Key Goal

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Key Goal

• Connected Kids Safe Strong Secure is an AAP
  program designed to support clinicians efforts
  to prevent youth violence by promoting the
  development of resilient children.

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Why Is This Important?

• Violence is a major cause of childhood morbidity
  and mortality in the United States.
• Homicide is the 2nd leading cause of death for
  13- to 21-year-olds
• The leading cause of death for African Americans
  13 to 21 years old1
• Increase in community violence during 1990s
• 21st century rates in the United States still
  among the highest in the world

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Why Is This Important?

• Many parents and pediatricians feel community
  violence screening should be routine in well
  child care.2-5
• Results from the 1998 and 2003 AAP Periodic
  Surveys of Fellows show that a majority of
  pediatricians feel unprepared to manage community
  violence.2-4

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Why Is This Important?

• Parents want more doctors to discuss community
  violence.5
• Results from the National Survey of Early
  Childhood Health

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Connected Kids provides

• Tools and strategies to help parents raise
  resilient children
• Educational materials for parents and youth
• Effective anticipatory guidance
• Developmentally appropriate guidelines
• Easy-to-use Clinical Guide with links to research

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Development Process

• Development of Connected Kids included6
• Input from parents, clinicians, and other experts
• Testing of program materials in focus groups with
  diverse families and clinicians7
• Incorporation of stakeholder feedback
• A broad and respectful approach for all of the
  educational materials
• Coordination with other AAP efforts

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Objectives

• Connected Kids will
• Strengthen the connections among children and
  youth, their families, and their community
• Reduce risk factors by building resilience8

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Connected Kids . . .

• Uses an asset-based approach to prevention that
• Emphasizes the identification and enhancement of
  strengths
• Enhances clinician-family alliance
• Helps parents with strategies to
• Promote positive development
• Develop prosocial interpersonal skills
• Obtain support and resources to help raise
  children

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Asset- Versus Risk-based Approaches to Guidance

• Assets
• Goal Help improve childs resilience
• Assess family strengths
• Link to community resources

• Risks
• Goal Reduce known risks
• Screen for risk factors
• Refer to services

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Connected Kids Includes

• Clinical guide
• Counseling schedule
• Handouts for parents and families
• Web site
• This training presentation
• Database of violence prevention materials
• Success stories

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Clinical Guide

• This presentation supplements the clinical guide,
  available online at www.aap.org/ConnectedKids
• Clinical guide contains
• Background information
• Counseling schedule
• Visit-by-visit suggestions from birth to age 21

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Building Blocks
Connected Kids centers on 4 overlapping themes of
anticipatory guidance
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Child-Centered

• Recognizes
• Childs changing abilities
• Cognitive development of child
• Related parental concerns

Parent- Centered
Community Connections
Physical Safety
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Parent-Centered
Child-Centered

• Addresses the importance of parental supports
• Incorporates the idea that parents develop along
  with the child
• Contributes to the quality of family life
• Promotes positive parenting

Community Connections
Physical Safety
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Positive Parenting
Teaching desired behavior begins with a positive
and nurturing foundation9
What to do when your child misbehaves
How to manage conflict and teach responsibility
Ways to nurture your children and prevent
misbehavior
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Community Connections
Child-Centered

• Research underscores the importance of10
• Social capital a measure of the
  interconnectedness among people with their
  community
• Community connections
• Clinicians can help connect families to community
  resources

Parent- Centered
Physical Safety
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Physical Safety

• Counseling schedule focuses on violence and
  intentional injury
• Complements AAPs TIPP
  (The Injury Prevention Program)
• Handguns in the home placed in the context of
  child development
• Provides objective information to help families
  make their own decisions

Parent- Centered
Community Connections
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Connected Kids Counseling Schedule

• Lists topics to introduce and reinforce at each
  visit
• Provides asset-based assessment and anticipatory
  guidance for each visit
• Links to use of parent and patient brochures
• Distributed when a topic is first introduced
• Promote discussion between provider and family
• Give useful information to foster the development
  of strong, resilient children

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Counseling Schedule
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Anatomy of a Brochure

• Front Cover
• Cover image visually conveys core message
• Designed by Artists for Humanity, a non-profit
  arts and entrepreneurship program for Boston
  teens.

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Anatomy of a Brochure

• Content
• Each brochure addresses one specific issue
• Content based on all four building block themes
• Reading level 2nd to 6th grade
• Contains concrete examples for key concepts

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Anatomy of a Brochure

• Back Cover
• Summarizes topics
• Space provided for
• Parent/patient guidance
• Follow-up suggestions
• Community resources
• Next appointment
• Practice name and address

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Counseling Schedule
Infancy Early Childhood 2 days 4 years
Middle Childhood 5 10 years
Adolescence 11 21 years
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Ideas for Optimal Use

• While implementing Connected Kids with an
  individual family depends on a familys starting
  pointand the familys interest in our inputwe
  can begin to consider some strategies for
  implementation in the following areas
• Intake Forms
• Counseling
• Educational Materials
• Practice Changes
• Community Connections

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Intake Forms

• Use the Bright Futures Pediatric Intake Form
• Introduce Connected Kids in a cover letter to
  families
• Use information gathered to prioritize issues for
  families and tailor the program
• As your relationship with a family evolves, it
  may become easier to discuss sensitive topics
• Use the information gathered at every visit

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Counseling

• Be sensitive to issues that might be difficult
  for a particular family
• Include both statistics and stories
• Prioritize topics covered on the families needs
• Use the adolescent brochures to facilitate new
  ways for parents and teens to talk

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Educational Materials

• Use brochures to introduce sensitive topics, such
  as domestic violence
• Encourage the parent to share the information
  with other adults caring for the child
• Ask support staff to help distribute materials
  while patients are waiting to be seen

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Educational Materials

• Personalize the brochures
• Circling or underlining a passage increases the
  likelihood that your advice will be followed
• Write down family-specific information in the box
  on the back cover during the visit
• Suggest placing it on the refrigerator so the
  cover image can be a reminder of what to do
• Encourage parents/patients to write questions in
  the box on the back while they are waiting

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Practice Changes

• Involve all office staff receptionists observe
  how parents and children interact
• Use the Counseling Schedule from the Clinical
  Guide to document when you have introduced and
  reinforced topics
• Talk with colleagues about how they have
  successfully implemented Connected Kids

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Community Connections

• Become familiar with programs in your community
• If resources do not exist, advocate for services
• Get involved
• Join coalitions working to rid the community of
  violence
• Speak to community and school groups
• Talk with the local media

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References

• 1. Centers for Disease Control and Prevention.
  Web-based Injury Statistics Query and Reporting
  System Online. (2001) National Center for
  Injury Prevention and Control, Centers for
  Disease Control and Prevention. Available at
  www.cdc.gov/ncipc/wisqars
• 2. American Academy of Pediatrics. AAP Periodic
  Survey of Fellows 38. 1998
• 3. American Academy of Pediatrics. AAP Periodic
  Survey of Fellows 55. 2003
• 4. Trowbridge MJ, Sege RD, Olson L, OConnor K,
  Flaherty E, Spivak H. Intentional injury
  management and prevention in pediatric practice
  results from 1998 and 2003 American Academy of
  Pediatrics Periodic Surveys. Pediatrics.
  2005116996-1000
• Kogan MD, Schuster MA, Yu SM, et al. Routine
  assessment of family and community health risks
  parent views and what they receive. Pediatrics.
  2004113(6 suppl)1934-1943
• 6. Sege RD, Flanigan E, Levin-Goodman R,
  Licenziato VG, De Vos E, Spivak H. American
  Academy of Pediatrics Connected Kids program
  case study. Am J Prev Med. 200529(5 suppl
  2)215-219
• 7. Sege RD, Hatmaker-Flanigan E, De Vos E,
  Levin-Goodman R, Spivak H. Anticipatory guidance
  and violence prevention results from family and
  pediatrician focus groups. Pediatrics.
  2006117455-463
• 8. Resnick MD, Ireland M, Borowsky I. Youth
  violence perpetration what protects? What
  predicts? Findings from the National Longitudinal
  Study of Adolescent Health. J Adolesc Health.
  200435424.e1-424.e10

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References

• 9. University of Minnesota Extension Service.
  Positive Parenting. Minneapolis, MN University
  of Minnesota 2000
• 10. Drukker M, Kaplan C, Feron F, van Os J.
  Childrens health-related quality of life,
  neighbourhood socio-economic deprivation and
  social capital. A contextual analysis. Soc Sci
  Med. 200357825-841

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Acknowledgments

• Howard Spivak, MD
• Robert Sege, MD, PhD
• Elizabeth Hatmaker-Flanigan, MS
• Bonnie Kozial
• Vincent Licenziato
• Kimberly Bardy, MPH
• This project was supported by Grant No.
  2001-JN-FX-0011 awarded by the Office of Juvenile
  Justice and Delinquency Prevention, Office of
  Justice Programs, U.S. Department of Justice.
  Points of view or opinions in this document are
  those of the author and do not necessarily
  represent the official position or policies of
  the U.S. Department of Justice.