307 current shortcomings in adolescent Lesbian, gay, bisexual, or transgender health care, 42 adolescents, 2–3, 173 eligibility, 272, 274 eating disorders among, 110 failure of eligible adolescents to enroll health-related data, 109 in, 273–276 in homeless population, 104–105 physician reimbursement, 285–286 population patterns, 108–109 pregnancy care, 168, 272 psychosocial stressors, 111 preventive care reimbursement, 287 recommendations for improving primary provider participation, 285–286 health care, 9–10, 305 recommendations, 12–13, 307–308 research challenges, 108 settings for adolescent medical care and, sexual health risks, 111 169 social stigma, 107–108 Mental disorders special issues for transgender teens, age of onset, 72, 77 112 among adolescents in juvenile justice substance abuse, 110 system, 113–114 suicidal behavior or ideation, 109–110 comorbidity, 72 violence victimization risk, 111 definition and clinical conceptualization, See also Subpopulations of adolescents 71 Licensing, certification and accreditation prevalence, 71–72, 73, 74, 75, 77, 157 adolescent medicine board certification, risk factors, 72–73 254 risk in adolescence, 53, 54 continuing education requirements, risks among homeless adolescents, 255 103–104 inconsistency in national system of, 260 risks in foster care, 98, 99 recommendations for, 11–12, 306–307 See also Mental health services; specific shortcomings of current system, 240, disorders 252, 260 Mental health services strategies for improving adolescent adolescent perceptions, 39 health care system, 255–256 confidentiality concerns of adolescents, 179

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7 INDEX N effectiveness, 158 evolution of costs and reimbursement, National Adolescent Health Information 282 Center, 257 fragmentation of current health system, National Initiative to Improve Adolescent 7, 301 Health, 29–30 inpatient hospitalization, 168 Nurses, 247–248 insurance and reimbursement, 8, 157–158, 280–284, 286, 302 online, 224–225 O primary care reimbursement, 143–144 public insurance coverage, 277, 286 Obesity racial differences in service delivery in adulthood, 94 settings, 73 associated health risks, 93, 94 recommendations for health insurance associated psychosocial risks, 93 coverage, 13, 308 current screening and counseling recommendations for improving public practice, 173 health system for adolescent care, electronic entertainment and, 35–36 10–11, 305–306 health management strategies in primary in schools, 206 care, 203 screening, 172–173 insurance coverage issues, 8, 302 shortcomings of current health system, objectives for adolescent health, 55 7, 158, 172–173, 301 patterns and trends, 6, 53, 93–94, 95 specialty consultation approach, 208 prevention, 30–31 substance abuse risk, 163 Objectives for adolescent health system, unmet needs, 158 4–5, 6, 135, 298–299 workforce, 157 application, 139 See also Mental disorders; Specialty care components, 138–140 services framework for evaluation of adolescent Models of care, 6–7, 19–20, 36–37, 300 health service models, 195 criteria for evaluating, 195 recommendations for health insurance Mortality coverage, 13, 308 adolescent risk, 53 recommendations for research agenda, in adulthood, adolescent health-related 13–14, 309 behaviors and, 54 shortcomings of current health system causes, 53, 62–64, 65, 172 performance, 55 patterns and trends, 6, 62–65 shortcomings of current service delivery Motivational interviewing, 203 models, 6–7, 296, 299–300 Motor vehicle accidents Office of Technology Assessment, 29 adolescent mortality, 53 Oral health. See Dental care alcohol use and, 84–85 causes of risky driving, 84 injury outcomes, 53 P mortality, 62, 65, 84 Parental educational attainment, dental objectives for adolescent health, 55 health and, 162 patterns and trends, 6 Pediatric care, 19 prevention strategies, 31 Perceptions and attitudes about adolescent seat belt use and, 85 health sleepiness as cause of, 85 adolescents’, 22, 38–39, 136 adolescents’ self-perceived health status, 54

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 INDEX data sources, 22 associated risks, 91 health care providers, 40–41 consent for care and confidentiality laws, historical evolution, 23–24 180 parents’ perspectives, 39–40 fetal loss rates, 92–93 perceptions of drug use, 90 health objectives for adolescents, 55 significance of, 37–38 incidence, 91 Personalized health services, 225 inpatient hospital utilization, 167–168 Pharmacists, 41 insurance reimbursement, 168 Pharmacotherapy oral disease risk and, 79 cost of medications as barrier to, 267 patterns and trends, 6, 53, 91–92 medication management, 202–203 risks among homeless, 101, 102 Physical activity Preventive interventions electronic entertainment and, 35–36 current insurance coverage and health and, 95 reimbursement, 278–279, 286–287 objectives for adolescent health, 55 disincentives for insurance providers, outcomes of adolescent health- 286–287 compromising behavior, 54 health management strategies in primary patterns and trends, 6, 95–96 care, 203 PIPPAH, 258 interaction and coordination among Policy making social service sectors, 174 privacy and confidentiality issues, 42, rationale, 195 43, 302 recommendations for health insurance recommendations for improving coverage, 13, 308 adolescent health care, 10–11, screening and assessment, 197–202 305–306 seat belt use, 85 shortcomings of current policy shortcomings of current health system environment, 41–42 performance, 137 significance of, in adolescent health care, See also Disease prevention; Health 4, 45, 298 promotion taxes to discourage alcohol and tobacco Primary care consumption, 212 adolescent medicine specialists, 144–145 See also Federal government; State behavioral health assessment and government monitoring, 144, 204 Poor families, 2–3 in community-based health centers, access to care, 6, 17, 18, 33–34, 97 150–151 chronic health condition risk, 65–67 goals for improving adolescent health insurance coverage, 8, 265, 275–276, services system, 195–196, 231 302 health management strategies, 202–204 Medicaid cost-sharing requirements, 277 hospital-affiliated, 151–152 population patterns, 34 medication management, 202–203 racial/ethnic patterns, 6, 34, 296 private office-based, 143–147 recommendations for health insurance provider–patient relationship in, coverage, 13, 308 203–204 recommendations for improving primary recommendations for improving, 9–10, health care, 9–10, 305 305 See also Socioeconomic status recommendations for research, 14, 309 Population-based health care delivery, 210 referrals to specialty care, 204–206, Population patterns and trends, 6, 17, 207–208 32–33, 34–35, 97, 296 reimbursement, 143–144, 145, 146, 201 Pregnancy, dental care in, 272 safety-net programs, 143–147 Pregnancy in adolescence school-based, 152–156 abortion rates, 92 scope of services, 142, 143

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 INDEX settings for, 143 importance of, for adolescent health care shortcomings of current health system system, 4, 44, 240–241, 261, 298 performance, 6, 18, 135, 145–147 innovative programs, 240, 256–258 specialty care linkages, 142, 157, interdisciplinary programs, 12, 252–253, 207–210 307 strategies for improving adolescent leadership programs, 252–253 health services system, 199–201, 231 levels of expertise in adolescent Privacy and confidentiality medicine, 245–246 adolescent candor and, 178 master degree programs, 255 adolescent concerns, 38, 42–43 patient simulations, 256 adolescent utilization of health services postresidency fellowships, 253–254 and, 177–179, 219, 220, 300–301 primary care physicians, 144–145 adult protections, 219 provider attitudes and beliefs, 41, conceptual approaches to adolescent 246–248 care, 219–220 recommendations for, 11–12, 306–307 consent for care law and, 180–181 recommendations for research, 14, 309 electronic health records and, 223 for screening and counseling, 174 insurance issues, 223, 287 shortcomings of current health system, legal framework, 181–183, 219 8, 240, 241, 244, 246–248, 249, parental concerns, 42 258, 302–303 parental involvement in adolescent care, for specialty care services, 167 221–222 substance abuse treatment, 164–165 policies of health care professional train-the-trainer programs, 256–257 organizations, 222 See also Licensing, certification and policy issues, 42, 43, 302 accreditation provider attitudes and beliefs, 43, 219, Provider–patient relationship 301 adolescent primary care, 145 provider communication with adolescents’ confidentiality beliefs and, adolescent, 220 177–178 recommendations for, 11, 306 clinical significance, 203–204 sexual and reproductive health service confidentiality discussions, 220 utilization and, 160 participation and engagement, 4, 195, significance of, in adolescent health care, 298 137, 183, 219, 301–302 provider perception, 41 Protective factors, 212 recommendations for adolescent care Provider education and training provider training, 12, 307 adolescent medicine specialists, 144–145, Provider performance measurement 252–255 primary care services, 10, 305 certification standards, 255–256 recommendations for monitoring health challenges, 258–261 care system performance, 14–15, competency domains, 249–251 309–310 conceptual evolution, 243–244 recommendations for research, 13–14, continuing education, 255 309 current models, 252–256 standards and guidelines, 248 doctoral programs, 255 See also Licensing, certification and economic disincentives, 259 accreditation funding for training programs, 12, 251, Psychosocial functioning 253, 307 changes in adolescence, 24, 25 future demand and supply, 244–245 dating violence, 86–87 goals, 241, 261 individual differences in adolescents, 41

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0 INDEX risks for lesbian, gay, bisexual, or quality of care and, 137 transgender adolescents, 107–108, recommendations for improving primary 111 health care, 9–10, 305 See also Mental disorders; Mental health sexual and reproductive health service services utilization, 159 sexually transmitted disease patterns, 77–78, 79 Q suicidal behavior or ideation, 77 tobacco use, 89 Quality of care violent crime victimization, 87 adolescent primary care, obstacles to, See also Subpopulations of adolescents 145 Referrals impediments to, in current adolescent goals for improving adolescent health health system, 18–19 services system, 195–196 insurance and, 8, 265, 302 strategies for improving, 204–206, racial/ethnic disparities, 137 207–208 in safety-net settings, 7, 300 substance abuse, from schools, 162–163 U.S. health system, 31 Regional resource management, 209 Reimbursement care management, 206 R immunization policies, 213 mental health services, 157–158 Race/ethnicity preventive care, 287 access to care and, 6, 17, 18, 33, 97, private office-based primary care, 137, 296 143–144, 145, 146 adolescent health status patterns and provider participation in public trends, 53 insurance programs and, 285–286 adolescent pregnancy, 53, 91, 92–93 recommendations for health insurance alcohol and substance use and, 76, 85, system, 13, 308 90 for screening and counseling, 174, 201 asthma prevalence, 66 Research cancer incidence and survival, 70 current shortcomings, 19–20, 294–295 diabetes prevalence, 67 for improving adolescent health services disparities in health care delivery, system, 232 177–178 notable past work, 29–31 insurance coverage patterns and recommendations for, 13–14, 309 disparities, 8, 265, 269–271, 272, recommendations for monitoring health 302 care system performance, 14–15, mental disorder risk, 73 309–310 mental health service delivery settings, See also Data collection 73 Risky behavior mortality patterns, 62, 64 adolescent morbidity, 53 obese and overweight patterns in assessment, 201–202 adolescence, 93 comorbidity risk, 6 oral health care needs, 79–82, 83, 162 current screening and counseling parental attitudes toward sexual practice, 173 behavior and sexual health, 40 health management strategies in primary physical activity patterns, 96 care, 202–204 population patterns and trends, 6, 17, morbidity, 84 32–33, 97, 296 normal adolescent development and, 24, poverty and, 6, 34, 296 25 provider workforce diversity, 242–243

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 INDEX oral disease risk, 79 significance of, in adolescent health care primary care intervention, 147 syste, 152 rationale for early identification and sponsors, 153 intervention, 197 strengths and weaknesses, 6–7, 299–300 scope of, 53, 115 substance abuse referrals from, 162–163 screening strategies, 197–201 School-based insurance coverage, 276 significance of, in adolescent health, 3–4, Sex education, 40, 158 5–6, 17–18, 52, 54, 91, 115, 172, Sexual abuse risk for homeless adolescents, 197, 211, 296, 297 100 unsupervised nonschool hours and, 35 Sexual and reproductive health See also Alcohol use; Behavioral health adolescent utilization of health services, in adolescence; Sexually transmitted 158–160 disease; Substance abuse among lesbian, gay, bisexual, or Rural areas transgender adolescents, 111 access to care, 34, 97 current insurance coverage, 279–280 agricultural workers, 106–107 current screening and counseling obese and overweight patterns in practice, 173 adolescence, 93–94 dating violence, 86–87 physical activity patterns in, 96 effectiveness of clinic services, 160 population patterns and trends, 34–35, family influences on adolescent health 97 behavior, 38 fragmentation of current health system, 7, 301 S guidance and counseling, 158 information technology, 224 Safety-net providers objectives for adolescent health, 55 advantages of, in adolescent care, 7, outcomes of adolescent health- 136, 156–157, 300 compromising behavior, 54 community-based health centers, parental attitudes and perceptions, 40 150–151 primary care reimbursement, 143–144 current research base, 147 privacy concerns of adolescents, 160, definition and characteristics, 147 178–179 quality of care, 7, 156, 300 public insurance coverage, 277 recommendations for improving, 9, 304 recommendations for health insurance scope of care settings, 147 coverage, 13, 308 shortcomings of current health system recommendations for improving public performance, 6–7, 299–300 health system for adolescent care, significance of, in adolescent health care 10–11, 305–306 system, 7, 156, 300 right to access to health care, 180–181 School-based health centers risks among homeless adolescents, characteristics, 153 100–102 clients, 152 risks for lesbian, gay, bisexual, or funding, 153–156 transgender adolescents, 105 in innovative integrated health risky behaviors, 77 programs, 226–227 sexual activity of adolescents, 40, 77 mental health services, 206 shortcomings of current health system number of, 152 performance, 7, 301 quality of care, 7, 300 Sexually transmitted disease rationale, 152, 153 consent for care and confidentiality laws, services, 153 180

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2 INDEX current insurance coverage for screening, provider preparation for, 167 279, 280 purpose, 142 patterns and trends among adolescents, recommendations for improving, 9, 304 53, 77–79 regional resource management, 209 risk, 77 scope of, for adolescent care, 242 risk for adolescents in juvenile justice service agreements, 209 system, 114 shortcomings of current system, risks among homeless adolescents, 100, 166–167 101–102 strategies for improving referral practice, risks for lesbian, gay, bisexual, or 204–206, 207–208 transgender adolescents, 111 See also Dental care; Mental health screening for, 198 services; Sexual and reproductive Single-parent families, 34, 38 health; Substance abuse treatment Sleep patterns, 85 Standards of care Society for Adolescent Medicine, 210–211, competency domains, 249–251 213, 222 provider implementation and adherence, Sociocultural context 248–249 perception and status of adolescents, recommendations for, 13–14, 309 23–24 screening practices, 198 significance of, in health care delivery, State Children’s Health Insurance Program 28 confidentiality of adolescent health care, Socioeconomic status 181, 287 adolescent health status and, 35 covered services, 277, 279, 280, emergency department admissions and, 281–283, 284–285 168 current shortcomings in adolescent insurance coverage patterns and health care, 42 disparities, 8, 269–271, 272, 302 dental care coverage, 267 insurance eligibility, 272–273, 274–275 eligibility, 272, 274 mental disorder risk, 72 failure of eligible adolescents to enroll mortality patterns, 64 in, 273–276 significance of, as adolescent health provider participation, 285–286 factor, 4, 298 recommendations for, 12–13, 307–308 See also Poor families reimbursement rates, 169 Solution-focused interviewing, 203 State government Special health care needs, 65. See also confidentiality laws, 182–183 Chronic illness interaction and coordination among Specialists, adolescent medicine, 144–145 social service sectors, 174 Specialty care services recommendations for health insurance access, 136–137, 166, 300 system, 12–13, 307–308 adolescent medicine board certification, recommendations for improving primary 254 care, 9, 304 adolescent perceptions, 136 Subpopulations of adolescents care management, 206–207 advantages of school-based health care competency domains, 250–251 delivery, 153 consultation, 208 barriers to assessment, 202 directories, 205 comorbidity risk, 6, 296 economic disincentives for adolescent goals for improving adolescent health health care specialists, 259 services system, 196 goals for improving adolescent health insurance coverage disparities, 269–271 services system, 196 population patterns, 35 primary care and, 142, 157, 207–210 primary care services, 146

OCR for page 329
 INDEX public perceptions and attitudes, 37 confidentiality concerns of adolescents, recommendations for adolescent care 179 provider training, 12, 307 consent for care and confidentiality laws, recommendations for health insurance 180 system, 12–13, 307–308 current insurance coverage, 280–284 recommendations for improving primary effectiveness, 165–166 health care, 9–10, 305 fragmentation of current health system recommendations for monitoring health as obstacle to, 7, 301 care system performance, 14–15, insurance coverage issues, 8, 302 309–310 need, 163–164 safety-net health care, 150 outcome indicators, 164 scope, 2–3, 27 public insurance coverage, 277 special needs and vulnerabilities, 4, 6, recommendations for health insurance 18, 27, 52, 96–97, 296, 298 coverage, 13, 308 unmet oral health needs, 162 recommendations for improving public See also Foster care system, adolescents health system for adolescent care, in; Homeless population; Immigrants; 10–11, 305–306 Juvenile justice system, adolescents relapse risk, 165–166 in; Lesbian, gay, bisexual, or schools as referral sources, 162–163 transgender adolescents; Poor shortcomings of current system, families 164–165 Substance abuse See also Specialty care services; among adolescents in juvenile justice Substance abuse system, 113–114 Suicidal behavior or ideation among lesbian, gay, bisexual, or access to weapons and, 86 transgender adolescents, 110 alcohol use and, 89 associated risks, 88 among lesbian, gay, bisexual, or clinical disorders, 75–76 transgender adolescents, 109–110 current screening practice, 173 depression and, 73 depression and, 74 mortality, 53, 62, 65, 77 health management strategies in primary prevalence, 77 care, 203 risks among homeless adolescents, 104 mental disorder risk, 72 screening for, 198 outcomes of adolescent health- compromising behavior, 54 T patterns and trends, 76, 87, 90–91 racial/ethnic differences in emergency Technology, health information, 10–11, room screening, 176 223–225, 305–306 risk in institutional settings, 163 Text messaging, 211–212, 224 risks among homeless adolescents, 102, Time use patterns, adolescent, 35–36 103 Title X, 181 risks in foster care, 98 Tobacco use screening and assessment, 198, dependency, 76 201–202 health consequences, 89 significance of, as adolescent health risk, mortality, 54, 88 53, 91 oral disease risk, 79 See also Substance abuse treatment patterns and trends, 6, 88, 89, 172 Substance abuse treatment secondhand smoke exposure, 88–89 adolescent attitudes and perceptions, 39 significance of, in adolescent health, 53, adolescent-specific provider certification, 91 164–165 strategies for discouraging, 212

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 INDEX Training and education for health care Violent behavior professional. See Provider education adolescent victims, 86–87, 105 and training dating violence, 86–87 Transgender adolescents. See Lesbian, gay, developmental patterns, 85–86 bisexual, or transgender adolescents victimization risk for lesbian, gay, bisexual, or transgender adolescents, 111 U See also Homicide U.S. Preventive Services Task Force, 199 Utilization of health care resources W confidentiality concerns of adolescents and, 177–179, 219, 220, 300–301 Weapons access and use, 53, 86 emergency care, 6–7, 171, 300 Workforce, health care insurance coverage and, 8, 265, 266, current structure and capacity, 242–246 267–269, 272, 285, 302 diversity rationale, 242–243 sources of care, 168–172, 299–300 need for multidisciplinary approach to adolescent care, 242, 249 shortcomings of current system, 240 V supply concerns, 244–245 See also Provider education and training Vaccination and immunization, 143, 213–214, 278–279