Improving Oral Health Through School-based Health Centers Experiences and Challenges. Eli Schwarz KOD DDS, MPH, PhD, FHKAM, FCDSHK, FACD, FRACDS

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1 Improving Oral Health Through School-based Health Centers Experiences and Challenges Eli Schwarz KOD DDS, MPH, PhD, FHKAM, FCDSHK, FACD, FRACDS Oregon School-Based Health Care Network Hillsboro, OR, October 2013

2 Oral Diseases The social impact of oral diseases in children is substantial. More than 51 million school hours are lost each year to dental-related illness. Poor children suffer nearly 12 times more restricted-activity days than children from higherincome families. Pain and suffering due to untreated diseases can lead to problems in eating, speaking, and attending to learning. Surgeon-General s Report on Oral Health, USA, 2000 Eli Schwarz - School of Dentistry

3 Oregon reality dashboard Cavity rates by geographic region 73% Eli Schwarz - School of Dentistry

4 Health-Promoting School early Beginnings The health-promoting school: organizations and policy development in Welsh secondary schools Nutbeam D, Clarkson J, Phillips K, Everett V, Hill A, Catford J. Health Education Journal 1987; 46: Eli Schwarz - School of Dentistry

5 Health Promoting Schools A school constantly strengthening its capacity as a healthy setting for living, learning, and working by engaging health and education officials, teachers, students, parents, and community WHO, 1997 Eli Schwarz - School of Dentistry

6 Seven Key Health Problems for Students Intentional and unintentional injuries Sexual risk behaviors Alcohol/drug use Tobacco use Asthma Physical inactivity Poor eating habits Council of State Governments, USA, 2005 Eli Schwarz - School of Dentistry

7 Eight Components of Coordinated School Health Program (CSHP) Health Education Physical Education Health Services Nutrition Services Health Promotion for Staff Counseling and Psychological services Healthy School Environment Parent/Community Involvement Council of State Governments, USA, 2005 Eli Schwarz - School of Dentistry

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9 Danish Children Dental Care Overall Main goals to provide free preventive and curative oral health care to all children and young adults in Denmark aged 0-18 years Eli Schwarz - School of Dentistry

10 Eli Schwarz - School of Dentistry

11 Examples of ways in which Oral Health can be integrated into curriculum WHO, 2003 Eli Schwarz - School of Dentistry

12 Oregon experiences and challenges Assessment of needs in school-based oral health Examples of existing school-based oral health programs Challenges and barriers in implementation Opportunities for growth with the expanded importance of school-based health centers Eli Schwarz - School of Dentistry

13 2013 Oregon SBHC Needs Assessment Survey: Oral Health Findings Oregon School-Based Health Care Network John A. Dougherty, PhD, IPHS Funded By Kaiser Permanente Northwest

14 Survey Questions Please describe in your own words the services or other capacities you would like to add or improve in your health center in the Shorter-Term (< 2 years) Longer-Term (3-5 years) Please describe the barriers to adding or improving those capacities. What types of assistance would be helpful to you in overcoming those barriers?

15 Supplemental Oral Health Service Questions How would you describe your current Oral Health service delivery model? How would you best describe the organization(s) you work with to provide Oral Health services?

16 Survey Methods Survey developed by OSBHCN and IPHS. Taken online via Survey Monkey between late August and early September, SBHC coordinators and/or center directors were invited to take the survey. A $25 gift card was provided as an incentive for completing the survey. Numerical and narrative data were analyzed.

17 Survey Participation Number of Respondents Number of FQHC SBHCs represented by the respondents Number of Non- FQHC SBHCs represented by the respondents Invited to take the survey Completed the survey Percent: 63% 75% 100%

18 Respondents that Listed Oral Health as a Shorter- or Longer-Term Program Addition or Enhancement Goal (N=17) Oral Health as Shorter-Term Goal 5 29% Oral Health as Longer-Term Goal 6 35% Total: 11 64%

19 Oral Health Short Term Goals (< 2 years) Adding dental services Dental care Dental prevention and treatment services Oral health prevention services Oral health screening, cleaning and referral Oral Health Longer-Term Goals (3-5 years) Adding dental services Addition of hygienist and/or dentist Become PCPCH Broad range of oral health services Dental Dental care Dental care Dental on-site Dental resources integrated internally Dental services

20 Percent of Respondents Barriers to Oral Health Services - What SBHCs Lack (N=17) Funding Dental partners Space Equipment Staffing limitations Supplies Staff interest Training & professional devel...

21 Percent of Respondents The Kinds of Assistance SBHCs Want - Oral Health Services (N=17) Funding sources Help identify partnerships Consultation Develop sustainable reim... Equipment Resources How OHD distributes OH $

22 Percent of Respondents Oral Health Service Models Used by Non-Metro and Metro Portland Respondents 100 Non-Metro Respondents (N=13) Metro Respondents (N=4) OH integrated within SBHC OH not directly integrated with the SBHC) No OH Services offered/delivered

23 Percent of Respondents Oral Health Partners of SBHCs: Non-Metro and Metro Area Respondents who offer OH services (N=11) Non-Metro Respndents (N=8) Metro Area Respondents (N=3) Dental Care / Primary Care Organization FQHC County Health Dept State Program Private Practitioner (dentist, expanded practice hygienist) Contractor

24 TOOTH TAXI mobile dental van Oct

25 Statewide

26 Tooth Taxi Brings dental care directly to students Oral health assessment Oral hygiene kits (brush, paste, floss, mirror, timer) Comprehensive care

27 BRING DENTAL HEALTH TO THE KIDS YOU CARE ABOUT Model: K-12 Visit for one week Full-time staff (dentist and assistants) Un-insured, underinsured, 1 st visit to the dentist Educational component Provide a positive experience Volunteers from the community

28 SERVICES PROVIDED Exams & x-rays Fluoride Varnish Cleanings & Sealants Fillings Minor oral surgery Nitrous oxide available

29 Education In classroom presentations on oral hygiene One-on-one during screenings School receives library book pack Students receive oral health bookmarks

30 Healthy Teeth Can Change Lives Launched in 2008 to respond to oral health crisis in Oregon >200 sites visited 13,826 students screened 13,457 students received oral hygiene education in classrooms 6,684 students treated in the Tooth Taxi $3.7 million, value of free dental services provided

31 Partnering with SBHC After SBHC oral health screenings Tooth Taxi can provide restorative care If no oral health component request the Tooth Taxi for screenings and treatment Model of one week provides opportunity for treatment to be completed For incomplete treatment uninsured students are referred to ODS/OEBB The Children s Program Students with OHP, contact information provided for their plan

32 Requesting the Tooth Taxi Title 1 schools Select a primary contact person from the school to coordinate our visit Submit a request form - or pick up a form at OEA Choice Trust booth

33 Questions Answers Information Mary Daly Visit the OEA Choice Trust booth

34 Creston Children s Dental Clinic Putting the Mouth Back in the Body By Kurt Ferre DDS OSBHCN Annual Meeting Hillsboro, OR. October 11, 2013

35 The Legacy of Creston

36 Working Board of Directors

37 Our two newest board members L: Carlos Moreno MBA; R:James Mason PhD

38 Our Creston Staff

39 Creston: A Dental Home Patients qualify if they re on free/reduced lunch Referrals are from student s school We have contracts with 3 different DCO s We want our patients/parents when asked where they go for dental care? To answer, Creston.

40 Oral Disease Learnings Cannot have good health without good oral health Healthy kids learn better Cannot drill our way out of this mess Prevention is key

41 Prevention Outreach Build it, and they will come not exactly Healthy Roots Program Creston Flyers: printed in 6 languages Back to School Nights Visiting the School-based Health Clinics

42 Cavity Free Club

43 Creston Children s Dental Clinic like us on Facebook: Creston Children s Dental Clinic Kurt Ferré DDS kferre51@gmail.com

44 2008 VIRGINIA GARCIA MEMORIAL HEALTH CENTER

45 Virginia Garcia Memorial Health FQHC Private Non-Profit Clinic Center Primary Care, Dental, Pharmacy, Vision & Mental Health (thru Pacific Univ. and Lifeworks NW) Partnerships with local schools: OHSU, Pacific University, PCC, Anthem College, Concorde Career Institute Partnerships with local organizations: HeadStart, OCDC, WIC, sister organizations

46 Tigard High School VG SBHC s with hygienists Primarily one full clinic day per week Two elementary schools requested screenings Forest Grove High School Limited clinic days- one per month this year Most elementary schools in district request screenings Willamina High School 1 day a week w/ recent expansion in services to include adults Century High School Started offering services this past July 1 day full clinic day a week 2008 VIRGINIA GARCIA MEMORIAL HEALTH CENTER

47 School-Based Health Center oral health services Co-located expanded practice dental hygienist working with NP and mental/behavioral health specialist Free comprehensive screening, treatment plan for dental hygiene services, triage for restorative care * Fee-for-service cleanings, fluoride and sealants Provide assistance to NP in providing well-child oral health screenings and fluoride varnish Free all-school screenings for interested schools * Dental Van (VG, MTI, Tooth Taxi) * handouts available after presentation

48 Strengthen Community Actions through advocacy- externally Local dental offices- particularly those who treat Medicaid and ODS Children s program, as well as orthodontist who offers reduced rates and payment plans on ortho care. Personally make connections, follow up in person Compassion Connect- Provide follow up services for all children in the district Advertise to parents upcoming clinics Volunteer during clinic to provide additional information 2008 VIRGINIA GARCIA MEMORIAL HEALTH CENTER Bull Mountain Dental Images

49 Strengthen Community Actions through advocacy- internally Coordinate care with NP, school counselors, teachers Medications Scheduling appointments to piggy back when they are already coming in for something else Receptionist asks all patients if they need additional services we offer and is specific and detailed. Advocate for student s dental coverage ODS Children s Program and OHP - Receptionist fills out application for ODS Children s program and gives referrals to local partners, even making phone calls for patients - OHP provides assistance for families filling out OHP forms 2008 VIRGINIA GARCIA MEMORIAL HEALTH CENTER

50 Ongoing challenges Paper charts/ehr Dental clinic on paper charts, SBHC in medical chart with EHR Shared patients Dental clinics have digital x-rays, vans have film Consents, medical histories - Deciding to use medical or dental consents and histories when they are different Deciding where need is greatest and trying to meet those needs Understanding the community and what they want 2008 VIRGINIA GARCIA MEMORIAL HEALTH CENTER

51 Karen Hall, RDH EPDH Expanded Practice Dental Hygienist Virginia Garcia Memorial Health Center Yadira Martinez, RDH EPDH Expanded Practice Dental Hygienist Virginia Garcia Memorial Health Center Lisa Bozzetti DDS Dental Director Virginia Garcia Memorial Health Center

52 Oregon School-Based Health Care Network October 11, 2013 Cindy Hallett CDA, EFDA Oral Health Program Manager Community Health Centers of Benton and Linn Counties

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54 Strategic Plan Access to Care, Delivery of Services Coordinate & Expand Resources in the Community to Address Oral Health Needs Education Improve and sustain the oral wellness of all Benton & East Linn County residents through wellness education and disease prevention. Partner with health care providers, community health centers and clinics, state agencies, schools, and community programs to deliver oral wellness educational materials and programs to every member of that community. Partners Increase, Enhance, and Develop Partnerships

55 Strategic Plan Children s Prevention Dental Strategies Ensure all children in Benton & East Linn County have access to basic dental care Increase Access to Preventative Services Provide all children in Benton and East Linn Counties access to oral disease prevention programs Educate parents with the knowledge and skills necessary to prevent tooth decay in young children Increase Access to Dental Care All children in Benton & East Linn County have access to dental screenings and referral for dental care starting at 12 months of age

56 Strategic Plan Funding/Reimbursement Ensure adequate funding for dental programs. Identify and obtain public and/or private funding to support the efforts of the Benton and East Linn dental communities. Ensure an adequate level of reimbursement for dental county programs for dental services provided Identify funding streams in both public and private sectors at the local, state and national levels to support dental programs. Increase delivery sites Explore existing or new facilities to expand services

57 Where to start? Who to lead? How to make it work? April Pilot reimbursable sealant and fluoride varnish services at a Title 1 school. Full implementation September Best Practice approaches and evidence based reports taken from the Association of State and Territorial Dental Directors (ASTDD). Center for Disease Control provided recommendations that are designed to guide practices of community public health programs for planning, implementing, and evaluating school-based sealant programs. Experienced advice from a service provider running a successful reimbursable screening, sealant, fluoride varnish, and dental cleaning school-based program. Oregon Health Authority, Sealant Program. Training hygienists and staff on State School-based Sealant program, use of portable equipment, and data reporting. Loaned portable equipment for pilot. Ability to contract with Dental Care Organization, EPDH, to provide service delivery and be a billing provider to seek reimbursement from Medicaid/Oregon Health Plan for services provided.

58 How did we do? What are the results? Where do we go from here? April 2011 Provided screenings, sealants, and fluoride varnish applications to 42 children Title 1 schools Lincoln and Monroe (rural) Enrolled 9 children with new dental coverage provider Value of services provided $6,153 Pilot considered a success due to response and support provided by schools, administration, and school nurses in a short time span. Next steps Seek funding to purchase portable equipment and hire hygienist.

59 From Pilot to Implementation July 2011 Kaiser Permanente Northwest Oral Health Initiative 3-year grant for work with high-risk populations. October Launched the School-based Preventative Services targeting 6 Benton County Title 1 Schools that are at or above the 50% student eligibility for free and reduced lunches. February The Ford Family Foundation grant to expand services in Monroe and Alsea School districts. March Pilot school-based services at Holley School in Sweet Home. July Oregon Community Foundation grant to expand schoolbased services to the Sweet Home School District. Provide dental screenings to all children in the district and preventive services to Foster and Holley Elementary Schools. Work with the State Sealant Program to transition Foster Elementary School from the State to local provider.

60 Supporting Community Partners Albany InReach Services VOLUNTEERS DENTISTS DENTAL HYGIENISTS DENTAL ASSISTANTS Alsea School District Corvallis School District Monroe School District Philomath School District Sweet Home School District

61 Challenges and Successes Challenges Returned consents, authorizations, medical histories, paper records to be scanned Coordination with other organizations/programs 100% dental coverage participation FERPA Successes Screened - 3,300 Sealants 195 Children Clinic 1,536 children visits Teamwork gets kids treatment Collaboration, partnerships, and non-conventional delivery of services (rural areas) w/epdh & EFDA

62 What we have learned The power of passion to overcome obstacles. Allow others to share in the successes. Utilize best practices. Gain support from those who believe in your vision, passion, and ability to make things happen or create opportunities where others have failed. Foster meaningful relationships that build stronger programs and personal connections.

63 Questions??? Comments Cindy Hallett Oral Health Program Manager Community Health Centers of Benton and Linn Counties