Child and Teen Checkups (C&TC)

Minnesota's: Early Periodic, Screening, Diagnosis, and Treatment program (EPSDT)

Spring 2021: Continuing preventive care during COVID is important

The importance of well child preventive care has been established. The significant drop in well child preventive care visits that occurred at the beginning of the pandemic continues to impact children and youth.

Nationally in comparison to the rates of adult outpatient visits, child and adolescent preventive well visit care has been slower to rebound from the significant drop seen when the pandemic began a year ago.

Minnesota Department of Health Immunization Program

Information on Vaccination During COVID-19

They have tracked vaccine rates through the MIIC data base and published the following information in their Got Your Shots newsletter.

• Rates for infants two and under improved compared to 2019 pre-COVID 19 levels by late summer.
• MN immunization over all rates had similar trends January 2021 in comparison to January 2020.
• However, the yearly rate comparison of January to December 2019 to January to December 2020, the doses of HPV, MenACWY, and Tdap by 11-12 years of age still lags by approximately 21,00 doses. For the same time frame, children 4-6 years of age were behind by 42,000 doses.

Preschool and adolescent catch up vaccinations should continue.

Consider the catch-up schedule and CDC guidance when planning for COVID 19 vaccination of youth and young adults.

CDC clinical guidance on COVID 19 coadministration with other vaccines

None of the currently authorized COVID-19 vaccines are live virus vaccines. Because data are lacking on the safety and efficacy of COVID-19 vaccines administered simultaneously with other vaccines, the vaccine series should routinely be administered alone, with a minimum interval of 14 days before or after administration of any other vaccine. For more information and exceptions to this guidance please refer to CDC's Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Authorized in the United States.

Women Infant and Children (WIC)

Most Minnesota WIC clinics are providing food benefits, nutrition education, breastfeeding support and referral services remotely to protect the health of families and staff during the COVID-19 pandemic. Because WIC is not able to see families in person, they are waiving the requirement to perform height and weight measurements and hemoglobin tests at this time.

Current WIC guidance to primary health care providers regarding hemoglobin screening

• WIC performs hemoglobin tests at the CDC recommended ages of 9 months, 18 months, 2 years, 3 years and 4 years to screen for risk of anemia.
• The WIC program asks Health Care Providers to consider providing hemoglobin testing for children per the WIC schedule until the pandemic has slowed and encourage families to share height, weight and hemoglobin results with WIC clinics.
• Refer to MDH's Minnesota WIC Services during COVID-19 (PDF) for more information and guidance. (pub. 2/2/21)

American Academy of Pediatrics (AAP)

Guidance to help providers promote and deliver well child health care. Here is an abbreviated list of their recommendations from the Guidance on Providing Pediatric Well-Care During COVID-19.

• Consistent with previous guidance, all well-childcare should occur in person whenever possible. For practices who have successfully implemented telehealth to provide appropriate elements of the well child visit virtually, these telehealth visits should continue to be supported, followed by a timely in-person visit.
• Inform families about the strategies already implemented in primary care medical home offices to assure safety. These strategies may include these examples:
  • Scheduling well visits and sick visits at different times of the day.
  • Separating patients spatially, such as by placing patients with sick visits in different areas of the primary care clinic or another location from patients with well visits.
  • Collaborating with providers in the community to identify separate locations for providing well visits for children.
• Identify children who have missed well-child visits and/or recommended vaccinations and contact them to schedule in person appointments inclusive of newborns, infants, children, and adolescents.
• Newborn visits should optimally be performed in person. Refer to the guidance webpage above for specifics on how to provide this care safely.
• Continue to follow Bright Futures 4th ed, guidance on surveillance and screening for developmental, social-emotional, and behavioral concerns. Give special consideration to populations with a higher base line risk, under resourced communities, children, and youth with special health care needs or those facing inequities.
• Emotional and behavioral health concerns were increasing even before the COVID 19 pandemic had a significant impact on wellbeing. Refer to Interim Guidance on Supporting the Emotional and Behavioral Health Needs of Children, Adolescents, and Families During the COVID-19 Pandemic.
• Considering a significant drop in preventive dental care visits for Medicaid eligible children over the last year, the AAP encourages providers to promote fluoride varnish application at all well visits for children through 5 years of age. Refer to Fluoride varnish in the Child and Teen Checkups (C&TC) setting for more information.

Minnesota's Child and Teen Checkups (C&TC) Program

The Minnesota Department of Health is committed to creating and improving health throughout the state of Minnesota. Well-child health care and preventive screenings support the mission and goals of healthier Minnesotans. Health in early childhood can have a big impact on helping families to create their own healthy futures. (Refer to the Centers for Disease Control and Prevention: Facts about Child Development.) Regular checkups throughout adolescence help young people prepare to be more independent and proactive in caring for their own health by the time they are young adults.

EPSDT is a federal program required in every state to provide comprehensive health care and dental services for children under the age of 21 who are eligible for Medicaid. Child and Teen Checkups (C&TC) is Minnesota's Early Periodic Screening, Diagnosis, and Treatment (EPSDT) program. Periodic examinations or screenings are delivered according to the C&TC Schedule of Age-Related Screening Standards.

Regular checkups give families and health care providers an opportunity to monitor children's growth and development, screen for and identify potential concerns, and treat them to prevent bigger problems later on. Over 500,000 children are eligible for C&TC in Minnesota.

The Minnesota Department of Human Services (DHS) administers C&TC in Minnesota.

• The Minnesota Department of Human Services (DHS) Minnesota Health Care Programs (MHCP) provider manual, C&TC section has more information about program requirements, policy, billing and coding, and other provider information.
• The DHS C&TC web page has more information including the C&TC County and Tribe Coordinators list.

The Minnesota Department of Health provides health consultation and technical assistance to C&TC providers, C&TC Coordinators and the Department of Human Services. This includes clinical recommendations about best practices in well child care and training about the required screening components for providers, local public health, Head Start programs and others who provide screening for children.

Additional Resources

• American Academy of Pediatrics Bright Futures
• Centers for Disease Control and Prevention (CDC)
• American Association of Pediatric Dentists (AAPD)
• United States Preventive Services Task Force (USPSTF)

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Spotlight

• DHS recently published C&TC COVID-19 pandemic visit guidance (4/1/20). This guidance can be found on the Provider News and Updates webpage and in C&TC provider's MN-ITS mailboxes.
• C&TC Documentation and Visit Forms are age-specific templates, which include all appropriate C&TC screening components.
• New Special Populations webpage: Considerations and guidance to support populations that are more likely to experience health disparities, including a Guide to Preventative Care for Justice Involved Youth.