Download Enhanced Well Child Care Protocol

Enhanced Well Child Care

I. DEFINITION

Enhanced well child care constitutes a set of coordinated practices and activities that expand the focus of primary care for young children to include greater emphasis on behavior and development--both the child's behavior and development and mothers' and fathers' understanding of behavior and development issues. Strategies for achieving enhanced well child care are not isolated activities; they are meant to be infused into virtually every contact between mothers and fathers and Healthy Steps Specialists, including home and office visits and telephone conversations, and incorporated into virtually every Healthy Steps^SM tool, including the Child Health and Development Record. By strengthening the relationship between parents and the Healthy Steps Specialist, the consistent use of these strategies can benefit children and families.

Objectives:

• Create "teachable moments," when mothers and fathers are most receptive to information concerning their child's development and behavior.
• Encourage positive maternal health behavior (e.g., linkages with obstetrical care, breastfeeding, referrals for maternal depression and smoking cessation).
• Strengthen the relationship between the family and the Healthy Steps practice.
• Promote early language development.
• Engage in problem-solving jointly with mothers and fathers.
• Promote and support the involvement of fathers in the care and nurture of the child.

II. SPECIFICATIONS

A. Content: Healthy Steps follows standard, well-tested, and respected guidelines for primary care for young children, including the American Academy of Pediatrics (AAP) guidelines for scheduled visits and immunizations, and uses the Brazelton Neonatal Behavioral Assessment Scale to provide mothers and fathers with a deeper understanding of their baby's temperament and to help mothers and fathers predict their child's behavior in new situations. In addition, Healthy Steps has adopted the objectives laid out in Bright Futures. Beyond this, Healthy Steps employs a set of strategies intended to provide an expanded, more developmentally-focused form of primary care for young children. The Healthy Steps strategies for enhanced well child care, which will be incorporated into all interactions with the families, include:
• Creating linkages to obstetrical care by informing obstetrical care providers of the existence of Healthy Steps and its purpose, and by making regular visits to share information and promote common goals.
• Encouraging and supporting breastfeeding.
• Creating "teachable moments;" that is, a window of time when mothers and fathers are particularly receptive to learning about their child's behavior and development as the result of a child's behavior, a parent's concern, or an evocative question from a health care professional.
• Identifying and making referrals for maternal depression and smoking cessation.
• Using Reach Out and Read to support early literacy experiences for children.
• Focusing on problem-solving with families to determine jointly how to address developmental issues or health concerns.
• Using the Healthy Steps Quick Check Sheets to remind the physician/pediatric nurse practitioner and Healthy Steps Specialist of milestones and child interactions and to trigger questions that should be addressed during each visit.

B. References: Information on strategies for enhanced well child care can be found in Chapters 4 and 5 of Strategies for Change: Child Development in Primary Care for Young Children.

C. Documentation: Teachable moments are suggested on the Healthy Steps Quick Check Sheets. Case notes will be added to Healthy Steps files.

• Maintenance of age-appropriate immunization coverage.
• Identification and use of "teachable moments."
• Strengthened relationship between the family and the Healthy Steps practice.
• Better linkages between obstetrical care of mothers and primary care of infants.
• Longer durations of breastfeeding (relative to pre-Healthy Steps average of practice).
• Referrals for maternal depression and smoking cessation.

• Parental satisfaction with practice, physician/pediatric nurse practitioner, and the Healthy Steps Specialist.
• Provider satisfaction with Healthy Steps approach.
• Proportion of mothers breastfeeding and duration of breastfeeding.
• Referrals for maternal depression and smoking cessation.
• Parental involvement with child's language development through reading.