The Bright Futures Guidelines for Health Supervision of Infants, Children and Adolescents, Third Edition

1. The Bright Futures Guidelinesfor Health Supervision of Infants, Children and Adolescents, Third Edition New Opportunities in the Primary Care of American Youth

2. 3rd Party Logo The National Assembly on School-Based Health Care Webinar February 20, 2008 Joseph F. Hagan, Jr., MD, FAAP Co-editor, The Bright Futures Guidelines, 3rd Ed.

3. Objectives Upon 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!

4. 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

5. Bright Futures Guidelines—3rd Edition The Centerpiece of the Initiative Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, 3rd Edition

6. 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

7. 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

8. 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

9. The Content of the Well Child Visit • 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!

10. Lofty goals:

11. “What’s Bright Futures?” 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.

12. Announcing… • 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

13. Bright Futures Guidelines,Third Edition • 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

14. Important changes:

15. Rethinking Well Child Care The 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 professionalideals for a developmentally-oriented form of Well Child Care

16. Rethinking Well Child CareParents 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

17. Rethinking Well Child CarePrimary 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

18. 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

19. Easy changes:

20. 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

21. What’s New? • Priorities for each visit • Five Anticipatory Guidance topics • Developed by Expert Panels • Anticipatory Guidance sample questions

22. What’s New? • Screening Tables for each specific visit • Universal screening • Selective screening, based on risk assessment • Evidence and Rationale

23. 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

24. What’s in it for you? • Coordination of care • Shared knowledge base • Shared agendas

25. 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 Shared knowledge baseTen Health Promotion Themes

26. Shared agendas • Health promotion priorities • Five priority topics for each visit • Age specific

27. Shared agendas • Anticipatory Guidance • Follows five priorities • Content • Sample questions • Guidance suggestions

28. Why change? • Evidence and Rationale • Transparent • Allows clinician implementation decisions • New efficiencies • It’s easy…

29. It’s really easy.

30. The Bright Futures VisitsThe 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!

31. 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.

32. Social-emotional • Tell me about your child’s typical play. • Plays interactive games, eg, peek-a-boo, pat-a-cake • Imitates activities • Hands 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-bye • Has a strong attachment with parent or significant caregiver • Shows distress on separation from parent

34. Some examples Early, middle and late adolescence: Priorities and Screening

41. In summary…

42. 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 % 1.5% 12.5 % 12.5 % 12.5 % 12.5 % 12.5 % 12.5 %

43. 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

44. The 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

45. The Bright Futures Toolkit • Developed by the BF Pediatric Implementation Project • To accompany BF Guidelines, Third Edition • Enhances implementation of Bright Futures

46. Big results!

47. 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

48. Results! In other words… A Bright Future for Health Supervision! …and for your vital work in our schools!

49. 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