definition and individuation that requires—to a greater or lesser degree—the creation of a private persona with desires and behavior that, even if not forbidden by parents, are separate from parental scrutiny and supervision. For a few young people, adolescence can lead to a significant disjunction of interests that may even threaten the integrity of the family. In some families, the impetus for this disjunction comes from the adolescent, while in others the parents are motivated by their own problems or their children’s behavior to initiate a break. Even so, the majority of adolescents obtain health services with the knowledge and support of their parents and benefit from that involvement.

Health professionals, both by inclination and by training, focus on the needs of their patients. For this reason, providers of health services to adolescents often view themselves as allies of the adolescent who is seeking to define a separate existence and decision-making structure. At the same time, adolescent health experts in clinical settings, research institutions, and professional organizations have repeatedly recognized the important role of parents in fostering the health of adolescents.

It is critical that these challenging issues be addressed within a current social and policy context in which there is little overt support for the adolescent experimentation and risk taking that may give rise to the need for confidentiality protection in adolescent health services. Even so, a large body of evidence, drawn from research conducted over the past several decades, serves not only to document the range and extent of behavior that affects adolescents’ health, but also to provide a rationale and strong justification for protecting confidentiality in their health services.

BEHAVIORAL AND CONTEXTUAL CHARACTERISTICS

Creating successful interactions between adolescents and health service settings and systems requires a multifaceted approach. The committee was guided by two frameworks in its data collection, review of the evidence, and attention to various dimensions of adolescent health status and health services. The first focuses on behavioral and contextual characteristics that influence how adolescents interact with the health system. The second, which is described in Chapter 3, focuses on the objectives of adolescent health services. Neither framework alone is sufficient to explain significant variations in adolescent health outcomes; rather, they complement each other and, in tandem, provide a more complete picture of the features of the health system that should be improved in order to provide adolescents high-quality care and thus help to improve their health status.

The committee recognized that certain sets of behavioral and contextual characteristics shape the ways in which adolescents approach and interact with health care services, providers, and settings. When these



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