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Spanish
for Pediatric Medicine new
A Practical Communication Guide Spanish for Pediatric MedicineEasy-to-use pocket guide, optimized for use with Bright Futures, includes an all-new audio program to help you communicate with Spanish-speaking patients and parents more effectively. For more information or to order, visit the AAP Bookstore.

Implement Bright Futures
in Your Practice
Using a Proven
Systems Approach new
3 volume setThis comprehensive, downloadable 3-Volume set of Bright Futures Training and Implementation Materials provides everything you need to implement the 6 key components of care:
  1. Use of a Preventive Services Prompting System
  2. Use of structured develop mental assessment
  3. Evaluation of parental strengths and needs
  4. Development of a recall and reminder system
  5. Development of linkages to community resources
  6. Identification of children with special health care needs

Healthy Active Living Prescription Pads new

rx pads
These attractive pads are available for free download to promote healthy eating and physical activity with the children in your practice. The pads are designed to be filled out by you along with the active involvement of the child and their parent/guardian.


Bright Futures Goals tool and resource kit

This new tool and resource kit provides materials for health supervision care from infancy through adolescence. It is designed to accompany and support Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition. The tools contained in the kit were developed reviewed, and piloted by multidisciplinary teams of pediatric health professionals. The tool and resource kit includes forms to streamline health supervision visits, documentation forms to reflect the richness of a Bright Futures visit and document work done, practice management tools, and additional tools designed to aid in screening and developing community linkages. Patient and parent handouts are also included to help the practitioner reinforce important topics discussed during the visit and deliver additional information.


The following Bright Futures Tool and Resource Kit materials are
available for download for review and reference purposes.
To incorporate forms into an Electronic Medical Record System
or to make multiple copies of specific items,
please contact aapsales@aap.org.

downloadable materials

Downloadable Materials:
Acknowledgements (PDF), Kit Contents and Development (PDF), Letter from AAP Executive Director (PDF)

 

visit forms

Click on title to reveal forms

 

 

 

  Adolescence (11 to 21 years)
   Developed by leading experts especially for early, middle and late adolescents

Bright Futures Adolescent Visit Forms Introduction

Early Adolescent Visits
Bright Futures Previsit Questionnaires and Supplemental Questionnaires for 11- to 14-year-olds must accommodate youth at very different developmental stages—prepubertal children, early and late puberty, and even adolescent mothers. Rather than specify an age, there are 2 sets of Previsit and Supplemental Questionnaires for these 4 visits. Practitioners can decide which forms are most appropriate for their patient populations and use them accordingly. Some practitioners feel that the Early Adolescent Visit questionnaires are appropriate for all youth in their practice, while others feel it would be helpful to use different forms for different patient groups.

Bright Futures Previsit Questionnaire—Older Child/Younger Adolescent Visits
does not include questions about sexual behaviors and is intended for use with younger or less physically mature youth. If youth completing this form do have concerns or questions about sexuality, sexually transmitted infections, and pregnancy, there are boxes in the patient concerns area of this form for them to check. Bright Futures Supplemental Questionnaire—Older Child/Younger Adolescent Visits does not ask questions about sexual behavior, although it does include a question that asks if the youth has discussed “relationships and sex” with a parent.

Bright Futures Previsit Questionnaire—Early Adolescent Visits
does ask about oral sex and sexual intercourse. If the question on oral sex or sexual intercourse is answered in the affirmative, there are additional questions at the end of Bright Futures Supplemental Questionnaire—Early Adolescent Visits that help the practitioner determine risk status. Neither 11- to 14-year questionnaire asks the more detailed risk assessment questions for syphilis and HIV (eg, “Do you trade sex for money or drugs or have sex partners who do?”). In this age group, these questions can be asked face-to-face when appropriate.

Middle and Late Adolescent Visits
The 15- to 21-year adolescent visits have been grouped into 2 age-based set of questionnaires, 15 to 17 Year Visits (middle adolescence) and 18 to 21 Year Visits (late adolescence). The risk assessment is appropriate for all of these visits.


Previsit Questionnaire

pdf 11-14 Year—Parent (PDF)


pdf 11-14 Year—Older Child / Younger Adolescent Patient (PDF)

pdf Early Adolescent Patient (PDF)


pdf 15-17 Year Middle Adolescent—Patient (PDF)


pdf 18-21 Late Adolescent—Patient (PDF)

Visit Documentation Form

pdf 11-14 Year (PDF)


pdf 15-21 Year (PDF)

Parent/Patient Education Handout

pdf 11-14 Year Parent (PDF)


pdf 11-14 Year Patient (PDF)


pdf 15-17 Year Middle Adolescent Parent (PDF)


pdf 15-17 Year Middle Adolescent Patient (PDF)

pdf 18-21 Year Patient (PDF)

 

Supplemental Questionnaire

pdf 11-14 Year—Parent (PDF)
pdf 11-14 Year—Older Child/Younger Adolescent Patient (PDF)
pdf Early Adolescent Patient (PDF)


pdf 15-17 Year Middle Adolescent—Patient (PDF)
pdf 18-21 Late Adolescent—Patient (PDF)

Medical Screening Questionnaire

 

pdf 11-14 Older Child/Younger Adolescent (PDF)
pdf 11-14 Early Adolescent (PDF)
pdf 15-21 Year (PDF)

Medical Screening Reference Table

pdf 11-21 Year (PDF)

Back to the top

 


Maternal Depression Screening
Patient Health Questionnaire-2 (PHQ-2) | Instructions
Patient Health Questionnaire-9 (PHQ-9) | Instructions
*Edinburgh Postnatal Depression Scale | Instructions

Parent and Family Assessment

Parental Screening Questionnaire: A Safe Environment for Every Kid | Instructions

Psychological and Behavioral Assessment
Pediatric Symptom Checklist (PSC-17) | Instructions
Pediatric Symptom Checklist (PSC-35) | Youth Report (Y-PSC) | Instructions
*Strengths and Difficulties Questionnaires (SDQ) | Follow-up | Instructions

Autism-Specific Screening Tools

Checklist for Autism in Toddlers (CHAT) | Instructions
Modified Checklist for Autism in Toddlers (M-CHAT) | Instructions

Substance Use
CRAFFT (Car, Relax, Alone, Forget, Friends, Trouble) Screening Questionnaires

Tool Name
Contact for Permission
*Permission is required to duplicate the following tools:
Edinburgh Postnatal Depression Scale

The British Journal of Psychiatry
E-mail: infoservices@rcpsych.ac.uk
Web site: http://bjp.rcpsych.org
Strengths and Difficulties Questionnaires (SDQ)
Robert Goodman
E-mail: youthinmind@gmail.com
Web site: www.sdqinfo.org

Note: The Bright Futures Tool and Resource Kit contains additional forms and materials.
To obtain these materials, order your CD today.

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