80% of what impacts the health of children happens outside the clinic walls.
That’s why Children’s Minnesota continues to leverage community health needs assessments (CHNAs) to actively engage our partners across various social sectors to improve the health of the children and families we serve.
To be every family’s essential partner in raising healthier children, we’re committed to hearing from families and collaborating with community leaders and organizations. As extensive as our expertise is, it will never equal the insight children, families and communities have about their own health and well-being.
In 2016, Children’s Minnesota began to emphasize health equity in the assessment process and broadened potential topic areas to include community conditions that contribute to health outcomes such as poverty, education and housing. The 2019 CHNA focused on honoring what was learned in 2016 while also creating space for new discussion topics to emerge. See our progress since the 2016 CHNA.
IN 2018 …
57,000+
children received emergency department services at Children’s Minnesota
13,000+
children were admitted to a Children’s Minnesota hospital
100,000+
visits used Children’s Minnesota’s interpreter services in 70 different languages
COMMUNITY DEFINITION
For the purposes of this CHNA, the community served includes the more than 700,000 children (0 – 17 years) who live in the seven-county Twin Cities region: Anoka, Carver, Dakota, Hennepin, Ramsey, Scott and Washington counties.
The assessment also placed emphasis on learning about the health needs, assets and priorities of children and families living in the following neighborhoods:
- In Minneapolis: Phillips and Powderhorn
- In St. Paul: West Side, Frogtown/Thomas-Dale, and Dayton’s Bluff
Priority Health Issues
Utilizing input from Children’s Minnesota staff and providers, community stakeholders and parents, as well as secondary data, five issues were identified as the most important to address for the health and well-being of children and their families:
Structural Racism
Structural racism refers to the ways in which the policies, practices and systems of organizations and institutions routinely advantage white residents while disadvantaging people of color and American Indians.
Structural racism contributes to disparities in areas such as employment, education, health, income and housing that disproportionately impact communities of color, including immigrant and refugee communities, and American Indians. Children’s Minnesota has intentionally focused on creating more accountable and equitable systems, and remains committed to addressing structural racism within the organization as well as in the communities we serve.
Structural racism impacts so much, yet there is still a lack of understanding. It affects a person’s ability to get an adequate education and quality employment, but it also causes trauma that can influence everything from mental health to birth outcomes.”
— Community-based organization staff
Health Disparities
Health disparities are persistent and pervasive in Minnesota, leading to some community groups experiencing higher rates of disease and poor health. Health disparities are preventable differences in health outcomes caused by an inequitable and unjust distribution of resources, opportunities, and power.
The community groups most often impacted by health disparities include:
- People who identify as persons of color or American Indian
- Immigrant and refugee populations
- Children from lower-income families
- LGBTQ youth
- Those living in the urban, densely populated and developed areas of the Children’s Minnesota community
It’s no secret that families in communities of color don’t have the same access to health care and that impacts people’s lives. Particularly with children, when we talk about asthma and even preexisting conditions, children just do not have the same support and access in communities of color.”
— Community-based organization staff
Economic Opportunity and Income
Economic opportunity and income are factors that ensure families can access and obtain financial resources that support the well-being of children and the community. Wealth and higher household income are closely tied to better health outcomes.
Disparities, especially racial disparities, in poverty, income and employment are evident in Minnesota. Over 200,000 children in the Twin Cities metro live in households with incomes at or near poverty levels.
% of patients served in 2018 who had Medicaid as primary insurance
Emergency Department
Inpatient Hospitalization
Minneapolis & St. Paul Clinics
Suburban Twin Cities Clinics
Mental Health and Developmental Well-Being
Supporting mental health and developmental well-being for all children and families is important, but certain populations may be more likely to have unmet needs due to barriers to obtaining mental health services, lack of appropriate services, exposure to adverse childhood experiences (ACEs), and other environmental conditions that contribute to or exacerbate mental health concerns. Stakeholders identified specific populations who have unmet mental health needs including children under five, persons of color and American Indian communities, immigrant and refugee families, children living in poverty and adolescents in need of intensive mental health services.
While systemic factors contribute to a child’s exposure to ACEs, it is important to note that some children are more likely to report experiencing four or more ACEs including children who are: American Indian, African American, Hispanic/Latino, low-income or homeless.
We see kids being diagnosed with developmental needs, but they are put on waitlists and that causes implications. Families may not get the support they need during a critical time, and the child could struggle to stay in school. There is a need for more therapeutic mental health services as we see more children suffering from the effects of trauma. We have a capacity issue.”
– Community-based organization staff
Access to Resources
Accessing critical resources is often most challenging for lower-income families, immigrant and refugee families, and communities that have been intentionally excluded or not taken into consideration when service systems are designed.
In neighborhoods of concentrated poverty, resources that support health and wellness are often limited, making it more difficult for residents to make choices that promote health. All of the CHNA’s focal neighborhoods within Minneapolis and St. Paul are areas of concentrated poverty; 60-81% of children experience poverty in these neighborhoods.
There are a lot of barriers to accessing resources or accessing them equitably. This includes providing necessary resources in areas of the community that really need them, making it possible for families to receive these services and helping them use what they have to improve their family’s condition.”
— Public school staff
Progress Since the 2016 Assessment
Asthma
Screening patients to identify families’ needs
Multi-lingual, multi-cultural resource navigators connecting families to social support resources
Extending and increased availability for walk-in appointments
Tracking disparities so providers can reach out to families proactively to ensure they have what they need
New clinician process to assist local school nurses when they work with children who have poor asthma control
Mental Health and Well-Being
Embedding behavioral health workers into primary care clinics
Testing patients for toxic stress and screenings for adverse childhood experiences as participant in the Harvard Center on the Developing Child’s Pediatric Innovation Cluster
Training pediatric behavioral residents to address the shortage of practicing providers
Implementing HealthySteps program which focuses on positive parenting, supportive resources and parent well-being
Screenings for symptoms of postpartum depression in new mothers
Partnering with Fraser and the Minnesota Autism Center to create a seamless approach to autism care for patients and families
Implementing telehealth services within psychiatry and eating disorder clinics to meet needs in rural Minnesota
Working with the Emily Program to support patients with eating disorders
Access to Resources
Launched Community Connect to improve access to support resources and to empower family decision making, while respecting cultural traditions
Income and Employment
Offer equity and inclusion internships to students in local programs and colleges
Created employee resource groups (ERGs) that promote retention, recruiting and professional development
Our ERGs collaborate with leading local companies to bolster community enrichment throughout the metro area
Leaders are given scorecards to measure specific equity and inclusion metrics
Structural Racism
Established a Health Equity Council at Children’s Minnesota to help build equity practices
Breaking down patient data by race, ethnicity and language to better address issues in patient experience
Developing tools to analyze the patient experience through an equity lens
Equity and social work departments have partnered to set equity goals and address individual bias
The urban American Indian population living in the Twin Cities metro area is one of the largest in the country and experiences some of the highest health disparities.
The Children’s Minnesota American Indian Collaborative builds relationships and drives better health outcomes with the American Indian community. One example is the First Gift program:
Education
Continuing to work with the St. Paul and Minneapolis school districts to identify intervention opportunities based on health conditions, geography, absenteeism and improved information sharing
Submit Your Feedback
We welcome input and comments from members of our community on the needs assessment process and implementation strategy.
Questions? Please contact a member of our team if you’d like to learn more about our work.