MINNESOTA’S EARLY HEAD START ORAL HEALTH CAMPAIGN PREVENTING TOOTH DECAY AT THE EARLIEST STAGE OF A CHILD’S DEVELOPMENT

Oral Presentation Presented at the 2006 National Oral Health Conference on May 2, 2006 in Little Rock, Arkansas Presented at the 2006 National Oral Health Conference on May 2, 2006 in Little Rock, Arkansas Authored by David Born PhD, University of Minnesota School of Dentistry, Christopher Okunseri, BDS, MSc, Marquette School of Dentistry and Gayle Kelly, BS, MS, Minnesota Head Start Association, Inc. Authored by David Born PhD, University of Minnesota School of Dentistry, Christopher Okunseri, BDS, MSc, Marquette School of Dentistry and Gayle Kelly, BS, MS, Minnesota Head Start Association, Inc.

Minnesota Head Start Association in partnership with MN State Head Start Collaboration Office Dental Consultants from the University of MN School of Dentistry Marquette University School of Dentistry Minnesota’s Early Head Start Programs And with funding and support from

Head Start and Early Head Start Goals To help low-income families prepare their children for school and life success:  Improving their child's: - Health - Health - Social Competence - Social Competence - School Readiness - School Readiness  Promoting self-sufficiency for parents

Early Head Start Eligibility Guidelines Serves children 0-3 and pregnant women Serves children 0-3 and pregnant women At least 90% of enrolled children must come from families At least 90% of enrolled children must come from families - at or below the federal poverty level or - at or below the federal poverty level or - eligible to receive public assistance. - eligible to receive public assistance. 10 % of enrollment in Head Start is reserved for children with diagnosed disabilities 10 % of enrollment in Head Start is reserved for children with diagnosed disabilities

In 2005: 21 federally designated and state-funded Early Head Start grantees served Minnesota 21 federally designated and state-funded Early Head Start grantees served Minnesota MN Early Head Start grantees served 1,295 children and 129 pregnant women MN Early Head Start grantees served 1,295 children and 129 pregnant women FOR MORE INFO... Head Start Program Information Report for the Program Year – Wayne Kuklinski, MDE

MN Early Head Start Oral Health Campaign Goals, Family Education Help young families value their children's oral health and adopt habits that prevent tooth decay. Staff Training Prepare Early Head Start (EHS) Home visitors to perform simple oral risk assessment to prioritize children for oral health prevention and dental referrals. Oral Risk Assessment Offer regular and consistent oral risk assessment and follow-up of EHS children (0-3) to prevent caries and refer children for treatment services.

Family Education The Tooth Book is MN Head Start’s oral health guide for families and educators. Produced in English, Spanish, Somali and Hmong Training and tools were available to all Head Start and Early Head Start Health Managers View an Electronic

Staff Training Intensive one-day workshop taught by dental school professors covering: Early Childhood Dental Caries and Guidance Early Childhood Dental Caries and Guidance Oral Risk Assessment and Referral Oral Risk Assessment and Referral Cultural Perspectives Cultural Perspectives Teaching Objectives were to enable Home Visitors to: Explain basic tooth development and appropriate oral health practices Explain basic tooth development and appropriate oral health practices Conduct an oral health risk assessment of children up to age three Conduct an oral health risk assessment of children up to age three

Oral Risk Assessment Home visitors met with EHS families in their home at a frequency determined by the families’ risks to assess: Environmental Risks (brushing, diet, bottle feeding practices, water source) Environmental Risks (brushing, diet, bottle feeding practices, water source) Family Risks (Caregiver oral health, SES, general health) Family Risks (Caregiver oral health, SES, general health)

Oral Risk Assessment (continued) Observe the child’s mouth (tooth development, decay, white spots, red or swollen gums, cleanliness of the teeth) Observe the child’s mouth (tooth development, decay, white spots, red or swollen gums, cleanliness of the teeth) Provide oral health education and skill building with family members Provide oral health education and skill building with family members

Results FAMILY EDUCATION: % of 48 HS and EHS Health managers had access to parent education tools 100% of 48 HS and EHS Health managers had access to parent education tools 88% of 48 HS and EHS Health managers participated in group instruction on oral health 88% of 48 HS and EHS Health managers participated in group instruction on oral health 40,000 copies of The Tooth Book distributed from ,000 copies of The Tooth Book distributed from % of 15,227 HS and EHS families participated in oral health education. 69% of 15,227 HS and EHS families participated in oral health education.

Results Staff Training: % of 90 EHS Home Visiting Staff participated in one of three oral risk assessment workshops 90% of 90 EHS Home Visiting Staff participated in one of three oral risk assessment workshops Knowledge assessments conducted prior and one month after the training showed gains for all three groups (p<.001) Knowledge assessments conducted prior and one month after the training showed gains for all three groups (p<.001) Program evaluation results showed high level of satisfaction and strong desire for more training Program evaluation results showed high level of satisfaction and strong desire for more training

Results: Oral Risk Assessment 87% of 1,014 EHS clients received one or more oral risk assessment and education 87% of 1,014 EHS clients received one or more oral risk assessment and education “Reliability Check” showed home visitors identified most potential problems and missed very few “Reliability Check” showed home visitors identified most potential problems and missed very few

Results: Parent Attitude Survey Measured pre/post changes in EHS parent attitudes about early childhood oral health risks. Increase in parent’s awareness of oral health risks (p<.008) Increase in parent’s awareness of oral health risks (p<.008) More education needed: More education needed: 1) Parent’s role in disease transmission 2) Oral health during pregnancy 3) Age for first dental visit

Impact on Dental Treatment Access Flat ~73% Increased by 50%

Next Steps: beyond Offering statewide training via ITV Offering statewide training via ITV Exploring best approaches to outreach to culturally diverse clients Exploring best approaches to outreach to culturally diverse clients Considering the feasibility of fluoride varnish and xylitol gum as Center-based strategies Considering the feasibility of fluoride varnish and xylitol gum as Center-based strategies