To describe the process that clinicians use to engage vulnerable urban adolescents in mental health counseling, the authors propose a tri-partite model of clinical engagement that takes into account:(1) consumer preference; (2) risk and worry; and (3) youth development (YD) perspectives. These conceptual lenses embody what adolescents want to talk about, their exposure to behavioral and environmental risks, and their coping and strengths. Based on responses given by urban adolescents seeking mental health services to a clinical self-assessment questionnaire (Adquest), this paper uses this tripartite model to summarize patterns of risk that service applicants experience, what they worry about, and how they cope. It explores the substructure of adolescent risk and vulnerability, through factor analysis of relevant items across a Downloaded by [UQ Library] at 07:03 17 November 2014 broad range of Adquest life areas, to develop a typology of adolescents by risk and worry. Patterns of coping and desire to talk across a range of life areas within this typology are described, as are the practice implications. The authors conclude that even those adolescents who most concern clinicians-because they have high environmental and behavioral risk and low worry-present many different opportunities for engagement.
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