2 

A call to action to promote 

the health of America’s 

42 million adolescents

Recommended citation: U.S. Department of Health and Human 

Services, Office of Adolescent Health, Adolescent Health: Think, 

Act, Grow® Playbook. Washington, D.C.: U.S. Government 

Printing Office, updated July 2019.

This document is available at: 

https://www.youth.gov/TAG
3 

Contents

Healthy Adolescents ............................................................................................................1

Five Essentials for Healthy Adolescents............................................................................ 2

Today’s Adolescents............................................................................................................ 3

Beyond the Numbers ....................................................................................................................3

Don’t Leave Youth on the Sidelines ..............................................................................................4

A Day in the Life ............................................................................................................................ 5

A Picture of Adolescent Health .................................................................................................... 7

Practice Both Offense and Defense .............................................................................................. 9

Trends for the Current Season................................................................................................... 10

Checking the Score ......................................................................................................................13

Spotlight: Youth with Disabilities................................................................................................14

Get into the Game ..............................................................................................................16

Action Steps for Health Care Professionals ................................................................................16

Action Steps for Public Health Professionals .............................................................................17

Action Steps for Out-of-school and Community-based Program Professionals........................18

Action Steps for Education Professionals...................................................................................19

Action Steps for Faith-based Community Professionals........................................................... 20

Action Steps for Social Services Professionals ...........................................................................21

Action Steps for Workforce Development Professionals .......................................................... 22

Action Steps for Parents, Grandparents, Families, and Caregivers .......................................... 23

Action Steps Teens Can Take to Be Healthier ............................................................................ 24

The Game Plan for Engaging Youth............................................................................................ 25

Ideas for Effective Youth Engagement........................................................................................ 25

Join the TAG Team ............................................................................................................ 27
1 

Healthy 

Adolescents

Adolescent Health: Think, Act, Grow® (TAG)

is a national call to action to improve health, to reduce 

risky behavior, and to promote engagement and healthy 

development among young people. The adolescent years (ages 

10-19) and the transition to young adulthood are important 

times for promoting current and life-long health. 

TAG uses a strengths-based, positive youth development 

framework to encourage youth-serving professionals, families, 

and youth themselves to take steps toward promoting 

better adolescent health. While teens are generally healthy, 

behavioral and mental health problems, alcohol and drug 

misuse, injuries, violence, obesity, and other challenges 

sideline too many young people. TAG calls for adults from all 

walks of life to make the health, safety, and development of 

adolescents a high priority. TAG is aimed at helping ensure 

achievement of national health objectives set forth in Healthy 

People 2020, the National Prevention Strategy, and other 

national plans.

TAG provides a framework 

for action 

The Office of Adolescent Health (OAH) in the U.S. Department 

of Health and Human Services systematically gathered 

input from national leaders working in out-of-school time or 

community programs, education, faith-based organizations, 

health care, public health, and social services who reach a large 

number of adolescents. These leaders developed the elements 

of the Five Essentials for Healthy Adolescents. With additional 

input from groups representing parents, families, and teens, 

the national organizations’ leaders crafted action steps 

appropriate for their field to use as they work with adolescents. 

In this updated version of the Playbook, you will find new 

sections on youth in the workforce and youth with disabilities, 

as well as action steps built on updated research findings, best 

practices, and experience from previous initiatives aimed at 

improving adolescent health.

Adolescence is a time of rapid change and development. It 

is the time for adults and all organizations that serve youth 

to be involved and stay involved. Just as good health means 

that adolescents are ready to learn and grow, meaningful, 

supportive relationships, places, and experiences can help 

prevent risky behavior and provide opportunities for swift 

intervention when problems emerge.
2 

Positive connections with 

supportive people

Adolescents thrive in safe, stable, and nurturing relationships 

with supportive adults, whether those are parents, coaches, 

neighbors, grandparents, teachers, program leaders, or 

mentors. These types of connections are important for all teens 

and may be difficult for at-risk youth to find and sustain.

Safe and secure places to live, 

learn, work, and play 

Schools, neighborhoods, and community settings can foster 

and support healthy adolescent development across the 

spectrum, including physical and mental health, social 

interactions, and cognitive growth. Adolescents also benefit 

from safe places to congregate, enjoy social, athletic, and other 

recreational activities, and just be with their peers.

Access to high-quality, teenfriendly health care 

Adolescents benefit from access to high-quality medical 

and dental care, mental and behavioral health services, and 

health care providers who understand adolescent health and 

development. Young patients prefer health services that are 

youth-friendly, culturally competent, affordable, convenient, 

and confidential. Health care that is adolescent-centered 

and involves parents, but allows for increased autonomy as 

adolescents reach their late teens, is ideal.

Opportunities to engage as 

learners, leaders, team members, 

and workers

Active youth involvement with people and programs is 

important for promoting healthy adolescent development. 

This includes activities at school, at home, or in the community, 

such as school clubs, sports, music, visual and performing arts, 

or out-of-school time programs, volunteer or paid jobs, and 

activities at places of worship. Adolescents also benefit from 

opportunities to shape programs and activities, which can 

improve the programs, provide valuable leadership skills, and 

build confidence.

Coordinated adolescent- and 

family-centered services

Adolescents enter health and social service systems in many 

ways and at different stages. Integrated and coordinated 

services can help ensure better health outcomes and support 

healthy development for adolescents. Unfortunately, the 

systems for providing services and supports to adolescents 

are often fragmented, spread across government agencies, 

nonprofit organizations, health care providers, businesses, 

and faith-based organizations. A more coherent, integrated 

approach to fostering health and healthy development would 

benefit all teens. 

Five Essentials for Healthy 

Adolescents 

The leading causes of death and disability for adolescents and young adults are 

largely preventable. The game plan is clear. Experts convened by the Office of 

Adolescent Health agree that adolescents flourish when they have: 
3 

There are 42 million adolescents between the ages of 10 and 19 

in the United States.2 That’s one out of every eight Americans. 

According to U.S. Census data, about 51 percent of adolescents 

are male and 49 percent are female. Nearly half of adolescents 

are between ages 10-14 (49.6%) and slightly more than half are 

between the ages of 15-19 (50.4%).3

Nationally, the United States is undergoing a demographic shift. 

The overall proportion of adolescents who are a racial or ethnic 

minority is increasing. For example, it is projected that by 2060, 

about one in three adolescents will be Hispanic.4 The graphic 

below represents the racial/ethnic background of adolescents 

in the United States.5 

Many teens live in metropolitan areas. Just over three in ten 

adolescents (31%) lived in the main city of a metropolitan area. 

Nevertheless, more than one in six adolescents (17%) lived in a 

nonmetropolitan area.6 

The National Survey of Children with Special Health Care Needs 

identified nearly 1 in 5 children ages 12-17 as having special 

healthcare needs.7

J Beyond the Numbers

Social and economic factors, such as education and income 

levels; health behaviors, such as tobacco use and diet and 

exercise; access to high-quality health care; and healthy and 

safe environments all contribute to an adolescent’s overall 

health.8 For all teens, positive influences and relationships 

during the adolescent years can set a course for good health 

throughout life.9,10

Members of racial and ethnic minority groups, in general, are 

more likely to lack a usual source of health care, experience 

more serious health conditions, and have higher rates of 

mortality than whites. It is critically important to address 

health disparities related to race and ethnicity now to ensure a 

healthy America in the future.11 

Any young person can be vulnerable to adverse health 

outcomes, and those living in poverty are particularly at risk. 

Roughly 16% of adolescents between the ages 10-17 lived below 

the federal poverty line in 2018. 12

Although high school graduation rates have increased since the 

2011-2012 academic year, from 80 percent to 84 percent (see 

graph on page 4); in 2016, six percent of all 16- to 24-year olds 

had dropped out of school without earning a diploma or GED.13 

Race/Ethnicity of America’s Adolescents

(from Current Population Survey: Projected Population by Single Year of 

Age, Sex, Race, and Hispanic Origin for the United States: 2016 to 2026)

Hispanics/Latinos can be of any race. As 

listed, all race categories, except for Hispanic 

and multiracial, exclude Hispanics/Latinos. 

AIAN stands for American Indian Alaska 

Native. HPI stands for Hawaiian or Other 

Pacific Islander. 

53% 0.4%

5%

Asian

HPI alone

0.9%

AIAN alone

3.6%

Multiracial

13.8%

Black

23.5%

Hispanic

White

THE PLAYERS: 

Today’s Adolescents
4 

J Don’t Leave Youth on the 

Sidelines

Youth who are children of immigrants or refugees, 

or who are homeless, living in foster care, involved 

with the juvenile justice system, or identify as 

lesbian, gay, bisexual, transgender, or questioning 

(LGBTQ), may need special support and attention to 

their health care and development.

Juvenile justice system. There were about 850,000 

juvenile deliquency cases in 2016,14 and over 800,000 youth 

between the ages of 10-17 were arrested in 2017.15 Youth involved 

with the juvenile justice system are considered a high-risk 

population who often have unmet physical, developmental, 

and mental health needs. Their poorer health status may result 

from living in impoverished or abusive environments or may be 

due to acquired health problems that are neglected or remain 

undiagnosed.16

Foster care. In 2017, about 40 percent of the over 440,000 

children in foster care in the United States were between the 

ages of 10 and 20.17 Many children and teens have experienced 

sporadic health care prior to entering foster care, and around 

80 percent have experienced at least one traumatic event.18

Additionally, youth may deal with traumatic events as they 

leave foster care, as about 30 percent of youth reported their 

worst trauma took place after the age of 16.19 Approximately 

50 percent of adolescents in foster care have chronic physical 

conditions, and nearly 10 percent are considered medically 

fragile.20

Lesbian, gay, bisexual, transgender, and 

questioning (LGBTQ) adolescents. Among adolescents 

ages 12-18, about 12 percent of females and 4.5 percent of males 

identify as LGBTQ.21 Most LGBTQ youth are healthy, but some 

are more likely than their heterosexual peers to experience 

negative health and life outcomes. LGBTQ youth are at 

increased risk for experiences with violence, such as bullying or 

physical assault.22 

Homelessness. In the 2016-2017 school year, over 1.3 million 

students between the ages 6-18 were homeless.23 Homeless 

youth often have a greater number of physical and mental 

health problems than their peers who are not homeless. In 

addition, they often face unique barriers to accessing health 

care, including lack of insurance and a need for parental 

consent.24

Disabilities. Among youth under the age of 18, adolescents 

ages 12-17 have the highest prevalence of special health care 

needs (18%). A higher percentage of males under the age of 18 

are estimated to have special health care needs than females 

(17% versus 13%).25 See page 14 for more information about youth 

with disabilities.

Public high school 

graduation rates

(from 2017 National Center for Education Statistics Dropout/

Completer Data Tables, 2015 Digest of Education Statistics)

Who do America’s 

adolescents live with

(from U.S. Census Bureau 2017 Current Population Survey, 

Living Arrangements of Children Under 18 Years Old: 1960 

to Present)

69%

4%

27%

2015-16

84.1%

80%

2011-12 2012-13 2013-14 2014-15

81.4%

82.3%

83.2%

AVERAGE FRESHMAN

GRADUATION RATE (%)*
5 

J A Day in the Life

The way adolescents spend their time can strongly influence their health later in life. For youth to achieve 

a healthy future, they need plenty of sleep; good nutrition; regular exercise; and time to form relationships 

with family, friends, and caring adults. Additionally, the time adolescents spend in school and in after-school 

activities with peers and adults can advance healthy academic, emotional, social, and physical development. 

Adolescents also are influenced by their exposure to media and their increasing use of social media. 

How do U.S. high school students spend their time each week? The detailed information in the American Time Use 

Survey, collected by the U.S. Bureau of Labor Statistics, provides a picture of a day in the life of a high school teen, comparing time on a 

typical school day and time on a weekend day during the school year.

Source: American Time Use Survey, Bureau of Labor Statistics, 2016.

All Adolescents

Weekdays Weekends
6 

Adolescents spend a substantial amount of time on media and communications activities, including watching TV, playing video and 

computer games, surfing the Internet, listening to or playing music, and using cell phones to call or text friends and others – many of 

these at the same time.

While high school males spend more time on the computer than high school females, all adolescents spend most of their media/

communications time watching TV and videos. On an average weekday, both females and males watch 1.4 hours of TV and videos. On 

an average weekend day, females watch 2.4 hours and males watch 2.6 hours. 

On Computer/Playing Games*

Weekdays Weekends

0.9

hours

1.3

hours

Time Spent on Media/Communications

Total Time

Weekdays

2.6

hours

Weekends

4.4

hours

0.1 

hours

Listening to/Playing Music

 Weekdays Weekends

0.2

hours

Watching TV or Videos

 Weekdays Weekends

1.4 

hours

2.5

hours

 Weekdays Weekends

0.3

hours

0.2

hours

Phone/Email/Text

 *Does not include time spent checking email or watching videos

 Source: American Time Use Survey, Bureau of Labor Statistics, 2016.
7 

Physical Health and Nutrition

 In 2017, male high school students were more likely than 

female high school students to report getting the recommended 

60 minutes of physical activity on five or more days a week.26

Approximately one in ten females (12%) and almost two in ten 

males (18%) in grades 9-12 were categorized as obese according 

to CDC growth charts. Being overweight can increase the risk 

of numerous health problems, such as cardiovascular disease, 

Type 2 diabetes, high cholesterol, and asthma.27

Mental Health

A high number of students report mental health issues such 

as anxiety and depression during adolescence. Female high 

school students were almost twice as likely as male high school 

students to report depressive symptoms.28

Reproductive Health

Teens who delay first sex are more likely to use contraception 

and have fewer sexual partners, which lowers their risk of teen 

pregnancy and sexually transmitted diseases.29 

Substance Use

Among 8th, 10th, and 12th graders, alcohol use and binge 

drinking continued to show a significant five-year decline.

Opioid use (narcotics other than heroin) dropped significantly 

over the last five years among 12th graders and reflects a longterm decline from a peak of 11 percent in 2003.30

Use of traditional cigarettes has continued to decline to the 

lowest levels in the history of the national Monitoring the 

Future survey.31

While these outcomes show promising changes in substance 

use among adolescents, use of tobacco, alcohol, and drugs 

continues to be associated with numerous adverse health 

outcomes.32

Educational Attainment

Good health promotes education and education promotes good 

health. Healthy students are generally better learners than 

their peers who lack healthy behaviors. In addition, youth who 

perform better in school and complete more education are 

healthier over the course of their adult lives. They engage in 

fewer risky behaviors such as smoking and binge drinking and 

participate in healthier behaviors such as exercise, which helps 

them to live longer.33

Healthy Relationships

 Intimate partner violence is associated not only with physical 

injury, but also with emotional and behavioral problems. In 

2017, 8 percent high school students who had dated in the 12 

months before the survey reported that they were hit, slapped, 

or physically hurt on purpose by their partner.34

Bullying is associated with a number of serious health issues, 

including substance use and emotional problems, and even 

suicide.35

Community Support

The actual or perceived safety of neighborhoods can influence 

health directly or indirectly. If safety concerns restrict 

opportunities to get physical exercise, for example, adolescents’ 

health can suffer.

Supportive neighborhoods—where people look out for each 

other’s well-being, and families can rely on neighbors’ help—

contribute to social and emotional health.36

J A Picture of Adolescent Health We know that good health enables adolescents to learn and grow. Although adolescents are generally 

healthy, they must learn life skills such as managing mental health issues, substance use, obesity, and 

peer and romantic relationships as they transition into independent adulthood. Here are some of the 

health issues adolescents will encounter as young adults and throughout life. 
8 

Percent 0f 12- to 17-year olds who had chronic 

health conditions, 2016.38

Physical Activity

39%

Females

58%

Males

Percent of high school students who reported 

60 minutes of physical activity on five or more 

days in the past week, 2015.37

Percent 0f high school students who reported 

feeling sad or hopeless in the past 12 moths, 

2017.39

Felt Sad or Hopeless

32%

Total

21% Male 41%

Female

Bullying

Percent of high school students bullied at 

school in the past 12 months, 2016.43

Percent of 8th, 10th, and 12th grade students 

who did not use alcohol in the past month, 2017.40

8th

grade

10th

grade

12th

grade

92% 80% 67%

Neighborhood Safety

Percent of parents who reported their 12- to 

17-year-old was safe in their neighborhood, 

2016.44

Alcohol-Free Status

Supportive Neighborhoods

Percent of parents who reported that their 12-

to 17-year-old live in supportive neighborhoods, 

2016.45

One chronic 

condition

55%

Live in 

supportive

neighborhoods

19%

Total

22% of Females 16% of Males

Math Proficiency

Percent of 8th and 12th grade students at or

above the proficient level in math, 2015.42

8th grade

12th grade

Percent of 8th and 12th grade students at or

above the proficient level in writing, 2011.41

Writing Proficiency

33%

34%

33%

Total

Male

Female

Total

Male

Female

25%

26%

23%

Male

Female

Male

Total

Female

8th grade

27%

21%

33%

12th grade

27%

17%

36%

Total

45%

Do not live in 

supportive

neighborhoods

22% 25%

53%

No chronic

conditions

Two or more 

chronic

conditions

Chronic Health Conditions

95%

never/

sometimes

safe

5%

Usually or 

always safe
9 

Experimentation and risk-taking are a part of life and play 

a role in adolescent development. Taking some chances 

helps adolescents establish their identities. Experiencing 

success allows teens to learn what worked well. A failure or 

disappointment gives them a chance to think through what they 

might do differently next time. Adolescents have limited life 

experiences, so a disappointment or embarrassment may seem 

overwhelming. When something does not go as planned, having 

a trusted adult to talk to can help a young person figure out how 

to make it right or bounce back. 

When it comes to adolescent health, the focus is often on 

preventing potentially harmful behavior. Yet, adolescent 

development experts point out that there are positive risks 

teens should take. Trying out for a team, joining a new club 

or activity, volunteering or working, taking a harder class in 

school, and making new friends are all examples of positive 

risk-taking and are usually a healthy part of growing up.46, 47

Teens who are engaged in learning and in meaningful activities, 

who have a good self-concept and have control of their 

emotions, who live in stable situations, and who are healthy and 

safe benefit from protective factors or strengths, which help 

them learn and grow when they take positive risks.

Then there are negative risk factors, such as alcohol, tobacco 

and drug use; unsafe driving; violence; sexual activity; and 

mental health problems that leave parents worried and 

communities troubled. Indeed, studies suggest that half of all 

behavioral risks first appear during adolescence.48 Yet statistics 

do not give much sense of what is going on with an individual 

young person or what’s happening in a school or neighborhood. 

Further analysis of the risk factors included in the 2015 

Youth Risk Behavior Surveillance System data provides some 

interesting insights, for example, about half of high school 

students reported engaging in zero or one risky behavior(s) 

during the prior year.49 On the other hand, one in four (26%) 

reported engaging in four, five, or more risky behaviors during 

the same period (see graph on the right).50 

It is challenging for caring adults to figure out how best to 

respond to an individual or small group of young people when 

negative behavior occurs. Is the behavior an issue that if caught 

early will not reoccur, or is it a warning sign of a much more 

serious problem? There are no easy “one-size-fits-all” answers, 

but some clusters of risky behaviors should alert adults to the 

possibility of negative outcomes.

For example, among the four percent of teens (9th through 12th 

grade) who reported in 2015 that they had sexual intercourse 

before age 13 for the first time, 23 percent were in one or more 

fights in school during the past year, four percent reported 

carrying a weapon to school, 30 percent reported feeling 

persistently sad or hopeless, 14 percent reported having 

unprotected sex, 33 percent reported currently drinking 

alcohol, 22 percent reported currently using marijuana use, 

and six percent reported ever using hallucinogenic drugs.51

However, the rates of some risky behaviors are down among 

adolescents; the percentage of adolescents ages 12 to 17 who 

smoked one or more packs of cigarettes per day was lower 

in 2015 (7.8%) than in 2002 to 2011, according to the National 

Survey on Drug Use and Health.52

Figuring out which teens are engaging in negative risks is 

complex. A teen with many risky behaviors may be one who 

needs serious attention from caring professionals, and who may 

benefit from behavioral counseling and coordinated follow-up 

services.

Number of risk behaviors 

among adolescents

(from analysis of 2015 Youth Risk Behavior Surveillance System data)

49%

14%

11%

8%

18%

J Practice Both Offense and Defense
10 

J Trends for the Current Season 

Efforts to improve health outcomes for adolescents 

are occurring against a backdrop of evolving 

policies and practices, demographic changes, and 

other trends. 

Health care. Access to and use of health care can 

significantly improve adolescent health and prevent the onset 

of some problems in the future. Continuous health insurance 

coverage, with access to preventive and behavioral health 

services, can mean better control of chronic problems and 

prevention or management of issues that can disrupt school 

attendance or healthy development.53 

Health care systems are increasingly focused on ways to 

increase the efficiency and quality of health care. Initiatives 

such as establishing medical homes for youth with special 

needs, better integrating and coordinating health care with 

mental health and social services, and giving increased 

attention to managing transitions from pediatric to adult health 

care can benefit young patients.

Prevention. Preventive health care services during 

adolescence can help protect youth and identify problems 

early. In 2016, nearly one in five adolescents (18%) did not 

receive any preventive medical care visits.54 Research shows 

that even those who saw a health care professional for medical 

care did not always receive all the recommended screenings 

and anticipated guidance on relevant health behaviors for 

this age group.55, 56 Rates for immunizations, dental care, and 

screening for smoking and other risky behaviors remain low. 

Risk assessments delivered in health care settings can quickly 

screen teens for multiple risks, and the provider can use patient 

responses to focus care. 

Health insurance. Most young people under age 18 have 

health insurance, and access to health coverage for millions of 

young adults expanded with implementation of the Affordable 

Care Act.57 About nine out of 10 white, black, Asian, and 

Hispanic adolescents had insurance health coverage in 2017.58
11 

Health plans offered in the Health Insurance Marketplace 

include mental health and substance abuse care, and vision 

and dental care for children under age 19 along with benefits 

such as medical visits and hospital care. Patients cannot be 

turned down for insurance due to a pre-existing medical 

condition, and insurers cannot impose annual or lifetime dollar 

limits on care.59 

As teens approach adulthood, many still lose health care 

coverage if they cannot stay on a parent’s plan until age 26, or if 

they live in a state that has not extended Medicaid coverage to 

childless adults. This gap in coverage also affects populations 

such as young adults who “age out” of foster care and youth 

who are disconnected from care by immigration status or other 

circumstances.

Social media and technology. The increasing use of 

social media permeates the fabric of adolescents’ daily lives, 

affecting where they get information and how they spend their 

time. The effects of social media on adolescent development 

are not yet fully understood. With improved ability to connect 

and share information using new technologies, there are 

more opportunities to break down silos and collaborate 

across health care, social services, education, or other sectors. 

Concerns about teens’ social media and technology use include 

texting while driving, exposure to mature content, and the 

psychological effects of limiting personal interaction.

Community prevention. Many communities are creating 

opportunities for prevention. There is increased attention 

to fitness and healthy eating, clean air and water, and safe, 

affordable housing. There is community-wide planning to 

implement policies and practices that support healthy living, 

including ensuring tobacco-free environments, initiatives that 

support walking and biking, and efforts to prevent injuries. 

Fitness and nutrition. Our understanding of nutrition 

and what is needed to support life-long physical fitness and 

health is changing. Major efforts are underway that are raising 

awareness, increasing opportunities, and developing policies to 

support better physical fitness and nutrition for all Americans, 

especially younger children and adolescents. 

Physical activity guidelines for children ages 6-17 recommend 

at least one hour a day of physical activity that includes aerobic 

activities and activities to strengthen muscles and build strong 

bones.60 In 2016, about 93 percent of school districts had 

adopted a policy stating that high schools will teach physical 

education.61

Schools increasingly play a role in making sure children are 

well-nourished and eating healthy foods. Schools with lowincome students provide food to eligible students through the 

school meal programs, which in some areas continue during 

school and summer breaks.62 For some youth, these programs 

are their primary source of nourishment. Some schools are 

increasing access to healthier foods through initiatives ranging 

from planting gardens to upgrading foods in the cafeteria, and 

changing suppliers to bring in fresh foods that are prepared 

on-site.

Education. Educators, health care professionals, parents, 

and others are increasingly recognizing the connection among 

healthy students, a healthy school climate, and academic 

outcomes. As one report notes, healthy eating and physical 

activity are linked with academic achievement.63

Although some schools face significant financial and staffing 

challenges, others provide a school nurse or health aide and a 

counselor along with educational staff. Requirements for school 

health professionals vary across states, and this lack of standard 

credentials may affect the services available at schools. Most 

school systems offer health education classes; however, there 

is wide variation in the curricula for health education across 

schools, districts, and states.64

In addition, a school’s environment, such as air quality or the 

location, age, condition, and physical layout of the building can 

affect student health.

FIND additional resources at 

www.youth.gov/TAG
12 

Work. There are nearly 5.5 million young people between 

ages 16 and 24, who are disconnected from school, work, or 

the military. These “opportunity youth” have the potential 

to succeed in various settings with appropriate supports.65

Work can be an important part of healthy adolescence and 

yield multiple benefits for youth and society in general. In 

addition to economic benefits and job-related skills, work 

experiences provide teens with opportunities to engage in key 

developmental tasks, such as decision-making, building social 

skills, and taking on new levels of responsibility. Working 

during high school has benefits now and into the future; it’s 

associated with a lower likelihood of dropping out of school and 

higher employment rates and better wages in adulthood.66

Unfortunately, in recent years, youth unemployment rates 

have reached their highest level in over fifty years.67 As a result, 

there is increased attention on improving work opportunities 

for young people. For example, implementation of the federal 

Workforce Innovation and Opportunity Act is focused on 

increasing access to employment, education and training, and 

support services for young people ages 16-24, especially youth 

who are homeless, in foster care, involved with the juvenile 

justice system, pregnant or 

parenting, low-income, not 

in school, or disabled. 

Public agencies, 

employers, youth-serving 

organizations, and other 

community partners are 

working to create job 

training opportunities 

and a continuum of work 

experiences for youth, 

including volunteer or 

community service, 

internships, and workstudy jobs, as well as full- or 

part-time employment. 

Professionals who employ or prepare and train youth for 

the workforce are not only helping young people now with 

additional income and job skills, but they are also improving 

their employment and career prospects. This has positive 

implications for individual youth, families, and society at large. 
13 

J Checking the Score

Beginning in 1980, the United States established national 

health objectives each decade to guide action to improve 

health and to track progress. Healthy People 2020 is the 

current centerpiece of efforts to improve and measure 

health outcomes in the United States. For the first 

time, Healthy People includes a set of objectives aimed 

at improving the healthy development, safety, and 

well-being of adolescents and young adults.68 Progress 

toward achieving the objectives is routinely tracked and 

reported. TAG is one activity focused on helping achieve 

these important national objectives. 

In addition to the adolescent health objectives shown 

below, there are additional objectives on related topics, 

such as reducing deaths from vehicle crashes or reducing 

the proportion of adolescents who report binge drinking.

Healthy People 2020: 

Adolescent Health 

Objectives

INCREASE THE 

PROPORTION OF 

ADOLESCENTS WHO:

• Had a wellness checkup in the past 

12 months

• Participate in extracurricular and/or 

out-of-school activities

• Are connected to a parent or other 

positive adult caregiver

• Transition to self-sufficiency 

from foster care

REDUCE:

• The proportion of public schools 

with a serious violent incident

• Adolescent and young adult 

perpetration of, and victimization 

by, crimes

• The proportion of adolescents 

who have been offered, sold, or 

given an illegal drug on school 

property

INCREASE:

• Educational achievement of adolescents 

and young adults

• The proportion of schools with a school 

breakfast program

• The proportion of adolescents whose 

parents consider them to be safe at school

• The proportion of middle and high schools 

that prohibit harassment based on a 

student’s sexual orientation or 

gender identity
14 

Adolescents living with disabilities face many 

health challenges. If these youth receive adequate 

supports and appropriate health care, they can 

thrive in adolescence and into adulthood. 

What is a Disability?

The definition of disability includes physical or mental health 

conditions as well as limitations in conducting routine activities 

of daily life. The HHS Maternal and Child Health Bureau defines 

children with special health care needs as “those who have or 

are at increased risk for a chronic physical, developmental, 

behavioral, or emotional condition and who also require 

health and related services of a type or amount beyond 

that required by children generally.” Although youth with 

disabilities have impairments or limitations in functioning, 

their life experiences can vary greatly depending on social and 

environmental barriers they encounter.69

Adolescents with Disabilities: What’s the Score? 

Among children ages zero to 17, adolescents have the highest 

prevalence of special health care needs.70 The National Survey 

of Children with Special Health Care Needs identified nearly 

1 in 5 children ages 12-17 as having special health care needs,71

and the American Community Survey estimates that more than 

1.3 million young people ages 16-20 have a disability.72

Unfortunately, youth with chronic conditions and disabilities 

have more complex health care needs, are more likely to 

have their needs go unmet, and experience more barriers—

including social stigma—to full participation in activities than 

youth without such conditions.73

Youth with disabilities face many social inequities that affect 

their health and well-being. For instance, youth receiving 

special education services are more likely to live in low-income 

households, experience bullying, and be suspended from 

school. They are less likely to participate in school sports, spend 

time with friends regularly, expect to enroll in post-secondary 

education or training, and have recent paid work experience.74 

Leveling the Playing Field: Your Role

Many youth with special health care needs need help with 

navigating complex health and service delivery systems. The 

youth, their family, the health system, and the community all 

have a role to play in promoting the health and resilience of 

adolescents with disabilities.75

• Coordination. Three-quarters of parents of youth with 

special health care needs report needing help with 

coordination of care or services, but only a little more than 

half of these parents had that need adequately met.76

Many parents learn to advocate for their adolescent with 

disabilities, but finding the time for this is a challenge for 

working parents. Parents must navigate the policies and 

bureaucracies related to their child’s needs, including the 

complex special education and disability benefits systems, 

and many families don’t have the financial resources to hire 

an attorney or professional advocate to help. 

• Health care transition. Making the transition from 

pediatric to adult health care can be especially difficult for 

youth with disabilities. 

Many youth and young 

adults - particularly 

those with complex 

health conditions, 

mental health problems, 

or behavioral health 

needs - can experience 

serious gaps in care 

when they transition to 

the adult health care system.77 Transition issues may include 

confidentiality, reducing risky behaviors, and how to obtain 

and sustain health insurance coverage.78 Of note, the 2016 

National Survey of Children’s Health showed that 17 percent 

of youth with special health care needs and 14 percent of 12-

17 year old youth without special health care needs received 

transition supports.79

• Accessibility. Often, modifications are needed to ensure 

that youth with disabilities can access services in medical, 

educational, and recreational settings. Examples include 

having information available in Braille or sign language, 

providing ramp access to facilities, allowing extra time 

or quiet spaces for taking tests, and providing assistive 

technology. It also can involve providers taking time to 

present age appropriate health information in a way that 

matches a youth’s developmental stage. 

• Education. Youth in grades K through 12 with certain 

types of disabilities can obtain an Individualized Education 

Program (IEP) or a “504 Plan.” These plans are created by 

the school, parents, health care provider, and the young 

person working as a team. IEPs are developed according to 

provisions of the Individuals with Disabilities in Education 

Act (IDEA) and 504 plans are developed according to Section 

504 of the Rehabilitation Act of 1973. These plans typically 

outline supports and services available to assist the child at 

school, together with regular assessments to track progress 

toward goals. Additionally, 504 Plans are generally intended 

for children and youth with less severe disabilities, and are 

Got Transition is a cooperative 

agreement between the HHS Maternal 

and Child Health Bureau and the 

National Alliance to Advance Adolescent 

Health and provides resources for 

health care providers, families, 

and young patients to improve the 

transition from pediatric care to adult 

health care. www.gottransition.org

J Spotlight: Youth with Disabilities 
15 

subject to fewer formal safeguards, but must also include 

classroom and other school accommodations appropriate to 

the student’s unique needs. States and school districts vary 

greatly in how they address these requirements and many 

states need assistance to meet requirements established by 

the U.S. Department of Education.80

Winning Plays to Support Youth with Disabilities

There are a few promising practices that can help youth with 

disabilities achieve improved health and healthy development.

One is a medical home, which is a health care delivery model 

developed by the American Academy of Pediatrics that provides 

family-centered, comprehensive, and culturally informed 

primary care.81 This approach facilitates partnerships among 

patients, their health care providers, and, when appropriate, 

the patient’s family in a health care setting. Evidence suggests 

the medical home model can lead to improved health outcomes 

for children with special health care needs.82 One example of 

this approach is the Mount Sinai Adolescent Health Center, 

which integrates physical health, mental health, and social 

services at one location that is free, accessible, and welcoming 

to all young people.

Another promising model for adolescent health care that can 

support adolescents with disabilities is school-based health 

centers. These centers have been found to increase access 

to care and improve mental health, resilience, and use of 

contraceptives.83 Health Centers in Schools is one example 

of an innovative, integrated school-based program aimed at 

improving student health in Baton Rouge, Louisiana. 

An additional way to support youth with disabilities is to 

encourage them to advocate for themselves. Youth with 

disabilities can join organizations for self-advocacy support 

and mentoring. Some resources to explore include: Autistic 

Self Advocacy Network, Family Voices, The ARC, Eye to Eye, and 

Partners for Youth with Disabilities.
16 

Improving adolescents’ health and supporting their healthy development

is a team effort.

TAG calls upon organizations and individuals working with adolescents in health care, public health, out-of-school or 

community, education, faith-based, social service, and workforce development settings, along with families and youth, to 

prioritize activities that improve adolescent health. The Office of Adolescent Health obtained the input of professionals 

from multiple youth-serving sectors to identify the following action steps. These steps, which some organizations and 

individuals are already engaged in, will strengthen collaborations and support better health outcomes for youth.

Get into the Game!

J Action Steps for Health Care 

Professionals 

Health care professionals are on the front lines 

for ensuring adolescent health and development, 

and can adopt several strategies for improving 

adolescent health outcomes. 

Make health care offices friendly and welcoming. 

Consider using patient portals or other ways to communicate 

confidentially with adolescent patients. Consider adolescents 

when selecting décor, furniture, and reading materials for your 

office. Set office hours to accommodate busy school schedules. 

Bring services to schools whenever feasible. Train all staff, 

including clerical and paraprofessionals, in how to welcome 

and interact with adolescents.

Ask hard questions and use risk-screening tools. 

Use screening protocols to ask adolescents about sensitive 

topics, such as weight; sexual orientation or behavior; mental 

health issues; drug, alcohol and tobacco use; and violence or 

victimization. Use assessments that identify strengths as well 

as risky behaviors. Integrate confidentiality policies into health 

care practices to improve patient care. Establish and implement 

follow-up procedures to see if patients obtain the referred 

services and how patients are doing.

Make preventive services a priority. Ensure 

adolescents receive recommended clinical preventive services, 

including immunizations, screenings, and counseling about 

behavior that supports their health. Adapt office systems, 

including patient portals, reminders, standing orders, and 

other means, to ensure that recommended preventive care is 

delivered. Establish policies and procedures for delivering brief 

interventions. 

Maintain referral sources for youth with chronic 

conditions, special needs, and mental health 

issues. Know who in your community can help with 

mental health issues, substance use, eating disorders, and 

other challenges. Make referrals to available services in the 

community and make sure that some of the services accept 

Medicaid or have sliding fee scales. Establish and implement 

follow-up procedures to see if the patient obtained the services 

and how they are doing. 

Improve and update training on adolescent 

health. Trainings should reflect the latest knowledge on 

adolescent health and development, risk and protective 

factors, and confidentiality laws, including interacting with 

adolescents who are over 18. Ensure that staff receive training 

and incorporate this knowledge into services. 

Facilitate smooth transitions from adolescent to 

adult health care settings. Assist adolescent patients 

with transitions and ensure continuity and quality of care. 

If an adolescent with special needs or a chronic condition is 

making the transition to a different health care setting, make 

referrals to providers who can meet those needs and provide 

required medical records. Encourage youth and parents to 

plan for medical coverage during the transition to adulthood. 

Maintain release forms to allow information to be shared 

among providers.

Be a leader in building partnerships in the 

community with others who serve youth. 

Promote adolescent health by taking a lead role in coordinating 

care across systems, including health, education, social 

services, and other community partners. Identify and engage 

allies such as the school system, parent-teacher groups, youth 

groups, nonprofit youth-serving organizations, and senior 

citizens. At-risk youth are often served by multiple providers 

and systems. Get involved in community efforts to improve 

adolescent access to health and sex education information, 

programs that strengthen families and build youth skills, and 

health centers convenient to schools.
17 

J Action Steps for Public Health 

Professionals 

As a public health professional, there are several key 

ways you can continue to contribute to improving 

the health and healthy development of America’s 

adolescents. 

Provide leadership for developing communitywide approaches to promoting adolescent 

health. Partner with community organizations, schools, 

faith-based organizations, businesses, health care providers, 

local foundations, parents, grandparents, and teens to identify 

priorities for advancing adolescent health in the community 

(e.g., activities in parks, safe spaces for adolescents to gather 

for sports and social events). Leverage grant opportunities, 

trainings, and cross-sector programming to raise awareness 

across settings and increase attention to improving adolescent 

health.

Conduct or provide data for community health 

assessments. Use assessments to identify and describe 

adolescent health needs, including measuring and tracking 

adolescent health outcomes. Assessments of local needs may 

have been completed in response to grant requirements, by 

community-based initiatives, or by tax-exempt hospitals. Be 

sure to include adolescent health needs as assessments are 

conducted or updated. Use and refer to state and local health 

departments, which routinely collect and maintain data and 

have benchmarks for adolescent health trends. Use national 

objectives such as Healthy People 2020 and data on adolescent 

health that are readily available to inform local assessments 

and plans.

Focus on risk reduction activities for 

adolescents. These include approaches for smoking 

cessation, addressing substance use, mitigating sexual 

risks, treating mental health problems, identifying diabetes 

precursors, and reducing obesity. Ensure adolescents, 

parents and others working with adolescents understand 

risky behaviors and the benefits of early, brief, and sustained 

interventions. Identify resources that can help reduce risky 

behaviors, and refer teens as appropriate. Use evidence-based 

approaches when available.

Train staff on working with adolescents using the 

latest knowledge about what is effective. Provide 

training on cultural competency, trauma-informed care, 

working with vulnerable populations, awareness of LGBTQ 

issues, positive youth development, and what is appropriate 

for younger versus older adolescents. Encourage staff to use 

positive youth development strategies that support adolescents 

in their day-to-day lives. Specifically consider the needs of 

vulnerable adolescent populations, such as runaway, homeless, 

LGBTQ, immigrant youth, and youth with disabilities. Ensure 

staff working with teens are properly screened and are trained 

in safety and reporting requirements.

Promote a positive, strengths-based view of 

adolescents. Participate in public awareness campaigns 

with positive youth development themes. Join ongoing 

community efforts to encourage and support better 

adolescent health outcomes by providing appropriate settings, 

programming, youth engagement and leadership opportunities, 

and staff training. Look for ways to promote and build on 

adolescent successes through social and traditional media 

campaigns.

Help young people take responsibility for their 

own health and promoting healthy communities.

Encourage older adolescents to navigate the health care 

system, and teach them how. Involve adolescents of all ages in 

creating and monitoring community programs and activities 

for adolescents. Support youth engagement and leadership 

development, which have the potential for creating career 

pathways into health. Provide internships for youth in public 

health and health care settings. Work with youth to ensure that 

strategies and services meet the needs of youth and are youthfriendly. Involve youth in the design of youth programming, 

materials, and media campaigns.

FIND additional resources at 

www.youth.gov/TAG
18 

J Action Steps for Out-of-school 

and Community-based Program 

Professionals 

As an adult working with adolescents in 

after-school activities, summertime, or community 

settings, you can help contribute to adolescent 

health today and into the future. 

Help youth connect to supportive adults, positive 

peers, schools, and the community. Encourage youth 

to connect with supportive adults such as program leaders, 

coaches, tutors, or mentors as well as peers who can also be 

mentors. Serve as a role model in your actions, behaviors, 

and speech. Be an individual resource to adolescents and 

provide access to space, equipment, or resources to support 

youth activities. Facilitate community service opportunities 

with senior citizens, schools and day care centers, and other 

community projects. Ensure that programs comply with 

guidelines and rules designed to protect adolescent’s safety.

Create a safe, warm, and enriching space.

Provide an attractive and safe environment to engage 

adolescents in positive activities and healthy relationships 

with peers. Create stability and consistency with well-trained 

staff, age-appropriate programs, and safe and secure settings. 

Teach about healthy relationships and encourage a sense of 

community. Support skill-building activities to contribute 

to adolescents’ overall sense of competence and their future 

accomplishments. Offer unstructured time where adolescents 

can just be together.

Encourage physical activity and good nutrition.

Plan group activities that include physical exercise, such as 

hikes, bike rides, competitive sports, and noncompetitive play 

such as aerobic, muscle- and bone-strengthening, and cardiorespiratory fitness activities. Establish policies to encourage 

healthy snacks or meals and share tips for healthy eating. 

Be another set of eyes and provide a listening ear.

Keep a lookout for how adolescents are doing in terms of their 

health and healthy development. Reach out to a young person 

who seems disengaged, lonely, or sad. Listen to adolescents 

talk and help them think about what they could do or say in 

challenging situations. Guide them to community resources 

that can help. Maintain confidentiality within legal guidelines.

Share local health resources with youth. Identify 

health resources in your community and share them with the 

adolescents in your programs and activities. Encourage and 

highlight the importance of wellness visits, vaccinations, and 

dental health, and make sure teens know about suicide and 

other help lines. Provide individual or group learning sessions 

on health topics. Refer adolescents to programs or services 

beyond the scope of your activities (for example, mental health 

professionals or social service providers). 

Teach youth about staying healthy and safe. Offer 

special sessions about health and healthy development. For 

example, bring in speakers and video presentations on online 

safety, texting, suicide prevention, and healthy relationships 

(with peers, romantic partners, family members, and mentors). 

Allow ample time for discussion, so teens can work out their 

opinions about a topic.

Youth (12-17) 

participation in 

after-school activities 

(from 2016 National Survey of Children’s Health)

18%

82%

activities

FIND additional resources at 

www.youth.gov/TAG
19 

J Action Steps for Education 

Professionals 

Adults working or volunteering at school have 

many opportunities to support adolescent health 

and development. 

Create a supportive and safe school climate. 

Develop an inclusive, caring, secure, and welcoming climate 

for adolescents and their families. Make certain that students 

of every race/ethnicity, gender, disability status, and sexual 

orientation feel safe and supported. Provide opportunities 

to participate in school leadership and honor youth voices 

and opinions. Foster a positive physical and psychosocial 

atmosphere and incorporate that approach into discipline 

and classroom management policies. Provide all school staff 

with information about community health resources, referral 

policies, legal reporting responsibilities, and confidentiality 

laws, regulations, and policies. 

Strengthen or increase health curricula and 

activities that support healthy development. 

Build students’ knowledge, skills, and positive approaches 

toward health and infuse positive, healthy development into 

all aspects of the curriculum. Include lessons that teach the 

benefits of avoiding risky health behaviors and fostering 

lifelong healthy habits. Teach problem-solving, critical 

thinking, communication, and collaboration. Offer music, 

visual and performing arts, technology, foreign languages, and 

other courses that build healthy connections between students 

and their school. Offer physical exercise activities during and 

after school that can be enjoyed into adulthood and create 

partnerships with community-based nonprofits and volunteer 

groups to support them. Provide healthy options in school meal 

programs and vending machines.

Implement annual health and safety assessments 

and coordinate with community efforts. Conduct 

annual assessments to identify strengths and weaknesses of 

health and safety policies. Develop an improvement plan and 

collaborate with teachers, parents, students, public health 

agencies, and the community to promote health-enhancing 

behaviors that mitigate risk and maximize protective factors.84

Support social and emotional development. 

Provide all school staff with training on the social and 

emotional development of adolescents. Teach students how 

to develop and maintain healthy relationships with peers and 

adults, which will help minimize bullying and other harmful 

interactions. Establish procedures that encourage safe reports 

of bullying and ensure policies are in place to handle these 

issues. Teach conflict resolution and anger management skills, 

which will also help mitigate behavioral challenges, and manage 

classrooms in positive ways.85 

Be a health resource for students and their 

families. Inform students of health resources available 

through the school. Encourage parent involvement and 

promote regular communication between school and home. 

Share information with families on developmental milestones 

for adolescents, how to encourage healthy behaviors, and 

how to help their children avoid risky behaviors. Provide 

this information in appropriate languages and reading levels 

through newsletters, emails, websites, sports teams, the parentteacher association, and parent meetings. 

Ensure schools are environmentally-healthy 

settings for learning.86 Regularly monitor the school’s 

environmental health to ensure it is free from toxins and 

other potential hazards, that it is clean, and that the building 

facilities and classrooms are safe and in good condition. Provide 

clean and safe water for drinking and washing, minimize 

unnecessary noise, and be certain indoor and outdoor areas are 

well-lit. Test air quality for carbon dioxide and dampness and, if 

possible, use green cleaning products.

Use open spaces to promote physical activity. In 

addition to physical education classes, use gyms and outdoor 

spaces such as fields, tracks, and paved areas to encourage 

physical activity, especially during breaks, lunchtime, and 

before/after school. Mark paved areas to encourage a variety of 

games, provide outdoor basketball hoops, and erect appropriate 

playground structures (especially for younger adolescents). 

Support community organizations in using the facilities for 

youth programs during evenings, weekends, and vacations.

FIND additional resources at 

www.youth.gov/TAG
20 

J Action Steps for Faith-based 

Community Professionals 

Adults working with faith-based organizations can 

help improve adolescents’ health and promote their 

healthy development. Many groups that provide 

social services are faith-based and offer a range of 

services to youth and families regardless of their 

religious beliefs. 

Support adolescents’ spiritual growth. Convey 

beliefs and values, recognize milestones, and help adolescents 

make connections within their religious community and 

to the larger world around them. For many youth, spiritual 

connection may be fostered by participation in community 

service and social activities that are sponsored by their faith 

community.

Connect adolescents to adults. Provide adolescents 

opportunities to meet and connect with members of the 

community, such as religious leaders or older adults, who can 

serve as role models or mentors. Offer activities, whether in 

worship, community service, outreach, music, or other ways, 

to help them connect with adults. Follow youth leader training 

and safety requirements of the sponsoring organization.

Provide opportunities for adolescents to connect 

with peers in a safe environment. Help adolescents 

establish a network of friendships that can be relied upon 

in good and bad times. Provide opportunities for youth to 

connect with peers through regular meetings, recreational and 

community service activities, and social media. Offer safe and 

fun spaces for adolescents to gather and share your space with 

out-of-school time programs and other community activities.

Provide service opportunities. Help youth grow in 

compassion and develop a sense of responsibility by providing 

opportunities to serve others in the community who are 

in need. Examples are providing child care while parents 

participate in worship or educational programs; packaging, 

delivering, or serving food to the hungry and homeless; and 

visiting homebound elderly people or people with disabilities.

Support the role of families in healthy adolescent 

development. Share ideas for strengthening families. 

Consider encouraging families to create special customs, 

such as family nights or holiday celebrations. Provide 

seasonal events for families to attend and/or family mission or 

community service opportunities. 

Connect young people to health information and 

resources. Identify and share existing community resources 

with young people. Offer programs on various aspects of 

adolescent health, such as physical activity, nutrition, social 

media use or preventive 

health care. Provide 

brochures or host special 

presentations from 

local health clinics. Ask 

congregants who are 

health providers to speak 

or provide immunization clinics at your place of worship. Host 

a blood drive and get teens involved in staffing, publicizing and 

donating. Share health-related messages with teens and parents 

through Facebook, Twitter, blogs, or texts.

Encourage healthy habits. Offer some activities that 

have a physical exercise component, such as fitness classes. 

Engage youth in making the community “greener” and 

healthier. Provide healthy food choices. Get teens involved in 

planting and harvesting a community garden and sharing the 

bounty with community soup kitchens.

Offer youth services or refer youth and their 

families to services. As appropriate, offer direct 

services to youth and their families, including health care, 

mental health, foster care, refugee resettlement support, and 

education. Make referrals to community resources to help 

adolescents and their families meet pressing needs for food, 

shelter, mental health, or other health and social supports. 

Ensure that some of these services accept Medicaid or have a 

sliding fee scale.

Facilitate opportunities for training and 

employment. Provide leadership opportunities and training 

courses in resume writing and job search skills. Facilitate 

internships or entry-level jobs. Offer employment opportunities 

directly or reach out to congregants and local businesses for 

jobs for teens. Use social media and congregation email updates 

to publicize internship and job opportunities for youth.

Today’s youth, 

tomorrow’s 

community

Participated in 

community service

Did not participate 

in community service

54%

46%

Percent of youth age 12-17 old who participated 

in any type of community service or volunteer 

work at school, church, or in the community

(from 2016 National Survey of Children’s Health)
21 

Provide opportunities for youth to offer input 

and build leadership skills into program design 

and activities. Involve adolescents in designing and 

reviewing program materials to confirm that language and 

materials work for teens. Establish a youth advisory panel to 

solicit input on policies or programs. Encourage older youth 

to be mentors to younger adolescents, with appropriate adult 

supervision. Reach out to youth who may not participate 

without encouragement. Find small ways for teens who lack 

confidence to get involved.

Join with others in your community to improve 

and coordinate service delivery. Collaborate with 

providers, health professionals, education and community 

leaders, and others to coordinate the provision of services to 

adolescents, particularly those involved in multiple systems of 

care, such as child welfare, juvenile justice, special education, 

and mental health. Where possible, try to deliver services in 

places where young people are, such as schools, malls, home, 

after-school or summer programs, or faith-based organizations’ 

meeting places. Catalog existing services and programs in the 

community and address gaps by expanding the reach of current 

programs or assisting in implementing new ones. 

Stay abreast of the latest research and 

implement best practices. Contact national resource 

and technical assistance centers for information and training. 

Learn about the latest research and best practices – including 

youth engagement and positive youth development – and 

train staff to provide and rigorously evaluate developmentallyappropriate services. Implement multi-pronged strategies to 

support youth in overcoming trauma and special challenges. 

Phase out programs that research has shown are not effective.

J Action Steps for Social Services 

Professionals 

As a social service provider, you already 

understand the multiple needs of adolescents and 

the complexity of the systems available to protect 

and support them. Your work is important to the 

current and lifelong health of the young people you 

serve.

Encourage positive connections between youth 

and supportive adults. Help youth reach out to adults, 

such as teachers, coaches, religious leaders, relatives, family 

friends, or older adults, who can serve as mentors or informal 

counselors. Make referrals to mentoring programs and ensure 

that mentors are appropriately vetted to ensure youth safety. 

Encourage youth to participate in healthy extracurricular 

activities. Support educational and work opportunities for 

young people.

Ensure services and programs are welcoming 

and developmentally appropriate. Make sure services 

and programs are welcoming to adolescents, including youth 

with disabilities and chronic health conditions. Use a youthfriendly approach that recognizes teens’ need for guidance can 

be at odds with their growing desire for autonomy. Engage them 

when making decisions about their care.

Encourage adolescents to learn about their 

health and connect them with trusted health 

care professionals, including mental health 

providers. Provide adolescents with information to help 

them manage their medical and dental care and prepare for 

the transition to adult services. Teach them how to advocate 

for themselves. Point them to resources that will help them 

navigate the health care system, including online resources 

and teen-friendly apps related to chronic health conditions, 

disabilities, or mental health needs. Ensure that youths’ health 

needs are fully assessed and refer them to those who can help. 

Make sure that some of these referrals accept Medicaid or 

have sliding fee scales. Establish follow-up procedures to see 

whether the youth obtained the services and how they are 

doing.

FIND additional resources at 

www.youth.gov/TAG
22 

J Action Steps for Workforce 

Development Professionals

Organizations that help prepare and train youth 

for the workforce, and those that employ them, can 

adopt several strategies that benefit adolescents’ 

health today and facilitate young people’s transition 

to adulthood as healthy, productive employees. 

Incorporate positive youth development into 

professional development training. Promote staff 

development that fosters holistic, strengths-based approaches 

to serving youth. Use training curricula and approaches that 

help adult professionals understand adolescent development 

and identify opportunities to foster resilience and promote 

healthy development. An increased awareness of the stages 

of adolescent development will help staff facilitate learning 

opportunities, promote meaningful youth engagement, and 

effectively teach the skills youth need to succeed in work, 

including academic, social-emotional, and practical life skills. 

Identify services to meet the unique needs of 

opportunity youth. Educate local workforce boards about 

the unique needs and barriers to work for youth, especially 

youth who are homeless, parenting, low-income, LGBTQ, 

disabled, in foster care, or no longer in school. Support 

community-based organizations in providing housing, health 

care, trauma-informed services, and other assistance to these 

youth. Obtain input from teens on how to improve services and 

supports to be more teen-friendly and effective. When possible, 

bring the services to young people instead of asking them to 

come to you to get what they need.

Work with vocational rehabilitation partners. 

Strengthen pre-employment transition services for youth 

with disabilities. Assist educators with incorporating health 

and employment planning into Individualized Evaluation 

Plan (IEP) meetings for high school students with disabilities. 

Provide information about support services and job training 

opportunities to school districts so they can help all students, 

including students with IEPs, plan for their lives after 

graduation. 

Facilitate mentoring opportunities. Connect young 

people to quality mentoring programs that acknowledge the 

individual differences among adolescents, including socioeconomic status, race, gender, sexual orientation, and disability. 

Supportive, healthy relationships are critically important to 

positive youth development. Mentors, including peer mentors, 

can help youth grow and develop by teaching the value of work, 

helping them prepare for work, and serving as life coaches that 

help to manage challenging situations that may interfere with 

education or employment. 

Identify and improve transportation options. 

Work with community partners to let local officials know 

how important transportation is to young people’s success 

at work. Reliable, safe, and accessible transportation helps 

youth get to their jobs on time and can help reduce stress 

and increase productivity. Encourage local governments to 

improve transportation options and urge employers to consider 

subsidizing transportation for young workers after school so 

students can get to their jobs. 

Promote financial literacy for youth and their 

families. Support local organizations, including high schools 

and community colleges that provide financial literacy training. 

Teach youth about financial literacy, which includes help with 

setting up a bank account, interpreting a pay stub, creating 

and staying on a budget, and understanding credit and debit 

cards. Partner with local banks and make sure youth know how 

to bank their earnings and understand interest. Help youth 

understand credit reports and how to build their credit. 

Engage employers in the community. Speak to 

employers about the many benefits of youth employment. 

Engage youth in outreach to employers to communicate how 

much they want to be employed. Share examples of employers 

that offer on-site and other supports that help youth be 

successful at work, such as transportation, child care, and 

health services. Encourage local workforce boards to create 

youth councils so young people can participate in a meaningful 

way.
23 

Be a good role model. Model healthy behavior and 

habits including wearing a seat belt, driving safely, exercising 

regularly, healthy cooking and eating, limiting use of 

technology, not smoking, using alcohol in moderation (if at all), 

and not drinking and driving. Develop techniques to manage 

the stress in your life and talk about them with your adolescent.

Encourage exercise, sleep, and healthy eating. 

Encourage youth to be and stay active through at least 60 

minutes of physical activity a day.91 Remind the adolescents in 

your life to limit the use of electronics and get enough sleep. 

Prepare healthy food and snacks and limit junk food. When 

possible, avoid keeping unhealthy, highly-processed food in the 

home.

Prepare adolescents for managing their health 

as they move towards adulthood. Teach your 

adolescents how to use the health care system, how to fill out 

the forms at medical offices, how to make appointments, how 

to get referrals (if needed), and where to get information online 

that can be trusted.

Make time for the adolescents in your life. 

Be available to talk and spend time with your teen. This can 

happen at unexpected times such as during a car ride, while 

washing the dishes, or when watching something on TV. 

Listen and let them sort out how to make good decisions as 

they manage peer pressure and conflict. Teach them about 

online privacy. Help them be connected at school and in 

your community. Support adolescents in building healthy 

relationships with peers and trusted adults in the family and 

community.92 Get to know their friends and their friends’ 

parents. 

J Action Steps for Parents, 

Grandparents, Families, and 

Caregivers 

Some evidence suggests parents, grandparents, 

guardians, and other family members may not 

know how best to promote the health of the 

adolescents in their care. While parents may 

sometimes feel irrelevant in the lives of their older 

children,87, 88 adolescents who report they have 

parental oversight, connectedness, communication, 

and/or support are less likely to engage in risky 

behaviors.89, 90

Ensure your adolescent receives health, mental 

health, and dental care services as needed. Make 

sure adolescents receive recommended preventive health 

care, including vaccinations and dental care, as well as care 

when they are sick. Be on the lookout for warning signs such 

as missing school, dropping out of extracurricular activities, 

abnormal weight loss, persistent sadness, or illegal drug use.

Start and keep the conversations going. Talk to 

your teen about health and developmental changes that occur 

during adolescence and into young adulthood. Keep lines of 

communication open, set boundaries, and monitor behavior 

while providing your teen with increasing autonomy. Encourage 

adolescents and celebrate their efforts and accomplishments. 

Share your family’s values with adolescents and let them know 

you will support them if they need to make difficult decisions 

(e.g., “You can always call or text us if you need help”). Role 

play with your adolescent to practice handling difficult 

situations. Be a good listener and support positive behaviors 

that reduce risks.

Provide opportunities to learn basic life skills. 

Give adolescents plenty of opportunities to learn how to do 

the laundry, empty trash, and change a light bulb. Gradually 

encourage them to manage their homework themselves. Show 

them how you handle finances, and discuss what things cost 

and how your family handles decisions about money. Encourage 

working or volunteering to gain experience. 

Learn about adolescent development. Talk to your 

child’s health professional about the expected developmental, 

psychological, emotional, and physical changes of adolescence. 

Check out online resources such as those available on OAH’s 

website, talk to other parents, or attend classes for more 

information.

FIND additional resources at 

www.youth.gov/TAG
24 

Find a trusted mentor, guide, or advisor. In addition 

to your parents and relatives, other supportive adults can offer 

helpful guidance and advice on school, work, and social life. 

Ask your school guidance counselor about mentoring programs 

that are available in your community. 

Be there for others. Volunteer with local community 

organizations such as soup kitchens, or help out at a local child 

care center or retirement home. Be a good role model for your 

friends and peers. Consider becoming a peer counselor. You 

can make a difference in your own life, the lives of your friends 

and peers, and your school or community. If a friend is facing a 

serious issue or challenge, help them seek the help they need.

Make good choices. No one can make healthy choices for 

you. So, take care of yourself, and do things to make you happier 

and healthier. Don’t rush into serious relationships before 

you’re ready. Focus on developing your interests and hobbies 

and learning about future careers. Avoid illegal substance use 

(e.g., drugs, alcohol, and tobacco products if you’re under 18), 

and don’t text while driving or drive while impaired by drugs or 

alcohol. Don’t get in a car with someone who has been drinking 

or using drugs; find a safer way to get home.

Maintain positive relationships. Hang out with 

friends who are supportive of healthy choices and make you feel 

good about yourself. Spend time with your parents, siblings, 

grandparents, and other family members to build strong 

relationships with them. Be respectful to others, even when you 

disagree. Resources from federal agencies such as NIH and the 

HHS Office on Women’s Health have great resources for people 

looking to improve or maintain relationships.

J Action Steps Teens Can Take

to Be Healthier

Being an adolescent is not always easy. While 

this period of life can be filled with fun, family, 

friends, and new adventures, sometimes the road 

to adulthood can be rocky. Some things you’ll 

encounter may feel outside your control, but 

there’s a lot you can do to support your health 

and happiness. 

Go to the doctor and the dentist regularly. Medical 

experts recommend that teens get regular medical screenings, 

check-ups, and dental care. Making sure you visit your health 

care provider on a regular basis is part of being responsible 

for your health, whether you are living with your parents or 

are away at school. Be sure to learn about what immunizations 

you need and keep those up-to-date. Keep a record of your 

immunizations and be aware of your allergies to food or 

medications. 

Learn how to use the health care system. Ask 

your parents, grandparents, doctor, school nurse, or another 

trustworthy adult to explain how to find doctors, make 

medical and dental appointments, read and understand billing 

statements and explanations of benefits, and complete forms. 

Ask them for resources you can trust to learn more about your 

health and preventing illness. If you’re away at college, make 

use of the college health services offered on campus. As you 

transition to adulthood and begin managing your own health 

care, be sure to check out www.gottransition.org for tips and 

resources.

Make healthy habits a priority. Exercise regularly 

and eat nutritious food. Being active physically can boost your 

positive mental state and give you more energy for school and 

other activities. Make time for sleep and keep a regular sleep 

schedule. Turn off your electronics an hour before going to bed, 

go to bed earlier than you think you need to and take naps if you 

need to catch up on sleep. Avoid high-risk behaviors, such as 

substance use or texting while driving. 

Get involved. Join clubs, play on sports teams, sing in 

the choir, take an art or dance class, learn a skill, or get a 

volunteer or paid part-time job. If you’re a member of a religious 

community, get involved with activities offered by your 

synagogue, church, mosque, or other place of worship. Find 

something you enjoy doing and pursue it. Being involved in 

these types of activities is good for your mood and your health! 
25 

J The Game Plan for Engaging 

 Youth 

 A 2016 report, Our future: A Lancet Commission on Adolescent 

Health and Wellbeing, highlighted the importance of engaging 

youth in seeking solutions to improve adolescent health. 

The TAG Game Plan for Engaging Youth offers ideas for 

professionals to engage adolescents in promoting their health 

and healthy development. More information about the Game 

Plan can be found on the OAH website.

A Win-Win Strategy 

In every field, there are innovative ways for professionals to 

engage with young people to promote adolescent health. What’s 

more, authentically engaging youth is a win-win strategy! 

Engaging teens as learners, leaders, team members, and 

workers helps adult professionals and programs make their 

services and supports more adolescent-friendly and effective. 

It also helps adolescents develop positive relationships with 

adults, and these relationships are key protective factors that 

help them learn and grow. 

Authentic leadership activities provide many benefits for young 

people. Specifically, youth engagement:

• Cultivates leadership and team skills and prepares young 

people to become future leaders, 

• Offers opportunities to practice the problem-solving skills 

they will need in adulthood, 

• Builds self-esteem and confidence; and, 

• Increases their influence and personal stake in the 

community. 

J Ideas for Effective Youth 

 Engagement 

Health Care Professionals

• Invite teens to help make your clinic or practice teenfriendly. Connect with a local youth council in your area or 

reach out to some of your own adolescent patients. Ask them 

to help stage a “makeover” to make your office and services 

more welcoming to teenagers and ask them what policies 

and procedures their doctors should have in place. 

Providers and Teens Communicating for Health Program

(PATCH), features an innovative approach empowering 

teens to communicate with health care providers, while 

also training providers to communicate with teens more 

effectively on sensitive health topics.

• Ensure teens are fully engaged in their self-care. Train 

your entire staff on how to foster open communication 

and trust with the teens you serve so young people will feel 

comfortable talking about their health and wellness. Be 

sure all staff are up-to-date on policies for protecting teens’ 

privacy and confidentiality. 

In New York, the Mount Sinai Adolescent Health Center 

provides high quality, comprehensive, and inter-disciplinary 

health and wellness services focused solely on the unique 

needs of adolescents and young adults. The center provides 

young people access to a wide range of services, including 

medical, reproductive health care, dental, optical, and 

mental health services as well as nutrition, fitness, and 

wellness programs. 

Public Health Professionals

• Involve young people in developing public health strategies. 

Include teens in conducting community health assessments, 

reviewing data, and helping to identify adolescent health 

issues to address.

In Florida, the Birth to 22: United for Brighter Futures 

project, supports the healthy growth, development, and 

education of children and youth from the prenatal stage 

through young adulthood. Youth were trained and then 

co-facilitated community conversations to develop the 

Birth to 22 Youth Master Plan entitled, “Strengthening the 

Steps to Success,” which identifies common outcomes, data 

collection, and action steps for the community.
26 

• Hire young people to staff projects that promote adolescent 

health. Train volunteer teens to reach other teens with 

health education or peer support.

The Houston Teen Community Health Workers program 

teaches youth about adolescent health resources and risks 

and how to share health information with their families, 

communities, and schools.

Out-of-school Time and Community-based 

Professionals

• Engage young people in evaluating and improving your 

program. Train and support teens to review and help 

interpret your program data, and then work together to 

develop ideas for program improvement.

Colorado 9to25 is a collective, action-oriented group 

of youth and adults working in partnership to achieve 

positive outcomes for all youth. The project works with 

youth to analyze service gaps, and develops plans to align 

youth-serving programs, practices, and policies across 

Colorado to address these gaps and promote positive youth 

development.

• Train youth to identify, share, and disseminate health 

resources. What’s on their minds when it comes to health? 

Work with them to learn more, locate resources, and 

determine the best ways to reach their peers.

Education Professionals

• Involve student leadership councils, or other groups of 

students, in implementing school-wide, youth-led programs 

that take a strengths-based approach to promoting 

adolescent health and mental health. Examples include 

peer tutoring, peer mediation, and peer support. 

Sources of Strengths is a universal, peer-leadership 

approach to preventing youth suicide, bullying, violence, 

and substance use. The program trains peer leaders to use 

positive social norming methods to create healthy climate 

and cultural change in their school communities.

• Recruit and support youth to conduct an assessment of your 

school’s approach to promoting adolescent health. 

Faith-based Community Professionals

• Sponsor meetings or retreats on adolescent health topics. 

Have youth select the topics and lead or co-lead the sessions.

Our Whole Lives is designed to provide accurate health and 

sexuality information in affirming and supportive settings 

with trained adult leaders. The accompanying resource, 

Sexuality and Our Faith, specifically puts the exploration of 

identity, relationships, and sexuality in the context of faith, 

worship, scripture, and sacred principles. This program 

is part of the United Church of Christ’s broad faith-based 

efforts to support justice, peace, and community building.

• Provide young people a leadership role in worship, in 

developing your youth programs, and in creating service 

projects. Ask them to help you create a welcoming 

environment where adolescents feel safe and supported. 

Social Services Professionals

• Focus on the positive and encourage staff to regularly ask 

the youth about their strengths, interests, passions, and life 

goals. Support teens in finding ways to become learners and 

leaders in their own lives.

• Enlist the help of current or former youth recipients of 

services in staff training. Ask teens to provide advice on 

how staff can best develop relationships and build trust 

with youth, and how to create an environment where young 

people feel comfortable asking for help, trying new things, 

and making mistakes.

FosterClub, the national network for young people in and 

out of foster care, uses an innovative youth-led training 

approach. FosterClub trains young leaders to provide 

training to child welfare agency staff on working with young 

people in care. 

Workforce Development Professionals

• Encourage local workforce boards to form a Youth Council 

to ensure the inclusion of diverse perspectives of out-ofschool youth in community-based efforts to create job and 

career opportunities for young workers. Youth-serving 

organizations can assist in identifying youth participants 

and help train and prepare youth so they can succeed in this 

role. The U.S. Department of Labor’s fact sheet on the Youth 

Program of the Workforce Innovation and Opportunity 

Act (WIOA) offers useful information for youth-serving 

organizations. The Departments of Labor and Education 

have also issued technical assistance resources to support 

local workforce development efforts to engage out-of-school 

youth.
27 

The 42 million adolescents living in the 

United States today present 42 million 

opportunities to improve the health and 

development of a young person, not only 

today but into the future. 

Information and materials produced by Adolescent 

Health: Think, Act, Grow® can be used by everyone 

who cares about adolescents and their health. 

TAG identifies concrete, viable actions steps we 

can take individually and collectively to improve 

adolescent health outcomes in the United States. 

Responsibility for adolescent health is not just in 

the hands of the health care providers, schools, or 

social service agencies. We all have a role to play.

More information and resources 

can be found on Youth.gov:

www.youth.gov/TAG

• Resources to help you implement the action steps

• Current adolescent health data

• Links to health and social services by zip code 

• Free materials you can download and share with friends and 

colleagues

• TAG Talk videos featuring adolescent health experts

• Webinars and TAG in Action: Successful Strategies–one 

pagers that profile successful program strategies 

• TAG information for your newsletter and website 

• Sample social media posts about adolescent health you can 

share with your colleagues or with teens

• Find the references for the TAG Playbook

JOIN THE

TAG

TEAM

Adolescent Health: Think, Act, Grow® and the logo design are registered trademarks of HHS.
www.youth.gov/TAG

July 2019