NHS Dental Epidemiology Programme for England Training for the 2012/13 survey

The NHS Dental Epidemiology Programme – current structure  Governed by Regional Dental Leads with funding from SHAs  Stakeholder planning sessions propose a five-year programme  Final content agreed by Regional Dental Leads  Operated by North West Public Health Observatory (NWPHO) and The Dental Observatory (TDO)  Advised by BASCD as a partner  Regional coordinators – training and support  Field work commissioned by PCTs - ?LAs

Strategy – in the re-organising NHS  Deputy Chief Dental Office (CDO) working on the mainstreaming of the programme through Public Health England (PHE), including the funding.  Roles of Coordinators, Trainers and Standard Examiners - working to put on a firm footing in the new system.  Provider role should have been identified in TCS specs and contracts.  Move to develop other sources of data collected in Dental Practice via the new contract IT support.

Academic year PlanReasonsOther surveys in England 2007/08Five-year-oldsLinks with Wales Y1 and Scotland P1 Supports first St HA water fluoridation reports APHO profiles Health Survey for England Child height and weight measurement Local health and lifestyle surveys 2008/0912 –year-olds caries, ortho and perceptions of enamel opacities End of transitional commissioning – richer data required Maximising yield from existing data sources Wales Y7 and Scotland P7 APHO profiles Health Survey for England Child height and weight measurement Local health and lifestyle surveys Bringing together of existing data TDO/NWPHO 2009/10Collaborative work with Adult Dental Health Survey (ADHS) main survey examining and local supplementary surveys Links with ADHS Wales – planning survey of adults Scotland P1 APHO profiles Health Survey for England Child height and weight measurement Local health and lifestyle surveys Decennial ADHS 2010/11SHA defined activities Advice and some core protocols to be provided by NWPHO/TDO Links with WHO international comparison. Supports St HA water fluoridation reports – measurement of fluorosis Scotland P7 APHO profiles Health Survey for England Child height and weight measurement Local health and lifestyle surveys 2011/12Five-year -oldsAs above 2012/13?12 year oldsLink to Child Dental Health Survey (CDHS) As above plus Decennial CDHS First Five Year Timetable

NHS Dental Epidemiology Programme The next five year programme

Academic year Proposed planParallel activityReasonsOther surveys in England 2011/12Five- year-olds with bigger sample sizes to inform local planning ?census surveys ?special needs Supports St HA water fluoridation reports Links with Wales Y1 and Scotland P1 APHO profiles Health Survey for England Child height and weight measurement Local health and lifestyle surveys 2012/13 Three-year- olds at child care institutions Transition period when Primary care based data collection is tested Feasibility Validity of sample Validity of measures Needs of special groups also need to be included. Links with CDHS Links with Wales Y7 and Scotland P7 APHO profiles Health Survey for England Child height and weight measurement Local health and lifestyle surveys ? decennial CDHS 2013/14Collaboration with CDHS 2014/15Further development work with Primary care data collection 2015/16Five-year-oldsLinks with Wales Y1 and Scotland P1 Timetable proposed by Strategic Planning Workshop November Modified by RDPH Network

NHS DEP 2012/13 Survey of three-year-olds

Aim  To measure the prevalence and severity of dental caries in three- year-old children attending child care institutions in England.

Purpose:  To establish a baseline for caries levels in this pre-school cohort  To identify populations with high levels of disease and relate levels to those found among five-year-olds  To inform LAs about interventions to address Outcome Indicator of caries levels among five- year-olds  Timing, design, scale, targeted/universal

Previous surveys of pre-school children:  Widespread throughout Scotland  Feasibility survey by 24 PCTs in North West SHA  Survey of 3-4 year olds across inner North East London

Key features that will stay the same  BASCD standard criteria for recording caries Training and calibration (five-year-olds)  Examination methods Examine supine on table with mat Use Daray lamp Dry teeth with cotton rolls or buds  Charting  Entering data on DSP2  Reporting methods

Changes to accommodate different circumstances:  Preparation High level contacts with Directors of Public Health, Directors of Education, Children’s Services, Early Years  Definition of population Children attending child care sites for at least three hours per week

Changes to accommodate different circumstances:  Preparation High level contacts with Directors of Public Health, Directors of Education, Children’s Services, Early Years  Definition of population Children attending child care sites for at least 3 hours per week  Sampling Minimum 200 examined children, stratify by child care type, substitution

Changes to accommodate different circumstances:  Preparation High level contacts with Directors of Public Health, Directors of Education, Children’s Services, Early Years  Definition of population Children attending child care sites for at least 3 hours per week  Sampling  Minimum 200, stratify by child care type, substitution  Handling missing incisors

Sampling geography  The sampling units will be Local Authorities Unitary authorities Metropolitan districts London boroughs Lower tier local authorities  And current non-clustered PCTs

Definition of survey population The survey population is defined as: all those children attending child care sites who have reached the age of three, but have not had their fourth birthday on the date of examination and who attend for at least three hours per week. Sites for children with special needs will not be included.

Classifying child care types: How is the site funded? By the state - LA What type of facility? Nursery class attached to a primary school A nursery, but not in a Children’s Centre Child care provision at a CC No Private business – users pay Is it a playgroup? Yes No Is it a playgroup? Yes Code 0Code 2Code 1 Code 4 Code 3

Letter from Chief Dental Officer, giving support for survey Letter received by Director of Public Health. Support expressed to …. Director of Children’s Services, or Education, or Early Years and Play Consultant in Dental Public Health or other PCT dental lead to talk with …. NHS DEP Fieldwork Team Request list of all pre-school child care sites and nurseries From list work out proportions and target numbers Send sampling table to RC and await confirmation that this is acceptable Contact first few sites in each category to seek co-operation Set date, request class lists, identify all 3 year olds Send out letters and consent forms for all 3 year olds Send letters and consent forms for the second time to non-responders Record on list which are returned Target numbers of children examined Continue contacting sites within categories Examine all consented children. Stickers for all. Enter data into DSP2 Create examination day list Check and clean data, label files. Send securely to Regional coordinator Some PCTs will continue with additional samples Stages for NHS DEP teams to undertake the 2012/13 survey of 3 year olds. Find out names of key contacts at Children’s Services

Establishing the population sampling frame Child care typeA Numbers of places regardless of age B Proportion of children attending child care sites C Calculation if only a minimum sample of 200 is to be seen D Sample – number of children to see from each type of institution LA nursery class attached to school LA Children’s Centre (CC) child care facility LA funded nursery not in CC Private nursery, regardless of site Playgroup, regardless of funding or site Total

Child care typeA Numbers of places regardless of age B Proportion of children attending child care sites C Calculation if only a minimum sample of 200 is to be seen D Sample – number of children to see from each type of institution LA nursery class attached to school 1034 LA Children’s Centre (CC) child care facility LA funded nursery not in CC 443 Private nursery, regardless of site 118 Playgroup, regardless of funding or site 118 Total 2954 Preparing for sampling – numbers of children attending sites

Child care typeA Numbers of places regardless of age B Proportion of children attending child care sites C Calculation if only a minimum sample of 200 is to be seen D Sample – number of children to see from each type of institution LA nursery class attached to school ÷2954 = 35% LA Children’s Centre (CC) child care facility. 443 LA funded nursery not in CC 1241 Private nursery, regardless of site 118 Playgroup, regardless of funding or site 118 Total 2954 Preparing for sampling – working out proportions

Child care typeA Numbers of places regardless of age B Proportion of children attending child care sites C Calculation if only a minimum sample of 200 is to be seen D Sample – number of children to see from each type of institution LA nursery class attached to school % LA Children’s Centre (CC) child care facility % LA funded nursery not in CC % Private nursery, regardless of site 1184% Playgroup, regardless of funding or site 1184% Total % Preparing for sampling – working out proportions

Child care typeA Numbers of places regardless of age B Proportion of children attending child care sites C Calculation if only a minimum sample of 200 is to be seen D Sample – number of children to see from each type of institution LA nursery class attached to school %200 x 0.35 =70 LA Children’s Centre (CC) child care facility %200 x 0.15 =30 LA funded nursery not in CC %200 x 0.42 =84 Private nursery, regardless of site 1184%200 x 0.04 =8 Playgroup, regardless of funding or site 1184%200 x 0.04 =8 Total % Preparing for sampling – working out numbers to see using calculated proportions

Child care typeA Numbers of places regardless of age B Proportion of children attending child care sites C Calculation if only a minimum sample of 200 is to be seen D Sample – number of children to see from each type of institution LA nursery class attached to school %200 x 0.35 = LA Children’s Centre (CC) child care facility %200 x 0.15 = LA funded nursery not in CC %200 x 0.42 = Private nursery, regardless of site 1184%20 x 0.04 = 8 8 Playgroup, regardless of funding or site 1184%20 x 0.04 = 8 8 Total % 200 Preparing for sampling – numbers of children to see at each type of child care site

Sampling – a worked example Name of institution Allocated number Order in which each is randomly sampled within each group Target of children to examine LA nursery classes attached to school – list them all 70 St Swithin’s1 Brook Road2 High Green3 St Mary’s4 Broad Oak5 Rowley Street6 ……and so on

Name of institutionAllocated number Order randomly sampled within each group Target of children to examine LA Nursery classes attached to school 70 St Swithin’s 1 12 th Brook Road 2 1 st High Green 3 6 th St Mary’s 4 2 nd Broad Oak 5 3 rd Rowley Street 6 8 th ……and so onand so on for all sites

Name of institutionAllocated number Order randomly sampled within each group Target of children to examine / numbers examined LA Nursery classes attached to school 70 St Swithin’s 1 12 th Brook Road 2 1 st 21 High Green 3 6 th St Mary’s 4 2 nd 18 Broad Oak 5 3 rd 24 Rowley Street 6 8 th ……and so on

Do the same for the next type of child care site Target of children to examine LA Children’s Centres, child care facility 30 Lowtown C Centre 555th Northern C Centre 5612 th Station Rd CC571st …..and so on

Missing incisors We want to be able to: Compare data with five-year-olds and know about all incisors affected by caries, to enable reporting of the prevalence of Early Childhood Caries So – we have a cunning plan to use the main chart and additional boxes

Missing incisors – the main chart RightLeft EDCBAABCDE D 2-2- O M B L

Missing incisors Right 666 Left EDCBAABCDE D 2-2- O M B L Additional box to code missing incisors

Other Minor Changes  Letter from CDO to Directors of Public Health being sought  Details of children with no parental consent need not be entered onto the computer  No need to record consent from first or second drop  Dates of birth – all 15 th of the month  Additional information statement to give to interested parties

Appendix J – helps with identifying children of the correct age For this month of exam Children born within these ranges will definitely be three years old There may also be a few more in these ranges Earliest birth month and year Latest birth month and year Birth Month / Year Check Day of Birth * and ** September 2012October 2008August 2009 September 2008 and 2009* October 2012November 2008September 2009 October 2008 and 2009* November 2012December 2008October 2009 November 2008 and 2009* December 2012January 2009November 2009 December 2008 and 2009* January 2013February 2009December 2009 January 2009 and 2010** February 2013March 2009January 2010 February 2009 and 2010** March 2013April 2009February 2010 March 2009 and 2010** April 2013May 2009March 2010 April 2009 and 2010** May 2013June 2009April 2010 May 2009 and 2010** June 2013July 2009May 2010 June 2009 and 2010** July 2013August 2009June 2010 July 2009 and 2010** August 2013September 2009July 2010 August 2009 and 2010** September 2013October 2009August 2010 September 2009 and 2010** * If born 2008 birth day should be later than day of exam, if born 2009 birth day should be same day or before day of exam. ** If born 2009 birth day should be later than day of exam, if born 2010 birth day should be same day or before day of exam.

Maximising consent returns  Identify sites likely to need more support  Identify and support Champions in each site  Use newsletters, posters, postcards  Hand letters direct to parents (have a pen with you)

Suggested graphic for newsletters, posters, postcards etc.

Other items to note  Separate guidance for cleaning data will be provided  No initial analysis is being requested  Timetable

Training for Regional Coordinators – National Protocol 13 th to 14 th June 2012 National clinical training and calibration Regional training and calibration As soon as can be arranged following national training Planned sampling methods sent to Regional Coordinators for verification Following regional training Preparation of samples, seeking consent and recording of responses From receipt of approval from Regional Coordinators Data collection To start as soon as possible and completed by 30th June 2013 Completion of data entry, checking and labelling of PCT and LA samples Secure forwarding of LA and PCT cleaned data files to Regional Coordinators as soon as possible before deadline By 31 st July 2013 Regional Coordinators to upload summaries and copies of LA and PCT data files to The Dental Observatory via the web portal To be uploaded as and when they have been checked, completed by 31 st August 2013 TDO - Checking of data and collationAs and when data files arrive NWPHO / TDO – compute estimates for LAs and PCTsFrom end of August 2013 Publication of results on website October 2013 or 2 months after receipt of last data set Feedback of cleaned data with SOAs attached to Regional Coordinators, PHOs, PCTs, SHA, CsDPH November 2013 or 3 months after receipt of last data set Publication of PCT estimates in Community Dental Health March 2014 dependent upon receipt of last set of data Appendix G - Operational timetable

Please…  Read the protocol and do what it says  Read the sampling guidance and follow it  Read the data handling guidance and follow it

Useful links: collections/primary-care/dentistry/nhs-dental- statistics-for-england first-quarterly- report (Annex 7)