1. New Mexico Results for Oral Health The National Survey of Children with Special Health Care Needs Rohini Singh, MPH candidate Tulane University School of Public Health and Tropical Medicine Graduate Student Internship Program Participant MCH Bureau/HRSA/DHHS Assigned to MCH Epidemiology, NM Dept. of Health

2. Prevalence of CSHCN in New Mexico

4. CSHCN Insurance Coverage 8.81% [95%CI;5.94-12.85] have no insurance coverage 8.81% [95%CI;5.94-12.85] have no insurance coverage 43.45% [95%CI: 38.45-48.59] have Medicaid or SCHIP 43.45% [95%CI: 38.45-48.59] have Medicaid or SCHIP 4.66% [95%CI: 3.17-6.79] are covered by Title V 4.66% [95%CI: 3.17-6.79] are covered by Title V 52.41% [95%CI: 47.34-57.44] have private insurance 52.41% [95%CI: 47.34-57.44] have private insurance

5. CSHCN: increased risk Some CSHCN are born with oral diseases Some CSHCN are born with oral diseases Nature of condition may require pediatric dentist with knowledge in caring for such children Nature of condition may require pediatric dentist with knowledge in caring for such children Reliance on family for daily oral health care Reliance on family for daily oral health care

6. CLEFT LIP AND PALATE Photos courtesy of Operation Smile.

8. Dental Care and Insurance 30% [95% CI: 22.94-38.46] of CSHCN without private insurance said that they did not need dental care. 30% [95% CI: 22.94-38.46] of CSHCN without private insurance said that they did not need dental care. Over 90%[95%CIs:86.3-94.84,66.49-83.97]of CSHCN with private insurance received all the dental care they needed, compared to 76% of those not covered by private insurance. Over 90%[95%CIs:86.3-94.84,66.49-83.97]of CSHCN with private insurance received all the dental care they needed, compared to 76% of those not covered by private insurance. 86% [95%CIs: 80.82-90.22, 43.29-84.08] of those with any insurance received dental care, compared to 66% of those without insurance. 86% [95%CIs: 80.82-90.22, 43.29-84.08] of those with any insurance received dental care, compared to 66% of those without insurance.

9. During the past 12 months was there any time when (“S” CHILD) needed dental care including check-ups?

10. Primary care and need for dental care 40% of families who claimed the doctor never spent enough time with their child said they did not need dental care. 40% of families who claimed the doctor never spent enough time with their child said they did not need dental care. Over 60% of families whose provider was never sensitive to their family’s customs and values said they did not need dental care. Over 60% of families whose provider was never sensitive to their family’s customs and values said they did not need dental care. Photo courtesy of http://dgl.microsoft.com/

11. Did (“S” CHILD”) receive all the dental care that he/she needed?

12. Receiving dental care is significantly associated with: Severity of child’s condition Severity of child’s condition # of missed school days # of missed school days Need for physical, occupational, or speech therapy Need for physical, occupational, or speech therapy Need for hearing and communication aids Need for hearing and communication aids Care coordination Care coordination Financial problems and need for additional income Financial problems and need for additional income The need to stop working or cut down hours to care for the child The need to stop working or cut down hours to care for the child

13. Children whose condition is considered severe are less likely to be receiving dental care.

14. More about severity of child’s condition and receiving dental care About half of the children who need communication aids and devices are not receiving the dental care they need. [95% CI: 20.31-81.12] About half of the children who need communication aids and devices are not receiving the dental care they need. [95% CI: 20.31-81.12] Only three quarters of the children who need physical, occupational, or speech therapy are receiving all needed dental care, compared to 90% of those who do not need this therapy. [95% CI: 63.97-83.54,83.01-93.05] Only three quarters of the children who need physical, occupational, or speech therapy are receiving all needed dental care, compared to 90% of those who do not need this therapy. [95% CI: 63.97-83.54,83.01-93.05]

15. Children are less likely to miss school if they are receiving dental care.

16. Children receiving care coordination are far more likely to be receiving dental care.

17. Take-home messages Low dental IQ: Families of CSHCN need to understand the importance of everyday dental care and check-ups Low dental IQ: Families of CSHCN need to understand the importance of everyday dental care and check-ups Dentist shortage: CSHCN, especially those with severe disabilities, have no where to go for dental care Dentist shortage: CSHCN, especially those with severe disabilities, have no where to go for dental care Socioeconomic status: Families having financial difficulties cannot and will not prioritize dental care Socioeconomic status: Families having financial difficulties cannot and will not prioritize dental care

18. Action and Policy State-wide social marketing campaign for dental hygeine State-wide social marketing campaign for dental hygeine Work with primary care providers to make sure that they are encouraging oral health Work with primary care providers to make sure that they are encouraging oral health Have insurance companies better advertise dental benefits Have insurance companies better advertise dental benefits Work with Medicaid to improve reimbursement rates and reduce paperwork hassles Work with Medicaid to improve reimbursement rates and reduce paperwork hassles Recruit more pediatric dentists to New Mexico Photo courtesy of http://dgl.microsoft.com/

19. LIMITATIONS under-representation of various minority groups under-representation of various minority groups lack of geographical data lack of geographical data income levels do not match New Mexico income cutoffs for state insurance income levels do not match New Mexico income cutoffs for state insurance self-report bias self-report bias recall bias recall bias

20. Acknowledgements Susan Nalder, EdD, MPH, CNM MCH Epidemiology Program Manager and Internship Advisor Susan Nalder, EdD, MPH, CNM MCH Epidemiology Program Manager and Internship Advisor Ssu Weng, MD, MPH Medical Epidemiologist and Advisor for Data Analysis Ssu Weng, MD, MPH Medical Epidemiologist and Advisor for Data Analysis Lynn Christiansen, MSW Children’s Medical Services Program Manager/ Mentor: Data to Action Lynn Christiansen, MSW Children’s Medical Services Program Manager/ Mentor: Data to Action Jane Peacock, MS Family Health Bureau Chief Jane Peacock, MS Family Health Bureau Chief Dr. Ray Lyons, DDS, FADPD Chief of Dental Services: Los Lunas Community Program Dr. Ray Lyons, DDS, FADPD Chief of Dental Services: Los Lunas Community Program