Special C&TC Populations
The following populations are more likely to have experienced health disparities such as having: been bullied, considered suicide, used or misused drugs, struggled with mental health and been a victim of sexual exploitation. The following considerations and guidance can help to support these youth.
For immigrants, as with all patients, ensure appropriate written and spoken language access for the caregivers and youth, noting that the preferences may be different within a family. Depending on their health care experiences, recently arrived families and youth may need information on how consent and confidentiality apply to health care. It is important to discuss the "what and why" of preventive health care. Providers should make an effort to understand the unique challenges and strengths of the immigrant populations they serve.
While asking about immigration status can cause discomfort and should be done only when relevant and with appropriate discussion of the reason and confidentiality, immigration status does affect access to health benefits as well as certain medical screening procedures. Those who arrive in the US with refugee, asylees, Victims of Human Trafficking (VOT), or parolee status, special immigrant visa holders or those are granted their asylum or VOT status in the US are eligible for a Refugee Health Screening in the US. There is overlap in some of the components of that screening and a Child and Teen Checkups preventive screening exam. Some of these immigrants would have also received a health screening and immunizations overseas. For continuity of care, it is useful to request the overseas medical records and those clinic records (families or the MDH Refugee Health Program can provide the name of screening clinic). Refer to the CareRef on-line screening tool and MDH Refugee Health Provider web page for more information on the Refugee Health Screening and on resources. For immigrants who have not gone through this screening process in the US or overseas, consider best clinical practices for potential additional screening labs, such as tuberculosis, blood lead level, Hepatitis B, and intestinal parasites based on disease burden in their countries of departure using the CDC Yellow Book.
Importance of continuing care for refugee children and youth
Refugee exams do not address all potential health concerns that can be identified by more thorough screening performed in C&TC exams. On arrival, many refugee and unaccompanied children have already demonstrated significant resilience, but may also experience mental health concerns. Resettlement itself can pose additional challenges and stressors. Compared with US- origin youth, refugee youth have higher rates of community violence exposure, dissociative symptoms, traumatic grief, somatization, and phobic disorder (Linton, 2019). As children and youth arriving with refugee status likely did not have routine access to health care before their arrival, they may require additional follow up after the C&TC exam.
Minnesota Statutes require that children in foster care receive a physical exam at least on an annual basis.
Children in foster care can receive Child and Teen Checkups health services more frequent ly than the C&TC schedule, based on a child's health needs.
Importance of continuing care for Children and youth in foster care
Children and youth frequently enter foster care with undiagnosed or under-treated conditions. Half have chronic conditions such as asthma, anemia, visual loss, hearing loss, and neurological disorders. Around 50% of children 5 years and under have a significant developmental disability that qualifies them for services. Twenty percent have significant oral health or dental problems. Up to eighty percent arrive in foster care with a significant mental health need (Szilagy, 2015).
Ninety five percent of justice involved youth live in community settings, although they are often likely to have lived in foster care. They are less likely to receive preventive health care even though they may qualify for Medicaid.
Importance of continuing care for JIY
The National Survey on Drug Use and Health (2009-2014) found a higher rate of substance use disorder, depression, and anxiety for youth with any degree of justice involvement. JIY reported a significantly higher rate of STI treatment in the prior year (Winkelman, Frank, Binswanger, & Pinals, 2017). Justice involved youth have substantially higher rates of ED and hospital use compared to their non-JIY peers (Winkelman T. G., 2017 ).
Youth who identify as lesbian, gay, or bisexual, transgender, queer or questioning (LGBTQ +) are an important population with unique healthcare needs, as they may experience significant health disparities in mental health, substance use, and sexually transmitted infections. Please refer to the American Academy of Pediatrics (AAP) adolescent sexual health guidance on Lesbian, Gay, Bisexual, Transgender and Questioning (LGBTQ+ ) Youth. Providers should implement a teen-friendly practice that accommodates patients of different backgrounds and orientations as they move through adolescence. Sexually active LGBTQ+ youth are typically resilient and can emerge from adolescence as healthy adults. However, the presence of stigma from homophobia and heterosexism can lead to psychological distress, which may contribute to an increase in risky behaviors.
Importance of continuing care for LGBTQ+ AYA
The rates of mental health disorders, substance use disorders and suicide are higher among LGBTQ+ populations. High school students who identify as lesbian, gay or bisexual are four times more likely to attempt suicide than heterosexual students (CDC 2021). Per the report, Sexual Orientation and Estimates of Adult Substance Use and Mental Health, LGBTQ+ youth (18-26 years) are twice as likely as their heterosexual peers to: smoke, initiate alcohol, and have earlier use of illicit drugs (Medley & Cribb, 2016).
Youth who identify as LGBTQ+ report dramatically lower rates of mental wellbeing than straight peers, including a 16 percent difference in reporting positive community relationships, 26 percent difference in positive identity, 18 percent difference in social competency and 26 percent difference in empowerment (Minnesota Department of Health, 2019).
Centers for Disease Control and Prevention (2021, October). Disparities in Suicide. Retrieved from Centers for Disease Control and Prevention.
Linton, J. M. (2019, September). Providing Care for Children in Immigrant Families. Pediatrics, 1-23. doi: DOI: 10.1542/peds.2019-2077
Medley, G. L., & Cribb, D. K. (2016). Sexual Orientation and Estimates of Adult Substance Use and Mental Health:. Retrieved from SAMHSA
Minnesota Department of Health. (2019, January). Minnesota Adolescent Mental Well Being (PDF). Retrieved from Minnesota Department of Health
Szilagy, M. R. (2015, October). Health Care Issues for Children and Adolescents in Foster care and Kinship Care. Pediatrics, 1142-1166.
Winkelman, T. G. (2017 ). Emergency department and hospital use among adolescents with justice system involvement. Pediatrics.
Winkelman, T., Frank, J., Binswanger, I., & Pinals, D. (2017). Health conditions and racial differences among justice-involved adolescents, 2009 to 2014. Academic Pediatrics.