most likely to depend on emergency departments for routine health care. Indeed, evidence shows that for some adolescents, safety-net settings may be more accessible, acceptable, appropriate, effective, and equitable than mainstream services. This may be especially so for more vulnerable populations of uninsured or underinsured adolescents. Although an extensive literature on the quality of school-based health services for adolescents is available, few studies have examined the quality of services received in other safety-net settings.

Evidence also shows that existing specialty services in the areas of mental health, sexual and reproductive health, oral health, and substance abuse treatment are not accessible to most adolescents, nor do they always meet the needs of many adolescents who receive care in safety-net settings. Even when such services are accessible, many adolescents may not find them acceptable because of concerns that confidentiality is not fully ensured, especially in such sensitive domains as substance use or sexual and reproductive health.

The various settings, services, and providers used by adolescents often are not coordinated with each other, and the result is barriers to and gaps in care. In some areas, such as mental health services for adolescents, the system of services is in substantial disarray because of financing barriers, eligibility gaps, and both confidentiality and privacy concerns—all of which can hamper transitions across care settings. Because of this segmentation, moreover, many providers of health services are poorly equipped to foster disease prevention and health promotion for adolescents. This is especially true in the areas of mental health, oral health, and substance abuse, as well as services that address sexual behavior and reproductive health.

This limited, problem-oriented approach fails to meet the broader profile, needs, and behavioral challenges that characterize adolescence.