Bright Futures Partners for State and Community Implementation

Medicaid providers, departments of public health, and Title V, child care, child welfare, and other local agencies that deal with family health, education, and well-being are key drivers of state health promotion and disease prevention initiatives. In some instances, these efforts might include agencies such as departments of housing and transportation.

The evidence-informed recommendations and guidance offered by Bright Futures, which has been developed by a broad base of multidisciplinary experts, serve as credible core content for these initiatives.

State agencies are in a unique position to

• Update or revise provider manuals or required Periodicity Schedules.
• Require or recommend standardized developmental assessments.
• Promote information about Bright Futures and available tools and resources.
• Partner with other groups to use data-driven strategies to improve the quality of preventive services delivered in their state and communities. When appropriate, these groups can provide data to implement high-quality state and community health care improvement projects (see Quality Improvement).
• Provide public education about new and ongoing important prevention topics such as immunizations, oral health, healthy weight, and emotional well-being.
  Sponsor provider trainings that incorporate Bright Futures content.
• Change billing and payment policies.
• Implement Bright Futures Guidelines in all public health clinics.
• Educate all home visiting professionals and early education and child care professionals about Bright Futures Guidelines so that they can reinforce messages when appropriate and help prepare parents to be effective partners during their children's well-child visits.

Key EPSDT Resources

State Medicaid agencies have been especially influential in the implementation of Bright Futures. In June 2014, the Centers for Medicare & Medicaid Services published EPSDT—A Guide for States: Coverage in the Medicaid Benefit for Children and Adolescents​, which references Bright Futures throughout. This guide help states, health care providers, and others understand the scope of services that are covered under EPSDT so that they may realize EPSDT's goals and provide the best possible child and adolescent health benefit through their Medicaid programs. The National EPSDT Improvement Workgroup is developing a series of strategy guides on specific topics to support states and their partners.

The AAP has developed EPSDT State Profiles that provide detailed information each state Medicaid program's EPSDT benefit and how this compares to the Bright Futures Guidelines.

Visit the Media Center to listen to brief recorded interviews with individuals who have been involved in state-level implementation projects.

Families, state and local agencies, pediatric practices, family medicine practices, professional organization chapters, individual health care providers such as physicians, nurse practitioners, physician assistants, nurses, and community health workers—all are important partners in the promotion of children’s health.

What Provider Organizations and Their Chapters Can Do

Provider organizations, such as the AAP, the American Academy of Family Physicians, the National Assembly on School-Based Health Care, the National Association of Community Health Centers, the National Association of Pediatric Nurse Practitioners, and the National Association of Physician Assistant, and their local chapters can be key partners in state- and community-level efforts to promote children's health and use of Bright Futures resources. These and many other national organizations participate in the Bright Futures Project Implementation Advisory Committee (PIAC).

For example, scores of state and local AAP chapters exist in the United States; each is dedicated to achieving the AAP child health goals in their communities, including Bright Futures implementation. AAP chapters can:

• Identify implementation barriers at the ground level
• Develop and share best implementation practices
• Provide feedback on implementation activities
• Champion the initiative and further spread implementation
• Present continuing medical education sessions on preventive services at annual chapter meetings
• Design and present a maintenance of certification (MOC) project on preventive services

The AAP provides technical assistance for state- and chapter-level quality improvement (QI) projects dealing with measurable implementation of Bright Futures, including those that provide MOC credits. For more information, see the Quality Improvement section.

Health care practitioners and community health workers are also key partners in statewide implementation of Bright Futures, and their inclusion in the planning phase can be crucial to obtaining provider acceptance and support for change. By participating in implementation activities, practitioners can develop channels of communication to state officials and agencies, improve practice efficiency and health outcomes, and, in some cases, benefit from incentives and reimbursements. They can also strengthen or create referral partnerships with community organizations, gain public recognition for their efforts to improve health care delivery for children, and may be able to earn required MOC credits for their participation in QI projects.

How Illinois is Individualizing Training

Illinois: The Illinois Chapter of the American Academy of Pediatrics (ICAAP) partnered with a number of organizations and funders, including state agencies, to develop individualized training based in part on the annual needs assessments of ICAAP members. Individualized learning sessions were developed by local experts and physicians and taught by peer instructors using case studies, problem-based exercises, and hands-on learning tools. Sessions were flexible to accommodate each practice's schedule and covered topics like coding and billing and staff roles. Additional technical assistance was available to providers. Learn more.

University departments of pediatrics and family medicine, nursing schools, and university-affiliated academic medical centers can be valuable partners in implementing Bright Futures. These institutions can:

• Improve preventive care service delivery
• Collect and share data that demonstrate positive health care outcomes resulting from Bright Futures implementation
• Contribute funds, staff, and other resources for implementation and training sessions
• Leverage existing networks to increase awareness of the project
• Implement Bright Futures Guidelines in all practice sites
• Where appropriate, promote use of electronic health records and other prompting systems
• Incorporate Bright Futures into course curricula and provide faculty, students, and trainees access to Bright Futures materials

Pediatric departments in academic medical centers may be especially willing to participate in Bright Futures implementation projects to help practitioners fulfill their licensure requirements.

Viriginia's Multidisciplinary E-Learning Training Modules

Virginia: Pediatric residents at the Virginia Commonwealth University (VCU) Medical School received training in clinical applications of Bright Futures. VCU faculty members have collaborated with partners from the state's Department of Health, AAP chapter, and Medicaid office to develop a series of e-learning training modules based on Bright Futures and represented as individual case studies. The modules are targeted to pediatric, nursing, and nutrition students; family practice physicians; nurse practitioners; physician assistants; Medicaid and community health providers; clinic nurses; and unlicensed assistive personnel. Learn more.

Improvement partnership networks offer established mechanisms for change, including access to interested health care providers, dedicated staff, and financial support. As a result, they can greatly facilitate Bright Futures implementation. Below are descriptions of some existing improvement partnership networks.

Chapter Al​​​liance for Quality Improvement and Chapter Quality Network​

As a provider of QI programs that meet the American Board of Pediatrics MOC requirements, the AAP developed the CQN, a program of the CAQI, to invest in the valuable and unique structure offered by AAP chapters to support pediatricians' efforts toward embedding QI into their everyday practice of medicine. The CQN provides chapters with the direct support they need to lead a QI effort. The CQN works at the practice, state, and national levels to build a network of AAP chapters and enhances their ability to lead QI collaboratives that achieve measurable improvements in the health outcomes of children.

Visit the CQN Web site for QI downloadable resources including A Resource Guide for Chapters: Building Local Capacity for Improvement, AAP policy statements, and other materials.

National Improvement Partnership Network​

NIPN is a network of more than 20 states that have developed improvement partnerships to advance quality and transform health care for children and their families. An improvement partnership is a durable state or regional collaboration of public and private partners that uses the science of QI and a systems approach to changing health care infrastructure and practice. Vermont's improvement partnership, the Vermont Child Health Improvement Program (VCHIP), provides leadership to NIPN. NIPN offers an information sheet and guide to developing an improvement partnership program.

The following resources can support states' initial work in mobilizing potential partners and establishing the basic components of an improvement partnership:

• Improvement Partnerships to Advance Child Healthcare Quality
• Establishing a Child Health Improvement Partnership: A How-to Guide

For more information, visit the NIPN website and download the article The National Improvement Partnership Network: State-Based Partnerships That Improve Primary Care Quality.

See the Quality Improvement section of this Web site for more information about QI partnerships.

Early care and education settings; Help Me Grow affiliates; family service agencies; Women, Infant, and Children programs; parent support groups; child advocacy groups; Head Start programs; and community mental health agencies are just a few examples of the types of organizations that participate in children's health promotion initiatives at the local level.

As partners in a Bright Futures implementation project, community-based organizations can:

• Provide resources such as meeting places, funded programs to address local needs, or staff
• Identify needed intervention services and programs to which providers can refer patients
• Increase awareness of Bright Futures
• Make connections to families and advocates

Community-based organizations play an important part in Bright Futures implementation efforts. They often link parents to appropriate referrals, and in some cases these organizations provide the needed service directly (eg, mental health, parent support). When community organizations interact with families, they can increase awareness of family resources and other resources to support active involvement in their children's well-child visits.

Building State Partnerships

Maine: Started in 2003 with Child Health Insurance Program Reauthorization Act funds, the Maine Child Health Improvement Partnership is run by Quality Counts and includes the Medicaid agency, public health departments, the local AAP chapter, and parents. This partnership has resulted in Bright Futures-related work, including an update to the state Medicaid forms to align with Bright Futures recommendations and the development of the First STEPS learning initiative, which offers developmental screening regional training sessions for primary care practices to improve developmental and autism screening. The mission of the partnership is to improve the health of the state's children using public–private partnerships to initiate and support measurement-based efforts to enhance children's health care. Learn more.

Vermont: In 2000, the Vermont Child Health Improvement Program, one of the first of its kind in the country was created to improve the health of Vermont's children and youth. A unique aspect of this project was the inclusion of health plans. In addition to the state Medicaid agency and the Vermont Department of Health, collaborators include Blue Cross Blue Shield of Vermont, MVP, and Cigna Health Services. From the beginning, the health plan providers were willing to focus on improving adolescent health in the state, a need with which everyone agreed.

The Vermont Chapter of the AAP, the Department of Health, and VCHIP organized a "roadshow" that traveled to 12 regions in the state to teach physicians, nurse practitioners, early child care and education professionals, and public health providers about Bright Futures. The AAP chapter distributed the Bright Futures Guidelines and Bright Futures Pocket Guides to all roadshow audiences. The meetings included an overview of Bright Futures, a discussion on preventive services, the public health's perspective on children, and the Vermont Chapter's role in the partnership, as well as a discussion about how preventive services can be adapted to the unique situations in each community. The use of Bright Futures to provide a common language and a united approach across services was also discussed. Learn more.

Bright Futures is built around family-centered care—the concept of partnership between families and health care providers that serve the best interest of the child and the family. Family-centered care encourages mutual respect for the skills and expertise that both partners bring to the table and focuses on trust, communication, and joint decision-making. Successful use of Bright Futures tools such as the Previsit Questionnaires largely depends on family participation. Parent and family organizations and parent advisors can be valuable team members that offer new perspective on the goals and processes of an implementation program.

Many states that have implemented Bright Futures have developed methods of informing families of proposed changes or additions to their children’s pediatric care. These mechanisms take advantage of the relationships among families that facilitate transmission of health information and recommendations.

By including these stakeholders as partners, states and communities can ensure that a key audience is being addressed. Families can:

• Help design and/or provide feedback on proposed changes to delivery of care and materials
• Serve as trusted peer-to-peer (family-to-family) advisors, transferring health information and recommendations
• Help increase the demand for preventive screening as recommended by Bright Futures
• Provide input on the types of information to be shared with the public
• Provide data on the success of implementation through satisfaction surveys
• Increase awareness of Bright Futures in the community
• Participate as instructors in Bright Futures training activities

Families may also be interested in learning more about the medical home—an approach to providing comprehensive primary care that facilitates partnerships among patients, physicians, and families. For more information on the medical home, including state contacts and resources, visit the National Resource Center for Patient/Family-Centered Medical Home​ website. Implementation programs may find the Family Voices Family-Centered Care Self-Assessment Tool helpful. Family Voices is a nonprofit family-led organization that works to keep families at the center of children’s health care. The self-assessment tool increases awareness of the family-centered care concept in outpatient health care settings and among families and provides an organized way for staff in health care settings to assess current strengths and weaknesses, plan future efforts, and track progress. This information helps implementation programs set realistic and attainable goals and assess quality improvement. The self-assessment tool comes in two forms—one for families and one for providers.

Partnering with Families

Illinois: The Illinois Healthy Kids EPSDT Web site provides resources to families participating in the EPSDT program and includes links to children's mental health, the Ounce of Prevention Fund, Zero to Three, and Bright Futures information. The state also has a Healthy Kids mailing that promotes Women, Infants, and Children program services. Learn more.

South Dakota: South Dakota produces a recipient handbook for Medicaid beneficiaries. In addition to providing a general overview of the state's Medicaid program, the handbook contains sections dedicated to baby care and well-child care. The well-child care materials include a suggested checkup schedule and an immunization schedule that make parents aware of the Bright Futures/AAP Periodicity Schedule adopted by the state.