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Improving the Odds for Adolescents
State Policies that Support Adolescent Health and Well-being

Authors: Susan Wile Schwarz and Yumiko Aratani
Publication Date: July 2011

Executive Summary

For policymakers, adolescence presents an invaluable opportunity to ensure that all young people can access the high-quality services and supports they need to improve their odds of becoming successful, healthy, productive adults. At an historic moment when the provisions and breadth of health care reform are under vigorous debate, it is important to take stock of how well the states are currently meeting the health and development needs of all adolescents, and particularly disadvantaged youth. This report presents information from NCCP’s Improving the Odds for Adolescents project about state policy choices that affect the health and well-being of adolescents.

Summary of Selected Key Findings

Health

For adolescents whose family income is up to 200 percent of the federal poverty line (FPL), almost every state offers public health insurance coverage through the Children’s Health Insurance Program (CHIP), and about a third offer coverage through Medicaid. Variability exists among states’ choices to extend coverage to different groups of vulnerable youth. Only about one-fifth of states do not terminate Medicaid enrollment for juvenile justice-involved youth.

Most states recognize the key role schools play in promoting the health and well-being of their students. However, there has been noticeably less agreement in how integrated and extensive this role should be and whether it should include health services provision. More than half of states have specific health-related curricula requirements, including physical education requirements, and about a third fund direct health services offered by school-based health centers. Health curricula in nearly two-thirds of states must cover prevention of HIV, sexually transmitted infections, and pregnancy. Yet, only one-fifth require schools to provide any services related to this prevention.

Nearly all states may allow adolescents to consent to a variety of reproductive health and family planning services, with the exception of abortion services, but very few have policies explicitly dictating who can and cannot consent to services and whether confidentiality will be maintained. Lack of clarity about the right to consent and confidentiality can cause confusion among service providers and especially among adolescents in need of care.

Mental Health

Overall support for mental health services is fairly low except around drug and alcohol-related issues. Almost three-quarters of states require that drug and alcohol prevention education is included in the health curriculum, but only one state explicitly establishes social and emotional learning standards for schools. Similarly, most states allow minors to consent to care for drug or alcohol abuse but less than half allow minors to consent to outpatient mental health care. The vast majority of states require that providers of mental health service in schools meet certain training or certification requirements, yet very few states require schools to provide mental health services to students.

Violence and Injury Prevention

States are mixed in their violence and injury prevention policies. Nearly two-thirds of states require that general violence and injury prevention education be included in the curriculum, but only a quarter require that school curricula explicitly address dating violence. All states have some form of graduated driver licensing system in place, but the individual components of these systems vary from state to state, as does the duration of the restrictions. More than half of states ban cell phone use for new adolescent drivers, and even more ban texting while driving. Less than half of states have comprehensive laws protecting adolescents from interpersonal violence, and only a few states have adequate laws protecting against cyberstalking.

Youth Development

States are also mixed in their efforts to promote youth development. Less than half of states require students to remain in school until age 18, but there is a growing movement to systematize and better track graduation rates at the state level. There is more support for providing further educational opportunities to former foster youth than for undocumented immigrant youth. All states provide some degree of funding to afterschool programs for youth, but there is little complementary effort to evaluate the quality of these programs, and even fewer states provide support for mentoring initiatives.

Summary

Looking at the overall national picture, states were weakest in supporting adolescent health and wellbeing in the following areas:

  • health service provision in school settings and school-based health center (SBHC) coverage through Medicaid and CHIP;
  • mental health services and supports in school settings;
  • consent and confidentiality rights for both reproductive and mental health services;
  • emerging topics, such as bullying, cyberstalking, interpersonal violence, and obesity prevention; and
  • socially divisive topics, such as abortion and services and supports provided to juvenile justiceinvolved youth and undocumented immigrants.

Recommendations

Each of these areas presents opportunities for states to fine-tune their existing policies, evaluating their efficacy and scale of implementation, and to establish new policies that are informed by adolescent health research. Based on the latest research in the field and in consultation with a panel of adolescent health experts and state coordinators, we identified steps states can take to better support adolescents’ healthy development.

  • Expand public health insurance coverage to reach more youth in need of care, regardless of living situation, such as immigration status or living in state custody.
  • Push schools to adopt evidence-based health promotion curricula and programs across all content areas that promote adolescent well-being.
  • Mandate a coordinated school health approach, incorporating student health and mental health into the mission of schools and integrating analyses of student health, health promotion, and health services into the No Child Left Behind school improvement plans, where applicable.
  • Invest in SBHCs and support the replication of other best practices shown to improve academic and health outcomes, such as high quality afterschool programs for youth.
  • Explicitly extend consent and confidentiality rights to adolescents, especially around sensitive topics such as reproductive health and mental health.
  • Strengthen laws to empower adolescents to protect themselves from violence and abuse, with particular attention to the most vulnerable youth, such as, but not limited to, protection order access and bullying and cyberstalking legislation.
  • Encourage potentially cost-saving collaborations with the private sector to expand growth opportunities for all youth, such as, but not limited to, internships and mentoring programs.
  • Invest in programs that enable adolescents, and especially vulnerable youth, to successfully transition to independent adulthood, such as, but not limited to, independent living skills training and other aftercare services, including education services, vocational training, and counseling.