Child and Teen Checkups Care for Focus Populations

For immigrants, provide appropriate written and spoken language access for the caregivers and youth, as preferences may differ within a family. Newcomers may need information on consent and confidentiality in healthcare. It's important to explain preventive healthcare. Providers should understand the unique challenges and strengths of immigrant populations.

Asking about immigration should only be done when relevant and with a discussion of confidentiality. Immigration status does affect access to health benefits and specific medical screening procedures. Those with refugee, asylee, Victims of Human Trafficking (VOT), or parolee status, special immigrant visa holders, or those granted asylum or VOT status are eligible for a domestic Refugee Health Screening.

Some of the components of refugee screening overlap with Child and Teen Checkups (C&TC) Schedule of Age-Related Screening Standards (PDF). Some newcomers have already had health screening and immunizations abroad. For continuity of care, request previous medical records (families or the MDH Refugee Health Program can provide the name of the screening clinic). Refer to the CareRef on-line screening tool and MDH Refugee Health Provider web page for more information on refugee health screening and resources.

For those without prior screening, consider additional screening labs, such as HIV, tuberculosis, blood lead level, Hepatitis B, and intestinal parasites based on disease burden in their countries of departure using the Yellow Book.

Importance of continuing care for refugee children and youth

Refugee health screening do not address all potential health concerns that may be identified by comprehensive screening performed in C&TC exams.

Many refugee and unaccompanied children show resilience but may experience mental health concerns on arrival. Mental health screening should be done during C&TC exams. Due to resettlement challenges, consider ongoing mental health screening. As children and youth arriving may not have had regular health care before, concerns identified during a C&TC visit require additional follow-up.

Minnesota Statutes require that children in foster care receive a physical exam at least annually.

Children in foster care should receive C&TC visits more frequently than the regular C&TC schedule of age related screening standards.

Refer to:

• Foster Care - American Academy of Pediatrics
• Primary Care Tools to Help Care for Children in Foster Care – American Academy of Pediatrics
• Foster Care Health Care Standards – American Academy of Pediatrics

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 80% arrive in foster care with a significant mental health need.

Ninety-five percent of justice involved youth (JIY) 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.

Guide to Child and Teen Checkups/Preventive Health Care for Justice Involved Youth (PDF)

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. Justice involved youth have substantially higher rates of ED and hospital use than their non-JIY peers.

Youth who identify as lesbian, gay, bisexual, transgender, queer, or questioning (LGBTQ+) are an important population with unique health care needs, as they may experience significant health disparities in mental health, substance use, and sexually transmitted infections. Stigma from homophobia and heterosexism can lead to psychological distress, which may contribute to an increase in risky behaviors.

Refer to the American Academy of Pediatrics (AAP) adolescent sexual health guidance. Providers should implement a teen-friendly practice that accommodates patients of different backgrounds and orientations as they move through adolescence. LGBTQ+ youth are typically resilient and emerge from adolescence as healthy adults.

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. LGBTQ+ youth (18-26 years) are twice as likely as their heterosexual peers to smoke, initiate alcohol use, and have earlier use of illicit drugs.

Youth who identify as LGBTQ+ report dramatically lower rates of mental wellbeing than straight peers, including a 16% difference in reporting positive community relationships, a 26% difference in positive identity

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: 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. (2024, 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.