Bright Futures: The Teenage Years

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Bright Futures The Teenage Years
Paula Duncan, MD, FAAP September 4, 2009
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• Paula Duncan, MD, FAAP
• Chairperson, AAP Bright Futures Pediatric
  Implementation Project
• Professor of Pediatrics
• University of Vermont College of Medicine

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 Learning Objectives

• Learn about key adolescent priorities and
  recommendations from the Bright Futures
  Guidelines for Health Supervision of Infants,
  Children, And Adolescents, 3rd Edition.
• Learn about tools and strategies for measurable
  implementation of Bright Futures in an adolescent
  health supervision visit.
• Discuss and share with call participants
  resources, tools and strategies for Bright
  Futures implementation with the adolescent
  population.

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The Team
Joseph Hagan, MD Judith S Shaw, RN, MPH,
EdD Paula Duncan, MD Mary Margaret Gottesman,
PhD, RN, CPNP Darcy Steinberg-Hastings, MPH Jane
Bassewitz, MA Amy Pirretti, MS
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The Adolescent Expert Panel

• Marty Fisher, MD, Co Chairperson
• Fran Biagoli, MD, Co Chairperson
• Pam Burke PhD, RN, BC-FNP,PNP
• Arthur Elster, MD
• Alma Golden, MD
• Katrina Holt MPH,MS,RD
• M. Susan Jay, MD
• Jamie Martinez, MD

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What Are the Bright Futures Guidelines?

• Comprehensive health supervision guidelines
• Developed by multidisciplinary child health
  expertsproviders, researchers, parents, child
  advocates
• Provide framework for well-child care from birth
  to age 21
• Present single standard of care based on health
  promotion and disease prevention model
• Include recommendations on immunizations, routine
  health screening, and anticipatory guidance
• Replace the former AAP Guidelines for Health
  Supervision

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To make scientific, evidence informed
recommendations on priorities, physical exam ,
screening tests and anticipatory guidance

• Approach to evidence and rationale
• Expert panel
• Evidence panel
• USPSTF recommendations for children
• Adult USPSTF recommendations
• CDC, AAP,AAFP, NAPNAP,GAPS, IOM policies
• Two public reviews

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• 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, clinical practice, community,
  health system and policy levels.

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How do the 3rd Edition Guidelines differ from
previous editions?
Overview of Changes

• Structure of the Book
• Changes to the recommendations

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Bright Futures in Action

• Bright Futures in Action Adolescent Visit

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Context The early adolescent is embarking on a
journey of remarkable transitions and
transformationsphysically, cognitively,
emotionally, and sociallyand the pace at which
these physical and emotional changes occur varies
widely.
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Who has an 11-14 year old?
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• ANTICIPATORY GUIDANCE
• For the parent
• Discuss youth responsibilities in the family and
  how they change with age.
• Get to know your childs friends and encourage
  him to make good decisions about choosing
  friends.
• Discuss your expectations for dress, friends,
  media, and activities, and supervise your child.
• Develop a pattern of communication and support
  him as an independent person. Make time every day
  to talk (mealtime, bedtime, drive time, or
  checkin time) about lots of things, not just
  about difficult or unpleasant topics.
• For the youth
• This is an important time to stay connected with
  your parents. You might not always agree on
  everything, but work with your family to solve
  problems, especially around difficult situations
  or topics.

SOCIAL AND ACADEMIC COMPETENCE Connectedness with
family, peers, and community interpersonal
relationships school performance
Young people are more likely to make healthy
choices if they stay connected with family
members, and if clear rules and limits are
set. Remind parents that, although their childs
friends are becoming increasingly important to
him, they should not underestimate their own
ability to positively influence his opinions and
decisions. This shift in the balance can be
difficult for parents to deal with, but it is an
important time to continue to cement family
relationships. This effort will pay off later
because close family ties are an important
protective, risk-reducing factor in middle and
late adolescence. Connection to parents and other
responsible adults is associated with a reduced
number of risk behaviors.
SAMPLE QUESTIONS Ask the parent How are you
getting along as a family? What do you do
together? Do you understand your childs world
and daily life? Ask the youth How do you get
along with your family? What do you like to do
together? How closely connected do you feel to
your familys cultural and faith life?
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• Date of Screening_____
• HEEADSSS Assessment
• Home (connection/independent decision-making)
• Education (competence)
• Eating
• Activities (physical activity, helping out)
  
• Drugs
• Sex
• Safety
• Suicide (coping, resiliency, self confidence)

Check Indicates a Preventative Screening

• Vision
• Hearing
• Anemia
• Cholesterol
• TB
• STI
• PAP
• Pregnancy
• CRAFFT? Y / N 2

Office Intervention Y/ N Referral Y / N
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Bright Futures Tool and Resource Kit

• Designed to accompany and support the Bright
  Futures Guidelines, 3rd Edition
• Organized compilation of current standards
  materials on preventive health supervision
  health screening.
• Pre-Visit Questionnaires
• Visit Documentation Forms
• Parent/Patient Education Handouts
• Parent/Patient Education Tools
• Developmental and Behavioral Screening
• Practice Management Tools for Preventive Care
• Developing linkages to Community Resources
• www.brightfutures.aap.org

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Bright Futures Tools 15 -17 Visit
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15 to 17 Year Visit
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15 to 17 Year Visit
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Bright Futures Medical Screening Table
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Bright Futures Previsit Questionnaire
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Bright Futures Previsit Questionnaire
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Bright Futures Supplemental Questionnaire
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Bright Futures Supplemental Questionnaire
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Bright Futures Supplemental Questionnaire
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Bright Futures Documentation Form
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Bright Futures Patient Handout
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Bright Futures Parent Handout
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Practice Based Implementation Strategies

• Use a recall reminder system
• Develop community linkages
• Compile a resource list of community agencies
• Develop a single referral form that can be used
  to communicate with multiple agencies
• Identify an office staff person to be responsible
  for updating community list and keeping track of
  referrals
• Cultivate office team involvement and buy-in
• Organize community practice meetings
• Identify small steps for implementing new change
• Use measurement

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References

• Hagan JF, Shaw JS, Duncan PM, eds. 2008. Bright
  Futures Guidelines for Health Supervision of
  Infants, Children and Adolescents, Third Edition.
  Elk Grove Village, IL American Academy of
  Pediatrics
• Duncan PM, Garcia AC, Frankowski BL et al.
  Inspiring healthy adolescent choices A rationale
  for and guide to strength promotion in primary
  care. J Adol Health 41 (2007) 525-535.
• Recommendations for Preventive Pediatric Health
  Care. American Academy of Pediatrics. Pediatrics.
  1206 (1367). 2007
• P.M. Duncan, E. D. Duncan, J. Swanson. Bright
  Futures The Screening Table Recommendations
  Pediatric Annals 37(3) 152-158.

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Contact Information

• QuIIN
• Phone [phone]
• E-mail quiin_at_aap.org
• New Web site http//quiin.aap.org
• Staff Contacts
• Jill Healy, MS Project Manager
• Keri Thiessen, MEd, Senior Health Policy Analyst
• Bright Futures
• Phone [phone]
• E-mail brightfutures_at_aap.org
• New Web site www.brightfutures.aap.org
• Staff Contacts