US adolescents, or young adults, are often a “missed population” in health care that slips between pediatric and adult medicine. While Pediatric Medicine includes a subspecialty in Adolescent Medicine, there is no analogous field in dentistry. Health services often consist of separate services that are fragmented, poorly coordinated, and delivered in multiple settings. They may be sought by parents and other times by adolescents who are seeking confidentiality. Even when health services are available for young adults, they may not be affordable, particularly to the uninsured and underinsured.

According to the Institute of Medicine (IOM), health care providers often lack the necessary skills to interact appropriately with this age group or are under-prepared to address the complex health issues that adolescents face. Many teens and young adults do not find services acceptable because of concerns about confidentiality and disclosure of treatment of sensitive areas, such as substance abuse or sexual health. Further, there remains a need to have coordinated, linked, and interdisciplinary adolescent health services that go beyond primary care when needed and policies that empower minors to give their own consent for health services and receive those services on a confidential basis when necessary to protect their health.

Adolescence is a critical time for effective health promotion and disease prevention, known as HP/DP (pronounced “HippyDippy”), because teens and young adults begin adopting their adult health behaviors. However, this period of life is also associated with unhealthy and risky behaviors, partly because neural development that affects emotional, physical, and mental abilities is typically not yet complete. Adolescent health services, therefore must engage adolescents, set up opportunities to talk about sensitive health and behavioral issues, and offer high quality care for them.

Adolescents often seek out stable and respected adults outside of their immediate families to open up about their concerns, such as teachers, physicians, coaches and even dentists. Teens may seek guidance from their dentists for issues well beyond their oral health. A holistic understanding of these health and social needs is reflected in the World Health Organization’s (WHO) recommendations for adolescent healthcare.

1. Accessibility: Policies and procedures MUST ensure services are broadly accessible
2. Acceptability: Policies and procedures MUST consider culture and relationships and climate of engagement
3. Appropriateness: Health services MUST fulfill the needs of all young people
4. Effectiveness: Health services MUST reflect evidence-based standards of care and professional guidelines
5. Equity: Policies and procedures MUST not restrict the provision and eligibility for services

Unfortunately, the WHO finds that no current healthcare system adequately achieves all five characteristics even though many satisfy some or most characteristics.

1. Coordinated primary health care systems, including oral healthcare systems
2. Health care providers capable of attending to adolescents who are the most vulnerable and demonstrate the most risky behaviors and poor health
3. Payment systems that feature HP/DP and include behavioral health coverage
4. Coordinated, linked, and interdisciplinary adolescent health services that go beyond primary care when needed
5. Policies that empower minors to give their own consent for health services and receive those services on a confidential basis when necessary to protect their health

Now that you have been introduced to the main concepts of health care delivery to the adolescent population, let’s try an activity to put these concepts into practice.