importance of designing health services that can attract and engage adolescents, create opportunities to discuss sensitive health and behavioral issues, and offer high-quality care as well as guidance on both disease prevention and health promotion. Consistent with these findings and views, a variety of national and international organizations have defined critical elements of health systems that would improve adolescents’ access to appropriate services, highlighted design elements that would improve the quality of those services, and identified ways to foster patient–provider relationships that can lead to better health for adolescents.

The World Health Organization has identified five characteristics that constitute objectives for responsive adolescent health services:

  1. Accessible. Policies and procedures ensure that services are broadly accessible.

  2. Acceptable. Policies and procedures consider culture and relationships and the climate of engagement.

  3. Appropriate. Health services fulfill the needs of all young people.

  4. Effective. Health services reflect evidence-based standards of care and professional guidelines.

  5. Equitable. Policies and procedures do not restrict the provision of and eligibility for services.

These five objectives provided the committee with a valuable framework for assessing the use, adequacy, and quality of adolescent health services; comparing the extent to which different health services, settings, and providers meet the health needs of young people in the United States; identifying the gaps that keep services from achieving these objectives; and recommending ways to close these gaps. In general, the committee found that existing approaches to providing health services for adolescents (primary care, school-based programs, hospital-based programs, and community-based models) reflect one or more of these objectives, but none of them achieves all five.


The committee’s many findings presented throughout this report can be consolidated into seven overall conclusions. These conclusions serve as the basis for the committee’s eleven recommendations.

Overall Conclusion 1: Most adolescents are thriving, but many engage in risky behavior, develop unhealthful habits, and experience physical and mental health conditions that can jeopardize their immediate health and contribute to poor health in adulthood.

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