Incorporating Bright Futures into your Project

1. Incorporating Bright Futures into your Project Paula Duncan, MD Bright Futures Steering Committee Chairperson American Academy of Pediatrics CATCH and Healthy Tomorrows Meeting August 15-16, 2008, Chicago, IL The speaker in this session has no relevant financial relationships with the manufacturer(s) of any commercial product(s) and/or provider of commercial services discussed in this CME activity. The speaker will not discuss or demonstrate pharmaceuticals and/or medical devices that are not approved by the FDA and/or medical or surgical procedures that involve an unapproved or "off-label" use of an approved device or pharmaceutical.

2. Workshop Objectives • Learn about the philosophy of Bright Futures and about the Bright Futures Initiatives at the AAP. • Learn how to implement the Bright Futures approaches and materials in their community and practice settings. • Understand how to partner with families in health promotion activities in both the community and practice settings. • Explore, with colleagues, strategies to implement Bright Futures in specific project areas.

3. What Is 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.

4. Bright Futures Mission The mission of Bright Futures is to promote and improve the health, education, and well-being of infants, children, adolescents, families, and communities.

5. Bright Futures Guidelines Promote Healthy Outcomes for All Children • Attaining a healthy weight and BMI, normal blood pressure, vision, and hearing • Pursuing healthy behaviors: nutrition, physical activity, safety, sexuality, and substance use • Accomplishing developmental tasks: social connections, competence, autonomy, empathy, and coping skills • Having a loving, responsible family supported by a safe community • For children with special needs or chronic health problems: achieving self-management skills and freedom from barriers to reaching their potential

6. Bright Futures And Medical Home • The medical home addresses well-child, acute, and chronic care from birth through transition to adulthood. • Bright Futures materials help pediatricians and other health care providers provide the best health promotion and prevention services possible for children within the context of a medical home.

7. History of the Bright Futures Guidelines Supported and funded by federal government’s Maternal and Child Health Bureau (MCHB) • First published in 1994 • Updated in 2000 • In 2002, AAP selected by MCHB to implement the next phase of the initiative

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

9. Who can use Bright Futures Guidelines? • In addition to child health care professionals and practice staff, health promotion and disease prevention requires coordinated effort of both medical and non-medical professionals and agencies, including • Public health • Social services • Mental health • Educational services • Home health • Parents • Caregivers • Families • Child Care

10. Pocket Guide • Quick reference tool and training resource for busy health care professionals • Concise summaries for each of the 31 age-specific well-child visits

11. How do the 3rd edition Guidelines differ from previous editions? Structure Part I—Themes • Includes 10 chapters highlighting key health promotion themes • Emphasizes “significant challenges”—mental health and healthy weight Part II—Visits • Provides detailed health supervision guidance and anticipatory guidance for 31 age-specific visits • Lists 5 priorities for each visit • Includes sample questions and discussion topics for parent and child

12. How do the 3rd edition Guidelines differ from previous editions? (continued) • Health Supervision Priorities • Designed to focus visit on most important issues for age of child • Anticipatory guidance presented in several ways • Include health risks, developmental issues, positive reinforcement

13. Priorities 18 Month Visit

14. Development 18 Month Visit

15. Physical Exam 18 Month Visit

16. Screening 18 Month Visit

17. 18 Month Visit: Anticipatory Guidance Example

18. Bright Futures and Community How to Use Bright Futures in Context of State and Local Efforts • Healthy People 2010 objectives • Link Bright Futures with State Early Intervention Programs and CSHCN efforts, especially the medical home component of State Early childhood Comprehensive Systems initiative • Ensure that all materials used by state and local health workers (e.g., home visit curricula, WIC handouts for clients, etc.) are consistent with Bright Futures Guidelines

19. Bright Futures and Community How to Coordinate and Implement Bright Futures Efforts • Bright Futures can bring credibility and consistency to community programs by providing a standard of care that can be referenced and shared between health care professionals. • Identify key content for specific audiences (eg, school nurses, child care consultants, etc) • Incorporate Bright Futures into care plans of home visitors, health promoters, and community health workers • Others have made Bright Futures the official standard for infant, child, and adolescent health supervision EPSDT.

20. Bright Futures Guidelines—3rd Edition Features of 3rd Edition: Ten Themes • Child Development • Family Support • Mental Health and Emotional Well-Being • Nutritional Health • Physical Activity • Healthy Weight • Oral Health • Healthy Sexuality • Safety and Injury Prevention • Community Relationships and Resources

21. Bright Futures has Identified Family Support as a Critical Component of Health Promotion How can community activities and initiatives help?

22. Family Support and Health Promotion • Access to a medical and dental home • Access to other necessary services, including child care • Peer to peer informal support • Culturally appropriate safe activities

23. Bright Futures has Identified Partnership and Two Way Communication Between Health Care Professionals and Parents as Critical to Healthy Outcomes How can community activities and initiatives help?

24. Partnership and Two Way Communication Between Health Care Professionals and Parents • Understand that strong communication develops—with work—over time • Share information with health care professionals—come with questions and take notes • Get more information—ask for materials or referrals to community resources • Ask what is likely to happen in the next phase of your child’s development • Find out how and when to contact your health care professional between visits

25. Bright Futures Encourages the Use of Strength based approaches How can community activities and initiatives help?

26. The Focus: Assets or Deficits?

27. Developmental Assets Function as Protective Factors for School Age Children and Adolescents • Coping skills • Resiliency • Competence • Connectedness to family friends and community • Decision making • Self confidence and hopefulness • Engaging in a positive way in the life of the community

28. Community Programs Can Play a Major Role in Promoting These Protective Factors

29. For Healthy Weight Bright Futures has Identified Seven Important Prevention Measures • 5 fruits and vegetables • Less than 2 hours of screen time a day • One hour of physical activity • No sweetened beverages • Eat breakfast • Limit fats food • Eat together as a family

30. Simple Message for Everyone

31. Communities in Partnership with Families and Youth have a Big Role to Play in Making these things Happen

32. Bright Futures, Healthy Tomorrows, and CATCH Use Bright Futures as a guide to develop policies and programs to improve quality of children’s health care and health outcomes. Use Bright Futures as common standard for clinical care. Use materials to help parents and youth get prepared and make the most of every visit. Use the anticipatory guidance sections for education of community partners other child health professionals and parents directly.

33. Bright Futures, Healthy Tomorrows, and CATCH Consider Bright Futures priority areas as part of community health assessments. Consider using Bright Futures themes in project for agency/community health fairs education activities. Consider using Bright Futures approaches materials as part of community education activity. Use strength-based approaches and shared decision making strategies to engage with community partners and parents.

34. Contact Information American Academy of Pediatrics Phone847-433-4223 E-mailbrightfutures@aap.org Websitehttp://brightfutures.aap.org