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132 Adolescent Psychiatry, 2015, 5, 132-139
2210-6766/15 $58.00+.00 © 2015 Bentham Science Publishers
Integrative Health Services in School Health Clinics
Nada Milosavljevic*
Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA
02114, USA
Abstract: Objective: Mental health treatment today incorporates neurobiology, genetics, neuro-imaging, and pharma-
cologic mechanisms, offering more options to patients. For some, these modern approaches are not viable choices due to
reasons such as limited access to care, cost, intolerable side effects, and, in the pediatric population, fears of potential
long-term effects. With the growing prevalence of chronic health conditions, concerns for age of onset, (McGorry, Pur-
cell, Goldstone, & Amminger, 2011) and a growing population of mental health patients, cost-effective and evidence-
based treatment options should be evaluated. Integrative treatments, also known as complementary and alternative medi-
cine (CAM), may offer interventions that meet today’s clinical needs.
Method: To evaluate evidence-based treatment options, we initiated the school-based integrative health program (IHP) in
January 2011 at three high schools located in Massachusetts. Our goal was two-fold: first, to design a holistic treatment
program and evaluate several integrative modalities, and; second, to determine the feasibility of providing a CAM health
program through school clinics. Our protocol utilized three integrative treatments that addressed stress and anxiety condi-
tions. Anxiety disorders are the most common mental illness affecting over 40 million adults in the US (Anxiety and De-
pression Association of America).
Results: The program has been successfully implemented. Preliminary results indicate that this intervention decreased
anxiety in these youth.
Conclusion: Providing integrative techniques to students in the school setting has the potential to decrease barriers to ac-
cessing care, lowering treatment costs and decreasing school absenteeism by instituting care on-site. Offering a holistic
approach to treatment in schools is feasible. Because utilizing these approaches involves their active participation, adoles-
cents can acquire life-long skills that improve their ability to cope and confront inevitable life stressors.
Keywords: Complementary alternative medicine (CAM), integrative medicine, pediatric medicine, adolescent stress and
anxiety.
INTRODUCTION
Integrative medicine recognizes the importance of us-
ing natural, effective, minimally-invasive interventions
whenever possible, especially in the pediatric population
where concerns of potential long-term effects are para-
mount. Delivering health services in schools has many
advantages, and school-based health centers are well-
established in many communities (see <http://www.hrsa .
gov/ourstories/schoolhealthcenters/>). These centers pro-
vide many services, but most focus mainly on traditional
medical care. This article describes a multi-site school-
based integrative health program (IHP) implemented in
Boston area public high schools, the first program of its
kind in the US.
COMPLEMENTARY AND ALTERNATIVE MEDI-
CINE (CAM)
Complementary medicine refers to the use of a non-
conventional approach to treatment partnered with
*Address correspondence to this author at Department of Psychiatry,
Massachusetts General Hospital and Harvard Medical School, 55 Fruit
Street, Boston, MA 02114, USA; Tel: 401-595-0600;
E-mail: nada_milosavljevic@hms.harvard.edu
conventional medicine. CAM treatments have been imple-
mented for hundreds of years and, in some cases, millennia.
Alternative treatment modalities such as acupuncture and
aromatherapy have been used since the third millennium BC.
Other more modern interpretations of CAM, such as lifestyle
interventions, (Nuwaha & Musinguzi, 2013) are able to pro-
vide considerable relief to patients; however, until recently,
holistic therapies were not considered appropriate treatment
choices due to a paucity of research to support their use. But,
more recent medical literature includes a growing body of
evidence that validates the efficacy and safety profile of nu-
merous integrative therapies and the popularity of CAM con-
tinues to grow.
INTEGRATIVE MEDICINE
Integrative medicine “combines mainstream medical
therapies and CAM therapies for which there is some high-
quality scientific evidence of safety and effectiveness” (defi-
nition from the National Institute of Health; see
<http://www.nlm.nih.gov/tsd/acquisitions/cdm/subjects24.ht
ml>). A growing body of research studies indicates that inte-
grative medicine offers practical and feasible approaches that
can be easily incorporated into pre-existing treatment plans
or used as stand-alone techniques. Integrative medicine,
Integrative Health Services in Schools Adolescent Psychiatry, 2015, Vol. 5, No. 2 133
which takes into account the entire person—body, mind, and
spirit, as well as individual lifestyle, underscores the thera-
peutic relationship and makes use of both conventional and
alternative therapies.
The U.S. Department of Health and Human Services, Na-
tional Center for Complementary and Alternative Medicine
(NCCAM) at the National Institutes of Health (NIH) re-
ported in 2007 that 40% of Americans use non-conventional
approaches to achieve well-being. CAM approaches are con-
sidered to be a part of integrative medicine, which is becom-
ing more prevalent. Many health care providers and systems
are beginning to integrate various practices of non-
conventional medicine like massage therapy and acupuncture
into treatment and health promotion. The driving factors of
this increase appear to come from consumers who perceive
benefits to their health or well-being.
Since 2007, the NCCAM has developed the Third Strate-
gic Plan for 2011-2015, Exploring the Science of Comple-
mentary and Alternative Medicine, (National Center for
Complementary and Alternative Medicine, 2011) which em-
phasizes the importance of basic and clinical research to
building evidence for CAM. This report further emphasizes
the importance of translational research and bringing the
methods of effectiveness and outcomes research to the real
world. A strategic objective of the plan focuses on the bene-
fits, risks, and cost-effectiveness of CAM use in the general
public. One of the strategies will be to study the safety of
adult and pediatric CAM.
SCHOOL-BASED INTEGRATIVE HEALTH PRO-
GRAM
Background and Goals
The Integrative Health Program (IHP), launched in 2011,
utilizes a multi-disciplinary approach to provide integrative
services to high school students in a school-based clinical
setting. The IHP implements mind and/or body techniques,
sound therapy, aromatherapy, and acupuncture to address
anxiety and stress-related disorders.
The initial goals of the IHP were: 1) to design a holistic
treatment program and evaluate several integrative modali-
ties, and; 2) to determine the feasibility of a complementary
and alternative health program in a school clinic. We sought
and received IRB approval from Massachusetts General
Hospital for evaluating the efficacy of the program, and en-
gaged in administrative negotiation with Chelsea High
School, Chelsea, Massachusetts in December 2010 and Janu-
ary 2011. Subsequently, interest in the program grew and we
expanded clinical sites into Revere High School located in
Revere, Massachusetts and Rindge and Latin High School in
Cambridge, Massachusetts. The Revere and Cambridge sites
joined the program in February 2012 and September 2012,
respectively (Helping Students Learn to Manage Anxiety
2013).
Description of the Program
The program utilizes three integrative treatments, all of
which address stress and anxiety conditions by providing
treatment, education, and self-help skills to its adolescent
participants. While there are many integrative therapies, we
focused on three: medical acupuncture, the use of clinical-
grade aromatherapy essential oils, and sound therapy.
We determined our focus to be stress and/or anxiety con-
ditions within an adolescent population. Anxiety disorders
are the most prevalent mental illness and 25 percent of 13 to
18 year olds are estimated to suffer from an anxiety disorder
at any given time. (Kessler, Chiu, Demler, & Walters, 2005).
Furthermore, 75% of persons suffering from anxiety disorder
experience their first episode around 21.5 years of age
(Kessler, Berglund, Demler, Jin, & Walters, 2005).
The initial IHP program at Chelsea High School was a
10-week treatment course, which included two informational
workshop sessions that provided an introduction to integra-
tive treatments, and eight weekly, 30-minute appointments
that included aromatherapy for relaxation, targeted acupunc-
ture points, and sound therapy. The acupuncture points are
supported by research data of known point locations that
impact anxiety and stress symptoms. Although traditional
allopathic medical interventions were available if needed,
none of the students involved in this group required acute
medical treatment and all participants completed the 10-
week program. Further, there were no reported or observed
side effects or adverse reactions.
Participants
For inclusion in the IHP program, students were referred
from several sources: teachers, parents, counselors, mental
health providers, and school nurses. After referral, students
were evaluated by clinicians in the student health clinic to
ensure they met Diagnostic and Statistical Manual of Mental
Disorders (DSM-IV) criteria for an anxiety or stress condi-
tion. Although most students in the program were not taking
any psychiatric medication, a number were in outpatient
treatment and on medication. This was not an exclusion cri-
teria. The protocol required that those taking psychiatric
medication could continue to do so but not partake in dose
changes during the course of the IHP program. Exclusion
criteria included pregnancy, psychosis, and substance abuse.
Participants under the age of 18 required parental con-
sent; however, students 18 and older could provide their own
consent. In either case, student participants received informa-
tional sessions, handouts, and met with health care providers
at the clinic to receive a full description of the IHP program,
insuring students made an informed decision.
The student participants were placed on a list and ran-
domly chosen to enter the IHP program. Those who were not
in the treatment group were offered other outpatient services
and some chose no treatment.
Participants engaged in the IHP program during normal
school hours. Each 30-minute treatment session allowed stu-
dents to excuse themselves from class but return during the
course of the same subject or lesson, as compared to leaving
school for an appointment at the hospital. This program de-
sign was most conducive to ensure minimal disruption of the
school day for participants, allow easier access to care, and
alleviate transportation concerns. The program design also
promotes school attendance, decreasing absenteeism for off-
site clinical appointments; this was well-received by both
parents and the school system.
134 Adolescent Psychiatry, 2015, Vol. 5, No. 2 Wittenauer et al.
Therapies Utilized
The IHP program consisted of two informational presen-
tations and eight, 30-minute, weekly sessions that included
acupuncture; sound therapy with tuning forks, and aro-
matherapy with essential oils, which are the highly concen-
trated, volatile extracts of herbs, flowers, and plants.
Students also learned about pressure points and other tech-
niques to manage mood and modulate their anxiety and
stress levels.
Medical acupuncture. For the purposes of the IHP pro-
tocol the same acupuncture points were used for each subject
at every treatment session. The points were selected as loca-
tions, according to Traditional Chinese Medicine (TCM)
practice, commonly used and associated with decreased
anxiety and stress (Aung & Chen, 2007) All acupuncture
points used in the IHP were located either on the head/facial
area, lower arms, or lower legs. For this reason, participants
were able to remain fully clothed for the session. In order to
access the acupuncture points, students exposed the lower
arm and leg areas by rolling up sleeves and pant legs. These
points include: head and facial region - GV20, Yintang Fig.
(1); lower arm - LI 11, HT 7 Fig. (2); ST 36, Sp 6, and LV3
Fig. (3). Once inserted, the needles remained in place for
fifteen minutes prior to removal.
Aromatherapy. Lavender and grapefruit essential oils
(EOs) were used in the IHP at the beginning and the end of
the session. The IHP implemented Lavender (Lavandula
angustifolia) EO utilizing the inhalation method. The EO
was aromatized near the participant’s nasal passages for sev-
eral minutes while they inhaled and exhaled normally. This
EO was used at the initiation of the treatment prior to acu-
Fig. (1). Head acupuncture points Yintang and GV 20. From “Gross An atomy and acupuncture: A comparative approach to reappraise the
meridian system,” by S. Marcelli, 2015, retrieved from <www.geneticacupuncture.com>. Reprinted with permission.
Fig. (2). LI 11 and HT 7; From “Point Finder” by K. Boyd, 2002, Retrieved from <www.pointfinder.org>. Reprinted with permission.
Fig. (3). (Top left and clockwise) ST 36, SP 6; LV 3; From “Point Finder” by K. Boyd, 2002, Retrieved from <www.pointfinder.org>. Re-
printed with permission.
Integrative Health Services in Schools Adolescent Psychiatry, 2015, Vol. 5, No. 2 135
puncture. At the end of the session, the final step was the
inhalation of grapefruit (Citrus Paradisi) EO.
Sound Therapy. Tuning forks were used for sound
therapy. Tuning forks are steel tines in a U-shaped form that
act as acoustic resonators. Once activated, which requires
firmly tapping the instrument on a rubber mallet base, they
produce a specific and constant musical pitch that endures
for several minutes. Figure (4) depicts examples.
Fig. (4). Tuning forks. From “Ohm Therapeutics” by Sound
Universe, 2015. Retrieved from www.soundhealingtools.com>
Reprinted with permission.
The particular tuning forks used for the IHP were set to
emit a pure musical tone at a frequency of 136.1 Hz. There
are hundreds of tuning forks of various lengths and masses,
each which produce different, precise sound frequencies.
Often they are used to tune musical instruments and
frequently applied in Indian temple music. The IHP chose
the 136.1 Hz frequency due to its deeply resonant sound and
long-term application in integrative treatments used to
reduce stress, relieve body tension, and assist in meditative
practices.
For the IHP session, the tuning forks were activated and
held bilaterally and simultaneously approximately three to
five inches from each ear for several minutes. As the sound
and vibration ceased the tuning forks were re-activated and
held in the same position for a total duration of
approximately five minutes. This is illustrated in the
following Fig. (5).
The Use of Structured Assessment Tools to Evaluate the
Program
The Beck Anxiety Inventory (BAI) and an integrative
medicine outcome measure, The Web of Wellness (WoW),
were administered pre- and post-intervention. The BAI was
developed to discriminate between anxiety and depression
and measures clinical anxiety using a 21-item self-report
scale that takes only 5 to 10 minutes to complete (Beck, Ep-
stein, Brown, & Steer, 1988).
The WoW is a self-report tool used in integrative and ho-
listic medicine. The WoW assists with establishing a base-
line and monitoring changes in overall health and well-being
post treatment. As Fig. (6) depicts, this report tool evaluates
eight interconnected aspects or parameters of life that affect
health and wellness (i.e. mental, physical, financial, spiritual,
family, relationships, career, and social). The WoW is a
thought-provoking exercise that provides a strong visual aid
to enforce the importance of a complete and balanced well-
ness model.
RESULTS
To date over 100 students have completed the 10-week
IHP program and treatments. All students who participated
in the program reported moderate to significant reduction in
anxiety symptoms. Preliminary results as measured by the
pre- and post-outcome measures described have shown sig-
nificant reductions in symptoms of anxiety and stress. Scores
on the BAI decreased and scores on the WoW increased fol-
lowing program completion. On average, symptoms were
reduced by one-third and wellness increased. The treatments
have been very well-tolerated and there have been no ob-
served or reported adverse reactions or side effects among all
cohorts.
We are optimistic that the program can expand through-
out the state of Massachusetts where there are 41 school-
based health centers where this program can be replicated.
DISCUSSION
Anxiety disorders, the most common mental illness in the
U.S., are widespread and costly to society (Kessler & Green-
berg, 2002) According to the most recent figures, anxiety
disorders cost the U.S. more than $42 billion a year, almost
one-third of the country’s $148 billion total mental health
bill (Anxiety and Depression Association of America Facts
& Statistics; http://www.adaa.org/about-adaa/press-room/
facts-statistics). The adolescent years are the core risk phase
for the development of anxiety symptoms and syndromes,
ranging from transient, mild symptoms to severe anxiety
disorders. A national survey of adolescent mental health re-
ported that of the 18 percent of the U.S. population that is
affected by this disorder, 8 percent are teens ages 13 to 18.
Of these teens, only 18% receive mental health care (Na-
tional Institute of Mental Health, n. d.).
Fig. (5). Tuning forks in bilateral ear position. From “Ohm
Therapeutics” by Sound Universe, 2015. Retrieved from
www.soundhealingtools.com> Reprinted with permission.
136 Adolescent Psychiatry, 2015, Vol. 5, No. 2 Wittenauer et al.
For many teenagers, anxiety is part of adolescence, a
stage of life rife with challenges. The physical and psycho-
logical changes that adolescents experience are a great deal
to handle, particularly when coupled with mounting aca-
demic demands and familial pressures. Difficulty in school,
trouble meeting and making new friends, and keeping up
with fashion and trends, all can further contribute to stress
and anxiety. Not having the resources to join in interests with
others, the inability to participate in sports or other activities
because an after school job is necessary can also be a con-
tributing factor.
The students participating in the IHP program bear their
share of anxiety and stress, but using the tools and tech-
niques that we taught them, they developed newfound confi-
dence and health. This is no mean feat in communities like
Chelsea and Revere where other pressures can exacerbate
emotional problems. Median household income in Chelsea,
for example, is two thirds of the state average, with 27 per-
cent of children living below the poverty line compared with
the state average of 12.8 percent.
The objective of the IHP program is to empower high-
school students to take an active role in their treatment and
long-term health. With this experience, adolescents gain a
deeper appreciation of their own physiology and become
more cognoscente of their body’s ability to heal itself and
maintain homeostasis. The adolescents who participate in the
program develop an understanding of preventive health
treatments and assume increased personal responsibility for
their overall health and well-being. This shift from an exter-
nal focus of control, (e.g. a medical professional administer-
ing a pill) to an internal focus of control that is patient cen-
tered can increase awareness and self-esteem, while decreas-
ing anxiety.
We chose the three modalities we used because they have
a good evidence base for efficacy in anxiety and it is feasible
to administer them in a school clinic.
Fig. (6). The Web of Wellness. From “Acupuncture Media Works” <www.acupuncturemediaworks.com>. Reprinted with permission.
Integrative Health Services in Schools Adolescent Psychiatry, 2015, Vol. 5, No. 2 137
ACUPUNCTURE
Traditional Chinese medicine (TCM) includes acupunc-
ture, which works on the principle of stimulating points in
the body to correct imbalances in the flow of energy (Qi)
through channels known as meridians (Ljubinovic, 2013).
Acupuncture is a safe CAM modality for pediatric patients
(Jindal, Ge, & Mansky, 2008).
Western medicine has made numerous attempts to ex-
plain acupuncture’s mechanism of action from an allopathic
perspective. While it has yet to be fully elucidated, there are
certain aspects that have gained general acceptance. First,
many of the over 350 acupuncture points correspond to nerve
bundles or muscle trigger points. Neuroimaging studies show
that acupuncture can calm areas of the brain that register
pain and activate those involved in down regulating the
stress response (Dhond, Kettner, & Napadow, 2007). Dop-
pler ultrasound has shown that acupuncture increases blood
flow in treated areas (Lo, Lin, Wei, & Sun, 2013). Finally,
thermal imaging shows that acupuncture can decrease in-
flammation (Santos et al., 2013; Stux, Berman, & Pomeranz,
2000).
Errington-Evans conducted an extensive literature review
to evaluate the role of acupuncture in anxiety conditions
(2012). Results showed statistically significant effects di-
rectly attributable to acupuncture treatment. It should be
noted that the author discussed the need for improved study
design, which lends influence and support to the use of acu-
puncture to significantly reduce the symptoms of anxiety
disorders.
AROMATHERAPY
Aromatherapy is a holistic medicine which uses the vola-
tile oils of aromatic plants for therapeutic applications. It is
concerned with the psychological, physiological and phar-
macological effects of essential oils (EO). Aromatherapy can
be introduced by means of inhalation, through the olfactory
system, and dermal application whereby the EO is absorbed
through the skin and travels through the tissue to enter the
circulation (van der Watt, Laugharne, & Janca, 2008).
The effects of aromatherapy are theorized to result from
the binding of chemical components in the EO to olfactory
bulb receptors in the limbic system (Buchbauer, Jirovetz,
Jäger 1993). Current research has also focused on topical
application of EO and found that it may exert antibacterial,
anti-inflammatory, and analgesic effects (Herro E, Jacob,
2010; Stea, Beraudi, & De Pasquale, 2014).
Lavender, like all essential oils, it is not a pure com-
pound. It is a complex mixture of naturally occurring phyto-
chemicals, including linalool and linalyl acetate. The scent
has a calming effect that may aid in anxiety and stress reduc-
tion as well as overall relaxation (Hongratanaworakit, 2011;
Shiina et al., 2008). Further, it has been shown to reduce
agitation and have sleep-promoting properties (Lewith, God-
frey, & Prescott, 2005; Lin, Chan, Ng, & Lam, 2007).
One of the major components of Lavender EO is linalool,
which has been demonstrated to act postsynaptically. The
possible mechanism is via the modulation of cyclic adeno-
sine monophosphate (cAMP) activity (Lis-Balchin & Hart
1999). Linalool has been found to inhibit the GABAA bind-
ing receptor in the central nervous system of animal models
and induce a relaxed state (Brum, Elisabetsky, & Souza
2001).
The grapefruit is the largest of the citrus fruits and a natu-
ral hybrid of the pummelo and sweet orange. The main
chemical constituents are monoterpene hydrocarbons (li-
monene and myrcene), sesquiterpenes, alcohols, aldehydes,
esters, and flavonoid glycosides (Feger, 2006). These con-
stituents work in concert and have shown various applica-
tions as olfactory stimulants. They have antibacterial proper-
ties, and apoptotic activity specific to human leukemia cells
(Abulrob, Suller, Gumbleton, Simons, & Russell, 2004; Hata
et al., 2003; Tanida et al., 2008).
SOUND THERAPY
Sound therapy has been used for centuries by many cul-
tural, religious, and indigenous groups around the globe in-
cluding, ancient Greek and Egyptian civilizations, Vedic
Indian culture, Tibetan traditions, Aboriginal groups in Aus-
tralia, and the American native Navajo tribes (Antrim, 2006;
Cook, 1997; Gaynor, 2002).
The broad category of sound therapy includes music
therapy. Fundamentally, music is organized sound and is a
form of treatment well-known in allopathic medicine. Since
the National Association of Music in Hospitals was created
in 1926, many hospitals and clinics throughout the US have
developed music therapy programs to support patient recov-
ery (Edwards, 2008).
Early music therapy programs grew slowly, but rapid
growth ensued following WWII. Soldiers returned home
from the battlefields with emotional and psychological prob-
lems and music and soothing sounds provided relief and
played a supportive role in their healing. In 1945, the U.S.
War Department issued Technical Bulletin 187, which de-
tailed a music therapy program created by the Office of the
Surgeon General (American Music Therapy Association,
2014). It was considered supportive of occupational therapy
and physical reconditioning.
The use of sound and music are non-invasive, simple and
cost-effective therapeutic tools. This form of treatment has
proven to reduce pain and anxiety for children undergoing
medical or dental procedures. In addition, when music ther-
apy is combined with other modalities it may be more effec-
tive than when implemented alone (Bekhuis, 2009). Sound
and music have also been shown to reduce arousal during
stress and support a state of calm (Pelletier, 2004). Further, a
recent Cochrane review highlighted the physiologic effects
of this modality and found that music may reduce the effects
of coronary artery disease and decrease blood pressure, heart
rate, and respiratory rate (Bradt & Dileo, 2009).
American adolescents listen to approximately 4.5 hours
of music per day. The use of sound and music are processes
with which they are familiar and easy to adopt (Campbell,
Connell, & Beegle, 2007). In this population, music therapy
has been shown to improve adolescent mood by reducing
stress and lowering anxiety levels, which can help counteract
or prevent depression (Misic, Arandjelovic, Stanojkovic,
Vladejic, & Mladenovic, 2010).
138 Adolescent Psychiatry, 2015, Vol. 5, No. 2 Wittenauer et al.
CONCLUSIONS
The IHP served as a model to evaluate the feasibility and
efficacy of an integrative treatment program in a school-
based clinical setting. The success of this program highlights
the interest, need, and workability of integrative health serv-
ices in school clinics. The IHP program ushers in a new
paradigm for a school-based patient-centered service that
involves the use of integrative modalities like acupuncture,
sound therapy, and aromatherapy. These modalities are used
to educate and help treat anxiety and stress-related disorders
in adolescents. The IHP program offers many benefits to
student participants including empowerment, education in
self-care techniques, and personal responsibility for one’s
own health. It has the potential to foster resiliency that pre-
pares individuals for coping with life’s inevitable stressors.
The overall benefits of the IHP program are decreased barri-
ers to access to care, decreased school absenteeism for
treatment appointments, cost-effectiveness, introduction to a
holistic approach to treatment, and promotion of long-term
preventive health care.
Even those new to integrative therapies can implement
these services with relative ease. Other than medical acu-
puncture, clinical aromatherapy and sound therapy can be
utilized with minimal training and a basic review of tech-
niques. In lieu of acupuncture, acupressure points, which
include the same point locations but stimulation of the
area with manual finger pressure rather than needles can
be used. These services are easy to implement, minimally
to non-invasive, and cost-effective. Evidence supporting
their efficacy continues to expand as well as a number of
other alternative and complementary treatments. This ho-
listic approach to patient care offers not only symptom
relief but an educational component as they acquire
new skills to enhance preventive health and self-care
techniques.
Our hope is for similar programs to be offered in school
health clinics. In addition to the three sites where the IHP
was conducted, there are several other schools in Massa-
chusetts that have meet with us and are in the planning
phase of initiating integrative health services in their
schools. We hope to facilitate similar programs and support
efforts to offer CAM therapies to the vulnerable adolescent
population.
ABOUT THE AUTHOR
Nada Milosavljevic, M.D., J.D. is Director of the Inte-
grative Health Program at Massachusetts General Hospital
and an Instructor at Harvard Medical School, Boston, MA
USA.
CONFLICT OF INTEREST
Dr. Milosavljevic reports no biomedical or financial con-
flicts of interest.
ACKNOWLEDGEMENTS
Financial support for the launching of the IHP program
was provided by an anonymous donor.
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Received: August 11, 2014 Revised: February 04, 2015 Accepted: February 06, 2015