Oral Care for School-Aged Children: WKRC In Cincinnati (Why Kids Receive Care) Lawrence F. Hill, DDS, MPH November 11, 2008 NNOHA Annual Meeting

School-based Dental Sealant Program

Sealants

Sealant Program Findings 34 – 47% of 8 year olds with untreated decay Pre 2000, 72 -78% received no care after one year

Case Management Program Pilot time-limited project Employed a social work grad student Letters to the parents of all children found to be in need of follow-up care offering referral assistance, utilizing community tx resources Letters followed by telephone contact Telephone contact followed by home visits Results: Of those in need of treatment, approximately 25% received care + value added (sibs and other family members)

2004 Pilot Programs Shuttle Dentistry (Take the kids to the dentist) The Dental Road Crew (Take the dentist to the kids) Interesting “middle class” bias

Shuttle Dentistry Move 3-4 dentists to a 6 chair dental clinic and have a dentist at each of 4-5 of the chairs and a dental hygienist at one chair A shuttle bus picks up a load of kids and drops off enough kids to fill the chairs and the waiting room As a child is completed they go to the waiting room and a child who has been waiting goes to a dental chair for treatment In the meantime, the shuttle has gone back to the school for another load and then returns the first load

Shuttle Dentistry: Advantages and Disadvantages Utilizes existing clinics (no capital) Utilizes existing staff Very efficient for clinical operations Disadvantages Requires intensive coordination Travel time Waiting time Treatment time Adds NO new capacity to the system – displaces current patients Cost for transportation

The Dental Road Crew

The Dental Road Crew 2-chair complete mobile dental office The van arrives at a school 30 minutes prior to the beginning of classes Parks immediately adjacent to the schools The school nurse and the appointment scheduler on the van work together to assure that both chairs are filled at all times Use electronic records and digital x-rays Kids are called from class to the van when the staff is ready for them

The Dental Road Crew Advantages and Disadvantages Minimizes time out of class Adds capacity to the dental tx system Great acceptance by kids, parents, school personnel and school nurses One van can serve multiple schools Disadvantages Capital expense Added capacity = added operational costs Storage, fuel, insurance

Treatment Rooms Fixed site Mobile vehicle

Inside of Van

dentalclinicmanual.com

Growing Well Cincinnati Collaborative Cincinnati Public Schools Cincinnati Children’s Hospital (pediatrics) Cincinnati Health Department (school nurses) Community Health Centers (primary care) Mind Peace (mental health/Junior League) CincySmiles Foundation (oral health) Lens Crafters (vision)

Growing Well Oral Health Partners CincySmiles Foundation Cincinnati Health Department Office of Community Dental Programs (dental clinics) School Nursing Program Cincinnati Children’s Hospital Medical Center Pediatric Dentistry Residency Program Cincinnati Dental Society Community Health Centers Private practices (individual and corporate)

Next Steps for Growing Well Geo mapping School centered maps with dental treatment resources plotted in concentric circles Dental treatment resource centered map with schools plotted in concentric circles Consider school preferences and existing relationships Match schools with appropriate tx resources and models Cost modeling utilizing dental interactive spreadsheet

School Nurses/Oral Health 2005/2006 school year incorporated oral health assessments with vision and hearing screenings for kids in grades K,1,3,5 2006/2007 school year screened more than 10,000 kids and found 28% in need of tx 89.6% received care Has stressed the system to the limits No ongoing preventive maintenance

WKRC Sealant Program Favorable ratio of school nurses to students Very efficient and capable coordinator With parental consent, presence not required Treatment resources Community Health Center Dental Clinics (3) Cincinnati Health Department Dental Clinics (5) Children’s Hospital Dental Residency Corporate Medicaid dental practice

Challenges Most communities do not have the treatment resources Requires significant school nurse cooperation Some FQHC’s try to stretch out the number of visits Dentists not comfortable doing as much tx as possible at the initial and subsequent visits Coordination intensive (shuttle program)

Consensus of What Works Best for the Kids, parents and School Staff ? Several mobile vehicles that could each have a case load of schools and Head Start programs, the ratio of which would be determined by the number of children, the annual number of new students and disease prevalence, and that each van be responsible for assessments, fluoride varnish, sealants and treatment

Knowing the Market Beware of the Entrepreneurs Be Competitive! “We provide care to all children” Do they cherry-pick Medicaid? Do they skim the quick, profitable procedures and leave the treatment to you or nobody Be Competitive! Don’t be afraid to sell your program

Lawrence F Hill DDS MPH CincySmiles Foundation 635 West 7th Street, Suite 309 Cincinnati, Ohio 45203 513-621-0248 larryhill@fuse.net