This chapter describes the clinical uses and practice impacts of a comprehensive adolescent self-assessment questionnaire (Adquest). It examines how Adolescent Health Center (AHC) clinicians use Adquest in planned and unplanned ways. Adquest is a self-assessment questionnaire designed by practitioners at Mount Sinai's AHC, with the aim of enhancing the effectiveness of psychotherapy with urban adolescents. When a parent or guardian is present, he or she is asked to complete a parallel, but briefer, questionnaire about the adolescent and the family environment. Accountability for service outcomes and the introduction of research methodologies into organizational practice has led to increasing interest in the development and use of formal instruments in direct practice situations. Chief among the organizational factors that make practitioners aversive to assessment instruments is the failure of managers and researchers to create an atmosphere conducive to such innovations, resulting in clinicians rarely being given adequate time, training, support, and preparation for these "new" methodologies.