Adolescence presents an enormous challenge for health and mental health agencies and adolescents are classified as a “population at-risk.” One in five adolescents has a serious health problem and a much higher proportion has pressing health care needs. Adolescents from poor, inner-city communities are seen as more likely to engage in multiple, co-occurring risk behaviors. However, prevailing emphasis has been on adolescents’ risk behaviors and less on their vulnerability. Explanations for their vulnerability may be both social and developmental. This article presents an overview of current theories of adolescent risk and vulnerability and suggests Youth Development (2000) as an overarching framework for understanding both. Experience within a comprehensive, adolescent health and mental health center demonstrates how to meaningfully engage adolescents in their own health care from the beginning. In summary, urban adolescents are high risk due to their experimentation, lack of experience in negotiating risky situations, and uncertainty with talking about their experiences with adults. However, they are also engaging, inquisitive, willing to learn new behaviors and are able to participate in decisions about their services, health, and mental health care, as well as their future. The starting point for their participation is openly asking them about their lives and paying attention to their answers. References