What’s the Head Start PIR and How Can the PIR Be Used for Program Improvement? Dental Hygienist Liaison Quarterly Webinar June 3, 2016 Reg Louie, D.D.S., M.P.H. Harry Goodman, D.M.D., M.P.H. Anne Gibbs, R.D.H., B.S. Kathy Hunt, R.D.H., ECPII

General Reminders This webinar will be recorded and archived on the ASTDD website Everyone except the presenters have been muted. Questions will be addressed after the speakers are finished. Please “raise your hand” by clicking on the icon at the top of your screen that looks like a person. You will be recognized in turn and unmuted so you may ask your question. Please answer the evaluation questions at the end of the webcast.

Learning Objectives Participants will: become familiar with the Head Start PIR and the oral-health- related items in the PIR, and what those data may show; learn how can PIR data be used to assess how a program compares to other local, state, and national Head Start programs; become familiar with other important issues that the PIR data do not reveal; learn how can PIR data were used to identify issues to address and to stimulate discussion about possible solutions; and, learn how two state DHLs have used PIR data and engaged community oral health partners to address “next steps” to assist in the resolution of issues identified by the PIR data.

What is the Head Start PIR? The PIR provides comprehensive data on the services, staff, children, and families served by Early Head Start (EHS)/Head Start (HS) programs nationwide All grantees and delegates are required to submit PIR reports to the HHS OHS annually Self-reported data The PIR data are compiled for use at the federal, regional, state, and local levels http://eclkc.ohs.acf.hhs.gov/hslc/mr/pir

Oral Health HS PIR Requirements PIR #C.17: The number of children with continuous, accessible dental care provided by a dentist: # at enrollment # at the end of enrollment year Dental home (as defined in the PIR): An ongoing source of continuous, accessible dental care provided by a dentist PIR #C.18: The number of children who received preventive care since last year’s PIR was reported: Preventive care (as defined in the PIR): Includes fluoride application, cleaning, sealant application, etc.

Oral Health HS PIR Requirements (cont’d) PIR #C.19: The number of children…who have completed a professional dental exam since last year’s PIR was reported: # at the end of enrollment year Professional dental exam (as defined in the HS Performance Standards): must incorporate the requirements for a schedule of well child care utilized by the EPSDT program of the Medicaid agency of the State in which they operate

Oral Health HS PIR Requirements (cont’d) PIR #C.19.a.: Of the number of children in C.19, the number of children diagnosed as needing dental treatment since last year’s PIR was reported; and, of these children the number who received or are receiving dental treatment: # at the end of enrollment year Dental treatment (as defined in the PIR): Includes restoration, pulp therapy, or extraction Does not include fluoride application or cleaning

Oral Health EHS PIR Requirements Infant & Toddlers PIR #C.20: Number of all children who are up-to-date on a schedule of age-appropriate preventive and primary oral health care according to the relevant state’s EPSDT schedule at the end of the enrollment year Pregnant Women PIR #C.21: Number of all pregnant women who received a professional dental examination(s) and/or treatment since last year’s PIR was reported # of pregnant women

Oral Health PIR Data for U.S. FY 2013-2015 PIR Indicator Related to Oral Health 2013 2014 2015 % Enrollees in US with a dental home 93% 91% % with professional dental exam 86% 85% 83% % diagnosed as needing follow-up Tx 19% 18% % receiving/have received needed Tx 80% 75% 73% % receiving preventive care % children ages 0-2 up-to-date on State Dental EPSDT Schedule 77% 78% 74% % pregnant women with completed dental exam 40% 39% 36%

PIR Oral Health Project Purpose/Methods [1] Begin to develop a data-driven model to help NCH and HS regional offices use PIR data to monitor HS grantees’ compliance with OH-related PIR requirements and to: Inform the development of follow-up and T/TA plans Reviewed 2011 and 2012 PIR data for grantees in 6 states focusing on 3 indicators (% examined, % needing Tx, % receiving/received Tx) Did not review % with “dental home,” % up-to-date with state EPSDT schedule, % pregnant women with exam or treatment or % with preventive care

PIR Oral Health Project Purpose/Methods [2] In analyzing data and for prioritizing grantees: Most weight given to % children w/ professional dental examination Less weight to % received/receiving dental Tx Least weight to % Dx as needing follow-up Tx Other considerations, some weight given to: How grantee’s data compared to the statewide average How % of children who received/receiving dental treatment compared to the reported % of children with continuous access to oral health care at year’s end (dental home) The size of grantee Considered grantee’s trend over 2 year time frame ID’d 10 lowest performing grantees in each state

PIR Oral Health Project – Findings All six pilot project states had higher % than the national average for children with completed professional dental exam and those Dx as needing Tx Three states had higher % percentages for children who received/are receiving dental Tx Variation among states in % children who received/are receiving dental Tx Variation within states, i.e., lowest-performing grantees skewed the state average, especially for % children with dental exams and for those who have received/are receiving dental Tx

PIR Oral Health Project – Other Findings Number of programs had significant drop-offs in 2012 from 2011 for % children with professional dental exams as well as the % of those needing Tx Of these, some were larger grantees (300+ children) with only 1-3% of children needing dental treatment Dental home data not reviewed/analyzed in detail because of variations in applying the definition of “continuous access to dental care” Some cases with identical percentages for dental home, preventive care and “completed a professional dental exam”, yet many of these PIR reports did not have similar % for “received/or receiving dental treatment”

PIR Oral Health Project Recommendations Expand pilot to one state in each region and expand review/analyses to 4 years including the most recent Share the analysis of grantees with the OHS, ROs and state Dental Hygienist Liaisons (DHLs). As appropriate, expand analyses, e.g., to better define the OH issues confronting the grantees “Having received/receiving dental Tx” captures many grantee issues. When appropriate, additional elaboration, explanation or clarification of the data should be obtained and reviewed. Expand to identify and disseminate information on “best practices” among best performing grantees

PIR Oral Health Project State Follow-up Actions Report submitted to OHS by NCH and accepted as revised in Spring 2014 Added 2013 PIR data to review and analysis of grantees in six pilot states; modified prioritizations accordingly Drafting specific-report revision for individual ROs with respective lowest performing grantees and offering direct follow-up conferencing with each to discuss possible “next steps” Models for individual state follow-up actions in Kansas and Colorado

PIR Oral Health Project State Models—Colorado Initial contact – PIR Project; collaborative efforts to identify issues with lowest PIR performing HS programs in Colorado and possible “next steps”, e.g., worked with RO PS and T/TA staff ID initiatives/priorities/activities into which oral health or Head Start can be integrated (HS health literacy, family and community engagement, staff development; CF3, HS-BSS, COHP trainings) Linkage between CO-PIOHQI and state HSA and State HS Collaboration Office and local HS/EHS programs Ongoing meetings to share, e.g., priorities, update/evaluate/explore/expand collaborations

PIR Oral Health Project State Follow-up Actions—Kansas Kansas Cavity-Free Kids, a statewide oral health initiative through the Kansas HSA to provides opportunities for families to increase oral health literacy DHL provides statewide leadership and TA to state and local HS programs (Oral Health Kansas; NCECHW-DHL; Early Childhood Task Force, Perinatal coalitions) DHL connects with HS programs with lowest PIR scores to determine issues/challenges. Offer TA where able and report concerns to Regional Office.

Oral Health PIR Data: FY 2013-2015 US-Kansas Comparison   2012-KS 2013-US 2013-KS 2014-US 2014-KS 2015-US 2015-KS Dental Home 90.59% 93.00% 86.97% 91.00% 89.67% 87.79% Preschool Completed Dental Exam 82.34% 86.00% 84.79% 85.00% 81.66% 83.00% 77.96% Preschool Needed Treatment 20.81% 19.00% 20.39% 19.97% 18.00% 18.22% Preschool Received Treatment 80.17% 80.00% 71.57% 75.00% 69.28% 73.00% 59.58% Preschool Preventive Care 87.96% 88.65% 89.26% 90.32% 0-2 up-to-date EPSDT 84.72% 77.00% 74.12% 78.00% 75.60% 74.00% 74.06% Pregnant Women Completed Dental Exam 41.75% 40.00% 42.86% 39.00% 32.30% 36.00% 28.08% I have captured our last 3 years of PIR data on this slide. The green column is data from 2012, which is the last set of data looked at by the PIR Oral Health Project Reg told you about. I wish I had a great success story to share with you, but you’ll see that when we compare our % to the US, they are nothing to write home about. The bad news first: the number of HS children receiving an exam in Kansas is consistently worse than the US average although you will see both the US and our state are trending downward, which is very disappointing. The same is true for those children receiving treatment. In KS case, our numbers have dropped dramatically. The most obvious reason that we can point to is that our Medicaid system switched over to managed care. Although we are no longer able to access the actual number of unduplicated providers, we feel that the provider network has shrunk substantially. The better news is that while the number of children needing treatment is still larger than the national average, we are making consistent progress on keeping our kids cavity free. The other good piece of news is that more HS children are receiving preventive services. We feel this is a because our safety net clinics are continuing to build their outreach with public health hygienists that provide preventive services on site…now if we can just get more of the dentists to come on site as well! We did a survey of HM several years ago as part of our evaluation of the impact of the Kansas Cavity Free Kids project. One of the changes we found is that the top reason for children not receiving treatment was parents lack of follow through. At the start of KCFK the most common reason was not being able to find a dentist that accepted Medicaid. Since then our state has adopted managed care and if we repeated the survey, I’m sure we would find that finding providers would be back on top. Both access and follow through are consistently the main reasons for incomplete care.

Preschool Preventive Care Preschool Completed Dental Exam Head Start Program Name Dental Home Preschool Preventive Care Preschool Completed Dental Exam Preschool Needed Treatment Preschool Received Treatment USD #489 Early Childhood Connections 100% 96.3% 92.59% 34.4% 95.35% Futures Unlimited, Inc. 96.74% 82.61% 86.96% 5% 75% COMMUNITY ACTION, INC. 99.32% 87.07% 76.87% 6.19% 14.29% Topeka Public Schools, USD 501 81.84% 83.33% 77.61% 0%   UNIFIED SCHOOL DISTRICT #383 93.72% 90.58% 85.86% 3.66% NORTHWEST KANSAS EDUCATIONAL SERVICE CENTER 96.42% 89.25% 97.49% 34.93% 76.84% Clay County Child Care Center 95.04% 21.74% 88% As interesting as it is to compare ourselves to the US averages, as a DHL what I found the most helpful was to look at each specific program across the state.

Ages 0 to 2 Up-to-Date Dental EPSDT Early Head Start Program Name Dental Home Ages 0 to 2 Up-to-Date Dental EPSDT Pregnant Women Completed Dental Exam KANSAS CHILDREN'S SERVICE LEAGUE 75.92% 47.64% 33.33% Heartland Programs 52.22% 94.54% 25.71% Futures Unlimited, Inc. 76% 64% 16.67% Dodge City Public Schools, USD# 443 44.71% 68.24% 37.5% Growing Futures Early Education Center 89.51% 71.43% NORTHWEST KANSAS EDUCATIONAL SERVICE CENTER 100% 82%

Current and Upcoming HS Strategies for Kansas KHSA annual Head Start Health Manager meeting Annual update on dental services, educational resources, and oral health legislation Offer support to all HS programs through monthly e-mail Contact low performing programs to determine barriers Contact high performing programs to capture best practices Explore closer relationship with RO PS and T/TA staff New Oral Health Kansas project (state oral health coalition) Working group to study barriers for pregnant women and children under age 3 receiving dental services Increase referrals by medical professionals for dental services Increase number of dentists comfortable with providing appropriate comprehensive services

National Center on Early Childhood Health and Wellness Toll-Free: (866) 763-6481 Email: health@ecetta.info Website: http://eclkc.ohs.acf.hhs.gov/hslc/tta-system/health/center

Still Have Questions? Contact Information: Dr. Reg Louie reglouie@sbcglobal.net Dr. Harry Goodman harrygoodman2307@gmail.com Anne Gibbs, RDH, BS Anne.gibbs@state.co.us Kathy Hunt, RDH, ECPII KHunt@OralHealthKansas.org Thank you!