July 2016

THSteps: Anticipatory Guidance

The THSteps Health Education/Anticipatory Guidance
Anticipatory guidance is a federally mandated component of the THSteps medical checkup, and includes health education and counseling. Health education and counseling is required to assist parents or guardians, and clients to understand what to expect about the member’s development and to provide information about the benefits of healthy lifestyles and practices, as well as accident and disease prevention. Written material may also be given, but does not replace face-to-face counseling.

The optional THSteps clinical records include age-appropriate topics on the back of each form. Below you will find examples of topics to discuss in the Anticipatory Guidance section.

Examples of health topics to discuss for ages 4-8:

• School Readiness/Limitations
• Discussion on child’s developmental progression: speech, physical and social
• Nutrition
• Review of measurements/BMI and laboratory screening
• Children and adolescents: Dietary practices, special diets, food allergies
• Restaurant/fast food
• Development
• Review of milestones: Subjective review of milestones by observation and parent report
• Objective screening using a standardized screening tool
• ASQ or ASQ:SE, or PEDS
• B questionnaire annually beginning at 12 months of age
• Safety
• Discussion of child safety helmets, car seats, risk for drowning
• Physical Activity
• Discussion on child’s participation in sports and/or getting regular exercise
• Personal Hygiene
• Discussion on child taking regular baths, brushing teeth and toilet training
• School Activities
• Discussion on child’s interests in school and favorite subject
• Oral Health
• Referral to dentist if there is no dental home
• Discussion on daily teeth brushing and gum care

Anticipatory Guidance must be completed at each THSteps medical checkup and include recommended timeframe for next checkup. Although written materials may be provided, counseling is imperative and both must be documented.

(Reference May 2016 Texas Medicaid Provider Procedures Manual chapter 5.3.11.4)

Below is a sample of Health Education/Anticipatory Guidance section from the THSteps clinical record form, for a child age 3. Checking the box indicates that health education and anticipatory guidance were provided, but does not define topics discussed. Each topic discussed must be identified (circled, initialed, checkmark, etc.) for compliance.