Prevention and Intervention

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Prevention and Intervention

 

​The concept of the Medical Home grew from the need for a well-organized, integrated approach to chronic care. The social context, family history, and therapeutic partnerships are fundamental elements of effective approaches to minimize disease progression. These are also foundational elements of wellness care – of universal attempts to avoid the occurrence of disease in the first place. Pediatricians are well placed to actively nurture healthy relationships. Observing relationships between infant and parent/caregiver can often be an effective vital sign. Well-child visits present an opportunity for pediatricians to emphasize the importance of these relationships during the first 1,000 days of life. While the primary focus during the first three years is on promoting health and wellness and preventing illness, there are also instances where secondary and tertiary intervention are indicated.

The Academy recommends following Bright Futures, which provides anticipatory guidance and recommendations on screening for social-emotional development. The following chart describes three different approaches to care.

 

​WELLNESS CAREACUTE, "SICK" CARECHRONIC CARE
​Type of PreventionPrimarySecondaryTertiary​
​Population
  • ​Universal
  • Selective or Targeted
    (those who are symptomatic)
  • Indicated 
    (those who are diagnosed)
​Primary Objective
  • To avoid the occurrence of disease
  • To diagnose and treat disease in the early stages - before it causes significant morbidity or mortality
  • To reduce negative impact of known disease by restoring function and reducing disease-related complications
​Essential Elements
  • Promote Wellness/Health
  • Anticipatory Guidance
  • Ecobiodevelopmental Surveillance for Risk Factors
  • Immunizations
  • Early identification and diagnosis of disease
  • Initial treatment or stabilization of disease
  • On-going disease education and management
  • Minimizing disease progression
​Possible Venues
  • Medical Homes
  • School-based Health Clinics
  • Wellness Coaches/Trainers
  • CAM Clinics
  • Medical Homes
  • School-based Health Clinics
  • Urgicare Centers
  • Emergency Departments
  • Retail Based Clinics
  • Medical Homes
  • Specialty Care Clinics
  • School-based Health Clinics?
  • CAM Clinics
Importance of Continuity (Therapeutic Partnership)
  • Extremely Important
  • Somewhat Important
  • Extremely Important
​Importance of Context
(Social + Family Histories)

  • Extremely Important
  • Somewhat Important
  • Extremely Important
​Amenable to Algorithms
  • Somewhat Amenable
  • Extremely Amenable
  • Somewhat Amenable
​Addressed in Training Programs
  • Limited Training
  • Extensive Training
  • Limited Training
​Incentivized Through Reimbursements
  • Minimal Incentives
    (due to bundling; low patient volume)
  • Major Incentives
    (large patient volume)
  • Minimal Incentives
    (low patient volume)
Long Term Returns on the Initial Investment
  • ​Large
  • Variable (depending on dx and age of the pt)
  • ​Moderate
Resources
  • CPR
  • PALS
  • Mental Health First Aid
​  

AAP Resources

  • Bright Futures: Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, provides detailed information on well-child care for health care practitioners. This includes recommendations on providing anticipatory guidance and screening for delays in social-emotional development.
  • The Resilience Project: This project is designed to provide resources for pediatricians and medical home teams to more effectively identify and care for children and adolescents who have been exposed to violence.
  • Reach out and Read: The AAP officially endorsed the Reach Out and Read model of early literacy promotion. Today, the Reach Out and Read model is also part of the AAP's official Bright Futures Guidelines for pediatric healthcare providers. Health care professionals incorporate this evidence-based model into practice by advising parents/caregivers about the importance of reading. Starting at the 6 month wellness visit, practices provide developmentally appropriate books to children.
View Translating the Science
View the Social-Emotional Safety Net Diagram
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