Promoting Child and Adolescent Health: Bright Futures and EPSDT

1. Promoting Child and Adolescent Health:Bright Futures and EPSDT

2. What Is Bright Futures? Expert Guidelines Developmental approach Vision Philosophy Children from birth through 21 years What Is Bright Futures? Although advances in public health and medicine have improved the lives of many children, today�s families and children face new pressures. Often referred to as �the new morbidities,� these issues include Changing family structures and the loss of extended family relationships. Highly mobile populations that often lack continuity of care. Racial, ethnic, and economic disparities in health. Deteriorating neighborhoods and communities. Additional concerns include: The negative cycle of poverty and diminished access to health care. The links between prenatal risk, preterm or low birthweight birth, and infant mortality The rising rates of intentional and unintentional injuries, substance abuse, depression, and HIV infection. What Is Bright Futures? Although advances in public health and medicine have improved the lives of many children, today�s families and children face new pressures. Often referred to as �the new morbidities,� these issues include Changing family structures and the loss of extended family relationships. Highly mobile populations that often lack continuity of care. Racial, ethnic, and economic disparities in health. Deteriorating neighborhoods and communities. Additional concerns include: The negative cycle of poverty and diminished access to health care. The links between prenatal risk, preterm or low birthweight birth, and infant mortality The rising rates of intentional and unintentional injuries, substance abuse, depression, and HIV infection.

3. Core Messages: Prevention Works! Families Matter. Health is Everyone�s Business.

4. Prevention Works! Specific preventive and health-promoting interventions lead to desired outcomes Target �children at risk� Improve health outcomes Improve school performance Improve social functioning  There is growing recognition that some childhood mental illnesses can be prevented & others can be prevented from causing long-term damage if early & appropriate intervention occurs. (Source: Children�s Mental Health Resource Kit) There is growing recognition that some childhood mental illnesses can be prevented & others can be prevented from causing long-term damage if early & appropriate intervention occurs. (Source: Children�s Mental Health Resource Kit)

5. Families Matter! Families are the primary caregivers in any health care system; they are often the first to recognize that a health problem exists Most parents are heavily invested in promoting their child�s development Children are affected by what happens in their family Beliefs & values matter

6. Child or Adolescent + Family + Health Care Provider + School + Community Health is Everybody�s Business! Health Supervision As a Partnership Health supervision efforts are most likely to succeed when they foster joint participation and shared responsibility among adolescents, families, health professionals, educators, and others who have a personal, professional, or supervisory relationship with adolescents. Key components of successful health supervision include a respect for individual differences, support for the adolescent's emerging autonomy, a developmental approach, and a focus on the adolescent's strengths. Because adolescents seek office-based health care less frequently than any other age group, they may need special efforts to help them participate in regular health supervision. Strategies to improve access to health care for adolescents can be evaluated with seven criteria: Services should be available, visible (convenient and recognizable), quality based, confidential, affordable, flexible (meeting diverse needs), and coordinated.1 Confidentiality is an especially significant component of health partnerships during adolescence. Health professionals need to clearly communicate to adolescents and their parents a firm commitment to the principle of confidentiality, and to explain that only a very serious risk to the health of the adolescent would override that commitment. Building effective health partnerships during adolescence depends, in part, on the health professional's ability to form a trusting relationship with the adolescent and the family. This will in turn enable the health professional to provide medical expertise and health supervision that engender confidence and to enjoy the rewards of helping adolescents achieve their full potential. Adolescents sometimes feel more comfortable with health professionals who have the specialized training and experience necessary for understanding and addressing their particular issues. Another valuable strategy for encouraging health-promoting behaviors is the use of peer influence, such as trained adolescent peer counselors, adolescent focus groups in offices and schools, or volunteer adolescent speakers. Different types of settings, such as community or school health clinics, may also be more successful in encouraging adolescents to participate in regular health supervisionHealth Supervision As a Partnership Health supervision efforts are most likely to succeed when they foster joint participation and shared responsibility among adolescents, families, health professionals, educators, and others who have a personal, professional, or supervisory relationship with adolescents. Key components of successful health supervision include a respect for individual differences, support for the adolescent's emerging autonomy, a developmental approach, and a focus on the adolescent's strengths. Because adolescents seek office-based health care less frequently than any other age group, they may need special efforts to help them participate in regular health supervision. Strategies to improve access to health care for adolescents can be evaluated with seven criteria: Services should be available, visible (convenient and recognizable), quality based, confidential, affordable, flexible (meeting diverse needs), and coordinated.1 Confidentiality is an especially significant component of health partnerships during adolescence. Health professionals need to clearly communicate to adolescents and their parents a firm commitment to the principle of confidentiality, and to explain that only a very serious risk to the health of the adolescent would override that commitment. Building effective health partnerships during adolescence depends, in part, on the health professional's ability to form a trusting relationship with the adolescent and the family. This will in turn enable the health professional to provide medical expertise and health supervision that engender confidence and to enjoy the rewards of helping adolescents achieve their full potential. Adolescents sometimes feel more comfortable with health professionals who have the specialized training and experience necessary for understanding and addressing their particular issues. Another valuable strategy for encouraging health-promoting behaviors is the use of peer influence, such as trained adolescent peer counselors, adolescent focus groups in offices and schools, or volunteer adolescent speakers. Different types of settings, such as community or school health clinics, may also be more successful in encouraging adolescents to participate in regular health supervision

7. Core Concepts Partnerships Communication Promoting health Managing time Educating Advocating What Is Bright Futures? Although advances in public health and medicine have improved the lives of many children, today�s families and children face new pressures. Often referred to as �the new morbidities,� these issues include Changing family structures and the loss of extended family relationships. Highly mobile populations that often lack continuity of care. Racial, ethnic, and economic disparities in health. Deteriorating neighborhoods and communities. Additional concerns include: The negative cycle of poverty and diminished access to health care. The links between prenatal risk, preterm or low birthweight birth, and infant mortality The rising rates of intentional and unintentional injuries, substance abuse, depression, and HIV infection. What Is Bright Futures? Although advances in public health and medicine have improved the lives of many children, today�s families and children face new pressures. Often referred to as �the new morbidities,� these issues include Changing family structures and the loss of extended family relationships. Highly mobile populations that often lack continuity of care. Racial, ethnic, and economic disparities in health. Deteriorating neighborhoods and communities. Additional concerns include: The negative cycle of poverty and diminished access to health care. The links between prenatal risk, preterm or low birthweight birth, and infant mortality The rising rates of intentional and unintentional injuries, substance abuse, depression, and HIV infection.

8. Partnership Respect Cooperation Sharing of resources and information Trust Dedication Working together

9. Communication Listen to child and family concerns Focus Select non-verbal behaviors that fit with the person�s cultural identification Speak clearly, without jargon Check for additional questions

10. Health Promotion Focus on growth and risk-reduction Note accomplishments of child Identify strengths of family and community Select relevant health topics

11. Time Management Provider and Family both responsible Use feedback forms and office staff Plan so maximize the time for health care Clarify goals Identify family needs and concerns Prioritize Identify options for meeting today�s unmet goals

12. Education Anticipatory Guidance Physical growth, nutrition, oral health, physical activity, mental health Connection to community

13. Advocacy Child /Family Program Administrative

14. Bright Futures Virginia Adopted as Standard of Care for Virginia�s children & adolescents by: Virginia Department of Health Virginia Department of Education Virginia Department of Medical Assistance Services Department of Mental Health, Mental Retardation & Substance Abuse Services

15. Bright Futures Virginia Goals Increase family knowledge, skills and participation in health-promoting and prevention activities Promote training of health care professionals and communities on Bright Futures and its implementation Develop and maintain partnerships that promote prevention and benefit the health of children and their parents

16. Training VDH Nurses and Social Workers WIC Nutritionists Dentists and Dental Assistants School Nurses Home Visitors ( Resource Mothers, CHIP, Healthy Families) Child Care Providers

17. Partner in Projects Governor�s New Parent Kit Health Record Calendar Child Care Provider Kits SOLs for Health Education (K-12) Perinatal Depression Screening Smart Beginnings Web Site

18. �Promoting Child and Adolescent Health�WEB COURSE 6 modules VDH, AAP, DMAS, VCU partnership CME/CEU for course/module completion Implement the Bright Futures approach in meeting the EPSDT guidelines

19. Web Course Goals To improve the quality of health care for children To increase the number of children receiving developmentally-based well-child visits To provide clinicians the tools they need to implement Bright Futures Conduct appropriate developmental screenings Provide appropriate anticipatory guidance Link to other child health training resources � � Module 1 Overview of Bright Futures Guidelines and Approach � Module 2 - Conducting Developmental Assessments Module 3 � Medical Assessment, Immunizations, & Screenings � Module 4 � Providing Anticipatory Guidance � Module 5 � Integrating Bright Futures into your Practice � Module 6 � Tools for Improving Quality in Well Child Visits � � � � � Module 1 Overview of Bright Futures Guidelines and Approach � Module 2 - Conducting Developmental Assessments Module 3 � Medical Assessment, Immunizations, & Screenings � Module 4 � Providing Anticipatory Guidance � Module 5 � Integrating Bright Futures into your Practice � Module 6 � Tools for Improving Quality in Well Child Visits � � � Conduct appropriate developmental screenings Provide appropriate anticipatory guidance Link to other child health training resources � � Module 1 Overview of Bright Futures Guidelines and Approach � Module 2 - Conducting Developmental Assessments Module 3 � Medical Assessment, Immunizations, & Screenings � Module 4 � Providing Anticipatory Guidance � Module 5 � Integrating Bright Futures into your Practice � Module 6 � Tools for Improving Quality in Well Child Visits � � � � � Module 1 Overview of Bright Futures Guidelines and Approach � Module 2 - Conducting Developmental Assessments Module 3 � Medical Assessment, Immunizations, & Screenings � Module 4 � Providing Anticipatory Guidance � Module 5 � Integrating Bright Futures into your Practice � Module 6 � Tools for Improving Quality in Well Child Visits � � �

20. www.vcu-cme.org/bf

21. Contacts Bright Futures Virginia Catherine J. Bodkin, LCSW, MSHA, co-chair catherine.bodkin@vdh.virginia.gov 804-864-7768 Sherry Shrader, RN, BSN, co-chair sherry.shrader@vdh.virginia.gov 804-864-7689