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

2. 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

3. 9/4/2015 5:14:55 PM 5864_ER_RED 3 Bright Futures in the Practice Setting Using the 3rd 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!

4. 9/4/2015 5:14:55 PM 5864_ER_RED 4 Bright Futures in the Practice Setting Using 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

5. 9/4/2015 5:14:55 PM 5864_ER_RED 5 Bright Futures in the Practice Setting Using the 3rd Edition Bright Futures Guidelines Bright Futures Guidelines—3 rd Edition Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, 3 rd Edition The Centerpiece of the Initiative

6. 9/4/2015 5:14:55 PM 5864_ER_RED 6 Bright Futures in the Practice Setting Using 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

7. 9/4/2015 5:14:55 PM 5864_ER_RED 7 Bright Futures in the Practice Setting Using 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

8. 9/4/2015 5:14:55 PM 5864_ER_RED 8 Bright Futures in the Practice Setting Using 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

9. 9/4/2015 5:14:55 PM 5864_ER_RED 9 Bright Futures in the Practice Setting Using 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

10. 9/4/2015 5:14:55 PM 5864_ER_RED 10 Bright Futures in the Practice Setting Using the 3rd Edition Bright Futures Guidelines Lofty goals:

11. 9/4/2015 5:14:55 PM 5864_ER_RED 11 Bright Futures in the Practice Setting Using 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?”

12. 9/4/2015 5:14:55 PM 5864_ER_RED 12 Bright Futures in the Practice Setting Using 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…

13. 9/4/2015 5:14:55 PM 5864_ER_RED 13 Bright Futures in the Practice Setting Using 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

14. 9/4/2015 5:14:55 PM 5864_ER_RED 14 Bright Futures in the Practice Setting Using the 3rd Edition Bright Futures Guidelines Important changes:

15. 9/4/2015 5:14:55 PM 5864_ER_RED 15 Bright Futures in the Practice Setting Using the 3rd 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, 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

16. 9/4/2015 5:14:55 PM 5864_ER_RED 16 Bright Futures in the Practice Setting Using 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

17. 9/4/2015 5:14:55 PM 5864_ER_RED 17 Bright Futures in the Practice Setting Using 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

18. 9/4/2015 5:14:55 PM 5864_ER_RED 18 Bright Futures in the Practice Setting Using 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

19. 9/4/2015 5:14:55 PM 5864_ER_RED 19 Bright Futures in the Practice Setting Using the 3rd Edition Bright Futures Guidelines Easy changes:

20. 9/4/2015 5:14:55 PM 5864_ER_RED 20 Bright Futures in the Practice Setting Using 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

21. 9/4/2015 5:14:55 PM 5864_ER_RED 21 Bright Futures in the Practice Setting Using 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

22. 9/4/2015 5:14:55 PM 5864_ER_RED 22 Bright Futures in the Practice Setting Using 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

23. 9/4/2015 5:14:55 PM 5864_ER_RED 23 Bright Futures in the Practice Setting Using 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

24. 9/4/2015 5:14:55 PM 5864_ER_RED 24 Bright Futures in the Practice Setting Using the 3rd Edition Bright Futures Guidelines What’s in it for you? Coordination of care –Shared knowledge base –Shared agendas

25. 9/4/2015 5:14:55 PM 5864_ER_RED 25 Bright Futures in the Practice Setting Using the 3rd 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

26. 9/4/2015 5:14:55 PM 5864_ER_RED 26 Bright Futures in the Practice Setting Using the 3rd Edition Bright Futures Guidelines Shared agendas Health promotion priorities –Five priority topics for each visit –Age specific

27. 9/4/2015 5:14:55 PM 5864_ER_RED 27 Bright Futures in the Practice Setting Using the 3rd Edition Bright Futures Guidelines Shared agendas Anticipatory Guidance –Follows five priorities –Content –Sample questions –Guidance suggestions

28. 9/4/2015 5:14:55 PM 5864_ER_RED 28 Bright Futures in the Practice Setting Using the 3rd Edition Bright Futures Guidelines Why change? Evidence and Rationale –Transparent –Allows clinician implementation decisions New efficiencies It’s easy…

29. 9/4/2015 5:14:55 PM 5864_ER_RED 29 Bright Futures in the Practice Setting Using the 3rd Edition Bright Futures Guidelines It’s really easy.

30. 9/4/2015 5:14:55 PM 5864_ER_RED 30 Bright Futures in the Practice Setting Using 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!

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. 9/4/2015 5:14:55 PM 5864_ER_RED 32 Bright Futures in the Practice Setting Using the 3rd 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

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

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36. 9/4/2015 5:14:55 PM 5864_ER_RED 36 Bright Futures in the Practice Setting Using the 3rd Edition Bright Futures Guidelines

37. 9/4/2015 5:14:55 PM 5864_ER_RED 37 Bright Futures in the Practice Setting Using the 3rd Edition Bright Futures Guidelines

38. 9/4/2015 5:14:55 PM 5864_ER_RED 38 Bright Futures in the Practice Setting Using the 3rd Edition Bright Futures Guidelines

39. 9/4/2015 5:14:55 PM 5864_ER_RED 39 Bright Futures in the Practice Setting Using the 3rd Edition Bright Futures Guidelines

40. 9/4/2015 5:14:55 PM 5864_ER_RED 40 Bright Futures in the Practice Setting Using the 3rd Edition Bright Futures Guidelines

41. 9/4/2015 5:14:55 PM 5864_ER_RED 41 Bright Futures in the Practice Setting Using the 3rd Edition Bright Futures Guidelines In summary…

42. 9/4/2015 5:14:55 PM 5864_ER_RED 42 Bright Futures in the Practice Setting Using 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 % 1.5% 12.5 %

43. 9/4/2015 5:14:55 PM 5864_ER_RED 43 Bright Futures in the Practice Setting Using 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

44. 9/4/2015 5:14:55 PM 5864_ER_RED 44 Bright Futures in the Practice Setting Using the 3rd 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

45. 9/4/2015 5:14:55 PM 5864_ER_RED 45 Bright Futures in the Practice Setting Using 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

46. 9/4/2015 5:14:55 PM 5864_ER_RED 46 Bright Futures in the Practice Setting Using the 3rd Edition Bright Futures Guidelines Big results!

47. 9/4/2015 5:14:55 PM 5864_ER_RED 47 Bright Futures in the Practice Setting Using 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

48. 9/4/2015 5:14:55 PM 5864_ER_RED 48 Bright Futures in the Practice Setting Using the 3rd Edition Bright Futures Guidelines Results! In other words… A Bright Future for Health Supervision! …and for your vital work in our schools!

49. 9/4/2015 5:14:55 PM 5864_ER_RED 49 Bright Futures in the Practice Setting Using the 3rd Edition Bright Futures Guidelines Bright Futures Contact Information Telephone: 847-434-4223 Email: brightfutures@aap.orgbrightfutures@aap.org New website: www.brightfutures.aap.orgwww.brightfutures.aap.org Staff contacts: Darcy Steinberg-Hastings, MPH, Director of the Bright Futures Education Center and Pediatric Implementation Project, dhastings@aap.orgdhastings@aap.org Jane Bassewitz, MA, Manager, jbassewitz@aap.orgjbassewitz@aap.org Or me: jhagan@aap.orgjhagan@aap.org

50. 9/4/2015 5:14:55 PM 5864_ER_RED 50 Bright Futures in the Practice Setting Using the 3rd Edition Bright Futures Guidelines