The National Alliance to Advance Adolescent Health

Daly City Youth Health Center

The SPOT

HiTOPS

Lakewood Hospital Teen Health Center

Teen Health Connection

The Corner Health Center

Mary's Center Teen Program

Adolescent Medicine and Young Adult Medical Practice at Children's Hospital Boston

University of Maryland Adolescent and Young Adult Medicine Clinic

Mount Sinai Adolescent Health Center (AHC)

Wilmington Health Access for Teens (WHAT)

West Suburban Teen Clinic

Wake Teen

Erie Teen Health Center

Daly City Youth Health Center
Daly City, California

For over 19 years, the Daly City Youth Health Center (DCYHC) has provided comprehensive health and youth development services in Northern San Mateo County outside of San Francisco. The DCYHC is a satellite teen clinic of the San Mateo Medical Center, a federally qualified health center, and operates as a school-linked health center for five high schools, and also as a provider for local community college students and older adolescents not enrolled in schools. San Mateo Medical Center funds the majority of medical staff and supplies, and the Jefferson Union High School District supports 10% of the center’s budget. Other funding support comes from a mix of foundation, government grants, and donations from corporations and individuals. A unique collaboration since its inception, the DCYHC was established by both the Jefferson Union High School District and the San Mateo Medical Center to combat adolescent health disparities, including disproportionately high rates of suicide. This partnership allows for an exchange of staff, as well as access to mental health counseling, vocational programs, and health education in high schools throughout the area.

The DCYHC is staffed by a comprehensive multidisciplinary team including nurse practitioners, family therapists, family therapist interns, health educators, a care coordinator, vocational counselors, and an adolescent medicine physician that is able to provide a wide variety of services. However, over 80% of medical visits are initially for reproductive health reasons. Each year, the center sees more than 2,400 youth for physical and reproductive health services and more than 425 youth for mental health counseling. Most of the adolescents seen at the center are Asian or Hispanic. Although appointments are necessary, the center has an “open access” system where appointments are made for the same or next day, helping to increase service utilization and decrease rescheduling and no-shows.

As a method of outreach to students in the high schools, the center furnishes a 10-day comprehensive health education program to nearly 1,700 youth in local high schools and middle schools. The program uses peer health educators, known as the “Sex Ed Squad,” to teach two of the days. The peer health educators are selected by a rigorous interview process, are trained in weekly meetings throughout the year, and participate in a daylong “Sex Ed Bootcamp” training in the fall and the “Sex Ed Olympics” in the spring. They also help with local health fairs and serve as resources at their own schools, wearing their squad t-shirts to market their unique knowledge to peers. This past year over 100 youth were trained.

Motivated by its mission to provide integrated services that increase resiliency, encourage responsibility, and promote self determination, DCYHC also offers youth development programs. A mentoring program matches at-risk high school students with an adult in the community to participate in monthly leadership and confidence-building activities, such as circus school and ropes courses. Another program helps youth prepare for the workforce through job readiness workshops, career exploration field trips, and a summer work program. Two counseling and educational support groups also meet weekly -- a group for parents of adolescents and a teen mom’s support group for pregnant and parenting teens. DCYHC is constantly piloting new ideas and programs such as the free condom availability program in local high schools and an obesity and nutrition education program. Feedback of DCYHC programs and services is regularly solicited to ensure that adolescent-centered care is provided.

For more information, please visit http://www.dalycityyouth.org/

The SPOT
St. Louis, Missouri

The SPOT, Supporting Positive Opportunities with Teens, was established in 2008 by clinicians at Washington University in partnership with an AIDS/HIV program and the St. Louis Children’s Hospital Adolescent Center in response to the need for an ambulatory site that could serve teens confidentially, comfortably, and free of charge. Located in a town house space separate from the hospital, The SPOT provides physical, behavioral, and reproductive health care, as well as social and support services such as job and housing searches and crisis intervention to youth ages 13 to 24. Funding for The SPOT comes from foundations, area hospitals, Washington University, SAMSHA, and individuals.

The SPOT is directed by a social worker and is staffed by a multidisciplinary team of health and social services professionals, including a Drop-In coordinator, a behavioral health therapist, a case manager, a psychiatrist, a substance abuse counselor, peer health educators, and also nurses and physicians from Washington University’s Adolescent Center and Division of Obstetrics and Gynecology. The SPOT is also home to a multidisciplinary team in training where residents, social work practicum students, undergraduate students, and peer educators learn to care for the whole adolescent, and not just simply address the adolescent’s chief complaint. It is open every weekday afternoon with morning appointments available if needed. In just over a year, it has served more than 1,700 youth, the vast majority of whom are African American. Those seeking health care typically come in for sexual health concerns, especially STD testing and pregnancy tests, but are helped to make use of the full range of preventive, physical, and mental health services, as needed.

A unique feature of The SPOT is the Drop-In. This is a large living room area where youth can hang out. In this space, teens have access to free computers, television, food, a kitchen, and, if needed, a shower, a washer and dryer, a phone with free local calls, and even clothing. Teens often spend free time at the center before they begin to use the health and social services resources. In this space, youth are treated as adults and advice is only given if asked.

The Drop-In is also used in the evening as a site for health education and prevention programs. One such program is a 10-week program for young women that focuses on knowledge and awareness of HIV and STDs as well as individual reproductive health and personal growth. Another is a 10-week youth training program to develop leadership skills. In the future, other HIV prevention programs will be offered to enhance the center’s HIV/STD prevention efforts, including a program for women of color and another for young homosexual men.

Central to The SPOT’s philosophy is a commitment to engaging youth in all aspects of the program’s development and building opportunities for fostering their leadership. For example, youth make activity suggestions for the Drop-In space. Organized activities have included an STD jeopardy game, discussions on youth rights with law students, and educational programs on safe relationships, nutrition, and food preparation. Youth also serve as members of the Youth Advisory Committee and meet monthly to consult with The SPOT staff about the center’s services, aesthetics, location, and outreach through Twitter, YouTube, and Facebook. Youth also work in the clinic as trained peer- health educators.

For more information, visit http://thespot.wustl.edu/.

HiTOPS
Princeton, New Jersey

HiTOPS, a free standing adolescent health clinic in Princeton, New Jersey, provides comprehensive primary and preventive health care to adolescents and young adults ages 13-26 and also provides health education to adolescents and to their teachers, parents, and caregivers. Established in 1989 in response to an unmet need in the community for adolescent reproductive health care and education, the center has since grown to being a comprehensive adolescent health and education facility. Funded primarily through corporation, foundation, and individual support, HiTOPS is open six days a week to deliver physical, reproductive, and primary mental health care, risk-reduction counseling, intensive and health promotion to some 1,800 young people, most of whom are low-income and about a third of whom are minority. Part of the center’s philosophy is to encourage adolescents who “just want to talk” to come to the center to meet with a nurse practitioner alone or with a partner or group of friends. Staff assure confidentiality and tell adolescents no question is “too silly” or “too stupid” to ask.

The center is staffed by a range of professional clinicians and educators, including social workers, certified nurse midwives, nurse practitioners, nurses, certified health education specialists, and health educators. A team of OBGYNs, adolescent medicine specialists, and urologists provides support and consultation and psychiatrists and psychologists are linked to the center through referral relationships.

Health education is integral to the center’s mission, and HiTOPS’ educational programs have received national recognition. Adult educators lead programs that convey factual information and teach risk-reduction strategies and skills for decision-making. These programs are delivered at the HiTOPS center, in middle and high school settings as part of health classes, at community-based agencies, scout meetings, youth groups, and private homes. There are also programs for teachers and parents, who are able to identify their own topics for an education series. iQuit, the technology-based smoking cessation program that HiTOPS developed itself is illustrative of the special capabilities of the HiTOPS staff. The program, which targets 18 to 24 year-old smokers, consists of a web site, www.iquitathitops.com, contains podcasts, text messaging, and email access to a tobacco dependence treatment specialist for individualized counseling.

Health education is also available from peer health educators, high school seniors who participate in the HiTOPS Teen Council and receive over 140 hours of training in human sexuality, presentation skills, group facilitation, and interactive educational techniques. They provide workshops for middle school and high school-aged youth at juvenile justice facilities, schools, and community agencies throughout the state on a number of topics, including postponing sexual involvement, dating violence, pregnancy prevention, HIV/AIDS, homophobia reduction and date rape. In collaboration with the Princeton Center for Leadership Training and the New Jersey Department of Health and Senior Services, HiTOPS developed a sexual health peer education program called Teen Prevention Education Program (Teen PEP), a for-credit class offered in 50 schools throughout New Jersey and two in North Carolina. The HiTOPS peer education curriculum and video package, “One by One: Teens Explore Date Rape” won a national Telly Award, which is given to exceptional educational teaching tools and materials.

In an effort to serve more of the area’s Hispanic population, HiTOPS has developed Latina Health Education and Empowerment Program (LHEEP), an educational outreach program targeted specifically at adolescent Latinas. Its purpose is to increase awareness about HIV, STDs, and pregnancy prevention among young Trenton and Princeton Latinas. The HiTOPS Latina Outreach Coordinator meets with participants after school for eight weeks and provides culturally relevant, science-based prevention education. The curriculum is reinforced as the group creates its own HIV or pregnancy prevention Public Service Announcement (PSA) or other outreach strategy for a targeted audience.

For more information, visit www.HiTOPS.org

Lakewood Hospital Teen Health Center
Cleveland, Ohio

Lakewood Hospital Teen Health Center has been providing comprehensive health care to adolescents in Cleveland and neighboring counties since 1999. Responding to concerns of school nurses who saw a growing need for adolescent-sensitive health care, Lakewood Hospital, part of the Cleveland Clinic hospital system, established the teen clinic in collaboration with the City of Lakewood's Department of Human Services, Lakewood City Schools, and community-based physicians. The center serves adolescents ages 12 through 19 and is based in a separate building about a mile from the hospital.

Lakewood Teen Health Center's mission is to enhance the overall health status of adolescents by providing high-quality, comprehensive, and multidisciplinary physical and emotional health care services and prevention education in a confidential, accessible, and affordable manner. The center is staffed by a multidisciplinary team that includes a pediatric nurse practitioner, an advanced practice nurse, a medical assistant, and several clinical social workers. A family physician and a child and adolescent psychiatrist provide consultation and routine supervision. Together they bring many years of experience in the care of adolescents.

Approximately 900 adolescents make 3,000 visits to the center annually. Although the center offers a wide array of services - including preventive care, health education, physical health services, sexual and reproductive health services, mental health care, and also substance abuse treatment when it occurs with mental health disorder - staff report that more than two-thirds of all visits are related to behavioral health problems. Many adolescents initially seen for physical health concerns receive behavioral health services as a result of warning signs identified by staff during the assessment process. The center offers a variety of treatment modalities to treat diagnoses such as depression, anxiety, post traumatic stress, bipolar, and adjustment disorders as well as education on prevention techniques. In addition, group therapy and support sessions, offered over a 10-week period, focus on education and coping techniques for a variety of behavioral and emotional issues facing adolescents. Recent group topics include anger management, self-harm, stress management, and self esteem.

The teen health center staff also provide many hours of outreach and education to the community. They offer screening services for adolescents at schools and other community sites, including yearly Body Mass Index and oral cancer screenings, and ensure proper follow-up. They also make more than 50 presentations each year to foster greater understanding of the health and social issues facing adolescents, addressing topics such as normal adolescent development, depression, eating disorders, self harm, stress, and cultural diversity. They are involved in community groups as well and participate, for example, in a school crisis management group that helps students deal with death and other serious emotional issues.

For more information, please visit www.lakewoodhospital.org

Teen Health Connection
Charlotte, North Carolina

Teen Health Connection was established in 1991 by a coalition of community organizations to promote improved systems of health care and support for adolescents and their families in Charlotte, North Carolina and surrounding areas. The freestanding community clinic provides family-centered, developmentally appropriate, and coordinated primary health care by a team of health professionals for adolescents ages 11 through 21. Services are delivered by an interdisciplinary staff that includes, in addition to the medical director, who is also the adolescent medicine director at the local children's hospital, pediatricians, nurse practitioners, therapists, nurses, dietitians, and health educators, all with extensive experience in adolescent health issues. The clinic serves about 2,500 adolescents each year, more than 80 percent of whom are African American or Latino.

Individualized physical, behavioral, and reproductive health care are core services at Teen Health Connection along with health education for adolescents and their families. Its Healthy Choices, Healthy Teens program is a four-part health education program designed to empower adolescents to make healthy living decisions. The focus is on 11- to 14-year olds before they adopt risky behaviors, but the program can be tailored to older adolescents as well. Adolescents participate in four one-hour sessions on puberty, emotional well-being, healthy relationships, and physical health.

Grounded in the belief that the most important factor in a teen's life is an involved and caring adult, Teen Health Connection does more than simply encourage communication between teens and their families. It offers two in-depth parent education programs. The first, the Parent-Teen Communication Forum, facilitated by a therapist with expertise in adolescent psychology and a community health educator, is a two-hour session for adolescents and their parents focusing on positive communication techniques. Adolescents and their parents meet separately for the first hour of the session and come together for the second hour for discussion and role playing. The second parent health education program, Parenting Healthy Teens, provides parents with the tools to develop and maintain a positive, healthy, supportive relationship with their teen. Among the many topics are family problem solving, effective communication techniques, adolescent growth and development, and helping adolescents with decision making.

Teen Health Connection also sponsors activities that engage adolescents in settings outside of the clinic. Free tennis lessons are offered in the summer for adolescents ages 13 to 16, and a summer movie program gives adolescents the opportunity to view a major motion picture and then discuss the issues raised in the film, such as racism, adolescent pregnancy, and drug addiction.

For more information, visit www.teenhealthconnection.org

The Corner Health Center
Ypsilanti, Michigan

Serving a primarily low-income clientele for 27 years in its freestanding, community-based location, the Corner Health Center in Ypsilanti, Michigan has as its mission to help young people make healthy choices now and in the future by providing high quality primary health care, education, and support for adolescents and their children without regard to income level. It provides not only comprehensive, interdisciplinary physical, reproductive, and behavioral health care for adolescents ages 12 to 21 but also on site pediatric care and WIC services for the children of adolescent parents. “Everything I need for my body and even my mind is right here. All in one place. Makes it a lot easier, with my baby and everything,” reports one patient. Nearly 2,000 adolescents - about half of whom are African American - make approximately 7,000 visits each year to the center.

Medical staff are affiliated with the University of Michigan Health System and the St. Joseph Mercy Hospital and include primary care physicians, pediatricians, psychiatrists, social workers, nurse practitioners, nurse midwives, nutritionists, and health educators. The center's clinical services include wellness, acute, and chronic medical care; psychiatric care and counseling; nutritional education and counseling; STD testing, treatment, and follow-up; prenatal and postpartum care; and family planning education and birth control services.

The Center also offers a range of other services. For example, Mom Power! is a special group for adolescent mothers who come together for six classes facilitated by social workers. Topics include child development, self medication and substance use, and how to connect with and play with children. For adolescents aging out of foster care services, the Center's Foster Care Resource Program educates them about other types of available assistance and how to apply for it. Monthly skill building workshops provide practical information on applying for jobs, obtaining a lease, managing finances, and other life skills. In addition, the center has organized a theatre troupe that has been critical for community outreach and education. Comprised of high school peer educators, the troupe performs interactive, educational skits and follow-up workshops in the community on dating violence, teen depression, HIV and STDs, and prevention of the use/abuse of alcohol and other drugs.

In an effort to meet its clients' basic needs, the center offers additional, nonmedical services, such as an on-site food pantry that provides nonperishable food items for any client who needs them. A Patient Assistance Fund is also available for clients who need monetary assistance in order to procure transportation to medical appointments, prescription drugs, or emergency medical needs. Patients also earn “points” for attending health care appointments that can be used to purchase a range of products from the Corner store, including personal care items, baby products, and gift cards to area movie theatres and stores.

For more information, visit www.cornerhealth.org

Mary's Center Teen Program
Washington, DC

Founded on the core belief that “teens will respond positively if they are treated with honesty and respect,” Mary's Center Teen Program in Washington DC offers a unique mix of general health, nutrition, sexual health, and counseling services as well as educational, vocational, and community-oriented support services to primarily Hispanic teens. The program, open to youth ages 13 to 21, helps young people develop responsibility for their physical and emotional health and to make wise lifestyle choices. It also supports them in developing healthy interpersonal relationships, improving their educational activities and economic circumstances, and thriving in a diverse community.

The teen program was launched in 1990, soon after Mary's Center for Maternal and Child Care, a federally qualified community health center, opened its doors. The program operates in a separate space with its own staff but arranges for certain medical and mental health services only available through the Center. It holds a special bi-monthly Saturday clinic in addition to being open during the Center's regular hours. Depending on individual needs, teens may see their case managers, known as Family Support Workers, weekly or multiple times a week. Unlike many adolescent programs that find it challenging to attract young men, Mary's Center Teen Program has successfully involved both male and female teens in its activities. Approximately half of the adolescents it serves are male. This is due in part to the fact that many boys previously seen in the Center's pediatric program make a natural transition to the teen program.

The program's commitment to youth development is visible from the teen's first contact. As part of the orientation process, the staff makes clear that the program is committed to giving the teen respectful and confidential care in a safe environment. After talking about their health needs and completing a thorough questionnaire on their educational and medical history, adolescents are paired with a Family Support Worker who actively engages them in their care. The emphasis on youth development is also apparent in the Teen Summer Urbanito Program, which provides job preparation and trips to colleges. In addition, there is an after-school peer health educator program that trains adolescents to present health education information to local schools and community organizations.

Parent involvement is another important component of the teen program. Seen as positive assets to teens, parents are provided valuable information on what to expect as adolescents move through different phases of development and are taught healthy ways to handle this sometimes challenging period of family life. Referrals to mental health services and other programs are also available to parents.

For more information, visit www.maryscenter.org

Adolescent Medicine and Young Adult Medical Practice at Children's Hospital Boston
Boston, Massachusetts

As the oldest adolescent medicine clinic in the U.S., the Adolescent Medicine and Young Adult Medical Practice at Children's Hospital Boston has been providing comprehensive interdisciplinary physical and mental health care for adolescents and young adults ages 10 to 23 since 1951. A multidisciplinary staff of adolescent medicine specialists, nurse practitioners, nurses, nutritionists, HIV counselors, and mental health professionals working collaboratively provide more than 17,000 primary care and specialty patient visits each year at Children's Hospital and four community-based satellite locations.

As part of its outreach to adolescents and their parents, the clinic uses 21st century technologies to bring health information to adolescents and connect them with health care services. It has developed two interactive websites, youngwomenshealth.org and youngmenshealthsite.org, that not only provide more than 150 easy-to-read, accurate, and professionally developed health guides on specific adolescent health topics that range from body piercing and acne to menstrual problems and STIs but also provide a forum for adolescents to share their health concerns with staff from the practice. These online chats occur monthly in the evening on specific topics and are meant to provide support and general information. Monthly chats have been held on polycystic ovarian syndrome, MRKH (vaginal and uterine anomalies), and endometriosis. Youth advisors have had an integral role in the development of the sites and have an ongoing role in peer education and outreach and education activities, including writing articles for the quarterly Teen Talk newsletter.

The practice also has a particular commitment to providing care to special adolescent populations with reproductive endocrine issues and eating disorders and those at risk for or living with HIV. The Reproductive Endocrine Program provides specialized care to girls with absent or irregular menses, polycystic ovary syndrome, and a variety of other gynecologic complaints. The Eating Disorders Program provides multidisciplinary consultative care to adolescents with anorexia nervosa, bulimia, and other disordered eating issues. Its Boston HAPPENS program provides free HIV counseling and testing, comprehensive clinical care to HIV positive youth, and a variety of counseling and support services for patients and families, including case management and individual and group therapy. Staff also work closely with youth-serving organizations on HIV prevention and intervention strategies and provide technical assistance, consultation, and staff in-service trainings. Faculty and fellows are also involved in a variety of research projects that focus on developing new interventions for improving adolescent health such as obesity, eating disorders, STIs, media, and bone health.

For more information, visit www.childrenshospital.org

University of Maryland Adolescent and Young Adult Medicine Clinic
Baltimore, Maryland

Occupying its own stand-alone, street-level office space in downtown Baltimore, the University of Maryland Adolescent and Young Adult Medicine Clinic is based in the community and reaches out to local teens and their families, while also drawing upon the substantial institutional resources of the university. The clinic provides continuing comprehensive primary and subspecialty health care for underserved and underinsured teens and young adults ages 12 through 24. Staff, many of whom are bilingual, have expertise in adolescent medicine, nursing, psychology, social work, nutrition, health education, and outreach.

Community outreach is deeply integrated in the clinic's approach to secure a connection between adolescents and needed health services. Clinic staff frequently participate in community events, including church programs, health fairs, and afterschool programs in efforts to better educate adolescents and those working closely with teens about adolescent health and the clinic's services. Of particular note is the clinic's work with new immigrant families who confront unique barriers in accessing health care services. The clinic has successfully engaged parents to bring their teens, particularly males, in for services. Males comprise 40% of the clinic's patient population, up from just 20% 10 years ago. The clinic also operates a teen-focused web site - www.yuhip.net where teens can connect to health experts and gather the most accurate and up-to-date information to enable them to make better decisions regarding their health. Furthermore, for the adolescents already linked to clinic services, various structures are in place for them to give feedback on services, solicit suggestions for needed resources, and share ideas that can improve clinic services. Teens can attend Community Advisory Board meetings or share their thoughts with a peer representative.

HIV prevention, treatment, and research are special areas of focus for the clinic. An interdisciplinary program called STAR TRACK (Special Teens At-Risk, Together Reaching Access, Care and Knowledge) addresses the complicated needs of adolescents who are infected with HIV through primary and subspecialty care, comprehensive counseling, case management, and support groups. Over the past fifteen years, STAR TRACK has launched community wide projects such as Project ACCESS, a multi-media social marketing campaign in 6 cities developed to encourage HIV counseling and testing among high- risk youth. Currently STAR TRACK is collaborating with Connect To Protect: Baltimore, a community based participatory research project working to create policy, procedural, and programming changes in the city to affect HIV acquisition in at-risk youth. The clinic is also a member of the national Adolescent Trial Network, which works to develop research initiatives for teens with HIV and facilitate their participation in research that has the potential to affect the lives of HIV positive youth on a national level.

For more information, visit www.umm.edu

Mount Sinai Adolescent Health Center (AHC)
East Harlem, New York

Mount Sinai AHC (East Harlem, New York) is a freestanding hospital-based adolescent medicine clinic whose mission is to provide adolescents with inclusive, integrated health services, and, in the process, help them develop into capable young people who can advocate effectively for their own health. In support of this goal, prevention, education, and opportunities for self-development are integrated into every aspect of the program. Staff at the center include 6 adolescent medicine specialists, a child and adolescent psychiatrist, an ob/gyn, 20 clinical social workers, 3 health educators, 2 child psychologists, dieticians, nurse practitioners, physician's assistants, and ambulatory care technicians. A cornerstone of AHC's approach is to have these staff members operate as a consciously collaborative team, with the aim of providing each patient with a coordinated, highly individualized care program. The health center serves more than 10,000 teens a year.

As a part of a comprehensive physical exam, a patient receives reproductive health screening and counseling, a mental health assessment, appropriate tests and immunizations, risk-reduction counseling, and health education. For adolescents requiring mental health services, AHC provides on-site testing and diagnostic services; individual, group and family psychotherapy; and substance abuse counseling. The center also provides a wide range of ongoing peer support groups, including groups for youth with HIV/AIDS, adolescents with eating disorders, children of alcoholics and drug abusers, and teen parents.

The program makes a conscious effort to welcome adolescents and engage them in ways that make them feel comfortable and safe. The clinic has Saturday and evening hours and accomodates walk-in appointments. Health education and skill-building are a core part of both primary care and the wide range of specialty health programs available to teens. Whether patients make use of programs on weight management and fitness, pregnancy prevention, eating disorders, HIV/AIDS, or teen parenting, they learn how to make healthy decisions, to value themselves, and to become informed, effective health care consumers. Their development is also supported through mentoring, tutoring, legal advocacy, and GED support programs.

The process of engaging teens also includes involving them as partners in furthering Mount Sinai's mission. A peer education program called SPEEK (Sinai Peers Encouraging Empowerment Through Knowledge) prepares teens to engage community youths and facilitate workshops on preventing pregnancy, HIV/AIDS, and other sexually transmitted infections.

For more information, visit www.mountsinai.org

Wilmington Health Access for Teens (WHAT)
Wilmington, North Carolina

In response to statistics showing that Wilmington, North Carolina teens significantly exceeded state and national averages for out-of-home placements, juvenile arrest rates, and substance use, WHAT opened its doors to area adolescents in 1997. Operating initially with generous financial support from the Duke Endowment, the center's mission was--and continues to be--ensuring access for all teens to quality physical and mental health services and providing prevention, education, and outreach services to promote optimal health.

In WHAT's first year, a staff of just six employees served 1,000 teen patients. By the time the center celebrated its 10th anniversary in 2007, more than 12,000 adolescents were receiving services from a staff of 40, including the region's only board-certified adolescent medicine specialist. Most importantly, the region has seen dramatic declines in teen pregnancy rates and the number of teens seeking care for non-emergency services in hospital emergency departments.

Today, WHAT operates a freestanding, not-for-profit adolescent health center as well as two school-based health centers. Staff includes pediatricians, registered nurses, physician assistants, licensed clinical social workers, a registered dietitian, and health educators. WHAT offers a range of physical, behavioral, and reproductive services, including management of chronic illnesses, STD testing and treatment, contraception, lab services, and nutritional counseling.
With an approach that emphasizes family counseling and case management, the center also provides adolescents with comprehensive counseling services for such issues as stress, school problems, relationships, drug and alcohol use, and smoking. The center accepts all insurance arrangements, including Medicaid and SCHIP, and provides services on a sliding scale to the uninsured. Continuing foundation and individual support has allowed WHAT's annual budget to grow to $2.5 million.

Services provided by the center extend beyond physical and behavioral health care. As part of its commitment to community outreach, the center developed a peer education program called SYNERGY that prepares teens to reach out to community youth and facilitate workshops on numerous topics, including bullying, hygiene, and preventing pregnancy and STIs. Staff has recently developed a SYNERGY program especially for Latino youth. Another program, called Question Why Tobacco Prevention Youth Empowerment, teaches adolescents to advocate for tobacco-free policies in restaurants, recreation areas, and other locations. The center also offers two pregnancy prevention programs, including one for young males called Wise Guys.

For more information, visit www.whatswhat.org

West Suburban Teen Clinic
Excelsior, Minnesota

Providing services in an atmosphere of confidentiality, acceptance, and respect is a bedrock principle of the West Suburban Teen Clinic, located in Excelsior, Minnesota, a suburb of Minneapolis. "The people are very understanding and don't make you feel bad about the stuff you've done," reports one client. The clinic's goal is to provide accurate information, teach problem-solving skills, and reinforce healthy decision-making by providing services in a relaxed and friendly environment. Feedback from adolescents has been overwhelmingly positive, with more than 90% reporting that the clinic's providers listen well, treat them with respect, take enough time with them, involve them in decision-making, and give good advice and treatment.

This community-based, not-for-profit clinic is the product of a teen task force convened in 1971 by local clergy concerned about the increase in teen pregnancy and STDs in the area. Initially providing reproductive care to 600 adolescents per year, the clinic now provides a continuum of prevention and intervention services to meet the physical, emotional, and educational needs of more than 2,000 adolescents and young adults up to age 23. Because the clinic is located in an early 20th-century house, it offers a comfortable, home-like environment that helps to alleviate the anxiety many adolescent clients feel when seeking health care in traditional medical settings.

In addition to medical and counseling services, the West Suburban Teen Clinic provides individual and group education programs for both teens and their parents. These programs are offered in the clinic as well as in schools, churches, and other community settings. Parent educators are available for group sessions to discuss parents' questions and concerns about raising adolescents and pre-teens, from developmentally appropriate behavior to current research on teen-related topics. Group classes are also offered on healthy sexuality for young adolescent girls and the trusted adult they each choose to bring with them. In addition, 2 peer education programs are available: the Labyrinth Program, which focuses on pregnancy and STI prevention and counseling for at-risk youth, and Dads Make a Difference, which prepares high school students to work with middle school students to understand the challenges involved in parenting and to avoid behavior that will lead to pregnancy.

For more information, visit www.westsuburbanteenclinic.org

Wake Teen
Raleigh, North Carolina

Based in Raleigh, North Carolina, Wake Teen Medical Services is a private office-based adolescent health practice that has been dedicated to providing a wide range of physical, reproductive, and mental health services to adolescents and young adults for over 30 years. Founded in 1977 by a local pediatrician mindful of the dearth of teen health services, the practice was originally based at the Wake Medical Center but has since moved to a free-standing site. With a strong emphasis on youth development and integration of care, Wake Teen provides not just comfortable and comprehensive health services but extensive risk reduction counseling and an active peer health education program as well.

The office is staffed by two pediatricians, a nurse practitioner, a health educator, a clinical social worker, a nutritionist, and a child and adolescent psychiatrist. Together, these health care professionals serve as an interdisciplinary team that regularly meets to design and coordinate treatment plans for new and existing patients. The practice serves approximately 1,600 adolescents per year, ranging in age from 10 through 23. The vast majority, almost three-quarters, of these patients are African American. A key component of Wake Teen’s mission is sensitivity to adolescents’ needs, providing the time necessary to address their multiple, often interrelated issues. Indeed, a spectrum of services are incorporated into a teen’s initial visit, including a physical exam, reproductive health screening and counseling, a mental health and psychosocial assessment, and even an initial mental health counseling session, if needed. Psychotherapy and family counseling sessions are also available.

Dedicated to helping adolescents make their own health-related decisions, Wake Teen provides on-site, risk reduction counseling to all patients on topics such as stress management, safe sex, staying in school, quitting smoking, pregnancy prevention, weight management, and avoiding drugs. In addition, Wake’s health educator makes presentations on adolescent health topics and decision-making skills in community settings, frequently speaking with parents and health professionals about how they can support teens in becoming healthy, self-confident young adults.

Wake Teen also sponsors an innovative peer health education program known as REAL (Realistic Education About Life) Teen Council, a 15-member, all-teen group that makes presentations to after-school programs and the community on a variety of health topics, such as drug and alcohol avoidance, pregnancy and STI prevention, and life skills. With this trained and passionate group of young volunteers, the program extends the reach of health education and skill-building to many settings that are normally inaccessible, such as sports events, parties, and concerts. Recently, Wake Teen has incorporated an online initiative known as Real Talk through which the office’s diverse and knowledgeable staff can post informative articles and answer questions pertaining to adolescent health issues.

For more information, visit www.waketeen.org

Erie Teen Health Center
Chicago, Illinois

Erie Teen Health Center is a freestanding clinic on Chicago's ethnically diverse North Side that focuses exclusively on providing health care services to adolescents and young adults ages 12-24.The center, which was founded in 1985 by a nurse-midwife and pediatrician who recognized an adolescent's need for a health care locale that respected their privacy, is one of seven sites within the Erie Family Health Center, a federally qualified health center system. A key aspect of Erie Teen's mission is to help adolescents develop the strengths and skills that will allow them to become effective stewards of their own health. Indeed, an initial visit includes a physical exam, a medical and psychosocial history, reproductive health screening and counseling, a weight and nutrition assessment, and even risk-reduction counseling about violence, safe sex practices, and illegal substance avoidance. Erie Teen receives up to 2,200 patients a year, plus 500 babies and young children of patients. Due to the large number of pregnant girls and teen mothers, the center provides a full range of prenatal, delivery, and postnatal services as well as pediatric care, thereby serving not just adolescents but also their families.

To address the fact that many parents of the predominantly Hispanic patients speak only Spanish, all support staff at Erie Teen are bilingual. Many support staff in fact are former patients not much older than the teens accessing services who understand the anxieties and doubts that accompany a young person's initial forays into the health care system. The center's clinical team is comprised of two pediatricians, a family nurse practitioner, a pediatric nurse practitioner, a nurse-midwife, and two clinical social workers, most of who work on a part-time basis. As a result of these part-time schedules, the clinical staff typically meets with each other frequently but informally, rather than in a meeting room. Feedback studies show that 96% of patients have reported satisfaction with their treatment, with most concurrently engaging in healthy practices they learned at Erie Teen. A key factor in this success has been the clinical staff's ability to engage teens in a respectful, non-judgmental way that is sensitive to their issues and anxieties, thereby establishing trust and a sense of comfort. Furthermore, the center is firm in its commitment to confidentiality, tailoring care so as to reflect the teen's privacy and the degree to which they want family members informed of the services provided.

One of Erie Teen's premier projects has been the Centering Pregnancy Program, a group model of prenatal care wherein pregnant patients join with other girls with similar due dates to receive prenatal care, education, and therapy. This model includes discussions and consultations with experts to build trust among members and form an enduring community of young mothers. Through this process, the patients become knowledgeable about their bodies and participate actively in self-care to ensure the best health outcomes for themselves and their infants. Recently, Erie Teen has developed a presence online with pages on Facebook, Twitter, and Myspace, as well as a regularly updated teen health blog called "Beats per Minute", which provides pertinent information, stories, and events.

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