Bright Futures Virginia: a State Project

1
Bright Futures Virginia a State Project

• Virginia Department of Health
• Co-Chairs
• Catherine J. Bodkin, LCSW, MSHA
• Division of Womens and Infants Health
• cbodkin_at_vdh.state.va.us
• Carol Pollock, RN, MSH, FNP
• Division of Children and Adolescent Health
• cpollock_at_vdh.state.va.us

2
(No Transcript)
3
Virginia Initiation

• Commissioners Approval 2000
• Bright Futures Guidelines adopted as the state
  standard for Child and Adolescent Health Care
• Planning Committee 2000-2001
• Kick-off Event with Teams June 2001
• Nurse, nutritionist, home visitor, dental staff

4
Why Bright Futures?

• Prevention Focus
• Practical, specific applications
• Developmental approach
• Family-centered
• Updates in future
• Comprehensive view of child

5
Prevention Research

• Resiliency and Mentoring
• Home Visiting with New Parents
• Early Brain Development
• Quality Child Care
• Pregnancy Prevention
• Positive Youth Development
• Community Health Indicators

6
National Initiatives

• Healthy People 2010
• IOM report Unequal Treatment
• Surgeon Generals Report on Mental Health
• Title V and Mental Health Association
• Presidential Initiatives at HRSA (CHC)
• Nutrition and Physical Fitness
• Healthy Start
• Womens Health

7
Recent Related Research

• Children Missing Developmental Screens
• Parents Want Information
• National Survey of Early Childhood Health
• 8.7 met all four measures of care
• anticipatory guidance
• assessment of parent/family
• substance abuse assessed for home
• family-centered care

8
Virginia Child Health Indicators

• 30 of public school students are eligible for
  free and reduced school lunch program
• Over 10 of children (0-18) have no health
  insurance
• 25 have no medical home
• 12-14 have baby bottle tooth decay
• 45 of children (0-18) have dental decay higher
  for children on free lunch

9
Virginia Child Health Indicators

• 37 of 4th graders are overweight or at-risk for
  being overweight
• 4th Graders watch T.V. or use computers 3 hours a
  day
• Low pass all 4 school physical fitness tests
  numbers decline as age increases
• 28 of youth smoke

10
Virginia Child Health Indicators

• Leading hospital discharge conditions for
  adolescents are
• Deliveries
• Depression
• Unintentional injuries
• Asthma
• Leading cause of death unintentional injuries
• Death rate for black youth is 2X rate for whites

11
Families Matter!

• Families as partners
• Families as caregivers
• Families as teachers
• Families as resources

12
Prevention Works!
Immunizations
Child Safety Seats
Fluoridation
Bike Helmets
Home Safety Practices
Back to Sleep
13
Health Promotion Is Everybodys Business.

• Health professionals
• Families
• Child care professionals
• Social service professionals
• Schools
• Local and state government
• Community groups
• Business/industry
• Faith communities
• Payers
• Community Health Workers

14
Core Concepts

• Partnership
• Communication
• Education
• Health Promotion/ Illness Prevention
• Time Management
• Advocacy

15
Health is a Partnership.

• Child or Adolescent
• Family
• Health Care Provider
• School
• Community

16
Partnership Vision Families Health Care
Providers

• Family-Centered Care
• Sharing knowledge
• Providing a developmental perspective
• Promoting healthy behaviors
• Discussing health concerns
• Collaborating to approach health issues
• Identifying community resources supports

17
Partnership with Managed Care
Using the Bright Futures model in clinical
practice, a leading managed care organization
reported these outcomes

• Improved parental safety practice
• Improved member satisfaction
• Improved physician satisfaction
• Decreased costs
• Decreased number of clinic visits and phone
  calls

18
Time Management

• Providers
• Complaints of too little time
• Too Many Forms
• Parents
• Waiting time
• Lack of information

19
Time Management

• Family Visit Forms
• Clinician Visit Forms
• Family Tip Sheets
• Clinic Flow

20
Advocacy in Administration

• Standards of Practice
• Program Development
• Staff Development
• Policies and Regulations
• Collaboration

21
Advocacy in Service Delivery

• Accessibility
• hours, location
• cost, transportation, medication
• cultural and language aspects
• staff knowledge of local community
• Quality
• staff training
• feedback loop to service system
• Community Health Workers Role

22
Advocacy for Individual or Family

• Identify Needs or Concerns
• Assess the Situation
• Develop a Strategy
• Follow Through

23
Implementation 2001

• Local Health District Team Plan
• Train local staff and give six-month report
• Distribution of Bright Futures books
• Local departments (135) received full set
• Pocket Guide to staff who work with children
• Guidelines sent to health care providers

24
Internal Orientation 2001

• Dental staff
• WIC
• Healthy Start
• School Health Coordinator
• Home Visiting programs

25
Internal Structures 2001-2002

• Advisory Committee
• Office of Family Health Strategic Plan
• Individual Employee Annual Work Plans
• Healthy People 2010 Committee
• Website, email, team leaders

26
Partnership Development 2001

• Advisory Committee Expansion
• Outreach to other Virginia Government Programs
  and Departments
• Meetings with Medical and Nursing schools and
  Hospital Association
• Meeting with Virginia AAP chapter president

27
Partnership with other State Agencies

• Adopted as Standard of Care 2001
• Virginia Department of Education Training of
  School Nurses
• Virginia Department of Medical Assistance
  Services (Medicaid)
• E.P.S.D.T.
• High-risk MCH Targeted Case Management
• Provider training

28
Partnership 2002

• Healthy Child Care Virginia Care Consultants
• Early Intervention (Part C)
• Childrens Museum Community Outreach
• Bright Futures Work Group
• Distribution of Bright Futures Health Records to
  all Health Districts patients ages 0-6

29
Partnership 2002

• Legislation on EPSDT using Bright Futures
  Guidelines as measure for mental health care
  service provision
• Legislation on Lead Screening
• AAP grant to Pediatrician for project on ADHD
  using Vanderbilt Scales

30
Partnership 2003

• Comparison of health care received by foster care
  children to other childrens
• District MCH and PHHS annual plans
• Tool kit for all licensed Child Care Providers

31
Staff Development 2002

• Training on Cross-Cultural Communication for
  Nurses
• Modules for home visitors
• Enhanced education for W.I.C. Nutritionists
• Additional training for Dental staffs
• Childrens Museum Conference with T. Berry
  Brazelton scholarships

32
Staff Development 2002

• Community Health Care Center Directors
• Home Visiting Programs Resource Mothers
• CHIP of Virginia
• Providers receiving Medicaid payments
• Child Care Consultants in 35 Districts
• School Nurses

33
Staff Development 2002-2003

• Schools
• Distributed BF materials to school nurses
• Projects
• Depression screening
• Promoting healthy weight activity
• Payers
• EPSDT Trainings
• Coordinated Benefits

34
Staff Development 2003

• Regional trainings for LHD staffs nutrition,
  nursing and outreach staffs on Mental Health and
  Nutrition tools
• Healthy Families supervisors and coordinators
  (train-the-trainer)
• Resource Mothers on Time Management
• Use of Edinburgh Depression Screening

35
Staff Development In Process

• Mental Health
• Training for substance abuse counselors
• Children with Special Health Care Needs
• Child Development Clinics
• Care Connection for Children

36
Materials Developed

• Snapshot on Virginias School-Age Population
• Displays (for providers and for parents)
• Case Studies for clinic staff training
• Milestones and Risk Flags for Screening
• Updates in AAP state newsletter

37
Materials Developed

• Local adaptation of Clinic Visit forms
• Training Manual for Home Visitors
• Training for CHWs on use of Edingburgh
• Website
• PowerPoint Orientation for New Employees

38
Materials In Process

• Health record for foster children
• Training for schools relating Bright Futures and
  SOLs
• Materials for families

39
Grant Proposals 2002-2003

• Healthy Start
• Lead Screening
• Healthy Child Care Virginia
• Early Childhood Coordination
• Title V Plan
• Nutrition and Physical Fitness in Early Childhood
• Womens Health Infrastructure

40
Partnering with Families 2003

• Governors New Parent Kit
• Calendar developed
• Health record
• Resource List supported by AAP chapter
• Governors Initiative Foundations for a
  Lifetime related to education and child care
• Evaluating use of the family visit record through
  Healthy Start/Resource Mothers

41
Bright Futures Related Activities 2003

• W.I.C. Brochures on Nutrition and Development
  during the first years
• Nutrition for Active Kids (public-private)Group
• Center for Injury and Violence Prevention (car
  seats, gun locks, depression/suicide, bullying)
• Walk Across Virginia
• Chronic Disease Prevention Projects targeting
  youth (Asthma, Diabetes)

42
Future Projects

• Child care professionals
• Head Start
• Child care facilities
• Social service professionals
• Medicaid/FAMIS workers in Social Service
• Foster Care workers and foster care parents
• Mental Health
• Mental Health Early Childhood Service Plan
• Attachment disorders training

43
Future Projects

• Health Districts
• Provided materials for local projects with
  measurable outcomes
• Schools
• Health Physical Education staff
• Food service staff
• PTA
• Family Materials
• Developing partnership
• Payers
• Reimbursement issues with HMOs and state

44
Observations

• Integration of Bright Futures into programs takes
  time due to multiple aspects of Bright Futures.
• Co-chair structure is useful.
• Family-centered prevention message is energizing
  to providers.
• Partnership, Time Management and Advocacy are
  concepts applicable to systems, programs and
  clients.

45
Observations

• Collaboration with partners develops based on
  what is needed in their system.
• Existing funds can be re-directed to
  collaborative efforts.
• Bright Futures helps non-medical staff (both
  professional and paraprofessional) feel more
  comfortable coordinating with medical providers.
• Bright Futures broadens the awareness of
  health.

46
Observations

• Bright Futures creates awareness in clinical
  providers about array of community services and
  resources.
• Bright Futures is readily seen as a quality
  assurance tool for providers, payers and
  families.
• Bright Futures helps community partners look at
  their roles in health care differently.

47
Promoting a Bright Future

• National
• www.brightfutures.org
• Virginia
• www.vahealth.org/brightfutures
• Family Voices
• www.brightfuturesforfamilies.org
• American Academy of Pediatrics
• www.brightfutures.aap.org

48
Every Child Deserves a Bright Future!

• Every child deserves to be healthy, experience
  joy, have self-esteem, have caring family
  friends, believe that he or she can succeed in
  life.