1. What’s the Head Start PIR and How Can the PIR Be Used for
Program Improvement?
Dental Hygienist Liaison
Quarterly Webinar
June 3, 2016
Reg Louie, D.D.S., M.P.H.
Harry Goodman, D.M.D., M.P.H.
Anne Gibbs, R.D.H., B.S.
Kathy Hunt, R.D.H., ECPII

2. General Reminders
This webinar will be recorded and archived on the ASTDD website
Everyone except the presenters have been muted.
Questions will be addressed after the speakers are finished. Please “raise your hand” by clicking on the icon at the top of your screen that looks like a person. You will be recognized in turn and unmuted so you may ask your question.
Please answer the evaluation questions at the end of the webcast.

3. Learning Objectives Participants will:
become familiar with the Head Start PIR and the oral-health- related items in the PIR, and what those data may show;
learn how can PIR data be used to assess how a program compares to other local, state, and national Head Start programs;
become familiar with other important issues that the PIR data do not reveal;
learn how can PIR data were used to identify issues to address and to stimulate discussion about possible solutions;
and, learn how two state DHLs have used PIR data and engaged community oral health partners to address “next steps” to assist in the resolution of issues identified by the PIR data.

4. What is the Head Start PIR?
The PIR provides comprehensive data on the services, staff, children, and families served by Early Head Start (EHS)/Head Start (HS) programs nationwide
All grantees and delegates are required to submit PIR reports to the HHS OHS annually
Self-reported data
The PIR data are compiled for use at the federal, regional, state, and local levels

5. Oral Health HS PIR Requirements
PIR #C.17: The number of children with continuous, accessible dental care provided by a dentist:
# at enrollment
# at the end of enrollment year
Dental home (as defined in the PIR):
An ongoing source of continuous, accessible dental care provided by a dentist
PIR #C.18: The number of children who received preventive care since last year’s PIR was reported:
Preventive care (as defined in the PIR):
Includes fluoride application, cleaning, sealant application, etc.

6. Oral Health HS PIR Requirements (cont’d)
PIR #C.19: The number of children…who have completed a professional dental exam since last year’s PIR was reported:
# at the end of enrollment year
Professional dental exam (as defined in the HS Performance Standards):
must incorporate the requirements for a schedule of well child care utilized by the EPSDT program of the Medicaid agency of the State in which they operate

7. Oral Health HS PIR Requirements (cont’d)
PIR #C.19.a.:
Of the number of children in C.19, the number of children diagnosed as needing dental treatment since last year’s PIR was reported; and,
of these children the number who received or are receiving dental treatment:
# at the end of enrollment year
Dental treatment (as defined in the PIR):
Includes restoration, pulp therapy, or extraction
Does not include fluoride application or cleaning

8. Oral Health EHS PIR Requirements
Infant & Toddlers
PIR #C.20: Number of all children who are up-to-date on a schedule of age-appropriate preventive and primary oral health care according to the relevant state’s EPSDT schedule
at the end of the enrollment year
Pregnant Women
PIR #C.21: Number of all pregnant women who received a professional dental examination(s) and/or treatment since last year’s PIR was reported
# of pregnant women

9. Oral Health PIR Data for U.S. FY 2013-2015
PIR Indicator Related to
Oral Health
2013
2014
2015
% Enrollees in US with a dental home
93%
91%
% with professional dental exam
86%
85%
83%
% diagnosed as needing follow-up Tx
19%
18%
% receiving/have received needed Tx
80%
75%
73%
% receiving preventive care
% children ages 0-2 up-to-date on State Dental EPSDT Schedule
77%
78%
74%
% pregnant women with completed dental exam
40%
39%
36%

10. PIR Oral Health Project Purpose/Methods [1]
Begin to develop a data-driven model to help NCH and HS regional offices use PIR data to monitor HS grantees’ compliance with OH-related PIR requirements and to:
Inform the development of follow-up and T/TA plans
Reviewed 2011 and 2012 PIR data for grantees in 6 states focusing on 3 indicators (% examined, % needing Tx, % receiving/received Tx)
Did not review % with “dental home,” % up-to-date with state EPSDT schedule, % pregnant women with exam or treatment or % with preventive care

11. PIR Oral Health Project Purpose/Methods [2]
In analyzing data and for prioritizing grantees:
Most weight given to % children w/ professional dental examination
Less weight to % received/receiving dental Tx
Least weight to % Dx as needing follow-up Tx
Other considerations, some weight given to:
How grantee’s data compared to the statewide average
How % of children who received/receiving dental treatment compared to the reported % of children with continuous access to oral health care at year’s end (dental home)
The size of grantee
Considered grantee’s trend over 2 year time frame
ID’d 10 lowest performing grantees in each state

12. PIR Oral Health Project – Findings
All six pilot project states had higher % than the national average for children with completed professional dental exam and those Dx as needing Tx
Three states had higher % percentages for children who received/are receiving dental Tx
Variation among states in % children who received/are receiving dental Tx
Variation within states, i.e., lowest-performing grantees skewed the state average, especially for % children with dental exams and for those who have received/are receiving dental Tx

13. PIR Oral Health Project – Other Findings
Number of programs had significant drop-offs in from 2011 for % children with professional dental exams as well as the % of those needing Tx
Of these, some were larger grantees (300+ children) with only 1-3% of children needing dental treatment
Dental home data not reviewed/analyzed in detail because of variations in applying the definition of “continuous access to dental care”
Some cases with identical percentages for dental home, preventive care and “completed a professional dental exam”, yet many of these PIR reports did not have similar % for “received/or receiving dental treatment”

14. PIR Oral Health Project Recommendations
Expand pilot to one state in each region and expand review/analyses to 4 years including the most recent
Share the analysis of grantees with the OHS, ROs and state Dental Hygienist Liaisons (DHLs). As appropriate, expand analyses, e.g., to better define the OH issues confronting the grantees
“Having received/receiving dental Tx” captures many grantee issues. When appropriate, additional elaboration, explanation or clarification of the data should be obtained and reviewed.
Expand to identify and disseminate information on “best practices” among best performing grantees

15. PIR Oral Health Project State Follow-up Actions
Report submitted to OHS by NCH and accepted as revised in Spring 2014
Added 2013 PIR data to review and analysis of grantees in six pilot states; modified prioritizations accordingly
Drafting specific-report revision for individual ROs with respective lowest performing grantees and offering direct follow-up conferencing with each to discuss possible “next steps”
Models for individual state follow-up actions in Kansas and Colorado

16. PIR Oral Health Project State Models—Colorado
Initial contact – PIR Project; collaborative efforts to identify issues with lowest PIR performing HS programs in Colorado and possible “next steps”, e.g., worked with RO PS and T/TA staff
ID initiatives/priorities/activities into which oral health or Head Start can be integrated (HS health literacy, family and community engagement, staff development; CF3, HS-BSS, COHP trainings)
Linkage between CO-PIOHQI and state HSA and State HS Collaboration Office and local HS/EHS programs
Ongoing meetings to share, e.g., priorities, update/evaluate/explore/expand collaborations

17. PIR Oral Health Project State Follow-up Actions—Kansas
Kansas Cavity-Free Kids, a statewide oral health initiative through the Kansas HSA to provides opportunities for families to increase oral health literacy
DHL provides statewide leadership and TA to state and local HS programs (Oral Health Kansas; NCECHW-DHL; Early Childhood Task Force, Perinatal coalitions)
DHL connects with HS programs with lowest PIR scores to determine issues/challenges. Offer TA where able and report concerns to Regional Office.

18. Oral Health PIR Data: FY 2013-2015
US-Kansas Comparison
2012-KS
2013-US
2013-KS
2014-US
2014-KS
2015-US
2015-KS
Dental Home
90.59%
93.00%
86.97%
91.00%
89.67%
87.79%
Preschool Completed Dental Exam
82.34%
86.00%
84.79%
85.00%
81.66%
83.00%
77.96%
Preschool Needed Treatment
20.81%
19.00%
20.39%
19.97%
18.00%
18.22%
Preschool Received Treatment
80.17%
80.00%
71.57%
75.00%
69.28%
73.00%
59.58%
Preschool Preventive Care
87.96%
88.65%
89.26%
90.32%
0-2 up-to-date EPSDT
84.72%
77.00%
74.12%
78.00%
75.60%
74.00%
74.06%
Pregnant Women Completed Dental Exam
41.75%
40.00%
42.86%
39.00%
32.30%
36.00%
28.08%
I have captured our last 3 years of PIR data on this slide. The green column is data from 2012, which is the last set of data looked at by the PIR Oral Health Project Reg told you about. I wish I had a great success story to share with you, but you’ll see that when we compare our % to the US, they are nothing to write home about.
The bad news first: the number of HS children receiving an exam in Kansas is consistently worse than the US average although you will see both the US and our state are trending downward, which is very disappointing.
The same is true for those children receiving treatment. In KS case, our numbers have dropped dramatically. The most obvious reason that we can point to is that our Medicaid system switched over to managed care. Although we are no longer able to access the actual number of unduplicated providers, we feel that the provider network has shrunk substantially.
The better news is that while the number of children needing treatment is still larger than the national average, we are making consistent progress on keeping our kids cavity free. The other good piece of news is that more HS children are receiving preventive services. We feel this is a because our safety net clinics are continuing to build their outreach with public health hygienists that provide preventive services on site…now if we can just get more of the dentists to come on site as well!
We did a survey of HM several years ago as part of our evaluation of the impact of the Kansas Cavity Free Kids project. One of the changes we found is that the top reason for children not receiving treatment was parents lack of follow through. At the start of KCFK the most common reason was not being able to find a dentist that accepted Medicaid. Since then our state has adopted managed care and if we repeated the survey, I’m sure we would find that finding providers would be back on top. Both access and follow through are consistently the main reasons for incomplete care.

19. Preschool Preventive Care Preschool Completed Dental Exam
Head Start
Program Name
Dental Home
Preschool Preventive Care
Preschool Completed Dental Exam
Preschool Needed Treatment
Preschool Received Treatment
USD #489 Early Childhood Connections
100%
96.3%
92.59%
34.4%
95.35%
Futures Unlimited, Inc.
96.74%
82.61%
86.96% 5%
75%
COMMUNITY ACTION, INC.
99.32%
87.07%
76.87%
6.19%
14.29%
Topeka Public Schools, USD 501
81.84%
83.33%
77.61% 0%
UNIFIED SCHOOL DISTRICT #383
93.72%
90.58%
85.86%
3.66%
NORTHWEST KANSAS EDUCATIONAL SERVICE CENTER
96.42%
89.25%
97.49%
34.93%
76.84%
Clay County Child Care Center
95.04%
21.74%
88%
As interesting as it is to compare ourselves to the US averages, as a DHL what I found the most helpful was to look at each specific program across the state.

20. Ages 0 to 2 Up-to-Date Dental EPSDT
Early Head Start
Program Name
Dental Home
Ages 0 to 2 Up-to-Date Dental EPSDT
Pregnant Women Completed Dental Exam
KANSAS CHILDREN'S SERVICE LEAGUE
75.92%
47.64%
33.33%
Heartland Programs
52.22%
94.54%
25.71%
Futures Unlimited, Inc.
76%
64%
16.67%
Dodge City Public Schools, USD# 443
44.71%
68.24%
37.5%
Growing Futures Early Education Center
89.51%
71.43%
NORTHWEST KANSAS EDUCATIONAL SERVICE CENTER
100%
82%

21. Current and Upcoming HS Strategies for Kansas
KHSA annual Head Start Health Manager meeting
Annual update on dental services, educational resources, and oral health legislation
Offer support to all HS programs through monthly
Contact low performing programs to determine barriers
Contact high performing programs to capture best practices
Explore closer relationship with RO PS and T/TA staff
New Oral Health Kansas project (state oral health coalition)
Working group to study barriers for pregnant women and children under age 3 receiving dental services
Increase referrals by medical professionals for dental services
Increase number of dentists comfortable with providing appropriate comprehensive services

22. National Center on Early Childhood Health and Wellness
Toll-Free: (866)
Website:

23. Still Have Questions?
Contact Information:
Dr. Reg Louie
Dr. Harry Goodman
Anne Gibbs, RDH, BS
Kathy Hunt, RDH, ECPII
Thank you!