Health care services in the United States for adolescents are fragmented, leaving gaps in care that "safety-net" resources cannot fill, especially for those who are uninsured or vulnerable to risky behavior or poor health, according to a report issued by the Institute of Medicine and the National Research Council.
The report, "Adolescent Health Services: Missing Opportunities," calls on federal and state agencies, private foundations, and insurers to develop a health care system that fosters coordination between primary and specialty care, as well as a way for primary care services to reach adolescents in safety-net settings, such as hospitals, community- and school-based health centers, and youth development programs. The report defines adolescents as individuals 1019 years of age.
"Adolescents have unique health needs, and our health system should not approach their care the same way it does children or adults," Dr. Robert S. Lawrence of Johns Hopkins University, Baltimore, said in a written statement. Dr. Lawrence is the chair of the 19-member committee that issued the report.
The Committee on Adolescent Health Care Services and Models of Care for Treatment, Prevention, and Healthy Development advised that disease prevention, health promotion, and behavioral health should be major components of routine health services. It also acknowledged that primary care providers will need adequate financial support from payment systems in order to manage and coordinate specialty services.
Public and private programs within communities will be required to manage referrals between providers of primary care services and other health services, the committee determined. Electronic health records could assist in this regard by providing opportunities for messaging, reminder services, and personalized health education services to improve interventions, especially for adolescents who may be most vulnerable to risky behavior or poor health. This population includes adolescents who are poor; are members of ethnic or racial minorities; are recent immigrants; are in foster care; are in the juvenile justice system; or are lesbian, gay, bisexual, or transgender.
The committee said that many of the existing specialty services in 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," especially if confidentiality is not fully ensured.
The system of mental health services for adolescents is especially uncoordinated and fragmented because of financial barriers, gaps in eligibility, and concerns about confidentiality and privacy.
Throughout the report, committee members recommended that federal and state policy makers should continue to support laws that enable adolescents to give their own consent for health services and to receive services confidentially when necessary, such as for contraception, mental health care, and substance abuse treatment.
In the report, the committee proposed several options for federal and state policy makers to develop to ensure that all adolescents have comprehensive, continuous health insurance coverage:
▸ Require states to provide Medicaid or other forms of insurance coverage for vulnerable or underserved adolescents.
▸ Design and implement Medicaid and State Children's Health Insurance Program policies to increase enrollment and retention of eligible but uninsured adolescents.
▸ Improve incentives for private health insurers to provide coverage, such as by requiring school-based coverage and allowing nongroup policies tailored to adolescents.
Because physicians and other health care providers frequently lack the skills to interact effectively with adolescents, the report advised that those who serve adolescents should receive a "specific and detailed education in the nature of adolescents' health problems and have in their clinical repertoire a range of effective ways to treat and prevent disease in this age group, as well as to promote healthy behavior and lifestyles within a developmental framework." These skills should also be a part of the minimal set of competencies that need to be demonstrated for the licensing, certification, and accreditation of providers, according to the committee.
The report was sponsored by the Atlantic Philanthropies Ltd., an international charitable foundation.