Adolescent Health, Vol. III: Crosscutting Issues in the Delivery of Health and Related Services. June OTA-H-467 NTIS order #PB

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Adolescent Health, Vol. III: Crosscutting Issues in the Delivery of Health and Related Services June 1991 OTA-H-467 NTIS order #PB Recommended Citation: U.S. Congress, Office of Technology Assessment,
Adolescent Health, Vol. III: Crosscutting Issues in the Delivery of Health and Related Services June 1991 OTA-H-467 NTIS order #PB Recommended Citation: U.S. Congress, Office of Technology Assessment, Adolescent Health-Volume III: Crosscutting Issues in the Delivery of Health and Related Services, OTA-H-467 (Washington, DC: U.S. Government Printing Office, June 1991). For sale by the Superintendent of Documents U.S. Government Printing Office, Washington, DC (order form can be found in the back of this report) Foreword Adolescence, the poet suggested, is the one age [that] defeats the metaphor. In many respects, such as legal and financial dependence, adolescents are still children; in other respects, such as physical development, they approach and then reach adult status, In part because they experience profound biological, emotional, intellectual and social changes, adolescents as a group-and some adolescents more than others-are uniquely vulnerable to the impact of many of the Nation s social policies. For numerous reasons, policymakers and the public have 1ong struggled with the establishment of appropriate health-related policies and programs for adolescents. OTA s report responds to the request of numerous Members of Congress to review the physical, emotional, and behavioral health status of contemporary American adolescents, including adolescents in groups who might be more likely to be in special need of health-related interventions: adolescents living in poverty, adolescents from racial and ethnic minority groups, Native American adolescents, and adolescents in rural areas. In addition, OTA was asked to: 1) identify risk and protective factors for adolescent health problems and integrate national data in order to understand the clustering of specific adolescent problems, 2) evaluate options in the organization of health services and technologies available to adolescents (including accessibility and financing), 3) assess options in the conduct of national health surveys to improve collection of adolescent health statistics, and 4) identify gaps in research on the health and behavior of adolescents, Senator Daniel K. Inouye, Chairman of the Senate Select Committee on Indian Affairs, and Senator Nancy Landon Kassebaum, Ranking Minority Member of the Subcommittee on Education, Arts, and Humanities of the Senate Committee on Labor and Human Resources, were the lead requesters of OTA s adolescent health study. Requesters included Chairmen or Ranking Minority Members of the Senate Appropriations Committee, the Senate Commerce, Science, and Transportation Committee, the Senate Finance Committee, the Senate Labor and Human Resources Committee, the Senate Small Business Committee, the Senate Veterans Affairs Committee, and the House Interior and Insular Affairs Committee; and the Chairman and six senatorial members of the congressional Technology Assessment Board. A letter of support was received from the House Select Committee on Children, Youth, and Families. This OTA assessment is being published in three volumes: Volume I, Summary and Policy Options; Volume II, Background and the Effectiveness of Selected Prevention and Treatment Services; and Volume III, Crosscutting Issues in the Delivery of Health and Related Services. Volume I was published in April Volume II will be available later in Two related reports have already been issued as part of this study (see appendix A in Volume I). OTA was greatly assisted by an advisory panel, chaired by Felton Earls, Professor of Behavioral Sciences at the Harvard University School of Public Health. Michael I. Cohen, Chairman of the Department of Pediatrics at the Albert Einstein College of Medicine in New York, served as vice chairman. In addition, many individuals from academia, the Federal Government, the private sector, and the public provided information and reviewed drafts of the assessment. OTA would like to especially thank Carnegie Corporation of New York, and its operating program, the Carnegie Council on Adolescent Development, for their generous and diverse assistance throughout the course of this assessment. Finally, the members of our Youth Advisory Panel-a group of 21 individuals ages 10 through 19, who met often with OTA staff, with OTA s advisory panel, and with workshop participants were essential to the study. These young people provided the adolescent perspective on health concerns of importance to young people, and made valuable suggestions for improving health services and health policy. The final responsibility for the content of the assessment rests with OTA. w Director Claire Brindis, Dr. P.H. Center for Reproductive Health Policy Research Institute for Health Policy Studies UCSF School of Medicine San Francisco, CA Ann W. Burgess, R. N., D. N. SC. van Amerignen Professor of Psychiatric Mental Health Nursing University of Pennsylvania School of Nursing Philadelphia, PA Delores L. Delaney President State of Virginia Parent and Teacher Association Virginia Beach, VA Abigail English, J.D. Staff Attorney Adolescent Health Care Project National Center for Youth Law San Francisco, CA Jewelle Taylor Gibbs, Ph.D. School of Social Welfare University of California Berkeley, CA Michael Graf, Ph.D. Director, Mental Health Tanana Chief Conference, Inc:. Fairbanks, AK David E. Hayes-Bautista, Ph.D. Professor, School of Medicine Director, Chicano Studies Research Center University of California, Los Angeles Los Angeles, CA Karen Hein, M.D. Division of Adolescent Medicine Department of Pediatrics Albert Einstein College of Medicine Montefiore Medical Center Bronx, NOTE iv Adolescent Health Advisory Panel Felton Earls, M. D., Chair Professor, Department of Behavioral Sciences Harvard School of Public Health, Boston, MA Michael I. Cohen, M. D., Vice Chair Chairman, Department of Pediatrics Albert Einstein College of Medicine, Montefiore Medical Center Bronx, NY Charles E. Irwin, Jr., M.D. Director Division of Adolescent Medicine Department of Pediatrics School of Medicine University of California San Francisco, CA Robert Johnson, M.D. Division of Adolescent Medicine Department of Pediatrics New Jersey Medical School Newark, NJ Alan Kazdin, Ph.D. Professor Department of Psychology Yale University New Haven, CT Teresa LaFromboise, Ph.D. Assistant Professor Counseling Psychology and Counselor Education The School of Education University of Wisconsin Madison, WI Mary Nell Lehnhard Vice President Office of Government Relations Blue Cross & Blue Shield Association Washington, DC Barbara D. Matula, M.P.A. Director Division of Medical Assistance Department of Human Resources State of North Carolina Raleigh, NC Robert B. Millman, M.D. Director, Adolescent Development Program Director, Alcohol & Substance Abuse Service Cornell University Medical College- New York Hospital New York, NY Leticia Paez, M.P.A. Associate Director Area Health Education Center School of Medicine Texas Technical University El Paso, TX Cheryl Perry, Ph.D. Division of Epidemiology School of Public Health University of Minnesota Minneapolis, MN Anne C. Petersen, Ph.D. Dean, College of Health& Human Development Pennsylvania State University University Park, PA Lee Etta Powell, Ph.D. Superintendent Cincinnati Public Schools Cincinnati, OH Roxanne Spillett Director, Program Services Boys and Girls Clubs of America New York, NY Edward Tetelman, J.D. Assistant Commissioner Intergovernmental Affairs New Jersey Department of Human Services Trenton, NJ Myron Thompson Trustee Bernice Pauahi Bishop Estate Honolulu, HI OTA appreciates and is grateful for the valuable assistance and thoughtful critiques provided by the advisory panel members. The panel does not, however, necessarily approve, disapprove, or endorse this report. O lla assumes full responsibility for the report and the accuracy of its contents. Adolescent Health Roger C. Herdman, Assistant Director, OTA Health and Life Sciences Division Clyde J. Behney, Health Program Manager Project Staff Denise Dougherty, Project Director Jill Eden, Senior Analyst Kerry B. Kemp, Analyst/Division Editor Kelly Metcalf, Research Analyst l Kirsten Rowe, Analyst 2 Gloria Ruby, Senior Analyst Pamela Simerly, Analyst Andrea Soharz, Carnegie Detailee 3 Urvi Thanawala, Research Assistant 4 Paul Robertson, Research Assistant s Other Staff James Havel, Carnegie Contractor 6 Charlotte Clarke, Carnegie Contractor Elizabeth Anglarill, Work Study Student 8 Helima Croft, Summer Intern 9 Jennifer Hart, Summer Intern 10 Administrative Staff Virginia Cwalina, Office Administrator Carol Ann Guntow, P.C. Specialist Carolyn Martin, Word Processor Specialist Eileen Murphy, P.C. Specialist luntil July 1990 Trom (ktober 1988 to March From December 1988 to Au~t From June From September From April to Septcmber 1~ %om May to August November 1989 to May 1990 %rom May 1990 to August 1990 IOprom June 1988 to Au~t 1988 v Contractors LaRue Allen, Ph. D., (University of Maryland and Christina Mitchell, Ph. D., New York University* Trina Anglin, M. D., Ph. D., Cleveland Metropolitan General Hospital* Lois Bergeisen, Gaithersburg, MD Barbara Burns, Ph. D., Duke University, Carl A. Taube, Ph.D.(deceased 9/28/89), Johns Hopkins University, and John E. Taube, University of Maryland* Paul Casamassimo, D. D. S., M. S., Children s Hospital, Columbus, OH Johanna Dwyer, D.Sc., R. D., New England Medical Center Hospital, and Carol N. Meredith, University of California at Davis James Emshoff, Ph.D. and Ronnie Margolin, Georgia State University* Mathea Falco, J. D., New York, NY Ronald A. Feldman, Ph.D., Columbia University Michelle Fine, Ph. D., University of Pennsylvania James Garbarino, Ph. D., Erikson Institute Josephine Gittler, J. D., Mary Quigley-Rick, J. D., and Michael J. Saks, Ph. D., University of Iowa Robert Guntow, Hyattsville, MD Thomas Hoffman, Washington, DC Angela Holder, LL.M., Yale University* Jonathan Klein, M. D., M. P. H., Milton Kotelchuck, Ph. D., and Gordon H. DeFriese, Ph. D., University of North Carolina at Chapel Hill* Barry Krisberg, Ph. D., National Council on Crime and Delinquency* Richard Kronick, San Diego, CA* Spero Manson, Ph. D., University of Colorado Margaet McManus, M. H. S., Harriette Fox, M. S. W., Paul Newacheck, D. P. H., Lori Wicks, and Rebecca Kelly, McManus Health Policy, Inc. Gary B. Melton, Ph.D. and Lois B. Oberlander, M.A., University of Nebraska-Lincoln Scott Menard, Ph. D., University of Colorado Larry Mi ike, M. D., J. D., University of Hawai i* Edward P. Mulvey, Ph. D., Michael A. Arthur, M.A., and N. Dickson Reppucci, Ph. D., University of Pittsburgh D. Wayne Osgood, Ph. D., and Janet K. Wilson, University of Nebraska-Lincoln* Carol Runyan, M. P. H., Ph.D., Elizabeth A. Gerken, M. S. P. H., and Laura S. Sadowski, M. D., M. P. H., University of North Carolina Stanley Sue, Ph. D., University of California, Los Angeles, and Nolan Zane, University of California at Santa Barbara* Dalmas A. Taylor, Ph. D., Wayne State University, and Phyllis A. Katz, Ph. D., Institute for Research on Social Problems* H. Rutherford Turnbull, Esq., J. D., LL.M. and Lisa Dorrill, M. A., University of Kansas Robert Valdez, Ph. D., University of California, Los Angeles* Margaret West, M. S.W., Ph.D. and Sally N. Stuart, M.S.W., University of Washington* Supported by Carnegie Corporation of New York and the Carnegie Council on Adolescent Development. vi Volume Ill CROSSCUTTING ISSUES IN THE DELlVERY OF HEALTH AND RELATED SERVICES
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