Smiles Within Reach: Building A Sustainable Oral Health Program Jared I. Fine, DDS MPH Santa Barbara County Children’s Oral Health Summit June 25, 2010

Dental disease is nearly 100% preventable yet… In Head Start 37% of children have untreated decay In Head Start 37% of children have untreated decay Pre-school students have 2X more urgent conditions than average across CA Pre-school students have 2X more urgent conditions than average across CA 1 DDS to 1000 Medi-Cal children in SBC 1 DDS to 1000 Medi-Cal children in SBC Impact on children is devastating affecting eating, chewing, smiling, laughing and learning. Impact on children is devastating affecting eating, chewing, smiling, laughing and learning.

What is Public Health? “The science and art of preventing disease, prolonging health through organized community efforts and informed choices of society, organizations, public and private, communities and individuals” “The science and art of preventing disease, prolonging health through organized community efforts and informed choices of society, organizations, public and private, communities and individuals” C.E.A. Winslow, 1920 C.E.A. Winslow, 1920

Core functions of Public Health Assessment Assessment –Professionally and client defined health needs –Causal factors –Manpower, facilities, services, programs and financing to address those needs Assurance Assurance –Provision of or assurance of access to state of the art resources, services and information that is acceptable, comprehensive and continuous; Policy Development Policy Development –Means to create policies and programs via a participatory process that addresses the identified needs.

Essential Services of Public Health Monitor health status Monitor health status Diagnose and investigate Diagnose and investigate Inform, educate and empower Inform, educate and empower Mobilize community partnerships Mobilize community partnerships Develop policies and plans Develop policies and plans Enforce and laws and regulations Enforce and laws and regulations Link people to needed service/assure care Link people to needed service/assure care Assure a competent workforce Assure a competent workforce Evaluate health services Evaluate health services Research Research

Legal Basis Federal Law EPSDT(CHDP) defined by the Social Security Act specifies that dental services are : 1) to be provided at intervals that meet standards…in consultation with recognized dental organizations; 2)provided at medically necessary intervals; 2)provided at medically necessary intervals; 3) at minimum include relief of pain and infection, restoration of teeth and maintenance of dental health. 3) at minimum include relief of pain and infection, restoration of teeth and maintenance of dental health.

What do the professions say? “..every child should begin to receive oral health risk assessments by 6 months…” – American Academy of Pediatrics “… children should be seen by a dentist following eruption of 1 st tooth but no later than 12 months of age..” – American Academy of Pediatric Dentistry

Maternal and Child Health Oral Health Performance Objective for the nation: By % of 3 rd grade students will have had at least one dental sealant By % of 3 rd grade students will have had at least one dental sealant

California Maternal and Child Health Title V Plan Essential Services #2 Mobilize community partnerships between policymakers, health care provider, families, the general public and others to identify and solve maternal, child and adolescent health problems. #2 Mobilize community partnerships between policymakers, health care provider, families, the general public and others to identify and solve maternal, child and adolescent health problems. #7 Link women, children and youth to health and other community and family services, and assure access to comprehensive and quality systems of care. #7 Link women, children and youth to health and other community and family services, and assure access to comprehensive and quality systems of care.

What’s the ideal? Capacity to : Conduct surveillance and assessment Conduct surveillance and assessment Conduct individual and group health education; Conduct individual and group health education; Mobilize community and organizational partnerships Mobilize community and organizational partnerships

Community Water Fluoridation

Client Support Outreach Outreach Case management Case management Insurance assistance Insurance assistance

Clinical Preventive Services Dental screening Dental screening Fluoride varnish application Fluoride varnish application Dental sealants Dental sealants

Restorative Dental Treatment Primary Dental Care Primary Dental Care Specialty Care: e g Specialty Care: e g Pediatric Dentistry or Oral Surgery Pediatric Dentistry or Oral Surgery Sedation Hospital based services Sedation Hospital based services

WIC/Oral Health Collaborative To strengthen partnerships that enables WIC to be the “entry point” for dental care : To increase the number of at risk one year olds who : have access care; receive preventive dental services; have a dental home.

WIC Oral Health Program Internal promotion: flagging clients, signups, appointments, reminder calls, bookmarks; Internal promotion: flagging clients, signups, appointments, reminder calls, bookmarks; Nutrition assistant conducted group oral health education; Nutrition assistant conducted group oral health education; Dental hygienist oral assessment, toothbrush cleaning, fluoride varnish, anticipatory guidance, goal setting; Dental hygienist oral assessment, toothbrush cleaning, fluoride varnish, anticipatory guidance, goal setting; Case manager insurance assistance and dental appointment making. Case manager insurance assistance and dental appointment making.

Key 18 Month Results at WIC July1,2008-December # of children served 55% on Medi-Cal 1376 # prophylaxis/fluoride varnish treatments 1230 # of adults attending dental education class 1190 children 9-15 months 34% children 16-months-5yrs 46%

Financial Sustainability Dental hygienist-foundation grant and Dental hygienist-foundation grant and Medi-Cal fee for service Medi-Cal fee for service Case manager- First 5-Alameda County Case manager- First 5-Alameda County Program manager-MCH-federal/local (FFP) Program manager-MCH-federal/local (FFP) Admin. support-MCH-federal/local (FFP) Admin. support-MCH-federal/local (FFP) Nutrition assts. & admin. staff-WIC grant Nutrition assts. & admin. staff-WIC grant Dental treatment-Medi-Cal and Tobacco Master Dental treatment-Medi-Cal and Tobacco Master Settlement Agreement for uninsured Settlement Agreement for uninsured Future: FQHC partnerships Future: FQHC partnerships

Comprehensive School Oral Health Program School Based School Linked Examinations Case management Education for Dental Care Dental sealants for Insurance Fluoride treatments other services Parent notification Pave way to tx Educate to self care Limit lost school hours Build partnerships Minimize barriers eg geography, language. Positive dental experience

Financial Sustainability Dental hygienist: FFS Medi-Cal and private grant Dental hygienist: FFS Medi-Cal and private grant Dental assistant: City grant and MCH federal/local (FFP) Dental assistant: City grant and MCH federal/local (FFP) Dentist: FQHC clinic partners Dentist: FQHC clinic partners Case manager: CHDP federal/local (FFP) and local general funds; Case manager: CHDP federal/local (FFP) and local general funds; Administrative staff: MCH federal/local (FFP) Administrative staff: MCH federal/local (FFP) Project manager: MCH federal/local (FFP) Project manager: MCH federal/local (FFP)

Know Where the Money Is, “Go Where the Money Is!” eg. Federal Financial Participation (FFP) Federal Financial Participation (FFP) Title XIX Medicaid funding for MCH,CHDP Federally Qualified Health Centers (FQHC) Federally Qualified Health Centers (FQHC) Tobacco Tax Settlement funds Tobacco Tax Settlement funds Private and Public Foundations Private and Public Foundations State, City and County General Funds State, City and County General Funds In kind support – volunteers and staff In kind support – volunteers and staff First 5 First 5

Know where the money is and go where the money is! Federal Financial Participation (FFP) provides Title XIX funds for administrative activities (not clinical) to achieve these goals: Assist Medicaid eligible people to enroll and/or Assist Medicaid eligible people to enroll and/or Assist those on Medicaid to access services. Assist those on Medicaid to access services. One qualifying dollar can be matched with one or three Title XIX dollars. One qualifying dollar can be matched with one or three Title XIX dollars.

Federal Financial Participation Skilled licensed professional personnel including dentists, dental hygienists can... Skilled licensed professional personnel including dentists, dental hygienists can... For example: Coordinate a sealant program Coordinate a sealant program Plan a needs assessment Plan a needs assessment Establish an early childhood caries prevention program at WIC Establish an early childhood caries prevention program at WIC Matching Sources: Local General, State General, Philanthropic or Private Funds donated to the County. Matching Sources: Local General, State General, Philanthropic or Private Funds donated to the County.

Create Credible Need Develop a Constituency of Advocates Establish Broad Goals and Tangible Objectives Building Capacity for Sustainability

How do we on the Local Level obtain resources to improve Oral Health? Build and Nurture Partnerships Know where the money is, “Go where the money is!” Be an Opportunist

Opportunism Go where the money is Goals and Tangible Object Partnerships Credible NeedDevelop Advocacy

KNOWLEDGE PREVENTION

KNOWLEDGE STRATEGIES PREVENTION

POLITICAL WILL KNOWLEDGE STRATEGIES PREVENTION