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Index
A
Abortion rates, 92
Abortion rights, 180–181
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, 300–301
health insurance and, 8, 265, 266–269, 274, 285–286, 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, 285–286
racial/ethnic disparities, 137, 177
recommendations for insurance system, 12–13, 307–308
right to confidential access, 180–183
in rural areas, 34–35
safety-net health services, 6–7, 136, 157, 300
shortcomings of current health system performance, 6, 299–300
sources of medical care, 168–172, 299–300
specialty health services, 136–137, 166, 300
Accidental injury
adolescent mortality, 53
health objectives for adolescents, 55
insurance coverage issues, 8, 302
mortality, 53, 62–64
patterns and trends, 6
Adolescence, defined, 2, 23, 25–27
Adolescent health status
adolescent self-perceptions, 54
adolescent subpopulations, 96–115
current state, 1, 17–18, 52, 54, 55–60, 115, 296
definition, 8–9, 28, 52, 54, 302
determinants of, 3–4, 18–19, 28, 43–45, 54–55
mortality and morbidity patterns and trends, 53
significance of, for adult health, 1, 3–4, 5–6, 17–18, 44, 52, 54, 60–61, 293, 297
socioeconomic status and, 35
See also Mental disorders;
Mortality
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Adolescent perceptions and understanding
access to care, 38
data collection, 22, 38
demographic differences in, 38–39
mental health services, 39
of parental involvement in health care, 38
privacy and consent for care issues, 38, 42–43
self-perceived health, 54
substance use treatment, 39
Alcohol use
addiction risk, 90
age at onset, 89–90
associated risks, 88, 89
mortality, 89
motor vehicle accidents and, 84–85
outcomes of adolescent health-compromising behavior, 54
patterns and trends, 6, 87–88, 89, 90
preventive interventions, 30, 212
risks among homeless adolescents, 102
significance of, in adolescent health, 53, 91
treatment needs, 163–164
American Academy of Pediatrics, 198, 222
American Medical Association, 198
Anxiety and anxiety disorders, 53, 72, 73, 77
Appropriate health care, 5, 299
Assessment of adolescent health
barriers for vulnerable subpopulations, 202
goals for improving adolescent health services system, 195–196, 231
Guidelines for Adolescent Preventive Services, 145, 198–199, 248
in primary care, 144, 199–201
privacy and confidentiality in, 202
public insurance coverage of screening services, 278
recommendations for adolescent care provider training, 12, 307
recommendations for monitoring health care system performance, 14–15, 309–310
recommendations for research, 14, 309
reimbursement, 201
screening tools, 172, 174–175, 197–199
shortcomings of current health system, 8–9, 172–175, 303–304
standardized screening practices, 198
strategies for improving adolescent health service system, 197–202, 203
substance use, 201–202
Asthma
limitations in normal daily activities due to, 66
prevalence, 53, 66, 67, 71
risk factors, 66–67
Attention-deficit hyperactivity disorder, 72, 73, 74, 202
B
Behavioral health in adolescence
advantages of safety-net health services, 7, 136, 157, 300
current adolescent health status, 53–54
developmental significance, 3–4, 17–18, 44, 52, 54, 60–61, 197, 211, 297
goals for improving adolescent health services system, 196
health management strategies in primary care, 202–204
monitoring, 204
morbidity, 84
patterns and trends, 6
primary care assessment, 144
primary care reimbursement, 143–144
protective factors, 212
rationale for early assessment and intervention, 197
recommendations for adolescent care provider training, 12, 307
recommendations for improving primary health care, 9–10, 305
recommendations for monitoring health care system performance, 14–15, 309–310
risks, 24–25
shortcomings of current health system performance, 5–6, 7, 301
significance of, in adolescent health system, 3, 43–44, 211, 297
See also Risky behavior
Bisexual adolescents. See Lesbian, gay, bisexual, or transgender adolescents
Board certification in adolescent medicine, 254
Body piercing, 84
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Brain development, 25
Bullying behaviors, 87
C
Cancer
mortality, 64
prevalence, 67–70
survival rate trends, 70
type distribution, 70
Case management
in community-based health centers, 150–151
recommendations for health insurance coverage, 13, 308
referral management, 208
Centers for Disease Control and Prevention, 253
Chronic illness
associated conditions, 65
causes in adolescence, 53
comorbidity, 65
epidemiology, 65–66
implications for health care system, 66
mortality, 64
risks in foster care, 54, 98
See also Asthma;
Cancer;
Diabetes
Community-based health centers
goals for improving adolescent health services system, 195–196
innovative programs, 150, 226–228
limitations, 151
scope of services, 150
significance of, in adolescent health care system, 150–151
Community-level public health interventions
disease prevention interventions in, 212
recommendations for improving, 10–11, 305–306
significance of, in adolescent health, 4, 44, 195, 298
youth development promotion, 218
Comorbidity
mental disorders, 72
patterns and trends, 6
special health care needs, 65
Competency domains, 249–251
Conduct disorder, 72, 73, 74–75
Confidentiality and privacy. See Privacy and confidentiality
Congenital anomalies, 64
Consent for care
adolescent concerns, 42–43
adolescent utilization of health services and, 178–179
current legal framework, 180–181
parental concerns, 42, 211
policy formulation challenges, 42, 43
recommendations for, 11, 306
Consultation, specialty, 208
Contextual factors
determinants of adolescent health status, 3, 4, 18–19, 43–45, 54–55, 138, 297, 298
recommendations for research, 14, 309
Continuing education for health providers, 255
Contraception
adolescent patterns, 159
counseling, 159
insurance coverage, 279, 280
parental notification, 211
right to access, 180
Coordination of care
adolescent primary care, 145, 146
care management of specialty services, 206–207
goals for improving adolescent health services system, 194, 196
recommendations for improving, 9, 10–11, 304, 305–306
regional approach to resource management, 209
shortcomings of current system, 7, 300–301
strategies for improving adolescent health service system, 206–207
strengthening primary care–specialty care linkages, 207–210
Correctional facilities, 35
Cost of care
access to care and, 267
chronic health conditions, 66
dental care expenditures, 266
insurance cost sharing arrangements, 285–286
Medicaid cost-sharing requirements, 277
mental health services, 282
recommendations for health insurance system, 13, 308
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D
Data collection
among homeless population, 99
current health care system, 21–22
recommendations for monitoring health care system performance, 14–15, 309–310
shortcomings of current health system, 8–9, 23, 294–295, 303–304
Definition of adolescence, 2, 23, 25–27
Definition of adolescent health status, 8–9, 28, 296, 303
Dental care
adolescent perceptions of access and quality, 38
barriers to, 161
current adolescent health status, 53, 79–82, 84
fragmentation of current health system as obstacle to, 7, 301
insurance coverage and, 8, 265, 266, 267–269, 271–272, 284–285, 302
in juvenile justice system, 114
juvenile periodontitis, 83–84
linkage with primary care, 208–209
opportunities for health promotion in dental practice, 161
oral disease risk factors, 79
parental educational attainment and, 162
preventive interventions, 161, 214
public insurance coverage, 277
recommendations for health insurance
coverage, 13, 308
recommendations for improving public health system for adolescent care, 10–11, 305–306
trauma risk, 84
trends, 82–83
unmet needs, 162
utilization, 161, 265, 269, 271–272
Depression
among homeless adolescents, 103, 104
associated behaviors, 73, 74
current screening and counseling practice, 173
pharmacotherapy, 202
prevalence, 72, 73–74
screening, 198
See also Mental disorders
Development
changes in adolescence, 24–25
developmental delays in foster care children, 98–99
significance of adolescent experience for later development, 1, 3–4, 5–6, 17–18, 44, 52, 54, 60–61, 197, 211, 293, 296, 297
violent behavior risk, 85–86
youth development promotion strategies, 214–219
Diabetes
health outcomes in adulthood, 67
prevalence, 53, 67, 71
Diet and nutrition
adolescent consumption choices, 24–25
current adolescent intake, 94, 172
current screening and counseling practice, 173
food and beverage marketing, 31
outcomes of adolescent health-compromising behavior, 54
risky eating behaviors, 94, 95
See also Obesity
Disease prevention
communication of behavioral health information, 211–213
fragmentation of current health system as obstacle to, 7, 300–301
goals for improving adolescent health services system, 196, 231
insurance policies and practices and, 265
in primary care settings, 145–146
rationale, 172
recommendations for primary care, 10, 305
in safety-net health services, 157
shortcomings of current health system performance, 7, 172–175, 301
strategies for improving, 211–214
strengthening protective factors, 212
See also Health promotion;
Preventive interventions;
Sexually transmitted disease
E
Early adolescence
definition, 55
mortality patterns, 62
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Eating disorders, 75, 79, 110
Education and training for health care professionals. See Provider education and training
Effective health services
family and adolescent participation and, 4, 298
mental health services, 158
objectives for adolescent health system, 5, 299
sexual and reproductive health clinics, 160
substance use treatment, 165
Electronic communication, 211–212, 224
Electronic health records
confidentiality, 223
recommendations for, 10–11, 305–306
Emergency care
adolescent utilization, 6–7, 171, 300
hospital-affiliated primary care and, 152
shortcomings of current health system performance, 6–7, 300
Equitable health care delivery, 5, 299
F
Family
influence on adolescent health behavior, 38
one- and no-parent homes, 34
parental involvement in adolescent care, confidentiality and, 221–222
parental notification effects on adolescent health care utilization, 178–179
recommendations for adolescent confidentiality and consent for care, 11, 306
role in preventive intervention, 212
significance of, in adolescent health, 4, 44, 298
Family medicine as model for adolescent care, 19
Family planning services, 160, 279–280
Federal government
confidentiality laws, 181–182
recommendations for confidentiality and consent policies in adolescent health care, 11, 306
recommendations for health insurance system, 12–13, 307–308
recommendations for improving primary care, 9, 304
recommendations for research, 13–14, 309
training grants, 251
Federal Interagency Forum on Child and Family Statistics, 14–15, 309–310
Fighting, 87
Financial factors
compensation for adolescent health care specialists, 259
funding for adolescent care provider training programs, 12, 251, 253, 307
funding for school-based health centers, 153–156
recommendations for health insurance system, 13, 308
recommendations for improving primary health care, 10, 305
scope of, in adolescent health care, 4, 44–45, 298
strategies for improving immunization programs, 213
See also Cost of care
Focus of adolescent health services, 7, 301
Foster care system, adolescents in, 2–3, 35
abuse and neglect patterns, 97–98
health risks, 53, 54, 98–99
insurance coverage after departure, 272
mental health services, 73
recommendations for health insurance coverage, 12–13, 307–308
recommendations for improving primary health care, 9–10, 305
substance abuse risk, 163
See also Subpopulations of adolescents
Free time, 35–36
G
Gay adolescents. See Lesbian, gay, bisexual, or transgender adolescents
Gender differences
adolescent health behaviors and attitudes, 38–39
board certifications in adolescent medicine, 254
demographic and population patterns, 32, 35
diabetes prevalence, 67
health care utilization, 171
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mental disorder risk, 72–73, 74, 75
mortality patterns, 62
physical activity, 96
seat belt use, 85
sexual and reproductive health service utilization, 158–160
sexually transmitted disease patterns, 77–78
substance use, 76
suicidal behavior or ideation, 77
Group homes, 35
Guidelines for Adolescent Preventive Services, 145, 198–199, 248
H
Health Insurance Portability and Accountability Act, 181–182
Health promotion
conceptual evolution in adolescent medicine, 37
in dental and oral health care, 161
fragmentation of current health system as obstacle to, 7, 300–301
goals for improving adolescent health services system, 196, 231
participants, 210
in primary care settings, 145–146, 147
print and electronic resources for, 210–211
rationale, 172, 195
recommendations for monitoring health care system performance, 14–15, 309–310
recommendations for primary care, 10, 305
in safety-net health services, 157
shortcomings of current health system performance, 7, 137, 172–175, 301
significance of intervention in adolescence, 3–4, 17–18, 54, 297–298
strategies for improving adolescent health service system, 210–212
Health system, adolescent care in
behavioral and contextual framework, 3–4, 43–45, 137–138, 297–298
community factors, 4, 298
conceptual and technical evolution, 36–37
current models of care, 6–7, 19, 300
data sources on current state, 21–23
determinants of adolescent health status, 18–19, 28
family factors, 4, 298
financial factors, 4, 298
focus, 7, 301
objectives, 4–5, 138–140, 298–299
perceptions and attitudes, 37–41
policy factors, 4, 298
rationale for improving, 15, 310
recommendations for improving, 10–11, 305–306
recommendations for research, 13–14, 309
research needs, 19–20, 294–295
safety-net services, 136
salient issues, 2, 20–21, 293–294
scope of settings and services, 3, 28–29, 37, 299
sectors, 140–142
shortcomings of current system, 1, 6–9, 15, 18–19, 142, 293, 299–304, 310
specialty care services, 136–137
See also Improving adolescent health services system;
Provider education and training
Healthy People 2010 objectives, 6, 55, 145, 196, 296
Heart disease, 64
HIV/AIDS, 78, 101, 111
Homeless population, 2–3, 35
alcohol and substance use, 102
associated health risks, 99–100
data collection challenges, 99
mental health, 103–104
patterns and trends, 99
physical and sexual abuse risk, 100
recommendations for improving primary health care, 9–10, 305
risks for lesbian, gay, bisexual, or transgender adolescents in, 104–105
sexual activity and health, 100–102
See also Subpopulations of adolescents
Homicide
access to weapons and, 86
mortality, 53, 62, 64, 65
victimization patterns, 87
Hospital-affiliated primary care, 151–152
innovative programs for adolescent care, 228–229
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I
Immigrants, 2–3, 35, 105–107
access to care, 18
insurance coverage disparities, 269–271, 272
insurance coverage patterns, 8, 302
population patterns, 33
public insurance eligibility, 274
recommendations for improving primary health care, 9–10, 305
See also Subpopulations of adolescents
Immunization. See Vaccination and immunization
Improving adolescent health services system
care management of specialty services, 206–207
community role, 4, 195, 298
consideration of special needs and vulnerable populations, 9–10, 194, 305
coordination of care, 194, 206–207, 231
family role, 4, 195, 298
goals, 194, 195–196, 231
health information technology, 223–225
health management strategies in primary care, 202–204
immunization programs and policies, 213–214
implementation of strategies for, 231–232
innovative programs, 225–231
linkages between primary and specialty care, 207–210
participation and engagement for, 4, 195, 298
personalized health services, 225
prevention and health promotion, 194, 195, 210–212, 231
privacy and confidentiality issues, 194
provider training, 255–258
rationale, 1, 15, 18, 194–195, 293, 310
recommendations for, 9–15, 304–310
referral practice, 204–206, 207–208
research needs, 232
screening and assessment, 197–202, 203, 231
youth development promotion, 214–219
Inpatient hospital care
adolescent utilization, 167–168
mental health and substance abuse treatment insurance coverage, 281–283
specialized units for adolescents, 167
treatment teams, 167
Institutionalized adolescents
population characteristics, 35
settings, 35
substance abuse risk, 163
Insurance
age distribution of coverage patterns among adolescents and young adults, 273, 288
barriers to health care access, 8, 265, 266–269, 274, 285–286, 287, 288, 302
confidentiality protection, 223, 287
cost sharing, 285–286, 287
coverage patterns and trends, 8, 265, 269–272, 276–285, 288, 302
current sources and benefit plans, 276–278
definition of adolescence for, 26–27
dental services coverage, 284–285
eligibility, 272–273
employment characteristics and, 269–271, 272–273
failure of eligible adolescents to enroll in public programs, 8, 265, 273–276, 302
health risks related to lack of, 8, 265, 266, 302
inpatient pregnancy expenses, 168
mental health and substance abuse treatment coverage, 158–159, 280–284
preventive services coverage, 278–279, 286–287
recent reform proposals, 42
recommendations for improving health care system, 12–13, 307–308
sexual and reproductive health services coverage, 279–280
shortcomings of current health system, 7, 18, 265, 276, 278, 287, 288, 300
source of medical care and, 169–170
strategies for increasing coverage, 275–276
Internet
harassment via, 87
online health services, 224–225
resources for medical education, 256–257
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J
Juvenile justice system, adolescents in, 2–3, 35
health risks, 53–54, 113, 114
mental disorder risk among, 113–114
mental health services, 73
population patterns, 113–114
recommendations for health insurance coverage, 12–13, 307–308
recommendations for improving primary health care, 9–10, 305
substance abuse risk, 163
victimization risk, 114
See also Subpopulations of adolescents
L
Leadership Education in Adolescent Health, 12, 307
Lesbian, gay, bisexual, or transgender adolescents, 2–3, 173
eating disorders among, 110
health-related data, 109
in homeless population, 104–105
population patterns, 108–109
psychosocial stressors, 111
recommendations for improving primary health care, 9–10, 305
research challenges, 108
sexual health risks, 111
social stigma, 107–108
special issues for transgender teens, 112
substance abuse, 110
suicidal behavior or ideation, 109–110
violence victimization risk, 111
See also Subpopulations of adolescents
Licensing, certification and accreditation
adolescent medicine board certification, 254
continuing education requirements, 255
inconsistency in national system of, 260
recommendations for, 11–12, 306–307
shortcomings of current system, 240, 252, 260
strategies for improving adolescent health care system, 255–256
M
Managed care
adolescent utilization, 169
carve outs, 205–206
confidentiality concerns, 287
recommendations for improving public health system for adolescent care, 10–11, 305–306
Maternal and Child Health Block Grant, 181
Maternal and Child Health Bureau, 252, 258
Medicaid
confidentiality of adolescent health care, 181, 287
coordination of care, 174
cost-sharing requirements, 277, 285
covered services, 276–277, 278–280, 281, 284
current shortcomings in adolescent health care, 42
eligibility, 272, 274
failure of eligible adolescents to enroll in, 273–276
physician reimbursement, 285–286
pregnancy care, 168, 272
preventive care reimbursement, 287
provider participation, 285–286
recommendations, 12–13, 307–308
settings for adolescent medical care and, 169
Mental disorders
age of onset, 72, 77
among adolescents in juvenile justice system, 113–114
comorbidity, 72
definition and clinical conceptualization, 71
prevalence, 71–72, 73, 74, 75, 77, 157
risk factors, 72–73
risk in adolescence, 53, 54
risks among homeless adolescents, 103–104
risks in foster care, 98, 99
See also Mental health services;
specific disorders
Mental health services
adolescent perceptions, 39
confidentiality concerns of adolescents, 179
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effectiveness, 158
evolution of costs and reimbursement, 282
fragmentation of current health system, 7, 301
inpatient hospitalization, 168
insurance and reimbursement, 8, 157–158, 280–284, 286, 302
online, 224–225
primary care reimbursement, 143–144
public insurance coverage, 277, 286
racial differences in service delivery settings, 73
recommendations for health insurance coverage, 13, 308
recommendations for improving public health system for adolescent care, 10–11, 305–306
in schools, 206
screening, 172–173
shortcomings of current health system, 7, 158, 172–173, 301
specialty consultation approach, 208
substance abuse risk, 163
unmet needs, 158
workforce, 157
See also Mental disorders;
Specialty care services
Models of care, 6–7, 19–20, 36–37, 300
criteria for evaluating, 195
Mortality
adolescent risk, 53
in adulthood, adolescent health-related behaviors and, 54
causes, 53, 62–64, 65, 172
patterns and trends, 6, 62–65
Motivational interviewing, 203
Motor vehicle accidents
adolescent mortality, 53
alcohol use and, 84–85
causes of risky driving, 84
injury outcomes, 53
mortality, 62, 65, 84
objectives for adolescent health, 55
patterns and trends, 6
prevention strategies, 31
seat belt use and, 85
sleepiness as cause of, 85
N
National Adolescent Health Information Center, 257
National Initiative to Improve Adolescent Health, 29–30
Nurses, 247–248
O
Obesity
in adulthood, 94
associated health risks, 93, 94
associated psychosocial risks, 93
current screening and counseling practice, 173
electronic entertainment and, 35–36
health management strategies in primary care, 203
insurance coverage issues, 8, 302
objectives for adolescent health, 55
patterns and trends, 6, 53, 93–94, 95
prevention, 30–31
Objectives for adolescent health system, 4–5, 6, 135, 298–299
application, 139
components, 138–140
framework for evaluation of adolescent health service models, 195
recommendations for health insurance coverage, 13, 308
recommendations for research agenda, 13–14, 309
shortcomings of current health system performance, 55
shortcomings of current service delivery models, 6–7, 296, 299–300
Office of Technology Assessment, 29
Oral health. See Dental care
P
Parental educational attainment, dental health and, 162
Pediatric care, 19
Perceptions and attitudes about adolescent health
adolescents’, 22, 38–39, 136
adolescents’ self-perceived health status, 54
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data sources, 22
health care providers, 40–41
historical evolution, 23–24
parents’ perspectives, 39–40
perceptions of drug use, 90
significance of, 37–38
Personalized health services, 225
Pharmacists, 41
Pharmacotherapy
cost of medications as barrier to, 267
medication management, 202–203
Physical activity
electronic entertainment and, 35–36
health and, 95
objectives for adolescent health, 55
outcomes of adolescent health-compromising behavior, 54
patterns and trends, 6, 95–96
PIPPAH, 258
Policy making
privacy and confidentiality issues, 42, 43, 302
recommendations for improving adolescent health care, 10–11, 305–306
shortcomings of current policy environment, 41–42
significance of, in adolescent health care, 4, 45, 298
taxes to discourage alcohol and tobacco consumption, 212
See also Federal government;
State government
Poor families, 2–3
access to care, 6, 17, 18, 33–34, 97
chronic health condition risk, 65–67
insurance coverage, 8, 265, 275–276, 302
Medicaid cost-sharing requirements, 277
population patterns, 34
racial/ethnic patterns, 6, 34, 296
recommendations for health insurance coverage, 13, 308
recommendations for improving primary health care, 9–10, 305
See also Socioeconomic status
Population-based health care delivery, 210
Population patterns and trends, 6, 17, 32–33, 34–35, 97, 296
Pregnancy, dental care in, 272
Pregnancy in adolescence
abortion rates, 92
associated risks, 91
consent for care and confidentiality laws, 180
fetal loss rates, 92–93
health objectives for adolescents, 55
incidence, 91
inpatient hospital utilization, 167–168
insurance reimbursement, 168
oral disease risk and, 79
patterns and trends, 6, 53, 91–92
risks among homeless, 101, 102
Preventive interventions
current insurance coverage and reimbursement, 278–279, 286–287
disincentives for insurance providers, 286–287
health management strategies in primary care, 203
interaction and coordination among social service sectors, 174
rationale, 195
recommendations for health insurance coverage, 13, 308
screening and assessment, 197–202
seat belt use, 85
shortcomings of current health system performance, 137
See also Disease prevention;
Health promotion
Primary care
adolescent medicine specialists, 144–145
behavioral health assessment and monitoring, 144, 204
in community-based health centers, 150–151
goals for improving adolescent health services system, 195–196, 231
health management strategies, 202–204
hospital-affiliated, 151–152
medication management, 202–203
private office-based, 143–147
provider–patient relationship in, 203–204
recommendations for improving, 9–10, 305
recommendations for research, 14, 309
referrals to specialty care, 204–206, 207–208
reimbursement, 143–144, 145, 146, 201
safety-net programs, 143–147
school-based, 152–156
scope of services, 142, 143
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settings for, 143
shortcomings of current health system performance, 6, 18, 135, 145–147
specialty care linkages, 142, 157, 207–210
strategies for improving adolescent health services system, 199–201, 231
Privacy and confidentiality
adolescent candor and, 178
adolescent concerns, 38, 42–43
adolescent utilization of health services and, 177–179, 219, 220, 300–301
adult protections, 219
conceptual approaches to adolescent care, 219–220
consent for care law and, 180–181
electronic health records and, 223
insurance issues, 223, 287
legal framework, 181–183, 219
parental concerns, 42
parental involvement in adolescent care, 221–222
policies of health care professional organizations, 222
policy issues, 42, 43, 302
provider attitudes and beliefs, 43, 219, 301
provider communication with adolescent, 220
recommendations for, 11, 306
sexual and reproductive health service utilization and, 160
significance of, in adolescent health care, 137, 183, 219, 301–302
Protective factors, 212
Provider education and training
adolescent medicine specialists, 144–145, 252–255
certification standards, 255–256
challenges, 258–261
competency domains, 249–251
conceptual evolution, 243–244
continuing education, 255
current models, 252–256
doctoral programs, 255
economic disincentives, 259
funding for training programs, 12, 251, 253, 307
future demand and supply, 244–245
goals, 241, 261
importance of, for adolescent health care system, 4, 44, 240–241, 261, 298
innovative programs, 240, 256–258
interdisciplinary programs, 12, 252–253, 307
leadership programs, 252–253
levels of expertise in adolescent medicine, 245–246
master degree programs, 255
patient simulations, 256
postresidency fellowships, 253–254
primary care physicians, 144–145
provider attitudes and beliefs, 41, 246–248
recommendations for, 11–12, 306–307
recommendations for research, 14, 309
for screening and counseling, 174
shortcomings of current health system, 8, 240, 241, 244, 246–248, 249, 258, 302–303
for specialty care services, 167
substance abuse treatment, 164–165
train-the-trainer programs, 256–257
See also Licensing, certification and accreditation
Provider–patient relationship
adolescent primary care, 145
adolescents’ confidentiality beliefs and, 177–178
clinical significance, 203–204
confidentiality discussions, 220
participation and engagement, 4, 195, 298
provider perception, 41
recommendations for adolescent care provider training, 12, 307
Provider performance measurement
primary care services, 10, 305
recommendations for monitoring health care system performance, 14–15, 309–310
recommendations for research, 13–14, 309
standards and guidelines, 248
See also Licensing, certification and accreditation
Psychosocial functioning
changes in adolescence, 24, 25
dating violence, 86–87
individual differences in adolescents, 41
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risks for lesbian, gay, bisexual, or transgender adolescents, 107–108, 111
See also Mental disorders;
Mental health services
Q
Quality of care
adolescent primary care, obstacles to, 145
impediments to, in current adolescent health system, 18–19
insurance and, 8, 265, 302
racial/ethnic disparities, 137
in safety-net settings, 7, 300
U.S. health system, 31
R
Race/ethnicity
access to care and, 6, 17, 18, 33, 97, 137, 296
adolescent health status patterns and trends, 53
adolescent pregnancy, 53, 91, 92–93
alcohol and substance use and, 76, 85, 90
asthma prevalence, 66
cancer incidence and survival, 70
diabetes prevalence, 67
disparities in health care delivery, 177–178
insurance coverage patterns and disparities, 8, 265, 269–271, 272, 302
mental disorder risk, 73
mental health service delivery settings, 73
mortality patterns, 62, 64
obese and overweight patterns in adolescence, 93
oral health care needs, 79–82, 83, 162
parental attitudes toward sexual behavior and sexual health, 40
physical activity patterns, 96
population patterns and trends, 6, 17, 32–33, 97, 296
poverty and, 6, 34, 296
provider workforce diversity, 242–243
quality of care and, 137
recommendations for improving primary health care, 9–10, 305
sexual and reproductive health service utilization, 159
sexually transmitted disease patterns, 77–78, 79
suicidal behavior or ideation, 77
tobacco use, 89
violent crime victimization, 87
See also Subpopulations of adolescents
Referrals
goals for improving adolescent health services system, 195–196
strategies for improving, 204–206, 207–208
substance abuse, from schools, 162–163
Regional resource management, 209
Reimbursement
care management, 206
immunization policies, 213
mental health services, 157–158
preventive care, 287
private office-based primary care, 143–144, 145, 146
provider participation in public insurance programs and, 285–286
recommendations for health insurance system, 13, 308
for screening and counseling, 174, 201
Research
current shortcomings, 19–20, 294–295
for improving adolescent health services system, 232
notable past work, 29–31
recommendations for, 13–14, 309
recommendations for monitoring health care system performance, 14–15, 309–310
See also Data collection
Risky behavior
adolescent morbidity, 53
assessment, 201–202
comorbidity risk, 6
current screening and counseling practice, 173
health management strategies in primary care, 202–204
morbidity, 84
normal adolescent development and, 24, 25
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oral disease risk, 79
primary care intervention, 147
rationale for early identification and intervention, 197
scope of, 53, 115
screening strategies, 197–201
significance of, in adolescent health, 3–4, 5–6, 17–18, 52, 54, 91, 115, 172, 197, 211, 296, 297
unsupervised nonschool hours and, 35
See also Alcohol use;
Behavioral health in adolescence;
Sexually transmitted disease;
Substance abuse
Rural areas
access to care, 34, 97
agricultural workers, 106–107
obese and overweight patterns in adolescence, 93–94
physical activity patterns in, 96
population patterns and trends, 34–35, 97
S
Safety-net providers
advantages of, in adolescent care, 7, 136, 156–157, 300
community-based health centers, 150–151
current research base, 147
definition and characteristics, 147
quality of care, 7, 156, 300
recommendations for improving, 9, 304
scope of care settings, 147
shortcomings of current health system performance, 6–7, 299–300
significance of, in adolescent health care system, 7, 156, 300
School-based health centers
characteristics, 153
clients, 152
funding, 153–156
in innovative integrated health programs, 226–227
mental health services, 206
number of, 152
quality of care, 7, 300
rationale, 152, 153
services, 153
significance of, in adolescent health care syste, 152
sponsors, 153
strengths and weaknesses, 6–7, 299–300
substance abuse referrals from, 162–163
School-based insurance coverage, 276
Sex education, 40, 158
Sexual abuse risk for homeless adolescents, 100
Sexual and reproductive health
adolescent utilization of health services, 158–160
among lesbian, gay, bisexual, or transgender adolescents, 111
current insurance coverage, 279–280
current screening and counseling practice, 173
dating violence, 86–87
effectiveness of clinic services, 160
family influences on adolescent health behavior, 38
fragmentation of current health system, 7, 301
guidance and counseling, 158
information technology, 224
objectives for adolescent health, 55
outcomes of adolescent health-compromising behavior, 54
parental attitudes and perceptions, 40
primary care reimbursement, 143–144
privacy concerns of adolescents, 160, 178–179
public insurance coverage, 277
recommendations for health insurance coverage, 13, 308
recommendations for improving public health system for adolescent care, 10–11, 305–306
right to access to health care, 180–181
risks among homeless adolescents, 100–102
risks for lesbian, gay, bisexual, or transgender adolescents, 105
risky behaviors, 77
sexual activity of adolescents, 40, 77
shortcomings of current health system performance, 7, 301
Sexually transmitted disease
consent for care and confidentiality laws, 180
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current insurance coverage for screening, 279, 280
patterns and trends among adolescents, 53, 77–79
risk, 77
risk for adolescents in juvenile justice system, 114
risks among homeless adolescents, 100, 101–102
risks for lesbian, gay, bisexual, or transgender adolescents, 111
screening for, 198
Single-parent families, 34, 38
Sleep patterns, 85
Society for Adolescent Medicine, 210–211, 213, 222
Sociocultural context
perception and status of adolescents, 23–24
significance of, in health care delivery, 28
Socioeconomic status
adolescent health status and, 35
emergency department admissions and, 168
insurance coverage patterns and disparities, 8, 269–271, 272, 302
insurance eligibility, 272–273, 274–275
mental disorder risk, 72
mortality patterns, 64
significance of, as adolescent health factor, 4, 298
See also Poor families
Solution-focused interviewing, 203
Special health care needs, 65.
See also Chronic illness
Specialists, adolescent medicine, 144–145
Specialty care services
access, 136–137, 166, 300
adolescent medicine board certification, 254
adolescent perceptions, 136
care management, 206–207
competency domains, 250–251
consultation, 208
directories, 205
economic disincentives for adolescent health care specialists, 259
goals for improving adolescent health services system, 196
primary care and, 142, 157, 207–210
provider preparation for, 167
purpose, 142
recommendations for improving, 9, 304
regional resource management, 209
scope of, for adolescent care, 242
service agreements, 209
shortcomings of current system, 166–167
strategies for improving referral practice, 204–206, 207–208
See also Dental care;
Mental health services;
Sexual and reproductive health;
Substance abuse treatment
Standards of care
competency domains, 249–251
provider implementation and adherence, 248–249
recommendations for, 13–14, 309
screening practices, 198
State Children’s Health Insurance Program
confidentiality of adolescent health care, 181, 287
covered services, 277, 279, 280, 281–283, 284–285
current shortcomings in adolescent health care, 42
dental care coverage, 267
eligibility, 272, 274
failure of eligible adolescents to enroll in, 273–276
provider participation, 285–286
recommendations for, 12–13, 307–308
reimbursement rates, 169
State government
confidentiality laws, 182–183
interaction and coordination among social service sectors, 174
recommendations for health insurance system, 12–13, 307–308
recommendations for improving primary care, 9, 304
Subpopulations of adolescents
advantages of school-based health care delivery, 153
barriers to assessment, 202
comorbidity risk, 6, 296
goals for improving adolescent health services system, 196
insurance coverage disparities, 269–271
population patterns, 35
primary care services, 146
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public perceptions and attitudes, 37
recommendations for adolescent care provider training, 12, 307
recommendations for health insurance system, 12–13, 307–308
recommendations for improving primary health care, 9–10, 305
recommendations for monitoring health care system performance, 14–15, 309–310
safety-net health care, 150
scope, 2–3, 27
special needs and vulnerabilities, 4, 6, 18, 27, 52, 96–97, 296, 298
unmet oral health needs, 162
See also Foster care system, adolescents in;
Homeless population;
Immigrants;
Juvenile justice system, adolescents in;
Lesbian, gay, bisexual, or transgender adolescents;
Poor families
Substance abuse
among adolescents in juvenile justice system, 113–114
among lesbian, gay, bisexual, or transgender adolescents, 110
associated risks, 88
clinical disorders, 75–76
current screening practice, 173
depression and, 74
health management strategies in primary care, 203
mental disorder risk, 72
outcomes of adolescent health-compromising behavior, 54
patterns and trends, 76, 87, 90–91
racial/ethnic differences in emergency room screening, 176
risk in institutional settings, 163
risks among homeless adolescents, 102, 103
risks in foster care, 98
screening and assessment, 198, 201–202
significance of, as adolescent health risk, 53, 91
See also Substance abuse treatment
Substance abuse treatment
adolescent attitudes and perceptions, 39
adolescent-specific provider certification, 164–165
confidentiality concerns of adolescents, 179
consent for care and confidentiality laws, 180
current insurance coverage, 280–284
effectiveness, 165–166
fragmentation of current health system as obstacle to, 7, 301
insurance coverage issues, 8, 302
need, 163–164
outcome indicators, 164
public insurance coverage, 277
recommendations for health insurance coverage, 13, 308
recommendations for improving public health system for adolescent care, 10–11, 305–306
relapse risk, 165–166
schools as referral sources, 162–163
shortcomings of current system, 164–165
See also Specialty care services;
Substance abuse
Suicidal behavior or ideation
access to weapons and, 86
alcohol use and, 89
among lesbian, gay, bisexual, or transgender adolescents, 109–110
depression and, 73
mortality, 53, 62, 65, 77
prevalence, 77
risks among homeless adolescents, 104
screening for, 198
T
Technology, health information, 10–11, 223–225, 305–306
Text messaging, 211–212, 224
Time use patterns, adolescent, 35–36
Title X, 181
Tobacco use
dependency, 76
health consequences, 89
mortality, 54, 88
oral disease risk, 79
patterns and trends, 6, 88, 89, 172
secondhand smoke exposure, 88–89
significance of, in adolescent health, 53, 91
strategies for discouraging, 212
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Training and education for health care professional. See Provider education and training
Transgender adolescents. See Lesbian, gay, bisexual, or transgender adolescents
U
U.S. Preventive Services Task Force, 199
Utilization of health care resources
confidentiality concerns of adolescents and, 177–179, 219, 220, 300–301
emergency care, 6–7, 171, 300
insurance coverage and, 8, 265, 266, 267–269, 272, 285, 302
sources of care, 168–172, 299–300
V
Vaccination and immunization, 143, 213–214, 278–279
Violent behavior
adolescent victims, 86–87, 105
dating violence, 86–87
developmental patterns, 85–86
victimization risk for lesbian, gay, bisexual, or transgender adolescents, 111
See also Homicide
W
Weapons access and use, 53, 86
Workforce, health care
current structure and capacity, 242–246
diversity rationale, 242–243
need for multidisciplinary approach to adolescent care, 242, 249
shortcomings of current system, 240
supply concerns, 244–245
See also Provider education and training
