Best Practices for State & Local Oral Health Programs ASTDD Best Practices Project March 2010 Introduction to Best Practices Optimal oral health across the lifespan…

Need for Best Practices Oral Health in America: A Report of the Surgeon General Building Infrastructure and Capacity in State and Territorial Oral Health Programs Prepared by: ASTDD National Call To Action To Promote Oral Health A Public-Private Partnership Under the leadership of The Office of the Surgeon General

Need for Best Practices To improve oral health and general health status To improve systems of care

Developing Best Practices What will be your program’s purpose for developing best practices?

Association of State & Territorial State Dental Directors (ASTDD ) Best Practices Project

ASTDD Best Practices Project Purpose Build more effective state, territorial and community oral health programs. For: Expand Infrastructure & Capacity Respond to National Call to Action Advance Healthy People 2010

ASTDD Best Practices Project Goal Promote the development of best practices by state, territorial and community oral health programs to enhance the oral health of Americans and reduce disparities.

Uses of Best Practice Information Use as building blocks Share ideas & lessons learned Raise awareness of oral health Promote collaborations Update guidelines

End-Users of Best Practice Information Best Practices Dental Directors Public Health Programs Coalitions ConsumersFunders Professional & Advocacy Organizations Government Officials & Staff

Best Practices for State & Local Oral Health Programs Using Best Practice Concepts Optimal oral health across the lifespan…

Best Practice Concepts 1. A best practice is a methodology that, through experience and research, has proven to reliably lead to a desired result. 2. Using best practices is a commitment to using all the knowledge and technology at one's disposal to ensure success.

Best Practice Concepts 3. Best practices do not have one template or form for everyone to follow. 4. “Best practice” does not commit people or organizations to one inflexible, unchanging practice.

Best Practice Concepts 5. Best practices is a philosophical approach based around continuous learning & continual improvement. 6. Learning & transfer of best practices is an interactive, ongoing & dynamic process that cannot rest on a static body of knowledge.

Best Practices for State & Local Oral Health Programs Best Practice Criteria Optimal oral health across the lifespan…

“Best Practice” “Best” from whose perspective and using what criteria?

Obtain Input from End-Users for Best Practice Criteria Build consensus through selection & ranking of BP criteria - Early buy-in Collect additional information to guide selection of BP criteria - Types of BP information end-users need - Public health strategies in use - Self-reported successful practices

Association of State & Territorial State Dental Directors (ASTDD ) Best Practices Project Setting Best Practice Criteria

ASTDD Best Practices Project Input from States State surveys: Developed list of BP criteria Ranked BP criteria Identified categories of Best Practices information states wanted Obtained listing of states’ reported top strategies and successful practices

ASTDD Best Practices Project Best Practice Criteria Impact / Effectiveness Efficiency / Cost Effectiveness Demonstrated Sustainability Collaboration / Integration Objectives / Rationale

ASTDD Best Practices Project Best Practice Criteria Impact / Effectiveness Provided benefits to the oral health care and well-being of certain populations or communities Efficiency / Cost Effectiveness Showed costs and expenses are appropriate to benefits achieved Demonstrated Sustainability Demonstrated sustainable benefits and/or demonstrated that the practice been sustainable within populations/communities and/or in states/territories

ASTDD Best Practices Project Best Practice Criteria Collaboration / Integration Built effective partnerships/collaborations among various organizations and integrated oral health with other health projects and issues Objectives / Rationale Addressed HP 2010 objectives, met the National Call to Action to Promote Oral Health, and/or built basic infrastructure and capacity for oral health programs

ASTDD Best Practices Project “Best Practice” Definition “Best Practice” is a service, function or process that has been fine-tuned, improved and implemented to produce superior results that demonstrate impact/effectiveness, efficiency, sustainability, and collaboration/integration, with appropriate objectives/rationale.

Best Practices for State & Local Oral Health Programs Best Practices Applying the Science Optimal oral health across the lifespan…

Best Practice Translate Research into Practice ■ Research evidence supporting the effectiveness & cost-effectiveness of a dental public health strategy ■ State of the science to design and implement programs and services

Why evidence? ■ Constant or diminishing resources require that public health programs focus on effective and efficient practices ■ “Evidence-based” approaches incorporate the best available scientific information into decision-making* *Based on Sackett et al., BMJ 1996

Systematic Reviews ■ Preferred method for identifying available knowledge; determining what is “best”; and summarizing it in a useful manner* ■ Rule-based process reduces bias and error in reviewing and summarizing findings Bader J et al., J Am Dent Assoc 2004; Mulrow C et al., American College of Physicians 1998

Process in Analyzing a Best Practice Approach ■ Describe the public health strategy ■ Evaluate the evidence for effectiveness and cost effectiveness of the strategy ■ Set initial review standards for Best Practice criteria ■ Learn from state/community practices that show successful implementation methods

In the Absence of Research Evidence ■ Realize that the intervention may or may not be effective ■ Review available information (e.g., related policies and position statements; theoretical rationale; consensus of expert opinion; descriptive data) ■ Identify and implement evaluative measures ■ Consider any unintended harms that could result from the intervention

ASTDD Best Practices Project Use of Evidence-Based Information BP Project uses evidence-based information: ■ In analyzing a Best Practice Approach ■ In promoting its use for program development, implementation, and evaluation ■ In sharing state of the science information on the ASTDD Website

Best Practice Approach Evaluation of Evidence Promising Proven Approaches …… … Approaches Strength of Evidence Research + Research +++ Expert Opinion + Expert Opinion +++ Field Lessons + Field Lessons +++ Theoretical Rationale+++

A Best Practice Approach Report Research Evidence

Summary of Research Evidence

Best Practices for State & Local Oral Health Programs Best Practices Field Lessons & Support Network Optimal oral health across the lifespan…

Successful Practices Project’s Database 48 states and 2 territories provided submissions 230+ successful practices described An expanding collection

Successful Practice Description Content History Justification Inputs, Activities, Outputs & Outcomes Budget Estimates Lessons Learned/Plans for Improvement Available Information Resources Best Practice Criteria Contact Persons for Inquiries

Successful Practice Descriptions Nevada’s State Oral Health Plan

Ongoing and Dynamic Development of Best Practices Identify Best Practices Cultivate Best Practices Promote Best Practices Collaboration Integration Science & Art of Successful Implementation Supportive Environment

Project’s Developing Role: Building a Supportive Environment A support network Partners’ support Building of evidence State of the science Capacity building tools Program & policy evaluation

Best Practices for State & Local Oral Health Programs Using Best Practice to Build Infrastructure & Capacity Optimal oral health across the lifespan…

Build Infrastructure & Capacity 1999 ASTDD Project State dental directors from 43 states participated 10 essential elements identified

Build Infrastructure & Capacity Essential Elements Surveillance System Leadership State Plan Policies Communication &Education Linkages / Partnerships Population-based interventions Community capacity Health systems interventions Leveraging resources

Best Practice Approach Reports 1. State Oral Health Surveillance System 2. State Oral Health Coalitions 3. State Oral Health Plans 4. Mandate for a State Oral Health Program 5. Community Water Fluoridation 6. School Sealant Programs 7. School Fluoride Programs 8. Workforce Development 9. Oral Health of Individuals with SHCN

Best Practice Approach Reports (continued) 10. Improving Children’s Oral Health through Coordinated School Health Programs (released March 2010) 11. Prevention and Control of Early Childhood Tooth Decay (released March 2010)

Building Infrastructure 1999 to 2007 Comparison State oral health surveillance systems 8 to 30 states State oral health coalitions 20 to 41 states State oral health plans 7 to 23 (33) states; 5 in development

Best Practices ASTDD Best Practices Project Optimal oral health across the lifespan… The Journey Continues