The Bright Futures Guidelines for Health Supervision of
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, FAAP Co-editor, The Bright Futures Guidelines, 3 rd Ed. 3 rd Party Logo
Bright Futures in the Practice Setting Using the 3 rd Edition Bright Futures Guidelines Objectives Upon completion of this lecture, you should be able to: • Appraise the changes recommended in the 3 rd 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! 10/23/2021 4: 34: 50 PM 5864_ER_RED 3
Bright Futures in the Practice Setting Using the 3 rd 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 10/23/2021 4: 34: 50 PM 5864_ER_RED 4
Bright Futures in the Practice Setting Using the 3 rd Edition Bright Futures Guidelines— 3 rd Edition The Centerpiece of the Initiative Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, 3 rd Edition 10/23/2021 4: 34: 50 PM 5864_ER_RED 5
Bright Futures in the Practice Setting Using the 3 rd 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 10/23/2021 4: 34: 52 PM 5864_ER_RED 6
Bright Futures in the Practice Setting Using the 3 rd 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 10/23/2021 4: 34: 52 PM 5864_ER_RED 7
Bright Futures in the Practice Setting Using the 3 rd 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 10/23/2021 4: 34: 52 PM 5864_ER_RED 8
Bright Futures in the Practice Setting Using the 3 rd Edition Bright Futures Guidelines 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! 10/23/2021 4: 34: 53 PM 5864_ER_RED 9
Bright Futures in the Practice Setting Using the 3 rd Edition Bright Futures Guidelines Lofty goals: 10/23/2021 4: 34: 53 PM 5864_ER_RED 10
Bright Futures in the Practice Setting Using the 3 rd Edition Bright Futures Guidelines “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. 10/23/2021 4: 34: 53 PM 5864_ER_RED 11
Bright Futures in the Practice Setting Using the 3 rd Edition Bright Futures Guidelines 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 10/23/2021 4: 34: 53 PM 5864_ER_RED 12
Bright Futures in the Practice Setting Using the 3 rd Edition 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 10/23/2021 4: 34: 54 PM 5864_ER_RED 13
Bright Futures in the Practice Setting Using the 3 rd Edition Bright Futures Guidelines Important changes: 10/23/2021 4: 34: 54 PM 5864_ER_RED 14
Bright Futures in the Practice Setting Using the 3 rd Edition Bright Futures Guidelines Rethinking Well Child Care The Rethinking Child Health Supervision Project J. Lane Tanner, MD, FAAP Martin T. Stein, MD, FAAP Lynn M. Olson, Ph. D, 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 10/23/2021 4: 34: 54 PM 5864_ER_RED 15
Bright Futures in the Practice Setting Using the 3 rd 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 10/23/2021 4: 34: 54 PM 5864_ER_RED 16
Bright Futures in the Practice Setting Using the 3 rd 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 10/23/2021 4: 34: 54 PM 5864_ER_RED 17
Bright Futures in the Practice Setting Using the 3 rd 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 10/23/2021 4: 34: 54 PM 5864_ER_RED 18
Bright Futures in the Practice Setting Using the 3 rd Edition Bright Futures Guidelines Easy changes: 10/23/2021 4: 34: 54 PM 5864_ER_RED 19
Bright Futures in the Practice Setting Using the 3 rd 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 10/23/2021 4: 34: 54 PM 5864_ER_RED 20
Bright Futures in the Practice Setting Using the 3 rd Edition Bright Futures Guidelines What’s New? • Priorities for each visit –Five Anticipatory Guidance topics –Developed by Expert Panels –Anticipatory Guidance sample questions 10/23/2021 4: 34: 54 PM 5864_ER_RED 21
Bright Futures in the Practice Setting Using the 3 rd Edition Bright Futures Guidelines What’s New? • Screening Tables for each specific visit –Universal screening –Selective screening, based on risk assessment • Evidence and Rationale 10/23/2021 4: 34: 54 PM 5864_ER_RED 22
Bright Futures in the Practice Setting Using the 3 rd 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 10/23/2021 4: 34: 54 PM 5864_ER_RED 23
Bright Futures in the Practice Setting Using the 3 rd Edition Bright Futures Guidelines What’s in it for you? • Coordination of care –Shared knowledge base –Shared agendas 10/23/2021 4: 34: 55 PM 5864_ER_RED 24
Bright Futures in the Practice Setting Using the 3 rd Edition Bright Futures Guidelines Shared knowledge base Ten 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 10/23/2021 4: 34: 55 PM 5864_ER_RED 25
Bright Futures in the Practice Setting Using the 3 rd Edition Bright Futures Guidelines Shared agendas • Health promotion priorities –Five priority topics for each visit –Age specific 10/23/2021 4: 34: 55 PM 5864_ER_RED 26
Bright Futures in the Practice Setting Using the 3 rd Edition Bright Futures Guidelines Shared agendas • Anticipatory Guidance –Follows five priorities –Content –Sample questions –Guidance suggestions 10/23/2021 4: 34: 55 PM 5864_ER_RED 27
Bright Futures in the Practice Setting Using the 3 rd Edition Bright Futures Guidelines Why change? • Evidence and Rationale –Transparent –Allows clinician implementation decisions • New efficiencies • It’s easy… 10/23/2021 4: 34: 55 PM 5864_ER_RED 28
Bright Futures in the Practice Setting Using the 3 rd Edition Bright Futures Guidelines It’s really easy. 10/23/2021 4: 34: 55 PM 5864_ER_RED 29
Bright Futures in the Practice Setting Using the 3 rd 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! 10/23/2021 4: 34: 55 PM 5864_ER_RED 30
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.
Bright Futures in the Practice Setting Using the 3 rd Edition Bright Futures Guidelines 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 10/23/2021 4: 34: 59 PM 5864_ER_RED 32
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Some examples Early, middle and late adolescence: Priorities and Screening
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Bright Futures in the Practice Setting Using the 3 rd Edition Bright Futures Guidelines In summary… 10/23/2021 4: 35: 27 PM 5864_ER_RED 41
Bright Futures in the Practice Setting Using the 3 rd Edition Bright Futures Guidelines The Bright Futures Visit Includes: 1. 5% 12. 5 % • Solicitation of parental and child 12. 5 % concerns • Surveillance and screening 12. 5 % • Discussion of certain visit priorities for improved child and adolescent health and family function over time • Strengths based assessments and anticipatory guidance 10/23/2021 4: 35: 27 PM 5864_ER_RED 42
Bright Futures in the Practice Setting Using the 3 rd 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 10/23/2021 4: 35: 27 PM 5864_ER_RED 43
Bright Futures in the Practice Setting Using the 3 rd Edition Bright Futures Guidelines 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 10/23/2021 4: 35: 27 PM 5864_ER_RED 44
Bright Futures in the Practice Setting Using the 3 rd 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 10/23/2021 4: 35: 28 PM 5864_ER_RED 45
Bright Futures in the Practice Setting Using the 3 rd Edition Bright Futures Guidelines Big results! 10/23/2021 4: 35: 28 PM 5864_ER_RED 46
Bright Futures in the Practice Setting Using the 3 rd 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 10/23/2021 4: 35: 28 PM 5864_ER_RED 47
Bright Futures in the Practice Setting Using the 3 rd Edition Bright Futures Guidelines Results! In other words… A Bright Future for Health Supervision! …and for your vital work in our schools! 10/23/2021 4: 35: 28 PM 5864_ER_RED 48
Bright Futures in the Practice Setting Using the 3 rd 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 10/23/2021 4: 35: 28 PM 5864_ER_RED 49
Bright Futures in the Practice Setting Using the 3 rd Edition Bright Futures Guidelines 10/23/2021 4: 35: 28 PM 5864_ER_RED 50
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