Dental Home Initiative

Transcription

1 A tool kit guide for grant development and program implementation of dental services for persons with development disabilities or intellectual disabilities. Dental Home Initiative for persons with developmental disablities or intelectual disabilities

2 Table Contents Oral Health Disparities... 2 Changing the Face or Oral Health Care Scope of Work 4 Dental Home Initiative Grant: Team & Partners....6 Dental Home Initiative Goals, Objectives, and Activities....7 Dental Home Initiative Outcomes Report Grant Development and Resource Guide.. 11 Appendices Appendix A Dental Team Training PowerPoints.12 Appendix B Association of State & Territorial Dental Directors, Basic Screening Survey Appendix C Program Informative, Permission Slips, and Consent Forms..14 Appendix D EPI Data Base Download and Tutorial...18 Appendix E Center Staff Power Point Presentation. 19 Appendix F Center Staff pre - post-test 22 Appendix G Arc of Florida Services Funding Application Appendix H W-9 Download Form for Arc Services

3 Oral Health Disparities Over Surgeon General, David Satcher, MD, Ph.D., published the first oral health report, Oral Health in America. This report has much to say about the inequities and disparities that affect those least able to muster the resources to achieve optimal oral health. The barriers to oral health include lack of access to care, whether limited to income or lack of insurance and transportation. Individuals with disabilities and those with complex health problems may face additional barriers to care. Dr. Satcher states t The mouth is an important mirror and a window to the body, it s not just what s going in the mouth, it s what s reflected in the mouth about the state of health in the body / Over the past 20 years, there has been an increased emphasis on health promotion, including prevention activities related to oral health for the general population, but not persons with developmental disabilities (DD) or intellectual disabilities (ID). Available data reveal a wide range of prevalence estimates for oral health conditions, but all suggest that these conditions are most prevalent among individuals with DD and ID compared with the general population. Disparities exist in the receipt of preventive and early treatment of oral health conditions. Recommendations for health improvement in these areas include better health planning, monitoring through data collection and increased emphasis on health promotion activities, and early treatment in the health care system by establishing a dental home. MRD Research Reviews 2006: 12: Wiley-Liss, Inc. As more people with DD and ID live longer and develop age-related morbidities like those of their typical age peers, it is increasingly important that these individuals continue to use preventive and therapeutic health services, including oral health. There are few reported studies about the epidemiology of oral disease among adults with DD and ID, groups who appear to have poorer oral health and oral hygiene. The prevalence of oral diseases including dental caries and periodontal disease is remarkably higher in persons with DD and ID. Moreover, by the time the dental diseases are diagnosed, adults with DD and ID are more likely to have extractions than restorative care which may lead to other dental issues. Access to oral health care and the needs of individuals with DD and ID are complex and multi-faceted. A shortage of dental providers who are trained in the treatment of persons with DD and ID is prevalent in our country. Many require hospital-based care. The mouth is an important mirror and a window to the body, it s not just what s going in the mouth, its what s reflected in the mouth about the state of health in the body, Persons with Disabilities may face more barriers than most when it comes to access to oral health care. The Palm Beach County Interagency Council for Persons with Developmental Disabilities (PBCIPDD) also faced with oral health disparities for their clients, proposed a pilot grant that would increase health promotion activities, preventive care, education, and the establishment of a dental home. 2

4 Changing the Face of Oral Health Care This tool kit is a collective body of work from The Palm Beach County Interagency Council for Persons with Developmental Disabilities (PBCICPDD) explaining the process of this innovative program, data collected, the impact on the community for persons with DD and ID and a guide on how to duplicate this program within your community. In the beginning The PBCIPDD is a coalition consisting of more than ten organizations serving persons with developmental and intellectual disabilities. The Council determined their clients oral health disparities and the lack of access to care were an epidemic. Once the need was determined, reaching out to local philanthropic organizations for support was the next phase in developing a program that would assist in providing much needed dental care. Most counties have county specific philanthropic organizations, however, if none is available, there are state and national organizations that do assist in providing oral health grants. Allegheny Franciscan Ministries and Quantum Foundation generously funded this grant for years one and two, and Quantum Foundation provided funding in the third year. Grant Overview and Deliverables The PBCIPDD, working closely with dental health professionals, proposed a pilot-grant program that was modeled after the Florida Dental Hygienists Association-Orange County Head Start Dental Home Initiative, funded by DentaQuest Foundation. In 2014, PBCIPDD received a two-year grant from Allegany Franciscan Ministries and Quantum Foundation to develop and implement the Dental Home Initiative for Persons with Development Disabilities program (DHI-DD) The goal of this grant was to increase access to dental care for people with developmental and intellectual disabilities by creating a network of dental professionals willing to provide dental care for those who did not have a dental home and required urgent care or those who had non-urgent needs but their existing providers could not provide the required services. The goal of the grant was achieved through the following activities: Hiring a dental hygienist to act as the Oral Health Care Coordinator, working with local dental hygienists to perform oral health screenings and fluoride varnish applications, provide one- onone oral health education to clients, staff, and caregivers at each of the ten participating centers. Providing presentations on sound nutrition to clients, caregivers, and center staff, then work with local dental providers to act as a referral point for the clients enrolled in the program. Assessment data identifying such oral health needs as urgency of care, ability to receive dental care with or without sedation, insurance coverage, dental home status, home care, and preventive care needs. Working with local providers to include the local dental hygiene college program, dental and dental hygiene associations, Federally Qualified Health Centers, and County Health Departments, all of which were the first point of provider resources. Providing a continuing education seminar on the treatment of persons with developmental and intellectual disabilities to increase community provider participation in the program, was provided during years one and three. 3

5 Scope of Work The goal of this initiative is to establish a system to ensure that individuals with developmental and intellectual disabilities in Palm Beach County have access to and receive oral health services in a dental home. The proposed pilot project is based on the fundamental medical truism that healthy mouths lead to healthy bodies, as evidenced by research identifying periodontal (gum) disease as a risk factor for heart and lung disease, diabetes and numerous other conditions (American Dental Hygienists Association). The Surgeon General of The United States confirms that 80% of dental disease in the United States occurs in just 20% of the population. This 20% is comprised mostly of disadvantaged populations and includes most of the population with developmental disabilities. As the vast majority of individuals with developmental and intellectual disabilities receive Medicaid, it is essential to note that at this time approximately 90% of the dentists in Florida do not participate in Medicaid. Access to oral health services in a dental home reduces the oral health disparity that exists among individuals with developmental and intellectual disabilities and the general population, ultimately improving the general health and overall well-being of the special needs population. A dental home is an ongoing relationship between a provider and patient, inclusive of all aspects of oral health care, delivered in a comprehensive and accessible manner. Historically, the nature of the population to be served has rendered the creation of a dental home to be nearly impossible to achieve. This project will produce an innovative approach to increasing oral health within the developmentally disabled community by developing a system of care approach that utilizes a dental hygienist as a community care coordinator. The creation of a logical oral health care system, including the identification of dental homes, will ultimately ensure the opportunity for future expansion of this model, so all persons with developmental and intellectual disabilities have the opportunity to receive oral health education and access to oral health care. A supplementary goal is that this pilot project will not only create a foundation for future expansion within Palm Beach County but will serve as the basis for replication throughout Florida and around the country. A collaboration of Palm Beach County s Developmental Disability Interagency Council providers will draw from a state model of Iowa s I-smile program and a pilot program of the Head Start Dental Home Initiative in Orange County, Florida, to create a model program that increases oral health access to the developmentally disabled community. As outlined by I-smile, access to oral health care is worsening for underserved individuals even though advances in technology have increased the opportunity for service outreach to non-traditional settings. This program will create opportunities to improve access to oral health care for the developmentally disabled through the use of available technology, including specialized software. The systems approach of care will include academia, dental providers, Federally Qualified Health Centers, the Health Department, dental and dental hygiene associations, and medical professionals, and will decrease oral health disparities to this vulnerable population. The program will incorporate a two-phase system: Phase I will include planning, analysis and development, and recruitment of providers (dentists, 4

6 dental hygienists, dental assistants, etc.) Phase II will be dedicated to the finalization of the program, followed by the early stages of the implementation of services to establish a dental home for individuals with developmental and intellectual disabilities. The program requires an Oral Health Care Coordinator and a Project Manager as the two primary staff members, supplemented by per diem dental hygienists or hygiene assistants, as needed. A registered dental hygienist will serve as the Palm Beach County Oral Health Care Coordinator. Working in coordination with the Project Manager, this individual will oversee care coordination, provide oral health assessments, and manage and organize advanced oral health training for dental professionals to address challenges to providing treatment to the developmentally and intellectually disabled population, with the goal of increasing oral health among consumers and participation among providers. The Oral Health Care Coordinator, together with the Project Manager, will also research, develop, and provide oral health literacy education to non-dental health professionals and DD program staff, residents and family (as appropriate). Dentists who are recruited for this program will also serve as trainers, providing both classroom models and instruction for the clients and their caregivers during visits. The Project Manager will provide insight into, and connections with, local, state, and national resources to ensure the successful application of both phases of the project. Also, the Project Manager will identify and secure sources of project service revenue to complement and subsidize initial funding, and will also be responsible for creating an outcome document, based on collected data, which will provide a foundation for the ongoing sustainability of the project. 5

7 Grant Partners The composition of the Dental Home Initiative for Persons with Developmental Disabilities represented local agencies caring for persons with developmental and intellectual disabilities, oral health associations, academia, Federally Qualified Health Centers and private practice dental providers. Grant Team Genevieve Cousminer/ Dan Shorter Executive Director Coalition for Independent Living Options Fiscal Agent/Steering Committee Pat Murphy, M.S Executive Director/Chief Officer Palm Beach County United Cerebral Palsy Steering Committee Scot F. Kannel, BA, M.A.Pgm Executive Director The Arc of Glades Steering Committee Catherine Cabanzon, RDH, BASDH Grant/Project Manager Steering Committee Michelle Ryan CRDH, M. Ed. Oral Health Coordinator Sue Correia, CRDH, BS Oral Health Screener/Coordinator Megan Swaney, RDH Oral Health Screener/Provider Raphael Urbino, DMD Dental Care Specialist CE Educator Palm Beach County Interagency Council for Persons with Developmental Disabilities grant members Agency for Persons with Disabilities (APD) Coalition for Independent Living Options (CILO) The Arc of Palm Beach County Arc of the Glades Palm Beach County United Cerebral Palsy Palm Beach Habilitation Center Jewish Association for Residential Care (JARC) FAU CARD Boca Habilitation Center Seagull Industries for the Disabled Program Partners and Supporters Quantum Foundation Allegheny Franciscan Ministries Palm Beach State College Palm Beach County Oral Health Coalition Benco Dental Advanced Dentistry South Florida Regency Court Dental Palm Beach County Dental Hygiene Association FoundCare, Inc. C.L.Brumback Primary Care Clinics - Dental Services, Health Care District PBC Allegheny Franciscan Ministries Arc of Florida 6

8 Dental Home Initiative Goals, Objectives and Activities Goal 1: Provide a dental home for persons with developmental and intellectual disabilities who do not have a dental provider. Objective: Utilizing a registered dental hygienist to act as an oral health care coordinator, provide referral resources, act as a liaison for the client, caregiver, and waive support coordinator (WSC), and ensure dental services are provided for persons with developmental and intellectual disabilities. Activities: Train all grant team members on oral health care for persons with developmental and intellectual disabilities (Appendix A) Meet with center managers to explain the program. Provide a presentation of the program to the WSC, who conduct quarterly in-service meetings. Develop program flyers to be sent to agencies, caregivers, and clients. Develop client program informative brochures, and consent and results forms. (Appendix B) Work with center managers to identify individuals who do not have dental homes. Provide oral health screenings to identify oral health needs, such as; urgency, need for special care, e.g., relaxation therapy, sedation, and specialty referral. Screening tool, Assocaition of State and Territory Dental Director, Basic Screening Survey (Appendix C). Identify clients ability to pay for services; insurance plans, Med Waiver, private pay or center funding. Provide oral health and nutrition education, and special home care devices that may aid in oral care. Enter data in the database (Appendix D). EPI info, the database provides a continuum of tracking for dental exams, specialty referral for restorative and preventive care. WSCs are key to program success and tracking care for clients needing to establish a dental home. 7

9 Goal 2: Increase oral health knowledge of center care givers. Objective: Provide face-to-face education to all waive support coordinators (WSC), center managers, and caregivers on the importance of good oral health and balanced nutrition. Activities: Work with the Agency for Persons with Disabilities (APD) to identify a pathway to incorporate oral health instruction with WSC education. Develop presentations on oral healthcare and nutrition (Appendix E) Develop pre-and post-tests to measure learning objectives (Appendix F). Reach out to center managers to schedule staff training. 8

10 Goal 3: Increase community collaboration of dental providers capable of treating persons with developmental and intellectual disabilities. Objective: 1 Engage and increase dental provider base for restorative, specialty, and preventive care. Activities: Meet with local dental and dental hygiene associations to engage provider participation. Prepare a community provider CE course- (the University of Florida was helpful in identifying a provider in Palm Beach County who could present). Send a survey to dental providers in the community to gauge interest in the program. Reach out to the local County Health Department and or the Federally Qualified Health Centers. Develop a memorandum of understanding for providers. o Allows contract agreement with providers to deliver: Pro-bono services and the number of services rendered per month Discounted services Medicaid services Arc of Florida services Or a combination of all the above Partner with Arc of Florida to establish a billing application system for allocated state funds or dental care. Funds are allocated annually, specific to the dental needs of those persons with developmental and intellectual disabilities (Appendix G,H). 9

11 Screenings: Education: Services: Grant Outcomes Nine centers participated in the program Over 550 client were screened All 550 screened, received a minimum of two preventive fluoride varnish applications 550 received personal home care supplies Those with dexterity issues received electric toothbrushes 550 clients received one-on-one oral hygiene care instructions and nutrition education at each screening, in addition to fluoride varnish applications Those who smoked received tobacco cessation counseling 180 center staff members received face-to-face oral health and sound nutrition education, with an increased knowledge post education of 90% 50 dental providers participated in a continuing education program on treating persons with developmental and intellectual disabilities 30 new providers were added to the community resource All screened who needed urgent care were treated 80% of those screened who needed restorative dental care received care to include o Crowns o Bridges o Oral surgery o Biopsies o Dentures o Fillings o Extractions 70% of those who did not have a dental home were connected to one 88% of those needing dental hygiene services received continued care to include o Prophylaxis o Non-surgical periodontal scaling o Fluoride varnish o Dental sealants Through the collaboration of more than twenty-nine community partners, agencies and associations this program was able to increase oral health care for our most vulnerable population. The Palm Beach County Agency for Persons with Developmental Disabilities would like to thank all partners for their contributions, vision, and collective impact. 10

12 Grant Development; Resources Identifying local and state philanthropic organizations: The process of finding grants typically begins with prospect research. Foundations generally give based on subject and geographic region, look for funders whose interests match your mission, services and population served. Foundations generally give to non-profit organizations with 501(c) (3) status. If you do not have status, work with local agencies that can act as your fiscal agent. During the development of the DD-DHI grant, one of the agencies that serve persons with disabilities acted as the fiscal agent. Free online resource for finding grants: Foundation Directory Online Quick Start: Search by name, city or state. Request or Proposals (RFP s): Announcements of funding opportunities. Map of International Grants: Click on a country to see a list of recipients and their funders for recent years. Community Outreach: Identifying community need by working with agencies that serve specific populations is key to developing a program. There are state agencies that can assist in identifying local agencies that may be willing to embark on a program such as the DHI- DD grant. State agencies: Agency for Persons with Disabilities (APD) Special Olympics Florida Developmental Disabilities Resource Arc of Florida Dental Home Initiative FB page Provider Resources: Florida Department of Health- Dental Health Florida Association of Community Health Centers Florida Dental Hygiene Association Florida Dental Association Florida Academy of General Dentistry 11

13 Appendix A Training and CME Credit 12

14 Appendix B Association of State & Territorial Dental Directors Basic Screening Survey 13

15 Appendix C DHI-DD Client Information Form Your center has been selected to participate in the DD Interagency Council s Dental Home Initiative Grant Project. Dental Decay and Periodontal diseases are the most common chronic oral diseases found in adults. Adults with developmental challenges are especially at risk for advanced progression of these chronic but preventable oral diseases. These diseases can and do affect the quality of life, ability to learn, work, eat, and socialize. Therefore, we will be providing dental screenings and preventive fluoride varnish treatments in your center to determine: If a participating client has untreated dental disease If a participating client is in pain and in need of immediate care If the client has a dental home How to create a dental home for those who are unable to see a dentist What preventive services can be provided for individual clients Evaluate access to care barriers Shortly, a packet of information will be sent home from your center. The packet will include a HIPPA notice, permission slips, and a general access to care questionnaire. Please be sure, once you receive the information packet, that you sign the appropriate forms and return it to your center by the due date if you would like to participate in the screening process. Sincerely, 14

16 Positive Consent Letter Cover Dear Client or Guardian: You or your dependent has been chosen to take part in the Developmental Disabilities Dental Home Initiative Dental Basic Screening Survey Project to identify oral health needs. Dental Basic Screening Survey Project will help us plan future dental health programs. As you know, a healthy mouth is part of total health and wellness. With your consent, a dental hygienist will screen your/your dependent s teeth to check for tooth decay and other dental problems. During the screening, with your consent a preventive fluoride varnish application will be provided, a toothbrush and a letter to take home that tells you about the health status of their teeth. This screening does not replace a regular dental check-up with a dentist. The diagnosis of dental caries, soft tissue disease, oral cancer, temporomandibular joint disease (TMJ), and dentofacial malocclusions can only be completed by a dentist in the context of delivering a comprehensive dental examination. Please be assured that the dental screening will be carried out in a healthy manner. Dental gloves will be worn, and we will use a new, disposable, sterilized mirror for each person being screened. The dental hygienist will follow all guidelines to prevent the spread of disease as set forth by the Centers for Disease Control and Prevention (CDC) for this type of dental survey. Please complete and sign the attached consent form. This will allow you/ your dependent to participate in Dental Basic Screening Survey Project. Please return this form to your Day Program Provider tomorrow. Thank you for working with us to help improve overall dental health. If you have any questions about the Dental Basic Screening Dental Home Initiative Project please contact, Program Coordinator at. Sincerely, 15

17 Screening Consent Form Your program has been selected to participate in a dental program. We will be at your center providing oral health screenings. These screenings do not replace a dental examination but will help to refer for services with participating dentist if you do not have a dental provider. Please complete this form and return it to your day program, Thank you. Name: Please check all that apply: Yes, I give permission to have my/my ward s teeth checked Yes, I give permission to have a topical fluoride treatment for myself/my ward. Yes, I consent to either interviews, photographs and or videos for non-profit purposes including use of print, Internet and news reports. Yes, the program dental coordinator may contact me personally to assist with a dental referral Signature /Guardian Date: Please answer the following questions as this will help us if dental services are needed. Please circle the answers that best applies: 1. Do you have a dentist that can assist you if you are identified as needing care? Yes No 2. Do you currently have aches or pains anywhere in your mouth? Yes No 3. Do you have any kind of insurance coverage that pays for some or all of your routine DENTAL CARE? Including dental insurance, prepaid plans such as HMOs, or government plans such as Medicaid? Yes No Don t know 4. If a dental referral needs to be facilitated by the program and you don t have insurance do you have means to assist with some of the cost? Yes No 16

18 Screening Results Letter Name: Dear Participant, As part of the Developmental Disabilities Dental Home Initiative Program, a dental screening and preventive fluoride were performed. No x-rays were taken and the screening does not replace an in-office dental examination by your family dentist. The results of the screening indicate that: You or the person under your care has no obvious dental problems but should continue to have routine examinations by your family dentist You or the person under your care have some teeth which should be evaluated by your family dentist. Your dentist will determine whether treatment is needed. You or the person under your care have some teeth which appear to need immediate care. Contact your family dentist as soon as possible for a complete evaluation. The diagnosis of dental caries, soft tissue disease, oral cancer, temporomandibular joint disease (TMJ), and dentofacial malocclusions can only be completed by a dentist in the context of delivering a comprehensive dental examination. If you do not have a family dentist and you need help in obtaining dental care, please contact Directions for Care after a Fluoride Varnish Treatment After the application of a fluoride varnish, you will feel a coating over all your teeth, and you may notice a difference in the color of your teeth while the varnish remains on the teeth. To obtain the maximum benefit during the 4-6 hour treatment period, we ask that you follow these instructions. - Do not remove the varnish by brushing or flossing your teeth for at least 4-6 hours - If possible, wait until tomorrow morning to resume normal brushing and flossing - Maintain a soft food diet during the treatment period - Avoid hot drinks and products containing alcohol i.e. beverages, oral rinses, etc A thorough brushing and flossing the next day will easily remove any remaining varnish from your teeth. Your teeth will return to the same shine and brightness as before the treatment. 17

19 Appendix D Centers for Disease Control EPI Info Date Base 18

20 Appendix E Staff Oral Health and Nutrition Education 19

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23 Appendix F Staff Training Pre and Post Education Test Pre-test and Post Test Measure pre and post knowledge 1. Is periodontal disease an infectious disease? a) Yes b) No 2. What is the most chronic childhood disease a. Asthma b. Cavities c. Diabetes 3. Can cavities be prevented? a) Yes b) No 4. Is flossing the only way to clean between teeth? a. Yes b. No 5. What causes cavities? a. Sugar b. Bacteria c. Snacks 6. Should we rinse our teeth after brushing with toothpaste? a. Yes b. No 22

24 Appendix G ARC of Florida Dental Care Application 23

25 Appendix H W-9 Provider Tax form 24