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 Meeting the Promise of ACA: How Bright Futures Is Being Used by State MCH Programs

Judy Shaw EdD, MPH, RN, FAAP
Co-Editor, Bright Futures Guidelines, 3rd Edition
American Academy of PediatricsBright Futures Steering Committee
Research Associate Professor of Pediatrics and Nursing, University of Vermont College of Medicine
Executive Director, Vermont Child Health Improvement Program, University of Vermont College of Medicine 

Public health leaders and communities are drawing from Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, 3rd Edition, to create a common approach to improving the health of infants, children, youth, and families.  

From policy development to quality improvement programs, home visitation programs to local health fairs and community education, state leaders are using Bright Futures. Bright Futures describes a system of health care that is unique in its attention to health promotion activities and psychosocial factors of health; its focus on child, youth, and family strengths; and its recognition that effective health promotion and disease prevention require coordinated efforts among a diverse array of medical and nonmedical professionals and agencies. Public health professionals are key partners in the implementation of Bright Futures and play an important role in ensuring the health of our nation’s children and their families. 

At the core of Bright Futures is recognition that the needs and concerns of families come first. Whether it is a home visitor who reinforces the importance of a well-child care visit; a Women, Infants, and Children staff member who discusses the importance of establishing mealtime routines with the parent of a 9-month-old; or a school nurse who, in promoting physical activity and nutrition, talks with an elementary school student about turning off the TV at mealtimes and suggests drinking water rather than soda, all these professionals are using components of the Bright Futures guidelines.  

How States Are Using Bright Futures

New York has used Bright Futures at the policy level and with quality improvement activities. Christopher Kus, MD, MPH, FAAP, Associate Medical Director, Division of Family Health, New York State Department of Health, has worked with colleagues to incorporate Bright Futures in the state Early and Periodic Screening, Diagnosis, and Treatment manual. The manual is directly linked to the American Academy of Pediatrics (AAP) Bright Futures website including the “Recommendations for Preventive Pediatric Health Care” (periodicity schedule).  

Bright Futures is regularly used in New York State Department of Health learning collaboratives dealing with developmental and autism screening. Dr. Kus states: “I always keep my Bright Futures Pocket Guide handy since it is an important maternal and child health resource.” He also notes that Bright Futures provides a useful framework in discussing issues with other agencies such as mental health and social welfare. 

In Wisconsin, the Maternal and Child Health program and local health departments developed a one-day orientation program for public health nurses, focused on the 10 Bright Futures themes. This workshop was followed by theme-based 90-minute webcasts given every two months. Local public health leaders have found these sessions useful and have incorporated Bright Futures themes into their practices.  

Gretchen Klug, RN, a public health nurse in Dodge County, WI, indicates, “Bright Futures has given us a framework to guide our public health programs into our everyday contact with families based on the 10 health promotion themes. Local public health activities and programs are supported and validated by the Bright Futures evidence-informed guidelines.”  

Top 5 Reasons Why States and Communities Are Adopting Bright Futures

1.     The Patient Protection and Affordable Care Act passed in 2010 recognized Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, 3rd Edition, as the authoritative standard for pediatric preventive health insurance coverage, requiring all private plans to cover Bright Futures preventive services for infants, children and adolescents without patient/family cost-sharing.

2.     Bright Futures uses a developmentally based approach to address children’s health needs in the context of the family and community.

3.   Accompanying the guidelines is Bright Futures Tool and Resource Kit, a comprehensive set of tools and resources to support health promotion and disease prevention that many public health programs are using.

4.   Some have used Bright Futures in developing policies and programs aimed at improving the quality of children’s health care and children’s health outcomes.

5.   Trainings, webinars, workshops, and presentations are available and have been made nationally and locally to Medicaid and Title V directors. Implementation and trainings use quality improvement principles to explore best approaches to linking communities and primary care to provide efficient and effective health care to children and their families. 

Visit the Bright Futures website to access resources and information described herein as well as other information. See the Resources section of this newsletter for a listing of the latest additions to the Bright Futures website.  

Bright Futures is supported by a cooperative agreement from the federal Maternal and Child Health Bureau (MCHB), Health Resources and Services Administration (HRSA). The guidelines are published by the AAP with support from the MCHB, HRSA, and collaborating partners.