Special C&TC Populations

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 who are granted their asylum or VOT status in the US, are eligible for a domestic Refugee Health Screening.

There is overlap in some of the components of required refugee screening and Child and Teen Checkups Schedule of Age-Related Screening Standards. Some of these immigrants would have also received 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 HIV, 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 health screening do not address all potential health concerns that may be identified by comprehensive 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. Mental health screening should be done during C&TC exams. As resettlement itself poses additional challenges and stressors, consider integrating mental health screening or discussion into ongoing care. 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, this delay in care can mean that concerns identified during a C&TC visit require additional follow up afterwards.

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 frequently than the C&TC schedule, based on a child's health needs.

Refer to Foster Care - 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 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.

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 (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. 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.