1. 1 Integrating Systems Successful Strategies and Lessons Learned Oral Health as Part of Total Health Presented by Dental Health Initiative of San Diego Share the Care County of San Diego Health and Human Services Agency

2. 2 This program is brought to you by a grant from the U.S. Department of Health and Human Services, Health Resources and Services Administration

3. 3 Speakers Laura Castaneda Moderator Nancy Bowen, MD, MPH Public Health Officer, County of San Diego Health and Human Services Agency Phyllis Elkind, MPH Children, Youth and Families Coordinator, County of San Diego Health and Human Services Agency

4. 4 Speakers continued Peggy Yamagata, RDH, MEd Dental Health Specialist and Share the Care Program Manager, County of San Diego Cindy Muehleisen California Children’s Dental Disease Prevention Program Coordinator, San Diego County Office of Education Parvathi Pokala, DDS Pediatric Dentist and Share the Care Advisory Board Member

5. 5 Overview of San Diego County Size of County – 42,000 mi 2 Urban and rural areas Population – 3 million residents (SANDAG, 2002) Ethnically and culturally diverse – borders Mexico, large refugee population

6. 6 Overview of San Diego County continued 742,000 children (0-17 years of age) (SANDAG, 2002) 269,000 children in households with income of <185% FIG (Census, 2000) 11.5% of children are medically uninsured (UCLA, 2001) and we know that even more children lack dental insurance.

7. 7 Oral Health Issues in San Diego County Tooth decay is the most common diagnosis –Reported through Child Health and Disability Prevention (CHDP) Program well child exams Most frequent treatment paid by CHDP- Treatment Reimbursement Program with a value equal to all other medical payments Denti-Cal spends $60 million annually on dental care for San Diego County residents

8. 8 Oral Health Issues in San Diego County continued Visual screenings of 4,451 local 2 nd – 5 th graders in 1999 revealed: –30% untreated cavities –74% active gum disease Unequal distribution of dentists –Several areas are designated as dental shortage areas Non-fluoridated county United Way survey found 285,428 children, approximately 40%,have dental disease (based on census 2000 – 722,602 children 0-17 years)

9. 9 How Did San Diego County Address Oral Health? Community forum held in 1992 identified specific issues: –Lack of emergency access for low-income children with no dental resources –Lack of fluoridation –High rate of Baby Bottle Tooth Decay (BBTD) and no prevention education programs Participants continued to meet forming the Dental Health Coalition (DHC)

10. 10 Addressing Oral Health continued –Members: dental, medical, public health, educators, community clinics, nurses, PTA, Community Based Organizations (CBO) DHC, San Diego County, and local dental societies formed Dental Health Initiative/Share the Care (STC) –Housed at County –Initially funded by small grants –Currently funded by grants and state, federal, EPSDT, MCH funds

11. 11 Addressing Oral Health continued Share the Care implemented 2 of 3 top issues –Emergency dental care for children with no resources Network of pro bono dental professionals who provide emergency care. Currently: 292 DDS, 91 RDH, 81 DA, 15 Labs = 479 –Preventative Education Integrate oral health into existing programs targeting children, adults, professionals

12. 12 Addressing Oral Health continued Within Children, Youth and Families –Maternal and Child Health Dental bulletin Addressing low birth weight babies Added to training to prevent infant mortality –CHDP Providers –Foster care –Access to care – San Diego Kids Health Assurance Network (SD-KHAN) Dental as part of total health

13. 13 Oral Health in the Schools California Children’s Dental Disease Prevention Program (CCDDPP) Collaborates with Share the Care who provides: –Emergency access to dental care for children with no dental resources –Sealant Clinics Community collaborative with CCDDPP, dental societies, and local hygiene school Private funding or grants Provide screening, sealants, education, access to care for families Reduce emergencies

14. 14 Oral Health in the Schools continued –Additional support for classes for teen parents –School nurses Resources and trainings –School Events Health and safety fairs, parent nights –Peer to peer training for students and parents 7 th and 8 th grade students trained to teach K-2 nd graders Private and public schools Schools that CCDDPP can not reach due to limited funding –After school and summer programs

15. 15 Reaching Children Outside Schools Educational pieces developed for traditional and non-traditional settings Curriculum, Arts and Crafts Manual, Activity Book Libraries – Promote literacy and dental health County run, temporary shelter care for children –At-risk children taught in small groups Juvenile detention facility for girls –Young girls are to be released soon –Oral health is part of teaching life skills

16. 16 Reaching Parents Peer to peer training for adults Oral Health Ambassador Program – Senior volunteer Healthy Start and Head Start –Parents and staff Women, Infants, and Children (WIC) –Parents and staff Aging and Independent Services (AIS) –Grandparents/kinship program

17. 17 Reaching Community Based Organizations Community events –Health and safety community fairs Look for areas beyond brushing and flossing –Acid Foods display and brochure –Coffee display and brochure Community Forums –First forum held in 1992 –Second oral health forum held in 2000 – 143 attended –Senior oral health forum held in 2001 – 127 attended

18. 18 Reaching community based organizations cont. Professional Meetings – Not just dental related –Girls Summit – addressed issues effecting the young girls of today –Statewide Obesity Conference –WIC and Head Start state wide conferences –American Cancer Society Head and Neck Conference

19. 19 Reaching Professionals University of California, San Diego (UCSD) pediatric medical residency program –Monthly trainings American Academy of Pediatrics (AAP) and the American Academy of Pediatric Dentists (AAPD) –Annual dinners –Grand rounds at Children’s Hospital Medical staff for County programs –Foster care –MCH –Public health nurses

20. 20 Reaching Professionals continued Nursing Kit developed to better equip professionals who work out in the community Outreach Worker Kit –Contents modified for professionals who would not be looking into the oral cavity Future professionals –Student interns Disciplines – nutrition, health promotion, public health, dental hygiene As many as 40 a year Various requirements – semester to one week rotations

21. 21 Media Movie slides –Series of three PSAs shown prior to start of movies Bus boards –Message on the back of a bus Weekly Advertisement Mailer –“Penny Saver” ad Website – www.sharethecaredental.org –Information on Share the Care, community events, and ability to download materials Bookmarks –Various oral health messages

22. 22 Systems Changes Pilot project –Adjust Report of Health Examination for school entry –Question added regarding medical, dental, and vision insurance –Permission asked to contact parents/guardians –Provide insurance information –Database tracked utilization Worked closely with organizations that address access to care –Assure literature stated medical/dental insurance San Diego Kids Health Assurance Network (SD- KHAN) brochure School lunch form –Welfare Eligibility Techs

23. 23 Systems Changes continued County wide programs use our educational materials –Waiting rooms and resource areas of STD/TB clinic, Immunization, Lead Poisoning, AIS Oral health is part of Juvenile Hall Well-Being Program Welfare to work job clubs United Way Outcomes and Community Impact Surveys now ask oral health questions –This lead to integration of oral health into County Report Card

24. 24 Lessons Learned Collaborate Start small Utilize non-traditional settings Do not isolate oral health - Integrate with what is “hot”

25. 25 Thank You For Joining Us!

26. 26 Contact Us Dental Health Initiative of San Diego Share the Care County of San Diego Health and Human Services Agency 3851 Rosecrans Street PO Box 85222 (MS: P511H) San Diego, CA 92186-5222 619-692-8858 Fax: 619-692-8827 Website: sharethecaredental.org Email:peggy.yamagata@sdcounty.ca.gov