C&TC for Adolescents and Young Adults, 11-20 Years
These resources for screening and referral help for adolescent and young adult (AYA) preventive health visits.
Minnesota statute includes provisions for minors' consent for health care services; clinics and providers should be familiar with this, and can share that information with patients and their families.
Refer to this short article for more information about implementing one-to-one (1:1) time between the AYA patient and the provider at each visit, to support healthy transition to adulthood. Clinics can consider adapting and using this parent letter template or something similar to share the clinic 1:1 time standard with families.
The AYA Health Questionnaire can be used at each well visit to assess health strengths and risks, start the 1:1 conversation between the clinician and the patient, and support young people to raise important questions about their health. The Guidance for Clinics document offers important considerations for using this Questionnaire, and implementing 1:1 time as a clinic standard.
These patient satisfaction surveys are available for clinics to use at each visit with young people, to improve the youth-friendliness of the clinic and its services. Clinic pilot sites found that it worked best to give the survey on paper to the patient, and ask them to leave it in an envelope in the exam room before they left.
These surveys are from the Adolescent and Young Adult Health National Resource Center, with adaptations from the University of Michigan's Adolescent Health Initiative's Adolescent Centered Environment (ACE) assessment and the School-Based Health Center Improvement Project's (SHCIP) Youth Engagement with Health Services (YEHS!) survey, and guidance from Envision New Mexico and University of Michigan Health Systems. The AYAH National Resource Center is supported by Grant #U45MC27709 from the Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau.
- AYA Patient Exit Survey Age 10-13 Years (English) (PDF)
- AYA Patient Exit Survey Age 14-17 Years (English) (PDF)
- AYA Patient Exit Survey Age 18-25 Years (English) (PDF)
- AYA Patient Exit Survey Age 10-13 Years (Spanish) (PDF)
- AYA Patient Exit Survey Age 14-17 Years (Spanish) (PDF)
- AYA Patient Exit Survey Age 18-25 Years (Spanish) (PDF)
Scroll to the bottom for information about C&TC and sports physicals.
Resources for C&TC Screening Components and Referral
Refer to the C&TC Fact Sheets and key resources for these screening components specific to adolescent and young adult (AYA) well visits:
In addition to the Anticipatory Guidance C&TC Fact Sheet, refer to these concise resources on adolescent and young adult development:
- 10 Developmental Tasks of Adolescents
- Early adolescence (10-14 years)
- Middle adolescence (15-17 years)
- Late adolescence / young adulthood (18-24 years)
At this age, the adolescent or young adult (AYA) patient can give the best assessment of their daily activities and health goals, including what they eat every day, how they feel about their weight, and other issues they may have not chosen to share with others, such as e-cigarette use or sexual activity. AYA can share their perspective on a health questionnaire, or through a conversation with the health care provider.
Parent or guardian input is important for a clear family or personal medical history for the young patient, but it's important to keep working on transitioning those questions to the young patient, so by the time they reach adulthood they're more ready to manage their own health.
The Health History C&TC Fact Sheet includes resources for assessing social determinants of health.
Mental Health Screening
Mental health screening is required at each C&TC visit from 12 through 20 years (and recommended at earlier ages). Refer to the Mental Health Screening C&TC Fact Sheet for an overview of validated tools and referral resources.
Use recommended screening instruments, which have proven accuracy for identifying patients who need further assessment. Document follow up on positive screening results or other mental health concerns (even if screening results are normal).
For referral and management of mental health concerns, these statewide resources are options to consider if services are not available in the patient's primary care clinic or health system:
- Find statewide School Linked Mental Health Services with this map and list of statewide School-Linked Mental Health Grantees.
- Call the Psychiatric Assistance Line (PAL) for:
- Same-day phone consultation for prescribing providers; a board-certified child and adolescent psychiatrist can help with starting, adjusting, or managing medications;
- Phone consultation with a licensed clinical social worker for help finding local mental health resources, or help with clinical questions.
- Search the online Fast-Tracker for statewide mental health professionals.
Tobacco, Alcohol or Drug Use Risk Assessment
This risk assessment can be done through a health questionnaire, patient interview, or by using validated tools such as the CRAFFT or the online S2BI or BSTAD. Refer to the Tobacco, Alcohol, or Drug Use C&TC Fact Sheet for more information.
Search the online Fast-Tracker for statewide substance use disorder treatment providers and programs for adolescents and adults.
Watch the brief HPV Vaccine Videos for Health Care Providers for examples of how to approach conversations around the HPV vaccine. This cancer-preventing vaccine still has relatively low rates of completion, in spite of its proved effectiveness.
A screening hemoglobin is required at least once for menstruating adolescents. This helps identify anemia, which is more common in Medicaid-eligible adolescents. Detecting anemia among young women of child-bearing age also important for pre-conception health, to help support healthy fetal brain development.
Sexually Transmitted Infection (STI) Risk Assessment
Risk assessment can be done through a confidential conversation with the patient, a broader health questionnaire, or an STI-specific patient-report questionnaire such as the HIV/STD/Hepatitis Risk Assessment (MDH).
Universal HIV screening at least once between 15-18 years of age is a C&TC requirement. Refer to the HIV Screening C&TC Fact Sheet for more information. Clinics can share HIV FAQ with families and youth to explain why HIV screening is offered to all patients at least once between 15-18 years of age.
Beginning at age 11, include the 6000 Hz level in the required hearing screen in addition to the 500, 1000, 2000, and 4000 Hz levels that are offered at earlier ages.
The 6000 Hz level screens for noise-induced hearing loss. Refer to the hearing screening procedures to ensure accurate hearing screening. It is especially important to do the environmental noise level check for this screening, to avoid false positives.
Requirements for each C&TC visit include the teeth as a part of the physical exam, education about oral health and hygiene, and a verbal referral for regular preventive dental visits (also covered under Medicaid). Oral health and preventive dental care is often overlooked in adolescence, and can have a lifetime impact. The patient's health plan can help them find a dental provider.
For a sports physical, provide a complete Child and Teen Checkup. The Minnesota State High School League (MSHSL) has a Sports Qualifying Physical Examination Clearance Form (2018-2019) (PDF). Download the most recent version from the MSHSL website. Clinicians should complete and sign the first page of the form to give to the school.
To complete a C&TC visit as a sports physical:
- Provide all required screening components according to the C&TC Periodicity Schedule for that patient's age.
- Ensure that the health history includes a focus on musculoskeletal, cardiac, respiratory, and neurological personal and family health history. Page 2 of the MSHSL form may be used for this purpose.
- To indicate approval, recommendations, or non-approval, a licensed health care professional completes and signs the first page of the form to return to the school.
Ideally, treat all school-age and adolescent C&TC visits as sports physicals, to avoid patients having to return for forms or additional visits.