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Bright Futures: Tell me more!Bright Futures: Tell me more!

• Nicole Abdy MD

• Assistant Professor, Pediatrics

• January 24th, 2012

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Bright Futures inBright Futures inthe Public Health Settingthe Public Health SettingUsing the 3rd Edition Bright Futures Guidelines

What is Bright Futures?

• The Bright Futures initiative, developed by the federal Bureau of Maternal and Child Health and implemented in collaboration with the American Academy of Pediatrics (AAP), provides a comprehensive set of health supervision guidelines for children from birth through 21 years of age.

• Promotes and improves the health, education, and well-being of infants, children, adolescents, families, and communities

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Bright Futures inBright Futures inthe Public Health Settingthe Public Health SettingUsing the 3rd Edition Bright Futures Guidelines

What is Bright Futures

• Set of principles, strategies, and tools that are theory based, evidence driven, and systems oriented that can be used to improve the health & well being of all children through culturally appropriate interventions that address their current & emerging health promotion needs

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Bright Futures inBright Futures inthe Public Health Settingthe Public Health SettingUsing the 3rd Edition Bright Futures Guidelines

Development of 3rd Edition

• 4 multidisciplinary expert panels divided by the ages/stages of infancy, early childhood, middle childhood, and Adolescence

• Each panel chaired by pediatrician

• Each panel had 38 members of different disciplines:–Mental health experts

–Nutritionists

–Oral health practitioners

–Family medicine providers

–Nurse practitioners

–Family & school representatives

–Members of AAP national committees

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Goals:

Improve the health of our nation’s children, families, and communities

1. Work with states to make bright futures approach the standard of care

2. Help health care providers shift their thinking to prevention-based, family focused, and developmentally-oriented direction

3. Foster partnerships between families, providers, and communities

4. Empower families with skills & knowledge to be active participants in their children’s healthy development

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Why use Bright Futures?

• Well child care accounts for 25% of visits to primary care practitioners younger than 15, 40% for children <1y/o

• These are important visits to assess the overall well being in addition to preventative care

• Reviewed by ~1000 practitioners, educators, and child health advocates throughout the United States

• Revised x 2, last in 2008

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Why use Bright Futures?

• Text is considered the gold standard for pediatric care.

• Its accompanying Pocket Guide boils down the information to its most basic points for quick reference.

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Who can use Bright Futures?

• Pediatricians

• Nurse practitioners

• Mental health, oral health professionals

• Residents

• Nurses, other trained medical workers

• Child care workers, educators & teachers

• Health Educators

• Parents, Families

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Bright Futures inBright Futures inthe Public Health Settingthe Public Health SettingUsing the 3rd Edition Bright Futures Guidelines

Core Concepts

• Open ended questions to communicate effectively

• Start with affirmative questions–What are some games you are good at?

• Wait 3 seconds for a response

• Ask questions in a supportive way to encourage communication

• Promote problem solving

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Bright Futures inBright Futures inthe Public Health Settingthe Public Health SettingUsing the 3rd Edition Bright Futures Guidelines

Building Effective Partnerships

1. Model & encourage open, supporting communication with child & family

2. Identify health issues through active listening & fact finding

3. Affirm strengths of child & family

4. Identify shared goals

5. Develop joint plan of action based on stated goals–Be sure each partner has a role in developing plan,

keep it simple & achievable, set measurable goals & a specific timeline, build in follow-up

6. Follow up to sustain the partnership–Share progress, successes, and challenges

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Bright Futures inBright Futures inthe Public Health Settingthe Public Health SettingUsing the 3rd Edition Bright Futures Guidelines

Fostering family-centered communication

• Effective behaviors–Greet all family members & introduce yourself

–Use names

–Incorporate social talk

–Show interest & attention

–Demonstrate empathy

–Acknowledge concerns, fears, feelings of child & family

–Use non-medical language

–Encourage questions

• Active Listening: Verbal behaviors

• Active Listening: Non-verbal behaviors

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Bright Futures inBright Futures inthe Public Health Settingthe Public Health SettingUsing the 3rd Edition Bright Futures Guidelines

• Active Listening: Verbal behaviors–Allow child & parents to state concerns without

interruption

–Answer questions completely

–Clarify statements with follow-up questions

–Acknowledge stress or difficulties

–Offer supportive comments

• Active Listening: Non-verbal behaviors–Nod in agreement

–Sit down at level of the child to make eye contact, touch if appropriate

–Show expression, attention, concern, interest

–Draw pictures to clarify, demonstrate techniques

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Bright Futures inBright Futures inthe Public Health Settingthe Public Health SettingUsing the 3rd Edition Bright Futures Guidelines

Educating Families through Teachable Moments

• Provides information bites

• Is directed to the child’s or family’s specific needs

• Is brief (few seconds)

• Requires no preparation time

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Bright Futures inBright Futures inthe Public Health Settingthe Public Health SettingUsing the 3rd Edition Bright Futures Guidelines

Teaching strategies Advantages

Telling Works best for initial explanations

Showing Illustrates concepts for visual learners

Providing resources Reference after family leaves

Questioning Promotes problem solving, critical thinking, elicits better information

Practicing Reinforcing new concepts

Constructive feedback Affirms family knowledge, corrects misunderstandings

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Bright Futures inBright Futures inthe Public Health Settingthe Public Health SettingUsing the 3rd Edition Bright Futures Guidelines

3rd Edition includes:

• Introduction

• Introduction to visits

• Health Supervision visits (31 recommended visits)–Visit priorities, development, physical, screening,

immunizations, anticipatory guidance

• Health Promotion topics

• Periodicity schedule

• Growth Charts

• Rationale & Evidence

• Acronyms

• Appendix

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Examples of 3rd edition:

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Bright Futures inBright Futures inthe Public Health Settingthe Public Health SettingUsing the 3rd Edition Bright Futures Guidelines

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9 m/o visit

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Bright Futures inBright Futures inthe Public Health Settingthe Public Health SettingUsing the 3rd Edition Bright Futures Guidelines

Includes 10 health Promotion Topics

1. Promoting Family Support

2. Promoting Child Development

3. Promoting Mental Health

4. Promoting Healthy Weight

5. Promoting Healthy Nutrition

6. Promoting Physical Activity

7. Promoting Oral Health

8. Promoting Healthy Sexual Development & Sexuality

9. Promoting Safety & Injury prevention

10.Promoting Community Relationships & Resources

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Bright Futures inBright Futures inthe Public Health Settingthe Public Health SettingUsing the 3rd Edition Bright Futures Guidelines

Further discusses subtopics, including patient handouts

• Physical Activity & concerns:–Asthma

–Special health care needs (including CF)

–Diabetes

–Eating disorders

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Bright Futures inBright Futures inthe Public Health Settingthe Public Health SettingUsing the 3rd Edition Bright Futures Guidelines

How to use Bright Futures

• Requires a team consisting of: physician, ancillary clinical staff member, and an administrative office representative to implement into office

• Elect a leader, set goals, have open discussion with clinic staff members

• Complete training: tool kit available in print or online, modules

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Toolkit & online provides handouts

• Patient questionnaires (by age)

• Screening tools

• Documentation form

• Supplemental questionnaires (school, mental health, nutrition/activity, oral health, safety)

• Parent handouts (by age)

• Medical screening reference tables (by age)

• Practice management tools

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Bright Futures inBright Futures inthe Public Health Settingthe Public Health SettingUsing the 3rd Edition Bright Futures Guidelines

Videos

• 15 most popular videos

• Can get links to videos for families to watch on given topics

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Bright Futures inBright Futures inthe Public Health Settingthe Public Health SettingUsing the 3rd Edition Bright Futures Guidelines

Additional Languages

• Select materials have been translated into Spanish

• No other languages currently available

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Bright Futures inBright Futures inthe Public Health Settingthe Public Health SettingUsing the 3rd Edition Bright Futures Guidelines

Implementing Bright Futures

Studied the implementation of Bright Futures on Office practices. For the approach to be successful:

•Involving all the office staff in improvements that were important to patient care & demonstrable on chart audits

•Many changes did not involve additional work, but rather a more coordinated approach

•Practices learned actionable changes from each other as they progressed

•Health care professionals may use data they gather to satisfy future recertification requirements

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Bright Futures inBright Futures inthe Public Health Settingthe Public Health SettingUsing the 3rd Edition Bright Futures Guidelines

Additional Resources

• Bright Futures for Families:

http://www.brightfuturesforfamilies.org/home.shtml

• Bright Futures Oral Health Resource Center:

http://www.mchoralhealth.org/Toolbox/professionals.html

Pediatrics in Practice:

http://www.pediatricsinpractice.org/index.asp?ck=pass

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Contact Information: Bright Futures

c/o American Academy of Pediatrics 141 Northwest Point Blvd.Elk Grove, IL 60007Brightfutures@aap.org

•http://brightfutures.aap.org/index.html

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Questions?