Minnesota Chapter of the American Academy of Pediatrics

Headlines

Casey Hokanson, BA, Zeinab Mohamud, BA, Janna Gewirtz O’Brien, MD, MPH



In Minnesota, nearly 6,000 youth experience homelessness each night. Trauma and marginalization are often causes of homelessness. Many have been harmed by systemic racism and identity-based oppression leading to stark disparities in the composition of youth experiencing homelessness (YEH) in Minnesota. 73% identify as BIPOC and 23% identify as LGBTQ+. Marginalization and oppression lead to health risks including trauma, injury, abuse, mental health risk, STIs, unplanned pregnancy, untreated medical conditions, substance use, and inadequate access to basic needs including housing, food, and healthcare access. Despite the many challenges YEH face, they display remarkable and inspiring resilience.



We would like to preface by emphasizing that housing is health. It is important for YEH’s basic needs to be met first before they access health. If you come into contact with a YEH who needs shelter, you can help them by bringing ysnmn.org to their attention. This resource that allows YEH to know which resources and shelters are in the community also comes as an app for easier access.



In our lab’s youth participatory action research, YEH identified barriers to navigating complex health systems. We offer some tips on how to overcome these barriers. Remember, although youth experiencing homelessness have a legal right to consent to their own healthcare, even as minors, when they are living apart from their legal guardian(s) and managing their own financial affairs, youth face many challenges accessing care. The last barrier encompasses supporting youth in owning their own healthcare. 



How can you as a healthcare provider do this?



<ul class="wp-block-list">
<li>Help them know their own medical conditions, medications, and allergies (use their phones, devices, or Health apps).</li>



<li>Encourage them to take pictures of their health insurance cards and vital documents so they have easier access to them.</li>



<li>Share employment opportunities, education and healthcare.</li>



<li>Know their healthcare team and how to reach them.</li>



<li>Ensure they have MyChart/electronic health record access.</li>



<li>Encourage regular checkups. Set up a follow-up before they leave the office or hospital.</li>



<li>Write down any questions or concerns they have between visits.</li>



<li>Help them understand their legal rights to accessing healthcare and shelter.</li>
</ul>



<figure class="wp-block-image size-large"><img loading="lazy" decoding="async" width="1024" height="387" src="https://wp.mnaap.org/wp-lib/wp-content/uploads/2024/05/Teal-Peach-Lilac-Modern-Playful-Productivity-Tips-Infographic-Instagram-Post-2-1024x387.png" alt="" class="wp-image-4577" srcset="http://wp.mnaap.org/wp-lib/wp-content/uploads/2024/05/Teal-Peach-Lilac-Modern-Playful-Productivity-Tips-Infographic-Instagram-Post-2-1024x387.png 1024w, http://wp.mnaap.org/wp-lib/wp-content/uploads/2024/05/Teal-Peach-Lilac-Modern-Playful-Productivity-Tips-Infographic-Instagram-Post-2-300x113.png 300w, http://wp.mnaap.org/wp-lib/wp-content/uploads/2024/05/Teal-Peach-Lilac-Modern-Playful-Productivity-Tips-Infographic-Instagram-Post-2-768x290.png 768w, http://wp.mnaap.org/wp-lib/wp-content/uploads/2024/05/Teal-Peach-Lilac-Modern-Playful-Productivity-Tips-Infographic-Instagram-Post-2-1536x581.png 1536w, http://wp.mnaap.org/wp-lib/wp-content/uploads/2024/05/Teal-Peach-Lilac-Modern-Playful-Productivity-Tips-Infographic-Instagram-Post-2.png 2000w" sizes="(max-width: 1024px) 100vw, 1024px" /></figure>



As a healthcare provider, you are a leader in dismantling health inequities and forging positive relationships with youth. It takes a trauma-informed approach, cultural humility, and gentle patience to rebuild this bridge and trust between healthcare providers and youth experiencing homelessness.

Caring for Youth Experiencing Homelessness

Minnesota’s newborn screening panel is expanding with the addition of guanidinoacetate methyltransferase (GAMT) deficiency, Mucopolysaccharidosis Type II (MPS II), and Krabbe disease.



Following the recommendation of the Newborn Screening Advisory Committee, Minnesota Commissioner of Health Dr. Brooke Cunningham has approved these conditions for routine screening of newborns in the state. 



Commissioner Cunningham has directed the Newborn Screening program to initiate the necessary steps for implementing screening protocols for GAMT deficiency, MPS II, and Krabbe disease, underscoring the commitment to early detection and intervention for these rare genetic disorders.



For more information, visit: <a href="https://www.health.state.mn.us/people/newbornscreening/program/newbornscreeningpanel.html">https://www.health.state.mn.us/people/newbornscreening/program/newbornscreeningpanel.html</a>

Newborn Screening Panel Updates

Anti-Racism &amp; Health Equity



The Anti-racism and Health Equity workgroup is currently working on ways to connect with other state chapters who are doing work similar to ours, and networking with them to strengthen the goals we have.



We will also finalize work over the next few months with our YWCA equity consultant to review our chapter’s strategic planning for improved health equity in our chapter and across the state. Our next meeting is Monday, June 10, from 12:15 pm -1:00 pm.



If you are interested in joining the Anti-Racism &amp; Health Equity Work Group, email Jeff Bauer bauer@mnaap.org to be added to the group’s email list for upcoming meeting dates and activities.



Early Childhood



The Early Childhood Work Group has been meeting monthly and supporting lectures devoted to the topic of early childhood which are located on the AAP website. Our presenters have included Erin Bailey, Keriann Mahon, Andre Dukes, and Ariel Handevidt speaking on topics such as early relational health, the Northside Achievement Zone and the Children’s Cabinet. The work group is also tracking and supporting activities such as early literacy, the Early Childhood Family Education program, parent-child relational health, and infant mental health. 



Additionally, the work group’s recent activities include legislative tracking and advocacy. The primary early childhood initiatives this legislative session have been directed to supporting the changes and programs funded in the ‘23 budget session&#8211;with attention to thenestablishment of the new Executive Department of Children, Youth and Families.



We are hoping that other AAP fellows will join us in this work for the crucial birth to preschool children we care for. Please Contact Krish Subrahmanian at subrahm2003@gmail.com or Roger Sheldon at rogeugshe@gmail.com to join the group.

Work Group Updates | Spring 2024

Pat McKone, American Lung Association 



E-cigarettes are addicting a new generation to nicotine. Since 2014, e-cigarettes have been the #1 tobacco products used by youth. It’s a crisis of youth addiction that is a result of thousands of kid-friendly flavors and massive doses of nicotine.



The 2023 National Youth Tobacco Survey (NYTS) reported over 2.1 million kids used these devices in 2023. It is estimated more than 4,300 kids (under 18) try e-cigarettes daily.



Scope of the problem:



<ol class="wp-block-list">
<li>Many youth are using these products most days or every day, a sign they are becoming addicted. More than 70 percent of youth who use e-cigarettes in MN show signs of nicotine dependence.</li>



<li>Flavors are at the core of this problem. Close to 90% of youth use flavored products – fruit, candy, sweet, mint and menthol among the most popular. In Minnesota, one in seven 11th graders uses e-cigarettes, and 88 percent of those students use flavored e-cigarettes.</li>



<li>Disposable and menthol e-cigarettes are on the rise, two categories of products that were left behind under current federal regulation.</li>
</ol>



Resources for youth, parents and educators:



<ul class="wp-block-list">
<li>American Academy of Pediatrics &#8211; https://www.aap.org/en/patient-care/tobacco-control-and-prevention/e-cigarettes-and-vaping/</li>



<li>American Lung Association – www.lung.org </li>



<li>My Life My Quit – www. mylifemyquit.com </li>



<li>Truth Initiative – This is Quitting www.truthinitiative.org/our-top-issues/vaping-issue</li>



<li>Campaign for Tobacco Free Kids –www.tobaccofreekids.org</li>
</ul>

What’s New With Vaping?

<img loading="lazy" decoding="async" class="size-medium wp-image-4566 alignleft" src="http://wp.mnaap.org/wp-lib/wp-content/uploads/2024/05/Headshot-300x300.jpeg" alt="" width="300" height="300" srcset="http://wp.mnaap.org/wp-lib/wp-content/uploads/2024/05/Headshot-300x300.jpeg 300w, http://wp.mnaap.org/wp-lib/wp-content/uploads/2024/05/Headshot-150x150.jpeg 150w, http://wp.mnaap.org/wp-lib/wp-content/uploads/2024/05/Headshot.jpeg 500w" sizes="(max-width: 300px) 100vw, 300px" />Please welcome Hanna Jorgenson as our new Communications Manager!
Hanna comes to us with a wealth of marketing and communications experience in both the non-profit sector and the medical device industry. With a genuine passion for the mission of the American Academy of Pediatrics, she brings a unique blend of professional expertise and personal dedication to the table.
Having navigated the challenges of childhood cancer firsthand, she is intimately acquainted with the critical importance of our mission. Diagnosed with osteosarcoma at the age of 16, and later with Li-Fraumeni syndrome, a cancer predisposition syndrome, she understands the significance of early intervention and advocacy for young patients’ health.
Driven by a deep-seated commitment to improving the lives of young people, she has dedicated considerable time and energy to serving on various non-profit boards and volunteering with organizations focused on pediatric health and well-being. With boundless enthusiasm and a steadfast dedication to our cause, Hanna is poised to lead our communications efforts with creativity, compassion, and purpose!
You can reach Hanna at hanna@mnaap.org.

Welcome, Hanna!

<img loading="lazy" decoding="async" class="wp-image-4559 alignleft" src="http://wp.mnaap.org/wp-lib/wp-content/uploads/2024/05/Screenshot-2024-05-23-at-9.31.52 AM-208x300.png" alt="" width="193" height="278" srcset="http://wp.mnaap.org/wp-lib/wp-content/uploads/2024/05/Screenshot-2024-05-23-at-9.31.52 AM-208x300.png 208w, http://wp.mnaap.org/wp-lib/wp-content/uploads/2024/05/Screenshot-2024-05-23-at-9.31.52 AM.png 225w" sizes="(max-width: 193px) 100vw, 193px" />I recently read an article in the New York Times about an account on X (formerly known as Twitter) where a child policy consultant, with a background in early childhood, comments about child development. The account posts videos from public social media accounts with commentary on developmental milestones as well as the fascinating learning that babies and young children are doing every day. From language skills to social connections to the importance of play (instead of screens), the videos highlight what every pediatrician knows-that kids are amazing!


The videos shared in the article are so good in so many ways. Equally important is the commentary about what skills you can nurture or just to recognize your child’s unique ability to learn by curiosity and how much is gained from human-to-human connection.



The videos are such good examples of everyday interactions. Many of them capture the exact moment of realization; the second the child accomplishes the “thing”, whether reciprocal verbalization, overcoming their fear of jumping into water or getting the strawberry piece onto the spoon and into their mouths.



As a bonus, the videos show experiences that don’t require fancy educational toys. Many of the videos are of parents/grandparents/aunties/uncles spending time with a baby or young child talking, singing or reading to them. I’m sure you experience and probably model these strengths for families every day in your offices. The article, X account and accompanying videos remind me, yet again, of the tremendous privilege and joy it is to work with children and their families. The trust and relationships that each of us builds, over many years, is what makes the practice of pediatrics the best.



<a href="https://x.com/DanWuori/status/1764282393634988091">Watch the video here. </a>

Word from the President: Eileen Crespo, MD, FAAP

We&#8217;re excited to announce an opening for a Communications Manager at the Minnesota Chapter of the American Academy of Pediatrics (MNAAP). This part-time, remote role is a unique opportunity for a communications professional with at least five years of experience, who is passionate about advancing child health through advocacy, education, and special projects. 



The role involves managing various communications channels, including email updates, social media engagement, and press releases, to support the MNAAP&#8217;s mission of promoting the health of children and adolescents in Minnesota. The position offers a flexible schedule of 15-20 hours per week, competitive compensation at $45 per hour, and the chance to work with a dedicated team committed to equity, diversity, and inclusion. We&#8217;re looking for someone with strong communication skills, the ability to manage multiple projects, and a commitment to including diverse perspectives in their work. 



If you&#8217;re interested in making a significant impact in the pediatric health community, we encourage you to apply by sending your cover letter and resume to Jeff Bauer at <a>bauer@mnaap.org</a> by February 26. 



Join us in our mission to protect and advance the health of every child and adolescent in Minnesota.



For more details about the role and how to apply, please visit the <a href="https://jobs.minnesotanonprofits.org/job/communications-manager-89705/hash/8616bae0576d37c70b08be224dddbed4">job listing on Minnesota Nonprofits website</a>.

Join Our Team: Seeking a Passionate Communications Manager to Shape the Future of Child Health Advocacy

<div id="attachment_4261" style="width: 209px" class="wp-caption alignleft"><a href="http://www.mnaap.org/minnesota-begins-universal-congenital-cmv-screening-how-is-it-going-so-far/mn-aap/" rel="attachment wp-att-4261"><img loading="lazy" decoding="async" aria-describedby="caption-attachment-4261" class="wp-image-4261 size-medium" src="http://www.mnaap.org/wp-lib/wp-content/uploads/2023/09/MN.AAP_-199x300.jpeg" alt="" width="199" height="300" srcset="http://wp.mnaap.org/wp-lib/wp-content/uploads/2023/09/MN.AAP_-199x300.jpeg 199w, http://wp.mnaap.org/wp-lib/wp-content/uploads/2023/09/MN.AAP_.jpeg 323w" sizes="(max-width: 199px) 100vw, 199px" /></a>Parent advocates Leah Henrikson and Steph Steidl are pictured here with their children, Vivian Henrikson Hank Steidl at the initiation ceremony for the new cCMV screening program. Both Vivian and Henry were born with cCMV. The “Vivian Act” is named after Vivian.</div>
On February 6, 2023, Minnesota became the first state to screen all newborns for congenital cytomegalovirus (cCMV), the most common infectious cause of pediatric disability in the United States. Most children born with cCMV are asymptomatic and have normal developmental outcomes, but up to 15 percent will have sensorineural hearing loss (SNHL). The need to monitor for SNHL is the driving force behind universal screening. This breakthrough in newborn screening was made possible by the passage of the “Vivian Act” in 2021, legislation driven by parental advocacy coupled with advances in biotechnology that made newborn dried blood spots sufficiently sensitive for newborn screening.
Since the advent of this newborn screening test, substantial numbers of infants with cCMV have already been identified. What is recommended if you, as a primary care pediatrician, receive a report from the Minnesota Department of Health (MDH) Newborn Screening Program that an infant’s cCMV screen is positive?
<ul>
<li class="p3">At this time, it is recommended that the infant have a PCR test of urine to confirm the cCMV diagnosis.</li>
<li class="p3">Evaluation should focus on the question of whether the infant has any signs or symptoms of cCMV. The history and physical exam are of great value. Was there a history of intrauterine growth retardation/SGA? Did the newborn demonstrate low birth weight, petechiae, microcephaly, hepatosplenomegaly, or other rashes? Did the baby “refer” on the newborn hearing screen? Does the baby have any neurological findings on the newborn physical exam that are abnormal?</li>
<li class="p3">Additional studies to help define whether the infant has CMV disease (versus asymptomatic infection) are recommended, including a complete blood count (including differential leukocyte count and platelet count), hepatic function tests, a cranial ultrasound examination, and ophthalmologic evaluation. If there is any uncertainty about cranial ultrasound findings, it can be very useful to have the imaging study reviewed by a pediatric radiologist. In some cases, MRI imaging might be warranted. A diagnostic algorithm for confirmed cCMV cases can be found on the MDH Newborn Screening Program’s website at:<a href="https://www.health.state.mn.us/people/newbornscreening/program/cmv/followup.html"> https://www.health.state.mn.us/people/newbornscreening/program/cmv/followup.html</a></li>
<li class="p3">A detailed audiologic assessment (preferably an auditory brainstem response, or ABR) is warranted in all cCMV cases: pediatricians should not just rely a routine newborn hearing screen at the time of newborn nursery discharge. This is important both to establish a baseline and establish a relationship with an audiologist for future follow-up. Ongoing care with an audiologist with specific pediatric training is preferred, when possible. As many as 75 percent of infants with eventual SNHL due to cCMV pass their newborn hearing screen and have normal hearing at birth.</li>
<li class="p3">Not all infants with cCMV need to be referred to a pediatric infectious diseases (ID) specialist. As ID clinicians, we note that most evaluations are being appropriately handled by primary care pediatricians and family practitioners. We are available, however, for consultation with primary care physicians if there is uncertainty on interpretation of laboratory, imaging, or clinical findings, or to review and discuss any cases identified by the newborn screen.</li>
<li class="p3">Consultation with a pediatric ID specialist can be particularly useful in making decisions about antiviral therapy. Antiviral therapy is of no proven benefit for infants with cCMV who are asymptomatic at birth. However, if an infant has signs or symptoms of cCMV disease, including abnormal ultrasonographic or laboratory studies, or an abnormal audiological evaluation, then discussion with an ID physician is recommended in considering the value of treatment.</li>
<li class="p3">All infants with cCMV should have regular follow-up audiologic assessments. Guidelines for audiological monitoring recommendations can be downloaded at the MDH web page at: <a href="https://www.health.state.mn.us/diseases/cytomegalovirus/professionals.html">https://www.health.state.mn.us/diseases/cytomegalovirus/professionals.html </a></li>
</ul>
Pediatric ID providers at the Mayo Clinic, the University of Minnesota Medical School, Hennepin Health, and Children’s Minnesota are available to assist Minnesota pediatricians with questions and, as needed, referrals for cCMV. ID providers available for consultation are listed at: https://www.health.state.mn.us/people/newbornscreening/providers/bloodspotresources.html. Excellent educational resources on cCMV for primary care physicians are available at <a href="https://www.health.state.mn.us/people/newbornscreening/program/cmv/resources.html">https://www.health.state.mn.us/people/newbornscreening/program/cmv/resources.html</a>. Physicians can also utilize resources for parents, families and caregivers that are available for download at the MDH website at <a href="https://www.health.state.mn.us/diseases/cytomegalovirus/parentpkt.pdf">https://www.health.state.mn.us/diseases/cytomegalovirus/parentpkt.pdf </a>

Minnesota Begins Universal Congenital CMV Screening: How Is It Going So Far?

<div id="attachment_4257" style="width: 210px" class="wp-caption alignleft"><a href="http://www.mnaap.org/food-insecurity-referral-project-leads-to-major-tech-connection/pexels-markus-spiske-175422/" rel="attachment wp-att-4257"><img loading="lazy" decoding="async" aria-describedby="caption-attachment-4257" class="size-medium wp-image-4257" src="http://www.mnaap.org/wp-lib/wp-content/uploads/2023/09/pexels-markus-spiske-175422-200x300.jpg" alt="" width="200" height="300" /></a>Photo by Markus Spiske</div>
A project designed to streamline the Minnesota Women, Infant, and Children (MN WIC) referral process for physicians and clinic staff is headed into its next phase with the creation of a statewide data-sharing system. The project, funded by an AAP Food Insecurity grant, aimed to close the loop between families and the MN WIC program through the touchpoint of routine clinic visits. The project examined how creating EMR referrals to the WIC program and sharing patient information can promote WIC enrollment and encourage sustained participation.
The project piloted a read-only system between Hennepin Healthcare and Hennepin County WIC that allowed a workflow to be integrated into a clinic visit record. According to Dr. Diana Cutts of Hennepin Healthcare, it was encouraging to see how the collaboration between the medical provider and WIC was enhanced.
“The focus on how technology can be helpful on both sides of this relationship,” said Dr. Cutts. “No more fax machines, no more mailing. It is appropriate for what’s possible these days. It helps everyone be more efficient. We were able to move some boulders in this process and create a connection that everybody benefits from. It’s been a really great gift to all of us involved.”
MNAAP is working with several partners including Ramsey County WIC, Minnesota WIC, and Hennepin County WIC to create a closed-loop family referral system between providers and the state’s Women, Infant, and Children (WIC) agency. The next step will be for the Minnesota Department of Health to help create a statewide system for referrals, as well as sharing vital statistics data.

Food Insecurity Referral Project Leads to Major Tech Connection

Authors: Ruegba Bekibele, MBBS; Lily Rubenstein, BSN, PHN; Sheyanga Beecher, CNP, MPH; Stacene Maroushek MD, PhD, MPH
INTRODUCTION
The Minnesota Department of Health Refugee Health Program (MDHRHP) aims to protect and promote the health of newcomer populations in Minnesota. The program assists in coordinating Refugee Health Assessments, supports new arrivals to Minnesota with complex medical needs, trains and supports providers in best practices and analyzes, summarizes, and shares data on newcomer health in Minnesota.
Newcomer populations often have unique clinical needs across the continuum of care. Knowing the steps of medical assessment and intervention before and after the resettlement process are key to being able to provide effective and efficient healthcare.
CASE EXAMPLE
A 10-year-old Afghani girl is brought in by her family for a routine well child check at the pediatric clinic. This visit was coordinated by the local public health agency and medical records have been made available prior to the visit. With the aid of a Pashto interpreter, the provider is able to determine that the family moved to the United States two months ago under the refugee resettlement program. The family shares their records of the overseas medical exam and immunization history paperwork.
A detailed review of systems is positive only for intermittent abdominal pain. After briefly reviewing the family’s diet, the mom shares the family has been eating more processed foods and packaged meals since arriving in Minnesota. The patient is straining with bowel movements which have been more infrequent than previously. The mother also mentions that the patient was found to have “low blood level” during the patient’s pre-departure screening at the refugee camp in Pakistan. The patient has no other past medical or surgical history. She has no known history of allergies.
Mom also says that the family has been stressed by the recent loss of patient’s paternal grandma who died of tuberculosis (TB) in Kabul last year. Family history is otherwise unremarkable. The patient lives with her parents and five siblings in temporary housing provided by the refugee resettlement program. The family has health insurance coverage under Medical Assistance. The patient and her siblings are enrolled in school. Transportation still remains a concern.
Vital signs: Temp 99.8, HR 107, RR 18, BP 96/54. The patient is tracking along the 15th percentile for weight and 20th percentile for height. Physical examination is remarkable for conjunctival and palmar pallor suggesting mild anemia and multiple carious teeth.
The provider orders a complete blood count with differential, lead test, and interferon gamma release assay (IGRA) TB blood test, Hepatitis A, Hepatitis B and HIV. Review of the patient’s immunization history paperwork and the CDC Childhood and Adolescent Immunization schedule indicates that the patient is due for Human Papilloma Virus (HPV) vaccine and Varicella vaccines for which the family consents. The provider review ways to increase fiber in the new diet and prescribes a course of polyethylene glycol laxative powder. The provider also counsels the family on dental hygiene. A dental referral is placed and the social worker is consulted to help co-ordinate transportation and provide the family with resources for housing. A two-week follow up visit is scheduled.
At the follow-up visit the doctor reviews the results of investigations with the patient’s caregiver. The CBC was remarkable for anemia with hemoglobin of 10g/dl, RDW 17%, MCV 65fL and RBC within normal range. Lead, IGRA TB blood test, Hepatitis A, Hepatitis B, and HIV were all negative. At this follow up visit, the patient initiates the Hepatitis A and B vaccine series and is started on a multi-vitamin with iron. Mother reports the patient is having softer stools and less abdominal pain. She also notes that they have an upcoming appointment with the dental clinic in 2-months’ time. The patient is discharged home with plans to follow up. The provider completes the Refugee Health Assessment Form (<a href="https://nam02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.health.state.mn.us%2Fcommunities%2Frih%2Fhcp%2Fassesfrm.pdf&amp;data=05%7C01%7CSheyanga.beecher%40hcmed.org%7C16928348c60e4f80e50e08db61db4d3c%7Cada0782c5f344003b5d63187f30aecdd%7C0%7C0%7C638211367177421560%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&amp;sdata=dHSoADiOqt986tKp0hSZ5lRHLWObc8MEsJBLGmj8qg8%3D&amp;reserved=0">https://www.health.state.mn.us/communities/rih/hcp/assesfrm.pdf</a>) and sends it directly to the local public health contact.
In three months, the patient is brought in by her mother for her follow up appointment. Mom has no new concerns. A review of the growth chart reveals that the patient is now tracking along the 25th percentile for weight and remains at the 15th percentile for height. A repeat CBC and IGRA TB blood test are normal. The patient no longer has abdominal pain. When asked about patient’s mental health and how the family is coping with paternal grandmother’s loss, Mom says the patient is seeing her school counselor. The family still lives in a temporary housing and relies on public transport. Dad is working on getting a job. Mom says they would like to establish care with this provider. The provider reaches out to the social worker to help with community resources for jobs and transportation needs. The social worker gets in touch with the family’s case worker at the local resettlement agency and discusses the families need and plan to address social determinant of health needs in more detail.
DISCUSSION
Immigration and visa status can have implications for one’s health as it determines benefits eligibility and the health care a newcomer may have received prior to and after arrival to the United States. MDHRHP works with arrivals who are eligible to receive Office of Refugee Resettlement benefits, including (but not limited to) refugees, Asylees, Special Immigrant Visa holders, Certified Victims of Human Trafficking, and certain humanitarian parolee groups. This article focuses on two of the largest populations currently served by the MDHRHP, refugees and those with humanitarian parole.
A refugee is someone who has experienced past persecution or has a well-founded fear of persecution on account of their race, religion, nationality, membership in a particular social group, or political opinion.
Humanitarian parole is a temporary status which gives individuals permission to be in the US legally for urgent humanitarian reasons. There are currently programs for those from Ukraine, Haiti, Cuba, Nicaragua, and Venezuela to seek humanitarian parole1,2.
Of note, asking one’s immigration status during a health care exam is not recommended as doing so may cause undue anxiety. However, one can ask about any overseas health screening as a surrogate because it is important to determine whether a patient has received any previous health exams.
Health Care Assessments Before and After Resettlement
Overseas Medical Exam
Those with refugee status receive an Overseas Medical Exam (OME) within six months of departure by a Panel Physician who is selected by the US Embassy and performs OME according to CDC recommendations3. The OME consists of several components including a medical history and physical examination and assessment for diseases of public health significance including Tuberculosis. However, Hepatitis B and HIV screening may not be included. Patients also receive some immunizations that are age-appropriate according to ACIP guidelines and protect against outbreak prone diseases or diseases that have been, or are in the process of being eliminated in the US4. Immunizations depend on availability in the country of departure which may vary. Consequently, refugee arrivals may not have received all ACIP-recommended immunizations at the time of arrival.
Within 1-2 weeks of departure, an abbreviated medical exam is performed (Pre-Departure Medical Exam). At this time, individuals may receive additional lab testing such as a COVID-19 and/or pregnancy test, additional immunizations, and presumptive treatment for parasitic infections5 and malaria6 if clinically appropriate.
The Refugee Health Assessment and Linkage to Primary Care
Thirty to ninety days after arrival in Minnesota, refugee arrivals receive an optional, but strongly recommended, comprehensive health assessment7 coordinated by MDHRHP and local public health agency in the county of residence. This visit is performed by physicians, PAs, and NPs who have been trained by the MDHRHP and consists of a history and physical, infectious disease, lead, and mental health screening, immunizations, and referral to ongoing primary care or specialty care as needed. Results are returned to the MDHRHP and monitored for trends. Aggregate results are shared to state and national partners.
Some Refugee Health Assessments are performed by primary care providers, and some are performed at more specialized clinics such as a city public health clinic. Newcomers may opt to stay with their assessment provider for ongoing primary care or move to a different provider or clinic. Those that receive their assessment at a public health clinic without ongoing primary care services will be referred to an alternate clinic.
Humanitarian parole health requirements
Those with humanitarian parole generally do not receive an OME. They may or may not be eligible to receive a Refugee Health Assessment depending on whether they have been granted Office of Refugee Resettlement benefits. For questions on which populations currently qualify, please reach out to MDHRHP. Several humanitarian parolee groups have health requirements set by the US Citizenship and Immigration Services office. These include, one measles, one polio, and one COVID-19 vaccine prior to departure, and completion of the COVID-19 series and an IGRA test within 90 days of arrival.
Medical records
Newcomers are provided with a copy of their Overseas Medical Exam records. The MDHRHP is also provided with a copy of these exams from the CDC and share them with the Refugee Health Assessment provider. These records hold lab results, immunizations, and history and physical results. A profile in the Minnesota Immunization Information Connection (MIIC) is established once these records are received, generally within 1-2 weeks after arrival. If a newcomer has not received an OME and not received care elsewhere, there may not be a MIIC profile.
Humanitarian parolees may have a copy of their immunization records and IGRA test results, or may be able to provide information on where domestic health care occurred. This information is not routinely collected by the MDHRHP.
For domestic records, determine where the Refugee Health Assessment occurred and request medical records per routine clinic processes. If the patient cannot remember where the RHA took place, please contact MDHRHP.
In addition to refugees, asylees, special immigrant visa holders, certified victims of human trafficking, and certain humanitarian parolee groups, there are other populations of foreign-born children, including unauthorized immigrants without any history of health screenings or immunization records. These patients also seek care in primary care clinics for routine well child checks and require thoughtful assessment and assistance navigating complicated healthcare needs. For additional information, please refer to Screening and Healthcare of Immigrant Children8 and the American Academy of Pediatrics toolkit on serving immigrant children <a href="https://downloads.aap.org/AAP/PDF/cocp_toolkit_full.pdf">https://downloads.aap.org/AAP/PDF/cocp_toolkit_full.pdf</a>
Works Cited
<ol>
<li>US Citizenship and Immigration Services. (2023, July 12). Process for Cubans, Haitians, Nicaraguans, and Venezuelans. <a href="https://www.uscis.gov/CHNV">https://www.uscis.gov/CHNV</a></li>
<li>US Citizenship and Immigration Services. (2023, July 12). Uniting for Ukraine. <a href="https://www.uscis.gov/ukraine">https://www.uscis.gov/ukraine</a></li>
<li>Centers for Disease Control and Prevention. (2019, October 16). Immigrant, refugee and migrant health, Panel physicians. <a href="https://www.cdc.gov/immigrantrefugeehealth/panel-physicians/introduction-background.html">https://www.cdc.gov/immigrantrefugeehealth/panel-physicians/introduction-background.html</a>.</li>
<li>Centers for Disease Control and Prevention. (2023, May 12). Immigrant, refugee and migrant health, Panel physicians on vaccines. <a href="https://www.cdc.gov/immigrantrefugeehealth/panel-physicians/vaccinations.html#:~:text=The%20panel%20physician%20must%20counsel,the%20vaccines%20they%20are%20using">https://www.cdc.gov/immigrantrefugeehealth/panel-physicians/vaccinations.html#:~:text=The%20panel%20physician%20must%20counsel,the%20vaccines%20they%20are%20using</a>.</li>
<li>Centers for Disease Control and Prevention. (2021, March 16). Presumptive treatment and screening for strongyloidiasis, infections caused by other soil-transmitted helminths, and schistosomiasis among newly arrived refugees. <a href="https://www.cdc.gov/immigrantrefugeehealth/guidelines/domestic/intestinal-parasites-domestic.html">https://www.cdc.gov/immigrantrefugeehealth/guidelines/domestic/intestinal-parasites-domestic.html</a>.</li>
<li>Centers for Disease Control and Prevention. (2019, September 13). Presumptive treatment of P. falciparum Malaria in refugees relocating from sub-Saharan Africa to the United States. <a href="https://www.cdc.gov/immigrantrefugeehealth/guidelines/domestic/malaria-guidelines-domestic.html">https://www.cdc.gov/immigrantrefugeehealth/guidelines/domestic/malaria-guidelines-domestic.html</a></li>
<li>Minnesota Department of Health. (2023, March 3). Minnesota Domestic Refugee Health Screening Guidance. <a href="https://www.health.state.mn.us/communities/rih/guide/index.html">https://www.health.state.mn.us/communities/rih/guide/index.html</a>.</li>
<li>Maroushek, SR. Screening and Healthcare of Immigrant Children, In: Nelson Textbook of Pediatrics, 20th Edition. Editors: Robert Kliegman, Richard Behrman, Hal Jenson, and Bonita Stanton. Elsevier Press, Philadelphia, PA, (2015).</li>
</ol>

Caring for a Newcomer Patient During the Initial Well Child Check in Pediatric Primary Care

Grand Itasca Clinic & Hospital is seeking a board certified/board eligible outpatient Pediatric Physician to join our busy and growing primary care clinic practice. Grand Itasca is a fully integrated multi-specialty clinic and hospital located in Grand Rapids, Minnesota.

Pediatric Physician

Partners in Pediatrics, Ltd. is seeking a full time BC/BE Pediatrician. The standard work week for a full-time pediatrician is 4 days a week plus a rotation of nights and weekends. Night and weekend shifts are shared equally among all providers. The salary package is competitive. You will have paid time off (PTO) and be given a CME allowance as well as CME days to further your medical education. We offer health, dental, disability and life insurance. You will also be eligible for a lucrative profit sharing 401(k). For inquiries, please contact our recruiting leads, Dr. Lisa Irvin at lirvin@pipstop.com and Dr. Megan Camerino at mcarmerino@pipstop.com

BC/BE Pediatrician

We’re excited to announce an opening for a Communications Manager at the Minnesota Chapter of the American Academy of Pediatrics (MNAAP). This part-time, remote role is a unique opportunity for a communications professional with at least five years of experience, who is passionate about advancing child health through advocacy, education, and special projects.

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