S. M. Lena MBBS, FRCP(C), MRCP, DCH.(Lond.)

Division of Community Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario;


Adolescents and youth make up over 50% of the world's population. Despite this fact, they have received very low priority for service delivery and programs in the past, by both government and non-government organizations. Due to their overall health and lack of political clout, the needs of youth are often overlooked during the allotment of resources. The needs of youth need to be carefully addressed, as they are not only the next generation, but also, as they are the most vulnerable age group after early infancy and prior to the very old age.

Youth are a nation's immediate future. In the last several years, due to the increase in the identification of problem behaviors associated morbidities and mortality statistics of adolescents, there has been many initiatives from various quarters to assess, evaluate and establish systematic programs for adolescents. The involvement of young people in the planning and implementation of programs and services has begun to take place over the last ten years.

Policy makers and planners, together with funding agencies must seek more and more to incorporate the views and experiences of people in the front line when making decisions and planning for youth programs. Youth leaders, social workers, teachers, nurses, psychologists, physicians are a rich source of expertise and information on which to base effective policies and develop programs.


The terms "youth, adolescence, adolescent, teen" are utilized in the context of this transition period of human growth. Each term refers to a particular age group. The term 'YOUTH' is generally used to designate the 15 to 24 age group, particularly used by the UN, WHO, and PAHO. This term is most useful in policy making, legislation, and funding projects. The term 'TEEN' is very clear in itself, and includes persons between the ages of 13 to 19 years. 'ADOLESCENCE' is a term used to indicate the process of psychosocial development of the adolescent. The term 'ADOLESCENT' is often used in medical practice to include the 11 to 19 age group. It is a practical range used to include the pre adolescent (11-13), mid-adolescent (14-16) and the late adolescent periods (17-19). 'PUBERTY' denotes the steroid mediated phase of growth and development. It is noteworthy, that there is an overlap in the utilization of the terms puberty and adolescence.

In legal matters, 'MINOR/ EMANCIPATED MINOR' refers to a youth who is under 16 years. These are terms used when dealing with rights, freedoms, consent, confidentiality and powers of attorney. Emancipated minor is used to denote the following people: married minors, minors serving in the armed forces, those living independently, and minors who are pregnant or are parents. A mature minor is a young adolescent who can make health care decisions.

Developmental Process of Youth

In considering youth and development it is paramount that the developmental process from childhood to adolescence, and then to adulthood must be given due thought and consideration. Planning programs for youth in order to potentiate their growth into healthy, responsible caring adults must take the stages of maturation of youth in account.

The developmental process of youth includes both physical growth and hormonal changes that occur with puberty, in addition to the psychosocial and sexual development of youth. Adolescence is marked by a period of rapid and extensive physical and pubertal growth, whose dramatic changes are surpassed only by intrauterine growth. Every organ and system of the body grows and matures. Previously dormant systems such as the hypothalamic pituitary genital axis become active and reach their peak activity during late adolescence.

Psychological developmental milestones are achieved during adolescence. Social skills that are necessary for adult life are learned and established. Sexual orientation and identity development are major tasks of adolescent development.

In view of the above it is generally accepted that health problems in adolescents and youth are characterized by infrequent somatic disorders but they have a high level of psychosocial, sexual, behavioral disorders. However, it is important to note this data may not be representative as the data gathering systems using existing indicators for mortality and morbidity in adolescence are not accurate.

In the process of development of adolescents, there is a wide range of normality. There are many deviations, aberrations and abnormalities from the normal. "Normal" is used here in the medical sense, when certain established milestones, such as normal patterns and values are not reached. In these cases, medical concerns arise and have to be investigated to identify and monitor morbidity. This does not happen in many parts of the world, as there are no established adolescent specific norms. Instead, extrapolations from childhood and interpolations from adult values are utilized. As a result, developmental problems may not be identified and could put the adolescent at risk for difficulties in later life. Research is needed to establish adolescent specific norms for nations, cultures and ethnic backgrounds. From a health perspective, this is an area that needs much development and support.

Pubertal Development

Puberty has a recognized age of onset and age of completion. Menarche should occur around 12.5 years in girls and andrarche in boys at 14 years. Onset of puberty at 8 years in girls or boys is a serious indication for medical investigation for precocious puberty. Similarly, delayed onset, with few changes by the age of 16 years, warrants investigation for delayed puberty.

There is much variability in the timing of the onset of puberty. Some children develop earlier than the norm and others have their development delayed. As a consequence, these children are at risk for emotional and psychosocial difficulties, acceptance of self and adjustment to peers. Apart from the timing of the onset and the completion of the physical development in adolescents, the many stages of growth may progress out of step or non-sequentially. Other factors can influence the growth process, such as onset of a chronic illness, malignancy, malnutrition from famine or anorexia nervosa, and can cause an arrest in growth. Pre-existing chronic illnesses such as diabetes, Crohn's disease or cystic fibrosis, may have profound effects on the process of adolescent development. Treatments associated with illnesses may also have serious consequences for growth and development.

Psychological Development of Youth

Many developmental psychologists have proposed theories of growth and maturation, often describing the phases and stages of human development. Erik Erikson described the eight stages of development through the life span, namely: infancy, pre-school, school age, adolescence, young adult, adulthood and senescence. In particular, he described the psychosocial tasks of adolescence. They are the development of self-identity, achieving adult autonomy, committing to a lasting sexual relationship, establishing a work or career path to economic independence.

In 1904 G. Stanley Hall, in his treatise on adolescence established the belief that adolescence is a period of storm and stress. Behaviors during adolescence were explained by an inner turmoil. It was assumed that it was necessary to work out these personal conflicts in order to achieve autonomy. Other psychoanalysts, Anna Freud, Pauline Kestenberg and Peter Blos have perpetuated this concept. Surprisingly, these early beliefs still strongly influence parents, teachers and care givers to the point that these theories have at times even inhibited and seriously interfered with the proper investigation and diagnosis of psychiatric morbidities. This interference can come with severe consequences, as many psychiatric illnesses have their onset during adolescence.

The reality is that the majority of teenagers do not show evidence of unusual conflict or stress during adolescent growth, if they are physically, emotionally, and mentally stable. Normal psychological development does not require adolescents to be rebellious or defiant, as long as they are physically, emotionally, and mentally stable with wholesome nurturing parents or adults in their lives.

Vandalism, juvenile delinquency, indiscriminate use of mind-altering substances, sexual promiscuity, are pathological behaviors. Teenagers have the tendency to over-value activities that relax them, challenge them, and improve their skills. They are happiest when they are engaging in sports, hobbies, music, art, dancing, intimate friendships and creative activities of various sorts. These activities give them a sense of fulfillment that increases their competence and consequently improves their self-esteem. Teenagers do not derive pleasure from indulging in destructive behaviors unless they are ill, dysfunctional or disturbed or struggling with internal or external conflicts. Another common myth is that boredom leads teens to find destructive behaviors to execute. On the contrary, teens who are functional and well adjusted find creative activities to do when they are bored.

These findings have been supported by a number of studies. Offer's longitudinal study of normal adolescent boys, confirmed that the majority of adolescents do not experience turmoil related to adolescent development. Offer and his colleagues identified three main developmental routes for adolescents. The first was continuous growth, which was found in 25% of the group. These adolescents followed a path characterized by smooth well adjusted, functioning through adolescence even in the face of stressful circumstances or adverse life events. The second classification was surgent growth, which comprised 34% of the group. In this path, well-adjusted adolescents showed good adaptation to the minor vicissitudes of ordinary life but with unanticipated stressful events they experienced noticeable difficulty and distress for a short time. In his study, only 21% of the adolescents showed a tumultuous growth. Adolescents in this group had mood swings, troublesome feelings, of anxiety, depression, guilt and shame. The researchers found this group was characterized by economic disadvantage, family and marital conflicts, and a high rate of family mental illness.

In Rutter's landmark study of British adolescents on the isle of Wight, it was found on a self-report questionnaire that 50% of teens were sad or miserable. However, on closer investigation, it was found that only 12.5 % of boys and 24.8 % of girls were depressed in an in - depth interview. Rutter estimated that 10% of teens were actually suffering from a diagnosable low level depression in this group. These findings are comparable to the tumultuous group described by Offer. These two studies are further confirmation that intense turmoil is not a part of normative adolescent development.

True turmoil represents psychopathology and will simply not be outgrown. Two longitudinal studies by J. F. Masterson and I B Weiner have shown that a majority of severely disturbed adolescents continue to be severely disturbed adults. Most of these adolescents also had disturbances during childhood. These disturbances were neither normative nor situational. These disturbances need serious clinical attention. Normative fluctuations are transient, lasting hours or days. On the other hand, unremitting, long-standing mood and behavior changes are serious and must be given serious clinical attention.

More recent researchers such as J. Brooks Gunn, Carol Gilligan have enlightened us on the psychology of women's development and the sociology of female development from a feminine perspective. Minority youth and disabled youth have specific characteristics and additional tasks to fulfill such as acceptance and integration of their disability into their sense of self which influences their transition into adulthood.

Sexuality Development

Teenage sexuality is often looked at from the perspective of parents and care giving adults. They view it negatively, from the teen pregnancy, teen parenting, loss of education, job prospects, career prospects, and as a means of contracting sexually transmitted diseases, such as AIDS. Sexuality is often associated with other undesirable behaviors such as smoking, drinking alcohol, drug use and victimization by sexual abuse and prostitution.

However, it is important to consider that sexuality development in humans includes many enriching features such as the development of bonds, relationships, and its affective capacity. These are important behaviors for adolescents to become familiar with. Sexuality development is unique in its ability to give and receive pleasurable sensations, its transcendental communicative powers, its creative and procreative capacity with shared moral and ethical responsibility for a new human being.

Sexual behaviors of adolescents are very diverse. Whether the sexual orientation is heterosexual, homosexual, bisexual or otherwise, there are inherent medical problems and outcomes of sexual behaviors. Some of the sexual orientations can lead to more serious medical problems. Similarly some sexual behaviors are more risky than others are. Sex without commitment, intimacy and responsibility is neither satisfying nor liberating for the mature, functional adolescent. Physical sexuality expression, or expression of a biological need is at one end of the spectrum of sexual behaviors in adolescents. This type of behavior meets a bio-physiological need, and basic propagation of species. The other end of the spectrum of sexual behavior is the ability to make choices, build a relationship and go through a process of completing sexuality development at a conscious level for expression of commitment, intimacy and procreation.

From an anthropological standpoint, in much of the animal world, sexual behaviors are only involved in the physical expression of their sexuality, and impregnation for the purpose of procreation. Other animals are involved with their mates for varying lengths of time; very few animals remain mates for a lifetime.

In human sexual behavior these evolutionary patterns have been paralleled and described by anthropologists (Simon Fraser University. Some humans do have sexual behaviors, which are of the most primitive forms and others show varying forms throughout the spectrum to completion of the process to commitment and partnership. For example humans may be mates for varying periods of time 18 months, three years, 5 years, 7 years, 13 years or more.

The progression of sexual development to its completion is variable in humans, the time of onset, the process of sexual development and its completion are all varied, biologically determined and genetically species specific. The course of development may be marked with inherent flaws such as arrest, premature onset, and delayed completion.

In light of this great variability in development, and the inherent risks involved with sexual intercourse in adolescents, it is important to develop comprehensive programs targeted at high-risk adolescents and their high-risk behaviors, with a harm reducing philosophy in mind. Youth require long-term, committed programs, which are geared to primary, secondary, tertiary and quaternary prevention. In addition, programs are needed for adolescents so that they may continue to grow and develop in spite of illness or pregnancy. As sexually mature humans, there will never be a situation where teens will never get pregnant or get sick because of their sexual behaviors. This is due in part to their desire to experiment and take risks. There are also influences such developmental delay, low self esteem, learning difficulties, impulsive behaviors and other human deviations in life.

The promotion of Young Peoples Growth and Development

The primary objective of adolescence is the acquisition of an identity, which defines each individual as a unique, independent, autonomous human being. Alienation of youth often occurs when under the pretext of the "common good" individuals are marginalized, discriminated against and mutilated because of their diversities. Authority in these cases is used to coerce, repress and manipulate, meanwhile trampling underfoot the moral dignity of individuals. All these factors need to be taken into account when developing programs for youth. The absence of discrimination and the respectful treatment of all individuals is paramount in program development.

The universal provision of basic needs of nutrition, clothing, living conditions, nurturing, caring, protective and safe environment is especially necessary throughout childhood and adolescence. The availability of education universally and programs that meet the special individualized educational needs of all youth with disabilities is also needed. From a medical perspective, programs that promote health, prevent illness, support and rehabilitate all forms of disasters and disabilities that occur in life would greatly increase the quality of life of youth, and increase their overall life expectancy. From a monetary standpoint, preventative programs are always more cost effective in the long-term.

Programs also need to address the promotion of ethnic, cultural, religious, personal, individual sexual diversities. Youth will then realize their own potential, acquire an identity, a uniqueness, become independent autonomous and meet the challenges of growing up. Once grown up they need to see their futures as bright, exciting and challenging.

Isolation of youth from Adult Role Models

In the past adolescents spent a great deal of time with their elders, learning cultural values, moral values, religious values and family values. They apprenticed with elders learning skills and trades that were useful for adult life. With modern socialization there is a segregation of the age groups. At present, adolescents spend a vast amount of their time with peers. This can lead to a great deal of competition, isolation, and missing out on learning about adulthood. Typically many adolescents return from school, do their homework, have supper and "hang out with their peers". Some adolescents do not come home till late after school, others who do not attend school "hang out with peers" most of the day. Meaningful cross-generational interactions and activities are extremely important in growth and development.

This very important consideration can be incorporated into programs for youth by utilizing older youth, parents, grand parents and other caring adults appropriately trained to plan, organize and run programs for youth. This is especially true for programs in developed and developing countries. It is also applicable to programs for job training for youth, for teen mothers and fathers, programs for substance abuse prevention, harm reduction and treatment. Programs need to incorporate general health education, AIDS education, well being and mental health programs.

Since teens spend a great deal of time together, it is important that adults organize themselves to run centers for teens in both urban and rural areas particularly in places where teens hang around. These should be targeted particularly for teens who drop out of school and hang around the malls. Therefore these facilities could be just outside malls and shopping centers.

The programs should include teen focused activities for all ages with access to information. These centers could provide information and support related to teen sexual health, general health clinics, back-to-school classrooms, and job training programs. An after school program in a teen-accessible location could organize homework clubs to allow the participants to sit down and complete homework in a socially supportive environment. Peer tutoring could provide both the tutors and students an invaluable opportunity to help each other and learn. Teens who have learning disabilities should be allowed to learn in the manner they can learn to develop life skills that will be useful for them as adults.

Adults must find time to be with adolescents sharing experiences with them, supporting them in their growth into responsible, productive adults. The alienation of youth from adults is an unhealthy cycle. Since teens like to spend time with peers, it makes sense to have trained mature youth participate in programs as front line workers, under adult guidance and supervision. Youth must be encouraged and welcomed in all committees that plan programs for youths.

Economically disadvantaged youth who live in housing projects, slums, on the streets and "runaways" all have very special needs. Teens who are from divorced and separated families, from families whose parents are abusive, alcoholic, drug abusers, irresponsible. In these cases, they need to have other adults in nurturing and supporting roles, such as grand parents, uncles, aunts, and retired adults. These adults can be excellent resources for youth and must be commandeered to fulfill these roles.

Parents and community leaders must anticipate and participate in advocacy roles for adolescent educational needs, employment needs, legislation that supports growth promotion of adolescents. Youth with disabilities need to be addressed, as they have very special needs, related to daily life, education, peer support, having fun, sports participation, employment, long term plans, adulthood, relationships, and transport. The issues discussed here are important factors to consider when planning and evaluating programs for youth.

The International Perspective

There is ample and strong evidence that successful programs all share some common characteristics. They all treat children, adolescents and their families holistically, are implemented from an early age and provide continuity as the youth matures. They fulfill many basic needs, as well as providing enrichment and growth through development promoting activities (Dryfoos 1990, Resnick 1992, and Barker & Fuentes 1995). Although multi-dimensional programs tend to offer better overall results to more people, even single focused programs fare well if their clients' needs are met holistically. The longevity of the program is also important; as continued support is needed to break cycles of behaviors and patterns in future generations. Programming must be in place for primary, secondary, and tertiary prevention. Regardless of the time of entry to a program, holistic approaches with long-term involvement are now proven beyond doubt to be most effective.

Health problems are a common entrance and gateway to addressing the many issues of adolescence. This is an important fact, and should be utilized when planning programs for youth. Through medical treatment, youth become part of the system, which allows their needs to be comprehensively identified and addressed. Chronic and debilitating health issues can create an environment for poverty, as it is difficult for the youth to provide for themselves and enter the workforce. To add to this problem, poverty propagates ill health, from malnutrition, poor hygiene, and lack of affordable services. Untreated and inadequately treated mental illness similarly propagates poverty. Resources for chronic sick youth need to be addressed.

While it is difficult to create global programs that address all the needs of individuals, inclusive programs should be mindful of all adolescents, taking into account all diversities, be they sexual, physical, cultural, racial, or religious. On a smaller scale, individual programs to address particular needs must be available. Some of the groups that need special attention are youth who are developmentally delayed, physically disabled, mentally compromised, or mentally ill. The youth themselves are important resources when developing special programs. Their input in program development is invaluable to create an appealing and worthwhile program. Another global group that needs their special requirements met is the aboriginal youth.

International programming must take into consideration the political climate, as the specific needs of youth will vary accordingly. Youth living in war zones, areas of drought and famine, as well as those recently affected by natural or man made disasters, require immediate special intensive services, such as medical treatment. Emergency programs need to be available and mobile, so that they may quickly meet the additional needs of a population in crisis. There should be protective legislation and strict monitoring of execution of these laws. Forceful coercion, coercion with seduction or promises of emancipation and bribery must be eliminated, as is sometimes the case in desperate situations.

In the past there have been numerous ways of coping with crisis situations. For example, during the 2nd world war situation, children and youth were evacuated from war zones to foster homes in hopes of safety. This temporary solution had its pros and cons. While the children's physical safety was better insured, the psychological trauma of the separation from family and community may have had lasting negative effects. However, this plan afforded the children a better chance at a future, rather than sending the youth to fight wars, and to be used and abused as has occurred in many countries over the last half a century.

In summary, international programming should address the ongoing needs of youth, and provide holistic, supportive programs over a long period of time. At the same time, it is important to have emergency measures programs that are mobile and available to provide short-term aid in crisis situations. The input of youth, especially when developing programs for adolescents with special needs, is vital to obtain program appeal and success.

The Exploitation of Youth

Another serious problem youth face on an ongoing basis is exploitation. Due to their status in society, youth are very vulnerable to abuse and exploitation. In recent years, there have been efforts to publicize and update the Convention on the Rights of the Child, and in turn, better protect children and youth. While these efforts are recognized, much change is still needed. Some areas that need attention include the following: commercial sexual exploitation of youth, exploitation of children in the workforce, children forced into armed conflict as soldiers or hostages in war situations, and the welfare of orphaned children. All these factors have enormous negative repercussions on the health and well being of youth. For this reason, these issues must be identified, and prompt and effective actions must be taken to ensure the welfare of youth.

Sexual exploitation of children and youth can range from familial abuse to commercial exploitation. It is important to note, that while many of victims of this type of abuse may be female, male youth are also at risk. The nature of the abuse varies from country to country and takes on many forms. For example, in Asia, there is widespread occurrence of sex trafficking, where child prostitutes provide services to local men, or do so as part of a "sex tourism" set-up. These children are often kidnapped, or coerced into these situations when separated from their families. In other areas, such as South America, young people who move to the cities to work find themselves in desperate situations, and seek protection. In many cases, they are desperate for money or drugs, and fall prey to a life of prostitution, where they are usually dominated by abusive pimps. In many industrialized countries, organized pedophile rings and high tech information services leads trafficking of young children with lesser financial resources to wealthier areas in efforts make money. In Middle East and Africa, many children are sold or employed as domestic servants, and are expected to perform sexual acts. In all these situations, youth often fall victim to physical and mental abuse, often become involved in illicit drug abuse, and exorbitantly increase their risk of sexually transmitted diseases and pregnancy.

Child workers are often exposed to many hazards in the workplace, and tend to be employed illegally, in unregulated workplaces to save on labor costs. In addition to suffering from a potentially abusive situation, children who are working do not have the opportunity to study and gain an education. Consequently, their future options are severely limited, and they often continue to work under these unhealthy work conditions into adulthood, unless they become ill or disabled. According to Article 32 of the Convention on the Rights of a Child, "children have a right to be protected form exploitation and from work that is hazardous. Exploitation means taking advantage of someone for your own profit. Work is hazardous when it involves dangerous or risky activities". In light of this, governments need to be aware of this potential exploitation, even in industrialized countries, and should develop laws to protect these young workers.

It is also important to protect children in hostile situations, such as war or civil unrest, where they are often exploited. In these types of volatile situations, children and youth are often neglected by government protection agencies. In war-torn areas, children are often kidnapped, forced to become soldiers, or forced out onto a battlefield as distractions and "easy targets". In this way, many children are killed, or suffer permanent physical and mental damage. As for those transported to refugee camps, many children are separated from their families and often suffer from physical and sexual abuse, as well as malnutrition. Even after the conflict ends, youth are not compensated for their injuries or their loss of education. As well, their previous homes may no longer exist, or be unsafe to live in, as is the case with land mines in many countries. Many children are killed, or suffer devastating injuries from land mines, even decades after the end of the war. Young children are especially vulnerable, as they cannot read the signs posted in some areas indicating the presence of land mines. In a war-torn country, these children do not have access to a high standard of medical care, and often suffer needlessly. The future generation needs to be better protected, and rehabilitated in these circumstances.

Orphaned children are the targets of many of the abuses and exploitation discussed above. They can easily "slip through the cracks" and disappear. For these reasons, governments need to pay close attention to children under the care of the state, as they may be at higher risk of a negative outcome.

Why Should we Invest in Adolescents?

1. Every youth that reaches adulthood healthy, with adequate education, happy and wholesome emotionally, spiritually, is an asset to himself/herself, family and the nation and the world.

2. An attitude of fixing problems that went wrong, instead of preventing these problems pays a far greater price, both economically, and from a human suffering point of view.

3. Anticipating the needs of all groups of youth, those at high risk, low risk and no risk as all are equally important individuals.

4. There are no "bad" youth, they are all special. Regardless of challenges they may face, such as physical disabilities, learning difficulties, poor social skills, lack of basic life needs, poor support systems and abuse, they all have their needs. Some have much greater needs than others do. If the differential needs are not foreseen and met, those in most need will suffer the most, and become the poorest of society. This sets up a vicious cycle where the most needy also become the most impoverished.

Suggestions for Developing Programs for Adolescents

As a first step in the development of effective programs, it is important to listen to the needs and issues of youth, the needs and issues of parents, and the needs and issues of service providers. Much information has already been collected in needs assessment studies, however, this information needs to be assimilated and utilized.

Long-term programs are needed to see adolescents through to the completion of adolescence. Youth tend to be very receptive to positive influences, but also vulnerable to negative ones. Adults, as role models, have the opportunity to be a major influence on the lives of youth. This influence should be recognized and used to its fullest positive potential.

The location of these programs is key to the success of the project. Delivering their needs to them where they are, be it at school, home, sports settings, clubs, bars, down town areas, malls, on the street, in war torn zones, at the cinema halls, or where ever teens hang out makes these programs accessible and more appealing. Advertising services should be used abundantly, to make programs accessible to the teens. Programs should be made user-friendly, by having young adults and youth in positions of responsibility. In this way, youth would feel more involved and capable of bringing about change in their environment.

Programs should be comprehensive with Holistic approach, providing specific needs of adolescents, food, clothing, shelter, medicines, birth control, information, support, counseling, money, travel expenses or transportation. Programs need to address safety, shelter, housing, education, as well as provide information on job training and employment. Some obstacles are that certain teenagers will have major problems with motivation and compliance, and being able to follow through with plans and suggestions. These are some of the challenges of meeting the needs of adolescents. Recognizing that there may be a cause for such apathy will lead to finding solutions to address such situations rather than abandoning a youth that appears to not care or has a negative attitude.

Strong Comprehensive Programs

Presently, several services are funded by various agencies such as: substance abuse programs, educational programs, life skills building programs, and best start programs. Through the affiliation with these agencies, the workload is shared and gives workers the chance to gain valuable work experience through their interaction with other programs. CIDA offers a wide range of programs that help both youth and populations in need. For example, there are a number of internship programs that send students to learn while helping, for example, youth are placed for 6-8 months with sustainable development organizations in Latin America, Africa, Eastern Europe, and Asia. Once on location, they assist in community decision-making on natural resource management, as well as building new information and communication technologies for sustainable development. This is just one of the many internship programs offered by CIDA, all of which emphasize growth through learning and helping others.

Other programs offer intensive integrated approaches such as providing a home for pregnant teens moms. Through the interactions with the staff, many of the needs of teenage mothers are better identified. Those who have alcohol and drug problems, have dropped out of school, smoke heavily, and/or require financial support have an increased chance of receiving support. In addition, these types of programs allow young mothers to receive antenatal care, postnatal care, well baby care and housing, in a non-threatening environment.

Building comprehensive networks by connecting with existing services, bringing in the public health department as a partner and other community resources as partners is very effective in sharing knowledge and services and service providers. These types of networks have been established in the case of teen pregnancy care programs for young mothers. Teen fathers can also be served through these young women's contacts. The sexual health clinics can come to the homes for teen moms to deal with future contraceptive care for the young mothers and fathers. This is an example of effective and efficient use of service, service delivery and networking all under one roof so that the teens receive the support services they need.

Identify Target population

The range of needs of youth differs greatly across the board. Youth in high-risk situations need to be identified and helped before their difficulties escalate. The greater the contact, high-risk teens have with a supportive group, the more likely it is that their needs will be addressed, and their knowledge of where to find helpful resources will be increased. Some high-risk groups that need special attention are: substance abusing teens, homeless youth, pregnant teens, delinquent teens, imprisoned youth, and mentally ill youth.

Programs for these youth should be age and developmental stage appropriate, for example, 11-15 year adolescents often benefit from preventive activities, with recreation, community services, which help to build self esteem and competence. In addition, family service needs, empowerment of youth workshops, problem solving and decision making skills session, assertiveness training. How to effectively use social support services.

Location of Services

The accessibility of service is paramount to the success of a program. Programs that are affiliated with larger organizations may be restricted by policies, but also may benefit in membership and longevity by providing a constant inflow of potential candidates. It also allows for a certain amount of funding. Larger organizations also possess the ability to recruit further funding from multiple sources. For example, school based/school linked sites, churches synagogues and other religious institutions, community centers, youth networks, and mobile units will often be more available to youth populations. These types of affiliations make it easier for potential members to learn about the services and programs, and make them easier to find. In situations where there is less centralization, efforts need to be made to inform youth about the services available. These may include programs in low-income housing projects; high crime and gang infested neighborhoods, downtown teen drop-in centers and shelters.

When considering the location of a potential program, it is essential that the program image be taken in account. The youth population tends to be a demanding consumer group and programs that have an undesirable location or image will have a tendency to be shunned. Therefore, it is important to consider the "image" of a program, especially when the program is affiliated with a larger organization such as a school or religious institution. Youth may be wary of becoming involved with school or church group, for fear of being branded as "uncool" by peers. In these cases, increased autonomy from the umbrella organization may result in a more successful program. In light of the ever-changing needs of youth programs, maintaining contact with institutions that have facilities to share and experts to give opinions is an extremely valuable resource. In this way, there are many opportunities to consult with and to create partnerships, as well as to study and evaluate program design.

Staffing Issues

Very often childcare workers who are inadequately trained to work with teenagers are employed to work with teens. These workers may not have the skills to manage difficult adolescents and they may use force and violence to control, which discourages adolescents and scares them from using services. Staff must be adequately trained to anticipate and identify risky behaviors and how to handle them age appropriately. They must be supported adequately and be aware when to ask for medical support and assessment. Recognizing diversity in teens, gender identity issues, racial, ethnic, developmental stage, and disabilities and sensitivities is very important. Staff support and strong positive leadership are also needed to maintain a cohesive environment for youth and increase staff well being.

Maintaining Integrity

Issues of consent are bound to surface in programs with youth. Confidentiality is essential, however, in some cases parents need to be involved, for legal or moral reasons. In these cases, the youth must be kept well informed and encouraged to be part of the active process. In this way, trust is less likely to be violated, and helps the youth feel in control of their life decisions.

Programs need to be evaluated on an ongoing basis, by analyzing data, documenting innovative programs, beneficial outcomes, service costs and cost savings. In this way, we can learn from existing programs, find what works and what does not, be better able to set up new programs, as well as improve upon existing programs. This is why the impact of new programs, participants' reports, component agencies' involvement and the social service systems should be examined. By documenting program successes and failures, organizations can remain current and better achieve optimal successes in the program.

Policies and legislation

The community infrastructure can have a major impact on the youth population. This type of infrastructure can help promote overall well-being of youth by protecting and overseeing programs and services that promote health, prevent problems, protect youth, provide necessary care and rehabilitation. Policies need to take in account the many needs of the youth population, such as: health, education, social welfare, population, national defense, as well as laws governing religious and cultural practices. The legislation in these areas can have great impact on the development of youth. However, it is important to remember that these services may not be well perceived and consequently not well utilized by youth. It is therefore important to develop cohesive policies that are able to attract youth and provide services that are developmentally appropriate and that address their physical, mental and social needs. This may be achieved by taking action to recruit diverse services, to help cover the range of needs and promote the programs to a greater number of people.

Achieving youth Involvement

To achieve the goal of an integrated society, youth, at 50% of the population, needs to play an active role in their futures. Program goals should keep this in mind, and find meaningful roles for youth to play, such as tutors, mentors, peer counselors, information disseminators, organizers, role models, and program designers. The involvement of youth in all areas of program implementation, organization and day-to-day activities empowers youth and will help to draw other youth into the program. In this way, the youth of the world feel a responsibility to their own futures, as well as the future of their peers. The sense of responsibility brings ongoing involvement and dedication, both of which should be encouraged and supported. It is by encouraging youth development through an active network of programs that we better ensure a brighter future for the youth of today.

This paper looks at a number of important factors that need to be identified and addressed when creating programs for youth. By first identifying the target group, we can better assess the range of needs that should be met. Consequently, we offer some suggestions for programs and investigate some special considerations that need to be implemented for specific populations


Sara A. Ingram, for her editorial support and research.