Georgias Bright Futures Story by gdf57j


Bright Futures Story

                           Laura Sternesky, M.P.A.
                          Beth Zimmerman, M.H.S.

                                February 2006

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                                       Georgia’s Bright Futures Story

Introduction                                            up to age 21 through the State’s Medicaid
                                                        Early and Periodic Screening, Diagnosis, and
In Georgia, Bright Futures has been used by             Treatment (EPSDT) program, known as
public health officials as part of an overall           Health Check. As a result of the State’s efforts
effort to improve child health indicators in the        to link all Medicaid recipients with a medical
State. In particular, these efforts have focused        home, most children on Medicaid now receive
on incorporating Bright Futures’ use into               their care in private physicians’ offices.
Medicaid-covered well-child exams delivered by          However, in some areas of the State, local
local health departments, especially by enhanc-         health departments continue to play an impor-
ing the anticipatory guidance provided to               tant role in providing Health Check screening
parents. Bright Futures also has been utilized as       exams in their areas. Looking to the future, the
part of the State’s broader efforts to improve          State envisions an increased role for local
child health, especially in the areas of mental         health departments in providing such care to
health and oral health. This case study, based          foster children.
on key informant interviews conducted in mid
2005, describes how Georgia has utilized                Through an agreement with the Georgia
Bright Futures in these various ways.                   Department of Community Health, FHB/ICH
                                                        is responsible for conducting quality monitor-
                                                        ing reviews and providing technical support
Context for Bright Futures                              and training to Health Check providers. It is in
Leadership for Georgia’s Bright Futures initia-         this role that ICH has promoted the use of
tives lies with the Division of Public Health           Bright Futures in Health Check examinations.
(DPH) Services, Family Health Branch (FHB),             Although ICH’s quality monitoring and sup-
Office of Infant and Child Health (ICH), locat-         port functions encompass both public and
ed within the Georgia Department of Human               private Health Check providers, the DPH to
Resources. The mission of FHB is to promote             date has focused primarily in encouraging the
the physical, mental, spiritual, and social well-       use of Bright Futures in the public sector.
being of children and families through
partnerships with communities. To achieve this          Initiating Bright Futures
goal, FHB spearheads a number of programs,
including those focused on the delivery of well-        The impetus for Bright Futures use in Georgia
child care, early intervention, newborn                 grew out of a review by the DPH Family
screening, school health, and the development           Health Branch leadership of Georgia’s ranking
of collaborative child care systems.                    in the annual KIDS COUNT report published
                                                        by the Annie E. Casey Foundation which pro-
Of the programs administered by FHB, the                vides national and State-by-State benchmarks
major focal point for Georgia’s Bright Futures-         of child health status. Georgia public health
related efforts has been the State’s Well Child         officials were concerned that Georgia’s child
Program, which supports the delivery of pri-            wellness indicators, including those on which
mary and preventive care services for children          Georgia ranked above the national average,

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                                       Georgia: The Bright Futures Story

were not as high as they should be. To address            tified parent education as an indicator for the
this situation, the Family Health Branch                  Health Check quality reviews – establishing an
launched a statewide effort aimed at improving            80 percent target for this measure. Health
Georgia’s child health status indicators.                 Check monitoring and exam forms were
                                                          revised based on Bright Futures to emphasize
In developing their strategies, State public
                                                          the delivery of comprehensive anticipatory
health officials focused on Medicaid as an
                                                          guidance. ICH also encouraged the use of
important vehicle for reaching a large number
                                                          Bright Futures
of children, especially those at high risk for
                                                          Family Tip
poor health outcomes. In particular, they con-                                        Georgia uses
                                                          Sheets as infor-     Bright Futures as a tool
sidered how the quality of the Health Check
                                                          mational              for strengthening the
examinations could be enhanced. It was decid-
                                                          handouts for              quality of EPSDT
ed that strengthening the focus on anticipatory
                                                          families. While          well-child exams.
guidance would help to improve child health
                                                          use of the forms
indicators broadly.
                                                          and Bright Futures materials is not mandated,
In looking for tools to support this goal, State          local health departments tend to use or adapt
staff identified Bright Futures and found it to           Health Check forms and follow guidance pro-
be a “perfect fit” for EPSDT. Key informants              vided by the DPH, especially given its role in
noted several reasons for this conclusion,                conducting Health Check quality reviews.
including Bright Futures’ organization by
                                                          The State held four regional Bright Futures
developmental period, its match with the
                                                          kickoff meetings to “roll out” Bright Futures
EPSDT periodicity schedule (which outlines at
                                                          and introduce the new Health Check forms to
what age well child screening exams should be
                                                          local public health providers. Representatives
received), its content, and its step-by-step guid-
                                                          from each of Georgia’s 19 public health dis-
ance regarding the provision of anticipatory
                                                          tricts – representing the State’s 159 county
guidance. The Bright Futures health supervi-
                                                          health departments – attended the regional
sion guidelines were also appealing because
                                                          trainings. Each district received an array of
they complemented the developmental screen-
                                                          Bright Futures materials, including the Bright
ing approach – “Ages & Stages” – used during
                                                          Futures health supervision manual and comple-
a Health Check visit; that is, Bright Futures
                                                          mentary pocket guide, the Bright Futures in
materials could be used to address issues identi-
                                                          Practice guides on oral health and mental
fied during the developmental assessment.
                                                          health, and family materials including the
Based on its positive review of Bright Futures,           Bright Futures Tip sheets and Family
the State took several steps to integrate Bright          Encounter Forms, and districts were told how
Futures into the Health Check program during              to obtain or purchase additional copies.
2002 and 2003. In accordance with Medicaid’s
requirement that anticipatory guidance be
delivered as part of EPSDT exams, ICH iden-

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                                       Georgia’s Bright Futures Story

Evolution of Bright Futures                             reviews of local providers as one of three ICH
Over Time                                               staff members who, through an agreement with
                                                        the Medicaid division within the Department
Consistent with the original vision that Bright         of Community Health, monitor and provide
Futures could support Georgia’s efforts to              technical assistance for Health Check
improve its performance on various child                providers. Ms. Lawrence is the primary Bright
health benchmarks, the State has built and              Futures “point person.”
expanded upon its initial Health Check activi-
ties in various ways. Driven by surveys of local        One of Ms. Lawrence’s responsibilities in this
public health staff members regarding their             role is to hold district-level Bright Futures
training and technical assistance needs, the            trainings for local public health staff members
State has hired additional staff members with           – for which continuing education credits are
responsibility for supporting Bright Futures use        available – to support the provision of high-
at the local level and also has conducted a             quality Health Check exams. To complement
series of regional Bright Futures trainings             the Bright Futures components of the Health
focused on mental health. Oral health is anoth-         Check monitoring and exam forms, the train-
er area in which Bright Futures has influenced          ings include general information about Bright
State policy and programs, as well as broader           Futures and the health supervision materials as
regional and national efforts addressing the            well as interactive discussions, focused on case
needs of children in Head Start. These are              examples, intended to illustrate how the mate-
described below, followed by examples of how            rials can be
Bright Futures has been incorporated into               applied in local           The State health
practice at the local level.                            public health                  department
                                                        practice. These             has designated
                                                        discussions take       a Bright Futures “point
Building State Capacity to Provide                      place within the          person” who offers
Bright Futures Support at the                           broader context        training to local public
Local Level                                             of how the                 health programs.
                                                        State and local
After the regional Bright Futures trainings that
                                                        providers, working collaboratively, can foster
focused on Health Check were conducted,
                                                        Georgia’s progress on child health indicators.
additional steps were taken to facilitate Bright
Futures use at the local level. An evaluation of        A particular area of focus in the trainings, con-
training participants found that Bright Futures         sistent with the Health Check quality review
was positively received but more training was           measures, is the importance of doing strong
needed to help translate it into practice. In           anticipatory guidance, especially for specific
response to this need, in April 2003, ICH               populations such as children who are suspected
hired Ancel Lawrence as a public health nurse           of being maltreated, abused, or neglected.
consultant to ICH’s Well Child Program. Ms.
Lawrence conducts Health Check quality

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                                         Georgia: The Bright Futures Story

   The State has placed a high priority on reduc-           Georgetown University, which correlates nicely
   ing child abuse and neglect, especially among            with EPSDT. She also reported that the Bright
   foster children, and key informants note that            Futures newsletter produced by AAP is helpful.
   Bright Futures can be used to prevent or                 However, knowledge of AAP’s role in Bright
                                    address this            Futures and the availability of online resources
                                    problem by              was quite variable among local level key
       Bright Futures
  is part of the State’s            educating par-          informants.
 approach for reducing              ents, helping
child abuse and neglect.            to create
                                    stronger fami-          Addressing Children’s Mental
   lies, and identifying abuse and neglect so that          Health Issues
   intervention becomes a primary action.                   Mental health is another important area in
   As indicated earlier, the State has an 80 percent        which Bright Futures has been used in Georgia
   target measure for the provision of parent edu-          and one that is strongly linked to the State’s
   cation as part of well-child exams.                      efforts to reduce child abuse and neglect.
   Ms. Lawrence indicates that health districts’            Surveys of local public health staff members
   overall scores for this indicator currently aver-        indicated that they needed more skills in
   age 95 percent or above and have increased               addressing the range of behavioral and mental
   since Bright Futures was introduced, and dis-            health issues being faced by families with
   tricts that use Bright Futures usually score             whom they work. In particular, staff in home
   higher on Health Check reviews. While county             visiting programs expressed a need for addi-
   health departments tend to use the standard              tional family resources.
   Health Check screening form developed by                 In response, Susan Bertonaschi, the
   ICH, different types of assessment forms are             Coordinator of Children 1st, the single point
   seen in private practice. According to key               of entry for public health children’s services,
   informants interviewed for this case study from          collaborated with the Department of Family
   both the public and private sectors, Bright              and Childen Services and other agencies that
   Futures is not commonly used in private physi-           often serve the same clients to develop a cross-
   cians’ offices.                                          agency training program on these issues. In
   In carrying out her role as the Bright Futures           2004, the State sponsored a series of seven
   lead trainer and presenter, Ms. Lawrence                 regional trainings around the State on the
   reports using the full complement of Bright              social and emotional development of the young
   Futures materials. She uses both the Bright              child (birth to age 5), with a major focus on
   Futures Web sites of both the American                   Bright Futures. During the training, partici-
   Academy of Pediatrics (AAP), supported                   pants received a bag of Bright Futures
   through AAP’s Bright Futures cooperative                 resources, including the health supervision and
   agreement with the Maternal and Child Health             mental health books as well as guidance on
   Bureau, as well as the one supported by                  how to use the Bright Futures in Practice:

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                                           Georgia’s Bright Futures Story

  Mental Health guide from one of the individu-             Dental Director, who continues to provide
  als who led its development at the national               consultation to the Georgia Department of
  level. Attendees included a total of approxi-             Human Resources’ oral health program,
  mately 430 district and county staff members              described the Bright Futures in Practice: Oral
  from early childhood, child care, substance               Health guide as being a very useful resource for
  abuse, child welfare, and other State agencies            statewide oral health promotion efforts. In par-
  and larger community agencies that work with              ticular, he notes that the guide discusses oral
  children in this age group. By including a                health issues in a way that is easily understood
  broad range of professionals working with fam-            by nondental professionals, emphasizes oral
  ilies with young children, the regional trainings         health as part of overall health, and has been
  were intended to allow consistent messages to             updated recently (in pocket guide form). Dr.
  be conveyed by the broad range of providers               Alderman identified several ways in which the
  dealing with mental health issues faced by this           Bright Futures oral health guide has been uti-
  population.                                               lized in Georgia as well as in broader-reaching
                                                            oral health promotion efforts:
  Based on evaluations of the trainings that indi-
  cated that they were well-received, the State in                Dissemination of guidance/information to
                                     2005 began to              public health professionals and other oral
                                     proceed with               health stakeholders. As  the State’s Dental
       Georgia uses
      Bright Futures                 plans for con-             Director, Dr. Alderman sent copies of Bright
to promote the delivery              ducting a                  Futures in Practice: Oral Health to the oral
of consistent messages               similar series             health contacts in the health districts when
 across a broad range                of trainings               the book was released. He has conducted
      of child health                focused on the             and continues to conduct lectures to public
      professionals.                 needs of chil-             health professionals in districts (nurse practi-
                                     dren in                    tioners, public health nurses, and others
  middle childhood. It is hoped that a subsequent               from dental and nondental staffs) about oral
  series focused on adolescents will be conducted               health. Bright Futures messages incorporated
  as well. To complement this work, the FHB                     in these lectures include how Bright Futures
  also developed a resource directory of licensed               addresses oral health supervision, how Bright
  mental health service providers who work with                 Futures assesses risk, and how to get Bright
  children and families. The directory includes                 Futures materials. In addition, Dr. Alderman
  approximately 1,200 licensed clinicians.                      conducted a 2-day course in late 2004 at the
                                                                Medical College of Georgia School of
                                                                Dentistry on providing dental care to chil-
  Improving Children’s Oral Health                              dren with special health needs in which he
                                                                presented information on Bright Futures.
  Another area in which Bright Futures has been
                                                                He also does an annual lecture at this school
  utilized in Georgia’s public health efforts is oral
                                                                on oral health and Bright Futures.
  health. Joseph Alderman, the former State

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                                        Georgia: The Bright Futures Story

      Development of State program rules and                  ance for Head Start/Early Head Start pro-
    guidance. In  2005, Georgia is providing                  grams in such areas as tooth brushing,
    more detailed information concerning the                  appropriate use of toothpaste, and applica-
    requirement that all children entering public             tion of fluoride varnish. In addition, Bright
    school get nutrition, eye, ear, and dental                Futures was noted as a tool for promoting
    screening exams. Dr. Alderman is consulting               consistent adoption of Medicaid and other
    with the State’s oral health program to devel-            policies supporting the initiation of dental
    op the dental screening requirements, and                 visits by 1 year of age – an important oppor-
    Bright Futures is being utilized in that                  tunity for providing anticipatory guidance to
    effort. Bright Futures also was used as a                 families around oral health – and also for
    source for updating manuals (on such topics               facilitating the delivery of anticipatory guid-
    as children with special health care needs,               ance on oral health by nondentists who are
                                     adolescent               more likely than dentists to see children dur-
                                     health, and              ing infancy and the toddler years.
     Bright Futures
  is informing policy                women’s
 development at the                  health) uti-
                                                           Use of Bright Futures
 State and national                  lized by local
                                                           at the Local Level
   levels to improve                 health depart-
children’s oral health.              ments for             Discussions with local-level key informants
                                     well-child            centered on how Bright Futures has been
    screenings with anticipatory guidance related          applied in Health Check and other programs
    to oral health. This work was done within              administered by local health departments. As
    ICH as part of Ms. Lawrence’s work to                  noted earlier, the level of involvement in well-
    update Health Check procedures and manu-               child Health Check screenings by public health
    als. The goal was to integrate oral health and         nurses is dependent upon the county in which
    nutrition for all age groups in all manuals.           they work. For this case study, key-informant
                                                           interviews were conducted with public health
      Development of national policy/program
                                                           nurses from numerous local health depart-
    guidance. Dr.  Alderman has translated his
                                                           ments with some role in conducting well-child
    Georgia-based Bright Futures experience to
                                                           screenings as a complement to those conducted
    his current role as the Region IV Head Start
                                                           in the private sector, as well as in nurse home
    Oral Health Consultant. Oral health recent-
                                                           visiting programs for at-risk families.
    ly has become one of Head Start’s priority
    areas, and efforts are focused on updating             In response to the initial trainings on Bright
    the program’s performance standards in this            Futures and Health Check, local-level key
    area and increasing the focus on prevention            informants noted a great deal of excitement
    of dental problems among children in Head              from the State regarding Bright Futures but
    Start and Early Head Start. Bright Futures is          were initially unsure what it meant for them.
    being used as part of this national effort as a        Originally, some nurses thought that they
    resource for development of consistent guid-           would have to start using all new Health

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                                       Georgia’s Bright Futures Story

Check forms based on Bright Futures, but they           during the visit
were happy to see that Bright Futures was               and given to             Local public health
incorporated into existing forms. Most nurses           them to take           programs report that
noted that while incorporation of Bright                home. They fre-          Bright Futures has
Futures into Health Check has not changed               quently                helped to strengthen
the way they conduct health screenings neces-           indicated that            parent education
sarily, Bright Futures supports the delivery of         having “some-                  services.
more comprehensive anticipatory guidance –              thing we can
focusing on both physical and mental health             put our hands on” and give to parents to take
needs – than might otherwise be done and                home was important, especially in assuring par-
helps nurses to cover the most important issues         ents that their baby is reaching appropriate
at each visit, helping to make better use of the        milestones.
time available. They note that the Bright
                                                        Some barriers regarding use of the materials
Futures emphasis on parent education helps to
                                                        were noted, in particular the expense of the
increase parental understanding in a nonthreat-
                                                        materials and the difficulty of copying them.
ening way and provides basic information on
                                                        Nurses also noted that clients require many dif-
how to direct children’s behavior. Simplifying
                                                        ferent types of teaching methods due to
and streamlining paperwork and supporting
                                                        different education levels and circumstances,
providers in connecting families to communi-
                                                        and it would be helpful to have more materials
ty-based resources were other benefits noted of
                                                        and methods to meet families’ needs. Nurses
Bright Futures, in addition to its use helping
                                                        indicated a need for lower-literacy materials
some health departments to score higher on
                                                        and simple, concise information. Picture illus-
their Health Check quality reviews conducted
                                                        trations were noted as something that would be
by ICH.
                                                        helpful to convey messages to low-literacy
Beyond the Health Check forms, public health            clients. There was varying levels of knowledge
nurses report using an array of Bright Futures          among key informants regarding the full range
materials including the books, pocket guides,           of Bright Futures materials (including Spanish-
Family Tip Sheets, and Family Encounter                 language materials for families) and the
Forms. Many nurses reported using the materi-           availability of online materials.
als to guide discussions with parents about
                                                        In addition to use during Health Check exams,
what should be happening with a child at each
                                                        Bright Futures is used in some local-level home
stage of development. Health department nurs-
                                                        visiting programs aimed at reducing child
es noted that families are very appreciative of
                                                        abuse and neglect. For example, Bright Futures
the time spent on parent education and of
                                                        has been integrated into the Visiting Education
Bright Futures materials, especially the Family
                                                        Nurse in Transition (VENT) program in
Tip Sheets or Family Encounter Forms (differ-
                                                        Gordon County, part of the Rome district.
ent clinics reported using one or the other
                                                        VENT is a pilot program – the county’s pri-
more frequently) that are reviewed with parents
                                                        mary prevention grant program – to reduce

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                                      Georgia: The Bright Futures Story

child abuse and neglect, through which at-risk           private providers and the need for more com-
mothers with at least one child under the age            munication and hands-on support at the local
of 1 receive home visiting services, averaging at        level. Each is discussed in turn below.
least one visit per month during the first year
of life. Bright Futures has been integrated into
                                                         Engaging Private Providers
this home visiting program as the basis of
VENT forms for use during the 1-, 2-, 4-, 6-,            In considering barriers to the State’s efforts to
and 12-month visits; the focus of these forms is         promote Bright Futures, the one that clearly
developmental milestones, safety issues, and             emerged as the major challenge was expanding
parenting information. Nurses in this program            its use in the private sector. While Bright
note that Bright Futures helps to focus and              Futures has been integrated into the way in
facilitate conversations between home visitors           which public health nurses conduct Health
and clients about nutrition, home environ-               Check screenings, the extent to which it is used
ment, sleeping, and other issues. They also use          among private providers appears to be very
the nutrition and oral health books and give             limited. This is of particular concern among
out information on issues such as baby bottle            public health officials because the bulk of
tooth decay. The Bright Futures mental health            patients receive care in the private sector.
book was also noted as being very helpful. The
                                                         Leaders of the Georgia AAP Chapter noted
home visitors copy materials for families from
                                                         that although they recognize that the national
the book and use the Edinburgh scale included
                                                         AAP is involved in promoting Bright Futures,
in the mental health toolkit for determining
                                                         there is some
postpartum depression. They noted that while
                                                         resistance to it
the issue of where to refer women who screen                                     More work is needed
                                                         by its members.           to engage private
positive remains, given the paucity of mental
                                                         Several reasons           providers in using
health providers in the area, the tool has been
                                                         for this were               Bright Futures.
helpful in documenting the problem and advo-
                                                         identified. In
cating for more resources to address it. In
                                                         addition to Bright Futures’ length and cumber-
Floyd County, Bright Futures also is being used
                                                         some nature, critical factors working against its
in a secondary child abuse prevention program
                                                         use include the existence of multiple national
providing medical/nursing consultation to
                                                         guidelines for child health delivery, even within
social workers conducting child abuse
                                                         AAP, and the variation in standards among
                                                         payers. Also, given the flat reimbursement fee
                                                         for well-child visits, anything that is perceived
Challenges                                               as increasing the time spent in a visit can be
Interviews conducted for this case study also            difficult to implement.
identified two areas in which Georgia is facing
                                                         State health officials and leaders of the Georgia
ongoing challenges in expanding the State’s
                                                         AAP Chapter both reported that the two enti-
continued efforts to promote Bright Futures
                                                         ties have a strong relationship and collaborate
use. These include barriers to its adoption by

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                                                             Georgia’s Bright Futures Story

 on many issues, such as standardizing develop-                               to adopt an approach without support from
 mental screening practices for the State and                                 such a major payer.
 planning for physician training to support
 implementation of the new standards (effective
                                                                              Fostering Communication
 for the Medicaid program as of October 1,                                    and Support at the Local Level
 2006).1 To date, however, encouraging Bright
 Futures use among private pediatricians has not                              Interviews with key informants uncovered
 been prioritized as an area for collaboration.                               varying degrees of communication among the
 Representatives of the Georgia AAP Chapter                                   various child health providers. A theme that
 report that although Bright Futures is listed as                             emerged from key-informant interviews was
 a tool for anticipatory guidance on its Web site                             the need to share information among public
 and they have shared information on Bright                                   health providers, as well as between public and
 Futures as part of the Women, Infants, and                                   private providers, about Bright Futures and
 Children program nutrition outreach efforts,                                 how it is being used.
 they have not received any requests from mem-                                Despite the State’s conduct of numerous
 bers for information on Bright Futures and do                                regional trainings on Bright Futures and the
 not believe that many members are using this                                 availability of a
 anticipatory guidance tool in their practices.                               State Bright
                                                                                                       Tailored, hands-on
 Leaders of the Georgia AAP Chapter noted that                                Futures point
                                                                                                       training is needed
 several factors would affect their interest in pro-                          person, local                 to maximize
 moting Bright Futures’ use among the State’s                                 key informants           Bright Futures use
 pediatricians, most notably a directive from the                             often reported a          at the local level.
 national AAP office or interest from their mem-                              desire for more
 bers. In order to facilitate its use in the field,                           clarity and support from the State in how to
 especially when AAP releases the third edition                               use the Bright Futures materials in their own
 of Bright Futures (which will integrate current                              settings. While the trainings at both the broad-
 AAP health supervision guidelines), the Georgia                              er regional and smaller district levels (including
 AAP Chapter noted that educational materials                                 multiple local health departments) were noted
 and assistance will be needed to help providers                              as useful overviews of the Bright Futures
 integrate Bright Futures easily into their prac-                             approach, it was felt that smaller 1-day training
 tices. In addition, approval from Medicaid was                               sessions for providers “at the same level” on
 noted as being essential in order for it to be                               how to use Bright Futures in clinics are needed
 adopted as a standard, as providers are unlikely                             to realize fully the benefit of Bright Futures.
                                                                              The importance of providing advance notice of
                                                                              trainings was emphasized to ensure that entire
1 Standardized developmental screening tools are required at ages             teams of staff members, who will use Bright
9 months, 18 months, 24 months, and 36 months. Suggested screening
tools include ASQ, PEDS, or other standardized screening tools with           Futures together and support each other, can
specificity of at least 80 percent. A Bright Futures health supervision       attend. Videos were another type of support
questionnaire or other similar template is recommended at all other
Health Check visits.

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                                        Georgia: The Bright Futures Story

identified for providing more indepth guidance                guidance to families. Although public health
on how to use Bright Futures.                                 providers may have more time to spend with
                                                              families than private practitioners, insights
                                                              from public health nurses indicating that
Lessons Learned
                                                              Bright Futures can help to focus discussions
Overall, the Georgia Bright Futures experience                with families and, if incorporated into exam
highlights several lessons learned regarding the              forms, also streamline related paperwork
use of Bright Futures, as discussed here:                     may help to engage private practitioners to
                                                              use Bright Futures.
    Bright Futures can be utilized as a flexible
                                                                 Champions are needed at all levels. In order
  tool in broad-reaching child health promotion
                                                              for Bright Futures to be integrated in local
  efforts. Bright Futures has been used in
                                                              practice, there must be someone at the local
  Georgia to support a range of activities to
                                                              level to “run with it,” and there is also a
  strengthen clinical practice, train health pro-
                                                              need for someone to embrace it at top level
  fessionals, educate parents, and develop
                                                              and make sure that staff members have the
  policies related to child health. This varied
                                                              resources and support they need to facilitate
  use helps to promote the delivery of consis-
                                                              implementation. It is also useful to have
  tent messages across public health providers
                                                              individuals “in the trenches” who have used
  serving families at high risk for poor health
                                                              it and can help to share lessons in how it can
                                                              be implemented successfully. This lesson
    Integrating Bright Futures into current                   may be particularly relevant to hopes for
  practices can facilitate its acceptance. It   was           better involving private providers in Bright
  noted that incorporating Bright Futures                     Futures efforts – stronger advocacy by lead-
  principles into the way work was already                    ers in the private sector for Bright Futures
  being done in the State helped to garner                    use at the national, State, and local levels
  buy-in of the end users. In particular, inte-               will be needed to build a base of support in
  grating Bright Futures into Health Check                    the private practitioner community.
  exam forms helped to ease the inclusion of
                                                                 Tailored support and training is needed to
  Bright Futures into well-child exams con-
                                                              facilitate implementation.In addition to
  ducted by public health nurses.
                                                              broad overviews of the Bright Futures phi-
    Bright Futures can help to streamline and                 losophy and materials, front-line providers
  enhance the delivery of comprehensive                       expressed a need for clear guidance in how
  anticipatory guidance during well-child exams.              materials can be used in practice and sup-
  The experience of public health nurses                      port and training tailored to the setting in
  working in clinical settings and conducting                 which they work. Better linkages to others
  home visits indicates that Bright Futures can               using Bright Futures in the State and across
  be used as a tool for delivering more consis-               the Nation can help to respond to this need.
  tent and comprehensive anticipatory

                                         Health Systems Research, Inc.                                    Page 10
                                        Georgia’s Bright Futures Story

Sustainability and Future                                                Key Informants
By incorporating Bright Futures into a range of
                                                             Ancel Lawrence
ongoing initiatives aimed at improving chil-
                                                               Well Child Program
dren’s health, Georgia has taken important                     Office of Infant and Child Health
steps to foster its use into the future, particu-              Division of Public Health Services
larly in the public-health sector. However,                    Georgia Department of Human Resources
ongoing support tailored to the needs of key
stakeholders is needed to further promote its
                                                             Susan Bertonaschi
use and realize its benefits in multiple venues.
                                                               Children 1st
Building on its experiences to date, ICH lead-                 Office of Infant and Child Health
                                                               Division of Public Health Services
ers are working to introduce Bright Futures to
                                                               Georgia Department of Human Resources
other agencies and organizations also interested
in promoting children’s health, such as the
Georgia Department of Education, the Parent-                 Joseph Alderman
Teacher Association, the Governor’s Council                    Former Dental Director, Georgia Department
on Developmental Disabilities, and others par-                 of Human Resources
                                                               Region IV Head Start Oral Health Consultant
ticipating in the Georgia Early Childhood
Comprehensive Systems building initiative.
Partnerships such as these will be important to              Shelba Key
continue to support Bright Futures’ use in the                 Putnam County Health Department
public-health sector as well as to expand its use
by private providers with a major role in pro-
                                                             Denise Dasher
moting the health and development of
                                                              Coweta County Health Department
Georgia’s children.

                                                             Wilma Ham
                                                              Spalding County Health Department

                                                             Lynn Cress, Judy Howerton,
                                                             and Melanie Vaughn
                                                               Gordon County Health Department

                                                             Rick Ward
                                                               Georgia Chapter of the American Academy
                                                               of Pediatrics

                                        Health Systems Research, Inc.                                  Page 11

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