Bright Futures Health Supervision Visits

1 Bright Futures Health Supervision Visits BFG 4TH 257 1/20/17 2:47 PM. Introduction to the Bright Futures Health Futures Health Supervision Visits . INTRODUCTION TO THE Bright . Supervision Visits Health Supervision Visits are an important oppor- Questionnaires, such as those provided in the tunity to assess the Health and function of a family Bright Futures Tool and Resource Kit, enhances and child. Bright Futures : Guidelines for Health visit efficiency by identifying concerns at the Supervision of Infants, Children, and Adolescents beginning of the visit .

2 Exists to improve the Health and well-being of all Certainly, we need to do things for which evi- children by improving a practice's clinical Health dence of effectiveness exists. We also may need to promotion and disease prevention efforts and provide other services that we consider essential the organizational processes necessary to meet to that particular child's Health and well-being, this goal. such as those defined by professional guidelines This fourth edition of the Guidelines follows the or state mandates. Bright Futures /American Academy of Pediatrics What about the things that we want to do?

3 We (AAP) Recommendations for Preventive Pediatric bring a personal view to Health based on our Health Care, commonly referred to as the training and experience, our knowledge of our Periodicity Schedule, which provides an up-to-date unique community and its needs, and our desires summary of the what to do in primary care prac- to adhere to guidelines from the AAP, American tice today. The Guidelines seek to describe how to Academy of Family Physicians (AAFP), National do this work efficiently. Association of Pediatric Nurse Practitioners Certainly, no Health care professional has the time (NAPNAP), the American Academy of Pediatric to do every possible Bright Futures intervention Dentistry, the American Dietetic Association, or discussed for a particular age visit .

4 How, then, others. Often, the interventions we want to include can Health care professionals choose what is most relate to disease prevention and Health promotion. important for one child and family at this time in Elucidation and enumeration of a child's and fam- this community? Experienced Health care profes- ily's strengths is an important undertaking and a sionals often say that a visit is made up of many good example of what many experienced Health to dos things we must do, things we need to care professionals want to do.

5 Do, and things we want to do. Accommodating all the musts, needs, and wants Families bring an agenda, and we must address sounds like a pretty big task and an extremely long these needs in the visit if we are to be success- visit , unless a Health care professional tailors the ful. An overlap generally exists between what visit and possible interventions to one child and the family needs us to discuss and what we feel family in the community. Not everything needs to is important to discuss; thus, creating a shared be done at every visit .

6 The specifics covered during agenda is essential to the visit 's success. Helping the physical examination, screenings, and anticipa- parents enumerate their concerns and questions tory guidance will evolve over a sequence of Visits is an efficient and effective way of establishing this during an age range. The time frame for providing shared agenda. Using parent and patient Previsit Health Supervision is not just one visit . Actually, it 259. BFG 4TH 259 1/20/17 2:47 PM. Bright Futures Guidelines for Health Supervision of Infants, Children, and Adolescents occurs over a child's development and may be pro- and the structure of the visit .

7 We also recognize Futures Health Supervision Visits . vided by a variety of Health care professionals in a both the importance and relative paucity of evi- INTRODUCTION TO THE Bright . variety of settings. dence supporting many components of the visit , The following sections explore these ideas in fur- and describe how supporting evidence is repre- ther detail through a discussion of the content of sented in the Guidelines. the Health Supervision visit , the timing of the visit , The Content of the visit A visit is composed of many potential interven- Supervision visit are broader than just detecting tions or Health care professional activities with the disease and they involve very different actions patient.

8 Interventions include obtaining a medical in the same encounter. Failure to recognize their history, administering questionnaires or screen- inherent incongruence will lead to incongruent ing tools, performing a physical examination, practice, with frustrations and compromised out- entering into discussion, and providing antici comes. The tone and content of disease detection patory guidance. should be remarkably different from that employed Some interventions, such as assessing growth and in discussing Health -promoting behaviors.

9 Development, occur at all Visits . But how do we capture the elements of disease prevention and Disease Detection Health promotion that are important to an indi . vidual child? And, when we find these elements, Surveillance and Screening how are the best interventions chosen so that the Child Health care professionals generally report best outcomes can be sought? 2 techniques of disease detection over time . surveillance and screening. Dworkin discussed Many Health care professionals see one child Health surveillance and screening in the context of child visit as one encounter, a view encouraged by third- development, and defined developmental surveil- party payers.

10 Unlike sick care Visits , which aim to lance as a flexible, continuous process whereby remedy a particular malady, the Health Supervision knowledgeable professionals perform skilled visit seeks many unique outcomes, often related observations of children during the provision only in their shared goal of the child's Health . of Health care. The components of surveillance Multiple desired outcomes inevitably drive many include eliciting and attending to parental con- separate interventions within the one encounter cerns, obtaining a relevant developmental history, of the visit .