The Bright Futures Guidelines

for Health Supervision of Infants, Children and

Adolescents, Third Edition

New Opportunities in the Primary Care of American Youth

The National Assembly on School-Based Health Care

Webinar February 20, 2008

Joseph F. Hagan, Jr., MD, FAAPCo-editor, The Bright Futures Guidelines, 3rd Ed.

3rd Party Logo

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Bright Futures in the Practice SettingUsing the 3rd Edition Bright Futures Guidelines

ObjectivesUpon completion of this lecture,

you should be able to:• Appraise the changes

recommended in the 3rd edition of the Bright Futures Guidelines.

• Appreciate new content in health supervision visits.

• Find ways to enhance synergy between health supervision and school health

• Covet the Bright Futures Toolkit.

• And, ask lots of questions!

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Bright Futures in the Practice SettingUsing the 3rd Edition Bright Futures Guidelines

Disclosures

•Neither Dr. Hagan nor any of his family have financial relationships to disclose.

•No off label uses of drugs or devices will be discussed

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Bright Futures in the Practice SettingUsing the 3rd Edition Bright Futures Guidelines

Bright Futures Guidelines—3rd Edition

Bright Futures: Guidelines for Health

Supervision of Infants, Children, and

Adolescents, 3rd Edition

The Centerpiece of the Initiative

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Bright Futures in the Practice SettingUsing the 3rd Edition Bright Futures Guidelines

Assumptions

•We all want to do our best job in well child, health supervision visits

•BUT…–There are time constraints–There is a lack of consensus regarding content

–Existing Guidelines contradict one another

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Bright Futures in the Practice SettingUsing the 3rd Edition Bright Futures Guidelines

Assumptions Office or Clinic

•We suspect here are missed opportunities

•We may not be giving the right services

•We may not be providing services in the most effective and efficient fashion

•We might be cutting the wrong corners

•We might have headaches•We might be behind in our schedules

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Bright Futures in the Practice SettingUsing the 3rd Edition Bright Futures Guidelines

Assumptions School Based Clinic

•You suspect here are missed opportunities

•You may not be matching advices and guidance with the community

•You might be cutting the wrong corners

•You might have headaches•You might be behind in your schedules

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Bright Futures in the Practice SettingUsing the 3rd Edition Bright Futures Guidelines

•Disease detection•Disease prevention •Health promotion•Anticipatory guidance

•Trade secrets: –It’s about health, not about heart murmurs!

–And you’d better address the patient/parent needs or agenda!

The Content of the Well Child Visit

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Bright Futures in the Practice SettingUsing the 3rd Edition Bright Futures Guidelines

Lofty goals:

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Bright Futures in the Practice SettingUsing the 3rd Edition Bright Futures Guidelines

Bright Futures is a set of principles, strategies and tools that are theory - based, evidence - driven, and systems - oriented, that can be used to improve the health and well-being of all children through culturally appropriate interventions that address the current and emerging health promotion needs at the family, policy, community, and health systems levels.

“What’s Bright Futures?”

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Bright Futures in the Practice SettingUsing the 3rd Edition Bright Futures Guidelines

•In partnership with HHS, MCHB–BF Education Center–BF Pediatric Implementation Project

•Multidisiplined Chairs and Expert Panels–Pediatricians, family medicine physicians

–Pediatric and family nurse practitioners

–Specialists in Oral Health, Mental Health and Nutrition

–Educators–Families

Announcing…

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Bright Futures in the Practice SettingUsing the 3rd Edition Bright Futures Guidelines

•Guidelines–Ten Health Promotion Themes–Embedded “Provider’s Manual”

•31 Well child visits•Bright Futures Toolkit•Bright Futures Pocket Guide•Bright Futures Systems Change Curriculum

•Bright Futures Systems Change Toolkit

Bright Futures Guidelines, Third Edition

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Bright Futures in the Practice SettingUsing the 3rd Edition Bright Futures Guidelines

Important changes:

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Bright Futures in the Practice SettingUsing the 3rd Edition Bright Futures GuidelinesRethinking Well Child

CareThe Rethinking Child Health Supervision Project

J. Lane Tanner, MD, FAAP

Martin T. Stein, MD, FAAP Lynn M. Olson, PhD, Linda Radecki, MS, and

Mary Pat Frintner, AAP Department of Practice and Research

Rethinking Child Health Supervision, Commonwealth Fund, 2005-07

•Qualitative study of parent and professional ideals for a developmentally-oriented form of Well Child Care

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Bright Futures in the Practice SettingUsing the 3rd Edition Bright Futures Guidelines

Rethinking Well Child Care

Parents do value well child care, and are motivated to attend visits to gain:

•reassurance regarding their child’s health and development

•reassurance that they are doing a good job

•information•immunizations, necessary referrals

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Bright Futures in the Practice SettingUsing the 3rd Edition Bright Futures Guidelines

Rethinking Well Child Care

Primary care clinicians most strongly endorsed the importance of:•establishing therapeutic relationships with their patients and families

•being responsive to the child and family’s individual needs

•improving support for comprehensive care, both within the practice and between practice and community

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Bright Futures in the Practice SettingUsing the 3rd Edition Bright Futures Guidelines

In the School Based Health Clinic

•I suspect there are the same practitioner values

•I suspect there are the same youth values

•There are likely the same values to families

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Bright Futures in the Practice SettingUsing the 3rd Edition Bright Futures Guidelines

Easy changes:

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Bright Futures in the Practice SettingUsing the 3rd Edition Bright Futures Guidelines

What’s New?

•Ten Health Promotion Themes–For review, for teaching–Perhaps for families and patient education

•Bright Futures Visits–An embedded provider manual

–31 individual visits (+ prenatal visit)

–Conforms to AAP Periodicity Schedule

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Bright Futures in the Practice SettingUsing the 3rd Edition Bright Futures Guidelines

What’s New?

•Priorities for each visit–Five Anticipatory Guidance topics

–Developed by Expert Panels–Anticipatory Guidance sample questions

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Bright Futures in the Practice SettingUsing the 3rd Edition Bright Futures Guidelines

What’s New?

•Screening Tables for each specific visit–Universal screening–Selective screening, based on risk assessment

•Evidence and Rationale

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Bright Futures in the Practice SettingUsing the 3rd Edition Bright Futures Guidelines

What’s in it for you?

•What is the value for school based health clinics?

•Rather, how will school based health clinics add value?–Community care–Coordinated care–Cooperative care

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Bright Futures in the Practice SettingUsing the 3rd Edition Bright Futures Guidelines

What’s in it for you?

•Coordination of care–Shared knowledge base–Shared agendas

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Bright Futures in the Practice SettingUsing the 3rd Edition Bright Futures GuidelinesShared knowledge

baseTen Health Promotion Themes

•Promoting Family Support

•Promoting Child Development

•Promoting Mental Health

•Promoting Healthy Weight

•Promoting Healthy Nutrition

•Promoting Physical Activity

•Promoting Oral Health

•Promoting Healthy Sexual Development and Sexuality

•Promoting Safety and Injury Prevention

•Promoting Community Relationships and Resources

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Bright Futures in the Practice SettingUsing the 3rd Edition Bright Futures Guidelines

Shared agendas

•Health promotion priorities–Five priority topics for each visit

–Age specific

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Bright Futures in the Practice SettingUsing the 3rd Edition Bright Futures Guidelines

Shared agendas

•Anticipatory Guidance–Follows five priorities–Content–Sample questions–Guidance suggestions

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Bright Futures in the Practice SettingUsing the 3rd Edition Bright Futures Guidelines

Why change?

•Evidence and Rationale–Transparent–Allows clinician implementation decisions

•New efficiencies•It’s easy…

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Bright Futures in the Practice SettingUsing the 3rd Edition Bright Futures Guidelines

It’s really easy.

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Bright Futures in the Practice SettingUsing the 3rd Edition Bright Futures Guidelines

The Bright Futures Visits

The 1 year visit

Sorry—I’ve only got animation for this visit. More to come on school aged youth!

Watch for the bouncing 12 month old!

Context

The 12-month-old stands proudly, somewhat bowlegged, belly protruding. Walking, one of the most exciting developmental milestones, occurs near the

toddler’s first birthday, bringing with it increasing independence.

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Bright Futures in the Practice SettingUsing the 3rd Edition Bright Futures Guidelines

Social-emotionalTell me about your child’s typical play.

Plays interactive games, eg, peek-a-boo, pat-a-cakeImitates activitiesHands you a book when he wants to hear a story.

Does your child feel free to explore or stay very close to your side?

Waves bye-byeHas a strong attachment with parent or significant caregiverShows distress on separation from parent

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Bright Futures in the Practice SettingUsing the 3rd Edition Bright Futures Guidelines

Some examples

Early, middle and late adolescence:Priorities and Screening

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Bright Futures in the Practice SettingUsing the 3rd Edition Bright Futures Guidelines

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Bright Futures in the Practice SettingUsing the 3rd Edition Bright Futures Guidelines

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Bright Futures in the Practice SettingUsing the 3rd Edition Bright Futures Guidelines

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Bright Futures in the Practice SettingUsing the 3rd Edition Bright Futures Guidelines

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Bright Futures in the Practice SettingUsing the 3rd Edition Bright Futures Guidelines

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Bright Futures in the Practice SettingUsing the 3rd Edition Bright Futures Guidelines

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Bright Futures in the Practice SettingUsing the 3rd Edition Bright Futures Guidelines

In summary…

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Bright Futures in the Practice SettingUsing the 3rd Edition Bright Futures Guidelines

The Bright Futures Visit Includes:

•Solicitation of parental and child concerns

•Surveillance and screening •Discussion of certain visit priorities for improved child and adolescent health and family function over time

•Strengths based assessments and anticipatory guidance

12.5 %

12.5 %

12.5 %

12.5 %

1.5% 12.5 %

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Bright Futures in the Practice SettingUsing the 3rd Edition Bright Futures Guidelines

The Bright Futures Visit

•An age-specific well child or health supervision visit

•Designed to allow practitioners to improve their desired standard of care

•Encourages community and practice specific modifications

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Bright Futures in the Practice SettingUsing the 3rd Edition Bright Futures GuidelinesThe Bright Futures

Toolkit•Tools for practice! (Coming soon!)

•Visit history questionnaires

–Interval history

–Surveillance information

–Risk assessment questions for selective screening

•Visit chart forms

•Anticipatory guidance tools

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Bright Futures in the Practice SettingUsing the 3rd Edition Bright Futures Guidelines

The Bright Futures Toolkit

•Developed by the BF Pediatric Implementation Project

•To accompany BF Guidelines, Third Edition

•Enhances implementation of Bright Futures

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Bright Futures in the Practice SettingUsing the 3rd Edition Bright Futures Guidelines

Big results!

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Bright Futures in the Practice SettingUsing the 3rd Edition Bright Futures Guidelines

Results:•A health supervision visit focused on family needs and wants

•A health supervision visit with a higher standard of care

•A health supervision visit relevant to your community

•A health supervision visit with time for individual practitioner input, variation and personalization

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Bright Futures in the Practice SettingUsing the 3rd Edition Bright Futures Guidelines

Results!

In other words…

A Bright Future for Health

Supervision!…and for your vital work

in our schools!

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Bright Futures in the Practice SettingUsing the 3rd Edition Bright Futures Guidelines

Bright Futures Contact Information•Telephone: 847-434-4223•Email: brightfutures@aap.org•New website: www.brightfutures.aap.org

•Staff contacts:Darcy Steinberg-Hastings, MPH, Director of the Bright Futures Education Center and Pediatric Implementation Project, dhastings@aap.org

Jane Bassewitz, MA, Manager, jbassewitz@aap.org

•Or me: jhagan@aap.org

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Bright Futures in the Practice SettingUsing the 3rd Edition Bright Futures Guidelines