Providing Dental Services in School-Based Health Centers: Lessons from the Caring for Kids Program Nancy Eichner, MUP, Senior Program Manager The Center for Health and Health Care in Schools June 15, 2006 National Assembly on School-Based Health Care Annual Conference, Portland, OR The Center for Health and Health Care in Schools

Caring for Kids Program History 3 – year initiative of the Robert Wood Johnson Foundation, announced in applicants received for 3 types of programs (Sealants, comprehensive, school-community partnerships) 7 grant awards February 2002 Average award: $225,000

Dental Health Grantees Methodist Health Care Ministries San Antonio, TX Montefiore Medical Center, Bronx, NY Columbia University, NYC, NY Samuel U. Rodgers CHC, Kansas City, MO St. John’s Community Health Investment Corp., Detroit, MI Children’s Hospital of NJ, Newark, NJ HEALS, Inc., Huntsville, AL

Caring For Kids Dental Initiative Project Goals Develop and expand dental services within school-based health centers Increase access to dental care for underserved populations Support the development of sustainable school-based dental models

Grantee SBHC Overview Snapshot quarter: January – March 2004 Number of schools: 17 School enrollment: 13,087 Median school enrollment: e.s. – 477, m.s. – 580 combined e.s./m.s. – 562; 1 h.s. – 4,296 Demographic of school population -- African Americans – 53% -- Hispanics – 38% -- Whites – 6% -- Asians – 3% -- Other – < 1%

Grantee SBHC Overview Average SBHC enrollment: 78% with health center enrollment ranging from 25% to over 100% Clinic users: 4,703; All clinic visits: 10,617; Average clinic visit: 758 Median clinic visits: 786 Dental visits: 1,952 (18%) Average dental visits per site: 139 Median dental visits per site: 124 Dental visits by gender: 54% female, 46% male High school: 63% female, 37% male

Dental Health Staffing January – March 2004 Hours DentistDental Hygienist Dental Assistant > 35 hrs/wk 1 (ES) 1 (HS) 2 (1 ES, 1HS) 20 – 35 hrs/wk 1 (HS) 01 (1MS) 10 – 20 hrs/wk 5 (3 ES, 2 ES/Ms) 5 (4 ES, 1 MS) 5 (3 ES, 2 ES/Ms) < 10 hrs/wk 8 (4ES, 2MS, 2ES/MS) 5 (2ES, 1MS, 2 ES/MS) 7 (4 ES, 1MS, 2 ES/MS) Total

Dental Services by Students Service No. of students Percent Exams/ Screenings 1,28624 Routine X-Rays Cleanings 1,05720 Sealants Fluoride Treatments 1,04120 Fillings 4008 Root canals 14.3 Crowns 15.3 Extractions 932

Caring for Kids Dental Services Provided by Service Type January - March 2004 Service -- ProcedureNumberPercent X-Rays 2,12441 Sealed Teeth 2,11041 Extractions 1413 Fillings Root Canals Crowns Totals 5,139100

Payment SourceNo. of Students (%) Medicaid fee-for- service 1,089 (19) Medicaid managed care 2,842 (49) SCHIP 189 (3) Private Insurance 760 (13) Uninsured/Self-pay 651 (11) Missing Information 283 (5) Health Insurance Status January - March 2004

Patient Care Revenues 5 of 7 projects billed Payment SourceBilled ($)Collected (%) Medicaid fee- for-service 133,271104,566 (78) Medicaid managed care 9,2931,215 (13) SCHIP 00 Private Insurance 16,42211,286 (69) Uninsured/Self- pay 10,1431,893 (19) Totals 169,129118,960 (70)

Caring for Kids Dental Health Lessons Learned #1 Partnering with community organizations is key to start-up, staffing, and on-site clinical and referral services Recruiting problems, staff turnover, recruiting problems, and clinic delays reduced productivity Patient care revenues can be generated through third-party billing

Caring for Kids Dental Health Lessons Learned #2 Integrating medical and dental activities is an important challenge to overcome System development is key to maximizing efficiently of services – billing, appointment procedures, quality assurance policy, and MIS

Contact Information The Center for Health and Health Care in Schools The Center for Health and Health Care in Schools 2121 K Street, NW Suite 250 Washington, DC Phone: Fax: Web Site: