9/9/ :01:41 PM 5864_ER_RED ‹#› Bright Futures: Tell me more! Nicole Abdy MD Assistant Professor, Pediatrics January 24 th, 2012

2 Bright Futures in the Public Health Setting Using the 3rd Edition Bright Futures Guidelines 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 Bright Futures in the Public Health Setting Using the 3rd Edition Bright Futures Guidelines 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 Bright Futures in the Public Health Setting Using the 3rd Edition Bright Futures Guidelines Development of 3 rd 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 Bright Futures in the Public Health Setting Using the 3rd Edition Bright Futures Guidelines Goals: Improve the health of our nation’s children, families, and communities 1.Work with states to make bright futures approach the standard of care 2.Help health care providers shift their thinking to prevention- based, family focused, and developmentally-oriented direction 3.Foster partnerships between families, providers, and communities 4.Empower families with skills & knowledge to be active participants in their children’s healthy development

6 Bright Futures in the Public Health Setting Using the 3rd Edition Bright Futures Guidelines 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 Bright Futures in the Public Health Setting Using the 3rd Edition Bright Futures Guidelines 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 Bright Futures in the Public Health Setting Using the 3rd Edition Bright Futures Guidelines 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

9 Bright Futures in the Public Health Setting Using the 3rd Edition Bright Futures Guidelines Successful Visit & Interaction ObservationSurveillanceHistory

10 Bright Futures in the Public Health Setting Using the 3rd Edition Bright Futures Guidelines 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 Bright Futures in the Public Health Setting Using the 3rd Edition Bright Futures Guidelines Building Effective Partnerships 1.Model & encourage open, supporting communication with child & family 2.Identify health issues through active listening & fact finding 3.Affirm strengths of child & family 4.Identify shared goals 5.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 6.Follow up to sustain the partnership –Share progress, successes, and challenges

12 Bright Futures in the Public Health Setting Using the 3rd Edition Bright Futures Guidelines 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 Bright Futures in the Public Health Setting Using the 3rd Edition Bright Futures Guidelines 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 Bright Futures in the Public Health Setting Using the 3rd Edition Bright Futures Guidelines 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

15 Bright Futures in the Public Health Setting Using the 3rd Edition Bright Futures Guidelines Teaching strategiesAdvantages TellingWorks best for initial explanations ShowingIllustrates concepts for visual learners Providing resourcesReference after family leaves QuestioningPromotes problem solving, critical thinking, elicits better information PracticingReinforcing new concepts Constructive feedbackAffirms family knowledge, corrects misunderstandings

16 Bright Futures in the Public Health Setting Using the 3rd Edition Bright Futures Guidelines 3 rd 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 Bright Futures in the Public Health Setting Using the 3rd Edition Bright Futures Guidelines EXAMPLES OF 3 RD EDITION:

18 Bright Futures in the Public Health Setting Using the 3rd Edition Bright Futures Guidelines

19 Bright Futures in the Public Health Setting Using the 3rd Edition Bright Futures Guidelines 9 m/o visit

20 Bright Futures in the Public Health Setting Using the 3rd Edition Bright Futures Guidelines

21 Bright Futures in the Public Health Setting Using the 3rd Edition Bright Futures Guidelines Includes 10 health Promotion Topics 1.Promoting Family Support 2.Promoting Child Development 3.Promoting Mental Health 4.Promoting Healthy Weight 5.Promoting Healthy Nutrition 6.Promoting Physical Activity 7.Promoting Oral Health 8.Promoting Healthy Sexual Development & Sexuality 9.Promoting Safety & Injury prevention 10.Promoting Community Relationships & Resources

22 Bright Futures in the Public Health Setting Using the 3rd Edition Bright Futures Guidelines Further discusses subtopics, including patient handouts Physical Activity & concerns: –Asthma –Special health care needs (including CF) –Diabetes –Eating disorders

23 Bright Futures in the Public Health Setting Using the 3rd Edition Bright Futures Guidelines 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 Bright Futures in the Public Health Setting Using the 3rd Edition Bright Futures Guidelines 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

25 Bright Futures in the Public Health Setting Using the 3rd Edition Bright Futures Guidelines

26 Bright Futures in the Public Health Setting Using the 3rd Edition Bright Futures Guidelines Videos 15 most popular videos Can get links to videos for families to watch on given topics

27 Bright Futures in the Public Health Setting Using the 3rd Edition Bright Futures Guidelines Additional Languages Select materials have been translated into Spanish No other languages currently available

28 Bright Futures in the Public Health Setting Using the 3rd Edition Bright Futures Guidelines 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 Bright Futures in the Public Health Setting Using the 3rd Edition Bright Futures Guidelines Additional Resources Bright Futures for Families: Bright Futures Oral Health Resource Center: ml Pediatrics in Practice:

30 Bright Futures in the Public Health Setting Using the 3rd Edition Bright Futures Guidelines Contact Information: Bright Futures c/o American Academy of Pediatrics 141 Northwest Point Blvd. Elk Grove, IL

31 Bright Futures in the Public Health Setting Using the 3rd Edition Bright Futures Guidelines QUESTIONS?