EFFECTIVE PARTNERSHIPS GUIDE: FQHCs and MSHS Programs Working Together to Improve the Oral Health of Migrant and Seasonal Head Start Children and their Families Jay Anderson, DMD October 26, 2011

I. INTRODUCTION Migrant and Season Head Start Programs, Children and Families History The Health Center Program How to Use This Guide

Overview 1 Overview of Migrant & Seasonal Head Start 2 Oral Health for Migrant Children 2 Strategies that are specifically designed to address the oral health needs and challenges of MSHS children 3 Contact Information 4

II. ABOUT HEAD START The Head Start Model of Comprehensive Services What are Head Start Performance Standards? HS Performance Standard: § 1304.20 Early Childhood Development & Health Services Early Periodic Screening, Diagnosis and Treatment (EPSDT) Dental Periodicity Schedules The Dental Home Program Information Report (PIR)

MSHS The Migrant Seasonal Head Start (MSHS) program is one of the largest community based service providers in the nation, providing a wide range of services to more than 35,657 migrant and seasonal children, ages birth to compulsory school age, and their families each year. The MSHS program provides education and support services to low-income children of migrant and seasonal farm workers and their families. Income below federal poverty guidelines Birth to compulsory school Age The entire family must have moved within the last 24 months in search of agricultural work 51% of income from agriculture within the last 12 months-families must meet this requirement each year

There were three distinct streams that migrant farm workers follow each year. Eastern Stream: Begin in Florida and travel up to Ohio, New York and Maine. Midwestern Stream: Begin in southern Texas and branch off through every Midwestern state. This stream is the most divergent, with some workers ending up in Washington state or Florida. Western Stream: Begin in southern California and hug the coast to Washington state, or head northeast from central California to North Dakota. Programs designed to be flexible based on crops and growing season. Programs run 8-10 hrs. a day, 5 days a week and when needed open on Saturdays during the pick of the harvesting season Open during extended summer months or year round if agricultural work is available in a given area Family PROFIE: Families move from one community to another in search of agricultural work More than half of the families income comes from agricultural work Primarily Spanish speaking, also families speaking indigenous dialects from Mexico such as Mixteco, Triqui and Zapoteco 75% of the families are a two parent family Migratory Patterns

MOU between HRSA & OHS to coordinate resources and align policies at the national level to express the commitment of the HRSA’s Migrant Health Center Program and OHS’s Migrant and Seasonal Head Start Program to foster strong working relationships at the national and local level for assuring access to quality, culturally competent comprehensive primary health care services in each State where programs exist. to support the development and strengthening of linkages between their programs at the local level.

MSHS & HRSA GeoMap Dr. Jay R. Anderson

III. ORAL HEALTH Importance of Oral Health Dental Caries “Tooth Decay” What You Should Know About Dental Disease

IV. EDUCATION PROGRAMS What Program Staff Should Know Anticipatory Guidance for Parents and Caregivers Classroom Activities for MSHS Children Examples: Cavity Free Kids Bright Smiles Other Oral Health Education Programs

V. DENTAL CARE The Dental Home Comprehensive Care Dental Caries Risk Assessment Oral Assessment The Dental Screening The Dental Examination Treatment Planning Preventing and Managing Dental Disease Completing Treatment Plans Evaluation and Quality Measurement

VI. FINANCING DENTAL CARE SERVICES Optimizing Medicaid and Children’s Health Insurance Program Funding Contracting with Federally Qualified Health Centers Partnering with Community Dental Practices

VII. PLANNING AHEAD Initial Contact Meeting Why an initial contact meeting? What are the goals? When should an initial meeting take place? Who should attend? What information should be shared and discussed?

VII. PLANNING AHEAD First Planning Meeting Purpose of the Meeting Who should attend? Creating a Mutual Plan Scheduling Future Meetings and Activities

VII. PLANNING AHEAD Subsequent Planning Meetings [Pre-Service Delivery] Ongoing Planning Agenda Items for Consideration

VII. PLANNING AHEAD Post-Service Delivery Meeting Assessing Processes and Outcomes Opportunities to Improve Celebration and Planning Next Cycle Resources and Tools

VIII. OTHER CONSIDERATIONS Barriers to Implementation Misunderstanding Regarding Roles, Responsibilities, and Resources Service Demands that Exceed Capacity Lack of Coordination

VIII. OTHER CONSIDERATIONS Keys to Success Early Planning Accountability Responsiveness to Needs of MSHS Children Programmatic and Financial Resources Best Practices

GLOSSARY X. INDEX

Contact Information FRANK MAZZEO Region XII Regional Oral Health Consultant, and President/Chief Dental Officer Family Health Centers of S.W. Florida 239.278.3600 Fmazzeo@hcnetwork.org JAY R. ANDERSON, DMD, MHSA Director Practice Improvement, DentaQuest Institute 508.329.2406 jay.anderson@dentaquestinstitute.org FRANCISCO J. RAMOS-GOMEZ, DDS, MS, MPH UCLA School of Dentistry 310.825.9460 frg@dentistry.ucla.edu