This document outlines Bright Futures in Practice: Mental Health, a guide for promoting mental health in children, adolescents, and families. It aims to provide prevention, early recognition, and intervention strategies in primary care settings. The guide was developed by experts in child development and mental health and covers topics like infancy, early childhood, middle childhood, and adolescence. For each developmental period, it discusses self, family, friends, and community and includes screening questions, areas of concern, and recommendations. It also has sections on specific mental health issues and provides tools to assess and support mental health. The goal is to help healthcare professionals and families promote good mental health from infancy through adolescence.

1. Bright Futures in Practice:
Mental Health

2. Every child and adolescent
deserves to experience joy, have high
self-esteem, have friends, acquire a sense of
efficacy, and believe that he
or she can succeed in life.

3. Goals
• Promote mental health in children, adolescents, and
families
• Provide prevention, early recognition, and intervention
strategies in primary care settings
• Encourage partnerships and collaboration between health
professionals, families, and communities

4. Development
• Funded by HRSA/Maternal and Child Health Bureau;
coordinated and published by the National Center for Education
in Maternal and Child Health, Georgetown Public Policy
Institute, Georgetown University
• Developed by an interdisciplinary panel of experts to provide
guidelines for mental health promotion for infants, children, and
adolescents
• Follows tradition of Bright Futures: Guidelines for Health
Supervision of Infants, Children, and Adolescents (1994; 2000;
2002)

5. Contributors
Introductory Material
Michael Jellinek, M.D., Chair
Judith S. Palfrey, M.D.
Robert Needlman, M.D.
Making Mental Health Supervision
Accessible
Kelly Kelleher, M.D., M.P.H., Chair
David K. Nace, M.D.
Sarah H. Scholle, Dr.P.H.
Infancy
Ann Stadtler, M.S.N., Chair
Kathryn Barnard, R.N., Ph.D.
T. Berry Brazelton, M.D.
Suzanne D. Dixon, M.D., M.P.H.
Denis Drotar, Ph.D.
Margot Kaplan-Sanoff, Ed.D.
Early Childhood
Barbara J. Howard, M.D., Chair
Raymond A. Sturner, M.D.
June Solnit Sale, M.S.W.
Roxane K. Kaufmann, M.A.
Middle Childhood
Eve Spratt, M.D., Chair
Cynthia Cupit Swenson, Ph.D.
Lisa Hand, M.D.
Janice Key, M.D.
Michelle Macias, M.D.
Linda Marsh, R.N.
Robert Needlman, M.D.
Adolescence
Martin Fisher, M.D., Chair
Stewart L. Adelson, M.D.
Alwyn T. Cohall, M.D.
Lois T. Flaherty, M.D.
Linda Juszczak, D.N.Sc., M.P.H., C.P.N.P.
Doris Pastore, M.D.
Sheridan A. Phillips, Ph.D.
Mark D. Weist, Ph.D.
Bridges
Bina P. Patel, M.D., Chair
Linden J. Cassidy, M.D.
Eve Spratt, M.D.
Mark Wolraich, M.D.

7. Organization of
Implementation Guide
• Making Mental Health Supervision Accessible
• Developmental Chapters
– Health Supervision Questions
– Key Points and Tips
– Resources/References
– Areas of Concern
• Bridge Topics
– Assessment
– Interventions
• Tools

8. Accessibility
• Making Mental Health Supervision Accessible
– Making Mental Health Supervision Accessible
– Managing Time and Reimbursement Issues
– Continuity of Care
– Training
– Cultural Competence
– Attitudes About Mental Health
– Coordination and Referral

9. Developmental
Chapters
• Developmental Chapters
– Infancy (ages newborn–11 months)
– Early Childhood (ages 1–4)
– Middle Childhood (ages 5–10)
– Adolescence (ages 11–21)

10. Developmental
Chapters
• Each developmental chapter is organized into four
functional areas
– Self: How children see themselves
– Family: How children relate to family members and
function at home
– Friends: How children socialize with peers and
friends
– Community: How children function at school and
within their community

11. Developmental
Chapters
• Health Supervision Questions from Bright Futures:
Guidelines for Health Supervision of Infants, Children, and
Adolescents, Second Edition
– Is Carlotta easy or difficult to console?
– How do you deal with tantrums?
– Does Kim bring friends home? Does she go to friends’ homes?
– What does Peter do when he is stressed, angry, or frustrated?
– What would you do if someone pressured you to have sex?
– What do you think about smoking? Chewing (or spit) tobacco?
Drinking? Taking drugs?

12. Infancy
• Self
Temperament; Regulation
• Family
Attachment; Family Formation
• Community
Stimulation

13. Early Childhood
• Self
Self-Control; Self-Esteem
• Family
Cooperation; Sibling Relationships
• Friends
Socialization
• Community
School Readiness

14. Middle Childhood
• Self
Self-Esteem/Inner Life
• Family
What Matters at Home
• Friends
Friendships
• Community
School Functioning

15. Adolescence
• Self
Self-esteem; Mood; Body Image; Sexuality
• Family
Identity and Independence
Family Relationships
Roles, Rules, and Responsibilities
• Friends
Friends and Leisure Activities
• Community
School Functioning
Injury Prevention
Violence Perpetration and Exposure
Substance Use and Abuse

16. Developmental Chapters
• Areas of Concern: Examples
– Insecure Attachment
– Severe Tantrums
– Difficulty Forming Friendships
– Bullying
– Academic Difficulties and Low Self-esteem
– Mood Problems

17. Developmental Chapters
• Office Practices to Promote Family
Partnership
• Community Practices to Promote Child
Mental Health
• Developmental Checklists

18. Bridges
• Anxiety Disorders
• Attention Deficit
Hyperactivity Disorder
• Child Maltreatment
• Domestic Violence
• Eating Disorders
• Learning Disabilities
• Mental Retardation
• Mood Disorders
• Oppositional and
Aggressive Behaviors
• Parental Depression
• Pervasive Developmental
Disorders
• Substance Use Disorders
Bridge Topics

19. Bridges
• Each Bridge topic is organized as follows
– Key Facts
– Description of Symptoms
– Commonly Associated Disorders
– Interventions

20. Bridges
• Potential Interventions
– Suggested tools and methods for assessment
– Guidelines for crisis stabilization
– Interventions that may be implemented at the problem stage
before more severe disorders develop
– Strategies for primary care management of the mental health
problem or mental disorder
– When to consider a mental health referral and types of
referral services to be considered
– Ongoing collaboration with mental health professionals and
other service providers
– Further resources and references

21. Mental Health Tool Kit
• Tools for Health Professionals
– Screening measures/questionnaires
– Resource lists
– Interactive handouts
– Forms to facilitate communication with schools
• Tools for Families
– Health education handouts
– Reading lists for families/children

22. Mental Health Tool Kit
• Sample Tools for Health Professionals
– Pediatric Symptom Checklist (PSC)
– Edinburgh Postnatal Depression Scale (EPDS)
– Postcard Satisfaction Survey
– Homework Problems
• Sample Tools for Families
– How to Soothe a Crying Infant
– Teen Dating Violence
– IEP Meeting Checklist
– Homework Tips

23. Implementation
Bright Futures in Practice: Mental Health can be used to
• Provide information to health care professionals
about the essentials of mental health promotion
• Identify the support that infants, children,
adolescents, and families need for good mental
health
• Develop and implement mental health promotion
programs and policies

24. Implementation
Bright Futures in Practice: Mental Health has
applications for a broad range of settings, including
• Primary clinical care
• Infant mental health programs
• Child care centers
• School-based health centers
• Training Programs
• Parent education programs

25. Contact Information
Bright Futures in Practice: Mental Health
To order, visit
www.brightfutures.org
For more information, contact
Mary C. Froehle, Ph.D.
E-mail: mfroehle@ncemch.org