Improving the Oral Health of School-Aged Children: Promising Approaches for Linking Them With Dental Homes Washington, DC May 11-12, 2006 Cincinnati Health Department/ Greater Cincinnati Oral Health Council School-Linked Clinic and Mobile Dental Van School-Linked Clinic and Mobile Dental Van Lawrence F. Hill, DDS, MPH Cincinnati Health Department, Dental Director Nancy L. Carter, RDH, MPH Cincinnati Health Department, Assistant Dental Director

History Pre 2004 Pre Inner-City School-linked/based hybrid clinics School-linked/based hybrid clinics Excellent in school-based Excellent in school-based Not good in linked Not good in linked 11 clinics – all antiquated 11 clinics – all antiquated Neighborhood health centers monopolized by adult emergencies and adult care Neighborhood health centers monopolized by adult emergencies and adult care 1982 – All school clinics closed

Sealant Program Results % of participants needed treatment 31-47% of participants needed treatment 78% of those received no care after one year 78% of those received no care after one year

Referral Failures Dental Assistant phone calls Dental Assistant phone calls Lists to school nurses Lists to school nurses Letters to parents Letters to parents Intensive case management Intensive case management

2004 Give Kids A Smile Day Linked one school with one 6-chair CHD clinic and two mobile vans Linked one school with one 6-chair CHD clinic and two mobile vans 40 dentist volunteers 40 dentist volunteers

Give Kids A Smile Day Organization Four Fridays in February Four Fridays in February Consents to all kids Consents to all kids Screened all with consents Screened all with consents Organized by number of decayed teeth per classroom Organized by number of decayed teeth per classroom ~ 300 kids and $80,000 gross ~ 300 kids and $80,000 gross

Subsequent Years Dental Society dropped out (now have their own volunteer clinic) Dental Society dropped out (now have their own volunteer clinic) We now move dentists and assistants from other clinics to supplement the Crest Smile Shoppe instead of volunteers We now move dentists and assistants from other clinics to supplement the Crest Smile Shoppe instead of volunteers We have paid transportation We have paid transportation Coordinated effort of the project coordinator, school-based health center, and the dental clinic. Coordinated effort of the project coordinator, school-based health center, and the dental clinic.

Numbers for 2005 Number of days = 21 (5 hour days) Number of days = 21 (5 hour days) Number of users = 425; encounters = 578 Number of users = 425; encounters = 578 Gross production = $216,118 Gross production = $216,118 Cost = $57,625 (salary + fringe + supplies + transportation) Cost = $57,625 (salary + fringe + supplies + transportation)Assumption: 2/3 Medicaid ($140,000) 2/3 Medicaid ($140,000) Medicaid pays about ½ of fees ($70,000) Medicaid pays about ½ of fees ($70,000) Thus, break even (only for costs shown) Thus, break even (only for costs shown)

+ Utilized current facility and staff - Doesnt increase community capacity, but may increase individual provider production

Lessons Learned School-Linked Program Requires: Intense organization Intense organization Reliable transportation Reliable transportation Cooperation of school staff (health center nurses) to coordinate consents/getting kids on buses, etc. Cooperation of school staff (health center nurses) to coordinate consents/getting kids on buses, etc. Resources of multiple providers at one place at one time Resources of multiple providers at one place at one time

Lessons Learned School-Linked Program Requires: Can be done with volunteers or paid staff (volunteer staff takes additional planning and coordination and is less reliable!) Can be done with volunteers or paid staff (volunteer staff takes additional planning and coordination and is less reliable!) Can provide continuous care for children in participating schools Can provide continuous care for children in participating schools Impractical to do with a solo private practitioner because of cost of coordinator and transportation Impractical to do with a solo private practitioner because of cost of coordinator and transportation Only works for schools that are in close proximity to safety net clinic Only works for schools that are in close proximity to safety net clinic

Alternative Model: Mobile Van High level of frustration in community over access to care for kids High level of frustration in community over access to care for kids Oral Health Regional Assessment and Planning Project (RAPP) – community request Oral Health Regional Assessment and Planning Project (RAPP) – community request School nurses and Head Start staff asked for a mobile van School nurses and Head Start staff asked for a mobile van

2004 Initiated Mobile Van Program Initiated Mobile Van Program Two chairs (1 Dentist, 2 Assistants, 1 Driver/Receptionist/Manager) Two chairs (1 Dentist, 2 Assistants, 1 Driver/Receptionist/Manager) Dentrix, direct digital radiography Dentrix, direct digital radiography

Funders My godfather at the Ohio Department of Health My godfather at the Ohio Department of Health Anthem Foundation of Ohio Anthem Foundation of Ohio Mayerson Foundation Mayerson Foundation United Way United Way

Capital Costs Capital Costs Van$315,000 Van$315,000 Dental Equipment 80,000 Dental Equipment 80,000 Digital/Electronics 80,000 Digital/Electronics 80,000 TOTAL $475,000

School-Based Clinic Construction Construction $100/sq. ft. x 400 $ 40,000 $100/sq. ft. x 400 $ 40,000 Equipment$ 80,000 Equipment$ 80,000 Electronics? Electronics? TOTAL$120,000

Targeting Blanket school with consent forms Blanket school with consent forms Sealant kids Sealant kids Kids who come to school nurse Kids who come to school nurse Nurse screenings Nurse screenings

Van Operations ,230 school children (users) 1,230 school children (users) 497 (40%) – diagnostic/preventive only 497 (40%) – diagnostic/preventive only 733 (60%) – diagnostic/preventive/treatment 733 (60%) – diagnostic/preventive/treatment 713 Head Start children (users) 713 Head Start children (users) 492 (69%) – diagnostic/preventive only 492 (69%) – diagnostic/preventive only 221 (31%) – diagnostic/preventive/treatment 221 (31%) – diagnostic/preventive/treatment

School Children Enrolled: 3,060 (6 schools) Enrolled: 3,060 (6 schools) Children participating: 1,230 (40%) Children participating: 1,230 (40%) Much higher participation in early grades Much higher participation in early grades Function of school principal and nurse Function of school principal and nurse

Lessons Learned About Vans Needs one strong dental staff person to provide liaison with schools Needs one strong dental staff person to provide liaison with schools Need a cooperative, designated school person to coordinate from inside (i.e. school nurse, office personnel, etc.) Need a cooperative, designated school person to coordinate from inside (i.e. school nurse, office personnel, etc.) Need linkages to pediatric specialists and to a private practice, safety net program, or dental school to provide back-up when van is not available Need linkages to pediatric specialists and to a private practice, safety net program, or dental school to provide back-up when van is not available

Lessons Learned About Vans Lessons Learned About Vans Need sound plan for provision of care and generation of revenue on days schools arent available Need sound plan for provision of care and generation of revenue on days schools arent available Need more vans Need more vans 16/62 schools in 2.5 years with only 40% participation 16/62 schools in 2.5 years with only 40% participation