Key Goal

2. Key Goal Connected Kids: Safe Strong Secure is an AAP program designed to support clinicians’ efforts to prevent youth violence by promoting the development of resilient children.

3. Why Is This Important? • Violence is a major cause of childhood morbidity and mortality in the United States. • Homicide is the 2nd leading cause of death for 13- to 21-year-olds • The leading cause of death for African Americans 13 to 21 years old1 • Increase in community violence during 1990s • 21st century rates in the United States still among the highest in the world

4. Why Is This Important? • Many parents and pediatricians feel community violence screening should be routinein well child care.2-5 • Results from the 1998 and 2003 AAP Periodic Surveys of Fellows show that a majority of pediatricians feel unprepared to manage community violence.2-4

5. Why Is This Important? Parents want more doctors to discuss community violence.5 Results from the National Survey of Early Childhood Health

6. Connected Kids provides… Tools and strategies to help parents raise resilient children: • Educational materials for parents and youth • Effective anticipatory guidance • Developmentally appropriate guidelines • Easy-to-use Clinical Guide with links to research

7. Development Process Development of Connected Kids included6: • Input from parents, clinicians, and other experts • Testing of program materials in focus groups with diverse families and clinicians7 • Incorporation of stakeholder feedback • A broad and respectful approach for all of the educational materials • Coordination with other AAP efforts

8. Objectives Connected Kids will: • Strengthen the connections among children and youth, their families, and their community • Reduce risk factors by building resilience8

9. Connected Kids . . . • Uses an asset-based approach to prevention that: • Emphasizes the identification and enhancement of strengths • Enhances clinician-family alliance • Helps parents with strategies to: • Promote positive development • Develop prosocial interpersonal skills • Obtain support and resources to help raise children

10. Assets: Goal: Help improve child’s resilience Assess family strengths Link to community resources Risks: Goal: Reduce known risks Screen for risk factors Refer to services Asset- Versus Risk-based Approaches to Guidance

11. Connected Kids Includes: • Clinical guide • Counseling schedule • Handouts for parents and families • Web site • This training presentation • Database of violence prevention materials • Success stories

12. Clinical Guide • This presentation supplements the clinical guide, available online at www.aap.org/ConnectedKids • Clinical guide contains • Background information • Counseling schedule • Visit-by-visit suggestions from birth to age 21

13. Child-Centered Parent-Centered Physical Safety Community Connections Building Blocks Connected Kids centers on 4 overlapping themes of anticipatory guidance

14. Child-Centered Child-Centered Recognizes: • Child’s changing abilities • Cognitive development of child • Related parental concerns Parent- Centered Community Connections Physical Safety

15. Parent- Centered Parent-Centered Child-Centered • Addresses the importance of parental supports • Incorporates the idea that parents develop along with the child • Contributes to the quality of family life • Promotes positive parenting Community Connections Physical Safety

16. Positive Parenting Teaching desired behavior begins with a positive and nurturing foundation9 What to do when your child misbehaves How to manage conflict and teach responsibility Ways to nurture your children and prevent misbehavior

17. Community Connections Community Connections Child-Centered • Research underscores the importance of10: • Social capital: a measure of the interconnectedness among people with their community • Community connections • Clinicians can help connect families to community resources Parent- Centered Physical Safety

18. Child-Centered Physical Safety Physical Safety • Counseling schedule focuses on violence and intentional injury • Complements AAP’s TIPP® (The Injury Prevention Program) • Handguns in the home placed in the context of child development • Provides objective information to help families make their own decisions Parent- Centered Community Connections

19. Connected Kids Counseling Schedule • Lists topics to introduce and reinforce at each visit • Provides asset-based assessment and anticipatory guidance for each visit • Links to use of parent and patient brochures: • Distributed when a topic is first introduced • Promote discussion between provider and family • Give useful information to foster the development of strong, resilient children

20. Counseling Schedule

21. Anatomy of a Brochure Front Cover Cover image visually conveys core message Designed by Artists for Humanity, a non-profit arts and entrepreneurship program for Boston teens.

22. Anatomy of a Brochure Content • Each brochure addresses one specific issue • Content based on all four building block themes • Reading level: 2nd to 6th grade • Contains concrete examples for key concepts

23. Anatomy of a Brochure Back Cover • Summarizes topics • Space provided for: • Parent/patient guidance • Follow-up suggestions • Community resources • Next appointment • Practice name and address

24. Counseling Schedule Infancy & Early Childhood 2 days – 4 years Middle Childhood 5 – 10 years Adolescence 11 – 21 years

25. Ideas for Optimal Use While implementing Connected Kids with an individual family depends on a family’s starting point—and the family’s interest in our input—we can begin to consider some strategies for implementation in the following areas: • Intake Forms • Counseling • Educational Materials • Practice Changes • Community Connections

26. Intake Forms • Use the Bright Futures Pediatric Intake Form • Introduce Connected Kids in a cover letter to families • Use information gathered to prioritize issues for families and tailor the program • As your relationship with a family evolves, it may become easier to discuss sensitive topics • Use the information gathered at every visit

27. Counseling • Be sensitive to issues that might be difficult for a particular family • Include both statistics and stories • Prioritize topics covered on the families’ needs • Use the adolescent brochures to facilitate new ways for parents and teens to talk

28. Educational Materials • Use brochures to introduce sensitive topics, such as domestic violence • Encourage the parent to share the information with other adults caring for the child • Ask support staff to help distribute materials while patients are waiting to be seen

29. Educational Materials • Personalize the brochures: • Circling or underlining a passage increases the likelihood that your advice will be followed • Write down family-specific information in the box on the back cover during the visit • Suggest placing it on the refrigerator so the cover image can be a reminder of what to do • Encourage parents/patients to write questions in the box on the back while they are waiting

30. Practice Changes • Involve all office staff; receptionists observe how parents and children interact • Use the Counseling Schedule from the Clinical Guide to document when you have introduced and reinforced topics • Talk with colleagues about how they have successfully implemented Connected Kids

31. Community Connections • Become familiar with programs in your community • If resources do not exist, advocate for services • Get involved: • Join coalitions working to rid the community of violence • Speak to community and school groups • Talk with the local media

32. References 1. Centers for Disease Control and Prevention. Web-based Injury Statistics Query and Reporting System [Online]. (2001) National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. Available at: www.cdc.gov/ncipc/wisqars 2. American Academy of Pediatrics. AAP Periodic Survey of Fellows #38. 1998 3. American Academy of Pediatrics. AAP Periodic Survey of Fellows #55. 2003 4. Trowbridge MJ, Sege RD, Olson L, O’Connor K, Flaherty E, Spivak H. Intentional injury management and prevention in pediatric practice: results from 1998 and 2003 American Academy of Pediatrics Periodic Surveys. Pediatrics. 2005;116:996-1000 • Kogan MD, Schuster MA, Yu SM, et al. Routine assessment of family and community health risks: parent views and what they receive. Pediatrics. 2004;113(6 suppl):1934-1943 6. Sege RD, Flanigan E, Levin-Goodman R, Licenziato VG, De Vos E, Spivak H. American Academy of Pediatrics’ Connected Kids program: case study. Am J Prev Med. 2005;29(5 suppl 2):215-219 7. Sege RD, Hatmaker-Flanigan E, De Vos E, Levin-Goodman R, Spivak H. Anticipatory guidance and violence prevention: results from family and pediatrician focus groups. Pediatrics. 2006;117:455-463 8. Resnick MD, Ireland M, Borowsky I. Youth violence perpetration: what protects? What predicts? Findings from the National Longitudinal Study of Adolescent Health. J Adolesc Health. 2004;35:424.e1-424.e10

33. References 9. University of Minnesota Extension Service. Positive Parenting. Minneapolis, MN: University of Minnesota; 2000 10. Drukker M, Kaplan C, Feron F, van Os J. Children’s health-related quality of life, neighbourhood socio-economic deprivation and social capital. A contextual analysis. Soc Sci Med. 2003;57:825-841

34. Acknowledgments Howard Spivak, MD Robert Sege, MD, PhD Elizabeth Hatmaker-Flanigan, MS Bonnie Kozial Vincent Licenziato Kimberly Bardy, MPH This project was supported by Grant No. 2001-JN-FX-0011 awarded by the Office of Juvenile Justice and Delinquency Prevention, Office of Justice Programs, U.S. Department of Justice. Points of view or opinions in this document are those of the author and do not necessarily represent the official position or policies of the U.S. Department of Justice.