Nicole Abdy MD Assistant Professor, Pediatrics January 24 th , 2012

1. Nicole Abdy MD Assistant Professor, Pediatrics January 24th, 2012 Bright Futures: Tell me more!

2. 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

3. 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

4. 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

5. Goals: Improve the health of our nation’s children, families, and communities • Work with states to make bright futures approach the standard of care • Help health care providers shift their thinking to prevention-based, family focused, and developmentally-oriented direction • Foster partnerships between families, providers, and communities • Empower families with skills & knowledge to be active participants in their children’s healthy development

6. 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

7. 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.

8. 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

10. 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

11. Building Effective Partnerships • Model & encourage open, supporting communication with child & family • Identify health issues through active listening & fact finding • Affirm strengths of child & family • Identify shared goals • 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 • Follow up to sustain the partnership • Share progress, successes, and challenges

12. 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

13. 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

14. 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

16. 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

17. Examples of 3rd edition:

19. 9 m/o visit

21. Includes 10 health Promotion Topics • 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 & Sexuality • Promoting Safety & Injury prevention • Promoting Community Relationships & Resources

22. Further discusses subtopics, including patient handouts • Physical Activity & concerns: • Asthma • Special health care needs (including CF) • Diabetes • Eating disorders

23. 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

24. 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

26. Videos • 15 most popular videos • Can get links to videos for families to watch on given topics

27. Additional Languages • Select materials have been translated into Spanish • No other languages currently available

28. 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

29. 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

30. Contact Information: Bright Futures c/o American Academy of Pediatrics 
141 Northwest Point Blvd.
Elk Grove, IL 60007
Brightfutures@aap.org • http://brightfutures.aap.org/index.html

31. Questions?