The National Alliance to Advance Adolescent Health
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Delivery System Innovations & Recommendations

A Research Agenda for Adolescent-Centered Primary Care in the United States
by Harriette B. Fox, Margaret A. McManus, Charles E. Irwin Jr, Kelly J. Kelleher, and Ken Peake. Journal of Adolescent Health. 2013:307-310.
This commentary presents a set of prioritized research recommendations on adolescent-centered primary care developed by experts participating in The National Alliance to Advance Adolescent Health's invitational conference in 2012. The recommendations pertain to increasing adolescent and parent engagement and self-care management, improvement preventive care and identifying conditions early, and integrating physical, behavioral, and reproductive health services. The commentary also addresses federal and private foundation funding priorities related to the adolescent research agenda.

Medical Home Innovations: Where Do Adolescents Fit?
by Ian Walker, Margaret McManus, and Harriette Fox, December 2011.
This report provides a summary of the activities underway in 12 innovative medical home programs and discusses how the health needs of adolescents are being addressed. Findings are based on interviews with leaders in public, private, and multi-stakeholder programs. The report examines each of the seven principles central to the medical home model: personal provider, physician-directed practice, whole person orientation, care coordination, quality and safety, enhanced access, and payment for excellence. It describes the progress that has been made in changing primary care practices and plans underway for future improvements.

Strengthening Preventive Care to Better Address Multiple Health Risks Among Adolescents
Presentations by Harriette B. Fox, Margaret A. McManus, Susan K. Maloney, Angela Diaz, and Anne Morris, November 2010.
This report summarizes the presentations at the Adolescent Preventive Services Institute at the American College of Preventive Medicine 2010 Annual Meeting. It reports on the prevalence and co-occurrence of teen risk behaviors, the underutilization of clinical preventive services for adolescents, and barriers to the delivery of preventive care. The report also presents evidence-informed strategies for improving clinical and community prevention and includes a description of the Mount Sinai Adolescent Health Center as an innovative primary care model.

Pediatricians' Interest in Expanding Services and Making Practice Changes to Improve the Care of Adolescents
by Harriette Fox, Margaret McManus, Karen O’Connor, Jonathan Klein, Angela Diaz, and Charles Wibbelsman, September 2009.
Based on a 2008 national survey of practicing pediatricians, this fact sheet examines pediatricians’ interest in adding or expanding preventive, mental health, and reproductive health services for adolescents if payment barriers were removed. It also identifies the specific practice and staffing changes they would have an interest in making, as well as the types of support and training they perceive would be most helpful to them in providing comprehensive primary care to adolescent.

Health Reform and Adolescents
by Harriette B. Fox and Margaret A. McManus, June 2009.
This issue brief documents the significant health risks and conditions of adolescents and the financing and delivery system barriers that affect their access to appropriate care. It urges Congress to consider coverage expansions under Medicaid and CHIP, benefit and payment improvements, grant programs to support interdisciplinary models of primary care, and funds to improve training for adolescent health providers.

Structuring Health Care Reform to Work for Adolescents
by Harriette Fox, Margaret McManus, Stephanie Limb, and John Schlitt, November 2008.
This issue brief on health reform and adolescents examines four major themes for restructuring the health care financing and delivery system -- placing greater emphasis on prevention, redesigning primary care, changing payment incentives, and relying more on evidence-based care. For each topic, reform proposals are summarized, issues of concern to adolescents are reviewed, and new options for addressing adolescent needs are presented.

Pediatric Perspectives and Practices on Transitioning Adolescents with Special Needs to Adult Health Care
by Margaret McManus, Harriette Fox, Karen O'Connor, Thomas Chapman, Jessie MacKinnon, October 2008.
Based on a 2008 national AAP survey of practicing pediatricians, this fact sheet examines pediatricians' perspectives on the appropriate age to begin planning for transition and their practices regarding the provision of transition support services to adolescents with special needs. It also identifies the economic and non-economic barriers that pediatric practices face in providing transition services and presents options for improving training, financing, adult provider availability, and adolescent and parent education.

Under One Roof: Primary Care Models That Work for Adolescents
by Marian Sandmaier, Alyssa D. Bell, Harriette B. Fox, and Margaret A. McManus, May 2007.
This report describes a model of comprehensive, interdisciplinary physical, behavioral, and reproductive health care for adolescents operating in three different health care settings — a hospital outpatient department, office practice, and community health center. The strengths and flexibility of the three models are profiled in detail, along with the financing challenges these programs confront. Information was obtained through a site visit and multiple telephone interviews with the programs' providers and administrators.

Making the Case for Addressing Adolescent Health Care
by Margaret A. McManus and Harriette B. Fox, January 2007.
Drawing on data from multiple studies and national surveys, this fact sheet documents that the compelling needs of our nation's adolescents are being poorly addressed through our current system of health care financing and delivery. It argues for more effective teen-friendly health care in which intensive health promotion interventions are available, physical and behavioral health care are integrated, and the unique perspectives and vulnerabilities of adolescents are addressed.

Preliminary Thoughts on Restructuring Medicaid to Promote Adolescent Health
by Harriette B. Fox, Stephanie J. Limb, and Margaret A. McManus, January 2007.
This issue brief examines state Medicaid benefit and payment policies affecting adolescents and concludes that they are inadequate to support the type of care that adolescents require. It includes a proposal for an enhanced set of health promotion and primary care benefits designed specifically for adolescents that can be offered through EPSDT or as an alternative benefit package under the Deficit Reduction Act and suggestions for possible changes to payment policies to support comprehensive preventive and primary care service delivery for adolescents.


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