Annual Maternal and Child Health Bureau Oral Health Grantee Meeting Summary

Transcription

1 Health Systems Research, Inc th Street NW Suite 700 Washington DC Phone: (202) Fax: (202) Annual Maternal and Child Health Bureau Oral Health Grantee Meeting Summary Washington, DC December 5 7, 2005 Prepared for: Health Resource and Services Administration Maternal and Child Health Bureau Prepared by: Anne Hopewell, M.S.W. Health Systems Research, Inc. January 2006

2 Table of Contents Introduction... 1 Welcome and Overview: HRSA s Role in Oral Health... 1 Day 1 Plenary Presentations... 9 Day 2 Plenary Presentations Day 3 Plenary Presentations Closing Remarks Appendix A: Appendix B: Appendix C: Appendix D: Participant List MCHB State Oral Health Collaborative Systems Grants State Presentations Meeting Agenda Head Start Regional Oral Health Consultants

3 Introduction On December 5 7, 2005, the Health Resources and Services Administration s (HRSA) Maternal and Child Health Bureau (MCHB) convened the State Oral Health Collaborative System (SOHCS) grantees for a 3-day meeting in Washington, DC. The purpose of the meeting was to update grantees on oral health systems development and data collection efforts at the Federal level, as well as to offer them an opportunity to learn from experts in the field regarding cuttingedge oral health issues. Presentations by the grantees also offered States the opportunity to share their successes, challenges, and lessons learned in building oral health infrastructure. Concurrent meetings of the MCHB-funded Regional Oral Health Consultants and the Association of State and Territorial Dental Directors (ASTDD) enabled SOHCS grantees to network with these individuals as well. A full participants list can be found in Appendix A. The impetus behind this conference was feedback that the Bureau received from SOHCS grantees during the MCHB All Grantees Meeting in The SOHCS grantees expressed a need for more targeted discussion on maternal and child health (MCH) oral health issues. In addition, the Bureau wanted an opportunity to gather information regarding the technical assistance (TA) resources needed by grantees and the future direction that the SOHCS program should take that could maximize the impact on the oral health of mothers, infants, and children. Welcome and Overview: HRSA s Role in Oral Health Mark Nehring Maternal and Child Health Bureau In his welcoming remarks, Mark Nehring, Chief Dental Officer of MCHB, thanked the planning committee who determined the content and flow of the meeting. The committee, whose efforts were led by Pam Vodicka, Public Health Analyst of the Oral Health Program at the Bureau, included Judy Feinstein (ME), Lew Lampiris (IL), Mary Foley (formerly MA), Dawn McGlasson (KS), and Katrina Holt from the National Oral Health Resource Center. He said that despite the diversity of grant objectives, each SOHCS grantee had the overarching goal of improving access to oral health care for MCH populations. Throughout the meeting, a number of the SOHCS grantees were provided with an opportunity to present their program objectives and successes. A chart summarizing the State presentations can be found in Appendix B. Dr. Health Systems Research, Inc. Page 1

4 Nehring expressed his hope that this annual meeting would provide the grantees with important information and resources to enhance their efforts to improve the oral health infrastructure in their States. He briefly reviewed the agenda, a copy of which can be found in Appendix C. He then introduced Steve Smith, Senior Advisor, Office of the Administrator, who spoke on the HRSA vision for oral health. Steve Smith Health Resources and Services Administration Steve Smith advises HRSA Administrator Betty Duke on a variety of public health issues. He said that he has had a long-term commitment to addressing oral health issues and was energized by the presence of the SOHCS grantees, State Dental Directors, and Head Start partners who are working to build collaborative systems that will improve the Nation s oral health infrastructure. As a former social worker involved with Social Security benefits, Mr. Smith said his career in public service always has focused on helping others. As an administrator, he says his efforts now involve an act of faith that although he is not working directly with clients, his efforts to create systems change do make a difference. Next, Mr. Smith reviewed HRSA's future directions for oral health. The Surgeon General's Report on Oral Health and its companion document A Call to Action prompted HHS to form a coalition, known as the National Partnership Network, to address oral health issues. He said that HRSA is making a long-term commitment to oral health with a focus on increasing access to care and reducing oral health disparities. HSRA recently updated the agency's oral health mission and goals. HRSA s mission for oral health is to: Improve the Nation s health by ensuring access to comprehensive, culturally competent, quality oral health care for all, as an integrated component of comprehensive health care. Health Systems Research, Inc. Page 2

5 He noted specific oral health goals, including the following: Improve the health infrastructure and systems of care for all, especially underserved, vulnerable, and special populations, to ensure access to comprehensive quality oral health services. Improve oral health status and outcomes to eliminate disparities. Improve quality of oral health services for all. Improve public-private partnerships in oral health at the Federal, State, and local levels. He noted that HRSA must not work alone to achieve these goals and that partnerships on the community, State, and local levels are necessary in order to implement change. Finally, he noted that data documenting oral health needs and program impacts are necessary in order to support future policy efforts and funding requests. He urged grantees to continue their data collection efforts demonstrating their progress toward oral health goals as well as toward the benchmarks set forth in Healthy People Peter C. Van Dyck Maternal and Child Health Bureau The next speaker was Peter C. Van Dyck, M.D., M.P.H., Associate Administrator of MCHB, who began his remarks with a brief overview of the MCH program. He noted that it is the oldest Federal health program, begun in 1912 and institutionalized in Title V of the Social Security Act of Originally, the MCH program funded a physician, a nutritionist, a public health nurse, a dentist, and a social worker for each State in order to implement programs to support public health. He noted that the Title V program currently is the principal funder of oral health programs in many States. He stressed that MCHB is dedicated to the right of every child to grow to his or her full potential that children should have access to quality health and oral health care and grow up in an environment that will nurture them into adulthood. He noted that the 2004 MCH All Grantees Meeting resulted in four committees that are working on strategic issues and will present their interim reports at the Association of Maternal and Child Health Programs (AMCHP) Annual Conference in Health Systems Research, Inc. Page 3

6 Dr. Van Dyck detailed past MCH funding efforts for oral health. He noted that when Title V was converted to a Block Grant, funding for oral health services decreased especially in rural areas. However, with the establishment of the school-based dental sealant program performance measure and the requirement that the Title V needs assessment include oral health data, attention is being drawn to the oral health needs of MCH populations. He remarked that MCHB also funds the Special Projects of Regional and National Significance and Community Integrated Service System grant programs, some of which have been used to increase oral health infrastructure in certain States. Next, he informed participants about the upcoming release of the National Survey of Children s Health. This chart book includes data on the oral health needs in every State. This survey began in 2003 and repeats every 4 years with the National Survey of Children with Special Health Care Needs (CSHCN) conducted in intervening years. Data from this chart book are obtained through telephone interviews with parents who are asked to report on their child s oral and overall health and safety in neighborhoods. The most recent survey findings indicate some positive oral health outcomes with 90 percent of parents noting that their children s oral health is excellent. Seventy-two percent of the families surveyed were able to see a dentist in the past year. Yet for young and poor children, the numbers are not as good. Fewer than 25 percent of 2-year-olds received a preventive dental visit, and 89 percent of the parents who reported their children did not see a dentist in the past year believed their children needed a visit. Only 58 percent of poor children received a dental visit in the last year compared to 82 percent of children whose family s income is over 400 percent of poverty. Since the SOHCS grants are to increase infrastructure and capacity of systems to address oral health needs, there was discussion of how State dental programs could present the survey data. Lack of public awareness of the need for dental visits to ensure optimum oral health is one theme States may use when discussing the survey results. Once the chart book has received clearance, it will be distributed to grantees and be available on the Web. Dr. Van Dyck also updated grantees on some MCHB activities in the wake of Hurricane Katrina. He noted that of the emergency shelters polled in Mississippi, the top unmet health need reported Health Systems Research, Inc. Page 4

7 was oral health. MCHB is currently working with AMCHP to develop a white paper on MCH program activities post-katrina. These remarks were then followed with Q&A on the need for the importance of oral health issues to be emphasized with various partners, including the planners of Border Health conferences and Community Health Center and primary care staff members. In addition, some attendees requested effective strategies for soliciting support of their MCH Directors for oral health efforts. Dr. Van Dyck noted that oral health programs must advocate internally for increased funding for oral health, since it cannot be federally mandated. He said that the Title V Block Grant is a public document, and once it is made available for public comment, oral health stakeholders should be encouraged to comment on the contents and advocate for more oral health funds. He concluded his remarks by suggesting that future oral health TA may aid in building capacity to document and support the need for MCH program involvement in oral health. Jay Anderson Bureau of Primary Health Care The next speaker, Jay Anderson, Chief Dental Officer of the Bureau of Primary Health Care (BPHC), welcomed participants and briefly described the BPHC s efforts on oral health. He noted that he grew up in an area served by a community health center (CHC) and has spent his career working on the behalf those served by such centers. He noted that the BPHC s greatest impact on oral health outcomes can be felt at the community level. CHCs receive funding to provide services, and Dr. Anderson noted that many define comprehensive primary oral health services quite broadly. He said that depending on the funds available and community needs, the oral health services provided range from education to restorative and preventive services. The populations served by CHCs include the intermittently employed who go in and out of the workforce. They pay for service on a sliding fee scale related to poverty guidelines. He noted that 63 percent of those treated at CHCs are minorities and 12 percent are less than 4 years of age. CHCs also serve approximately 1.4 million Migrant and Seasonal farmworkers and persons experiencing homelessness. He said that currently CHCs are not focused on the oral health needs of patients under the age of 4 but that efforts are underway to increase access to preventive oral health care for very young children. Health Systems Research, Inc. Page 5

8 Regarding funding, Dr. Andersen noted that one-third of the financial support for CHCs comes from Medicaid and therefore is becoming increasingly limited. However, he noted that over the past 7 years, there has been a gradual increase from 45 to 66 percent of CHCs offering preventive oral health services on site at more than 210 locations. Since CHCs are seeing an increased number of clients since 1999, he noted that the BPHC has as one of its goals to increase and improve oral health encounters for the millions of clients seen annually at CHCs. Unfortunately, with projected cuts in Medicaid spending, this will be a formidable challenge. Presently, the cost per dental encounter averages $120, and although Medicaid covers some of this, the CHC must supplement the funding in order to cover costs. Another challenge presented by Dr. Anderson was CHC workforce needs, which include 600 additional dentists and a commensurate number of hygienists. He speculated that hygienists may play an even greater role in the future in oral health service delivery. Other topics mentioned by Dr. Anderson included: Health and oral health disparities for minority children Need to focus attention on the detection, prevention, and treatment of early childhood caries (ECC) Successful CHC oral health pilot programs in Colorado Importance of good perinatal oral health for pregnant women served by CHCs Need for State Dental Directors to educate Medicaid Directors on the importance of oral health. He encouraged SOHCS grantees to collaborate with their CHCs, especially regarding the oral health needs of pregnant women. Ray Lala Bureau of Health Professions The next representative on the Federal welcoming panel was Ray Lala of the Bureau of Health Professions (BHPr). He told participants that he had 15 years of experience as a private practice dentist, 8 years working for the Indian Health Service, and 4 years serving as the State Dental Director of South Carolina. He currently manages the training programs for health professionals. Health Systems Research, Inc. Page 6

9 He echoed Dr. Anderson s suggestion for increased collaboration among oral health stakeholders at both the local and State levels. Dr. Lala briefly reviewed the various training programs funded through Title VII. Among the various programs funded by his Bureau are: Collaborative training between family medical programs and oral health programs Dental public health residency training The National Health Service Corps A loan repayment program for physicians and dentists. He informed participants that if States already have a relationship with dental programs, they may be eligible to apply for BHPr grants that can train dentists and dental students regarding dental public health needs. He noted that the Bureau is very supportive of training efforts that increase capacity of CHCs. He added that there is an opportunity for an oral health component in virtually all training programs and that he is working to maximize that opportunity. Finally, Dr. Lala noted that Congress is becoming increasingly interested in outcome data; therefore, he urged States to collect data that demonstrate their oral health needs. This is especially important regarding workforce issues, oral health disparities, and unmet needs. Although regional data are available, he suggested that State-level data will be more persuasive. Barry Waterman HIV/AIDS Bureau Barry Waterman, Chief Dental Officer of the HIV/AIDS Bureau, introduced himself as a Public Health Service officer who had previously served in clinical assignments with the Coast Guard before coming to work with the Ryan White programs. He now manages the two Ryan White CARE Act Dental Programs: Dental Reimbursement, and Community-Based Dental Partnership. Although all of the CARE Act programs, not only the dental programs, can fund the provision of oral health services for HIV-positive children and adult patients, the dental programs fund both services and the education and training of dental and dental hygiene providers to be able to manage the oral health needs of HIV positive populations. In Fiscal Year 2005, 66 dental Health Systems Research, Inc. Page 7

10 reimbursement programs in 23 States plus Puerto Rico and the District of Columbia reported caring for more than 31,000 positive patients and training more than 7,500 dental and dental hygiene providers. In Calendar Year 2004, 12 Community-Based Dental Partnership programs in 11 States reported serving more than 3,200 positive patients in dental clinics located in community settings. Dr. Waterman also mentioned that the Bureau has developed and continues to develop resources to meet the training needs of dental providers to be able to provide quality clinical care for positive populations. These include a five-chapter monograph entitled Principles of Oral Health Management for the HIV/AIDS Patient; a 9-module core curriculum of slides and speaker notes based on the monograph and other resources, entitled Principles of Oral Health Management for HIV/AIDS Adult and Pediatric Patients: A Course of Training for the Oral Health Professional; and an HIV Oral Health Curriculum for Nursing Professionals. The monograph and core curriculum are being updated and will be translated into Spanish. These and other HIV-related dental provider-training resources can be found on the Ryan White CARE Act AIDS Education and Training Centers National Resource Center Web site at For more information, Dr. Waterman can be reached on or at bwaterman@hrsa.gov. Pam Vodicka Maternal and Child Health Bureau Pam Vodicka, Public Health Analyst for the Oral Health Program at MCHB, concluded the welcoming panel. She introduced herself to grantees as a former practicing pediatric dietitian who began working with Dr. Nehring in 2004 reviewing grants and providing support to MCHB s oral health efforts. She met many of the SOHCS grantees at the MCHB All Grantee Meeting in She used the analogy of MCH oral health funding being like the knuckle joints on a bridge: they are meant to adjust to changing conditions and be flexible in order to meet the needs of MCH populations. She commended the SOHCS grantees on their efforts to improve the oral health infrastructure and mentioned an upcoming MCHB-funded effort through ASTDD to provide support for the oral health of CSHCN. These are just two examples of ways in which the Bureau is working strategically to improve oral health outcomes. Throughout the conference, Ms. Vodicka said she would be available to answer questions and guidance regarding the SOHCS initiative. Health Systems Research, Inc. Page 8

11 Day 1 Plenary Presentations Office of Performance Review Cindy Sego from HRSA s Office of Performance Review (OPR) and Dr. Steve Geiermann, HRSA Regional Dental Consultant for the OPR Chicago and Boston regional divisions, offered the first plenary presentation, entitled HRSA s Role in Oral Health. Their goal was to provide grantees with an overview of the performance review process emphasizing the importance of data collection and documentation to achieve results. Dr. Geiermann addressed the importance of outcome-based program planning and the need to collect relevant data in order to improve the dental public health infrastructure and close the gaps in service delivery. He noted that collaboration is the key to improved outcomes. The State strategic partnership performance review will enable multiple HRSA grantees within a State to review systematically how to reduce duplication of effort and enhance results through collaboration. Although this version of the performance review addresses HRSA-funded grantees within State government, the collaboration and results filter down to the local level. For example, in the course of a recent performance review, it was noted that poison control centers are receiving an increased number of queries on the safety of fluoride due to recent national publications addressing this issue. Poison control centers wonder why they had not been provided with clear answers to frequently asked questions prior to the release of this information. For the general populace, these centers are often the front-line for information sharing and distribution. This is an opportunity for State Dental Directors to collaborate with the Centers for Disease Control and Prevention (CDC) to share appropriate information on the safety of fluoride with communities, local organizations, and the general public through a new partner: poison control centers. Performance reviews help HRSA grantees identify where they are and where they want to go to maximize results. The philosophy behind the process is somewhat analogous to the basic premise of public health: assessment, policy development and implementation, and assurance. Grantees already have goals and objectives stated within their workplans. This is an ideal starting point, but it is not necessarily the end point. Health Systems Research, Inc. Page 9

12 Dr. Geiermann and Ms. Sego identified four areas of focus when preparing for performance reviews: Where have programs reached a plateau? The goal is within reach, but remains unattainable. Where are negative trends noted despite your best efforts? Where have you made significant progress? Are there best practices and models that work within your program that can be shared with others? Finally, as one works towards meeting stated (and funded) workplan goals and objectives, new needs can be uncovered. The documentation from the OPR process can help a grantee to tell their story better and may help make clear their need to secure additional resources. Despite the effort involved in preparing for an OPR review, the recommendations that emerge from the process can make the difference between a so what review and one that truly makes a difference. Dr. Geiermann continued by saying that OPR attempts to schedule site visits 3 to 6 months in advance and makes specific data requests well in advance of the 2- to 3-day onsite portion of the review. Through a series of conference calls prior to the onsite visit, grantees are asked to identify multiple areas in which they want to improve outcomes. Reviewing grantee information, the OPR team does the same. Together, OPR and the grantee identify three to five primary outcomes and the appropriate measures to track change. The grantee s Project Officer is invited to provide comments and participate in the review. Cindy Sego identifying the core functions of Office of Performance Review as: Conducting reviews to improve the performance of HRSA-funded programs Convening State and community strategic partnership sessions Tracking State and regional trends Providing feedback to HRSA about the impact of its policies on program implementation and performance Providing TA as appropriate in coordination with the various HRSA bureaus. Health Systems Research, Inc. Page 10

13 Ms. Sego noted that of the more than 3,000 HRSA grantees, approximately 350 would be reviewed by OPR in Review teams consist of two to four members, depending on the complexity of the grants being reviewed. These teams may include outside consultants who provide substantive expertise as necessary. The performance report generated as the result of this review includes performance improvement options of low- or no-cost, evidence-based strategies for program improvement, and suggested partnerships to enhance outcomes. From this information, the grantee develops an action plan that addresses any performance improvement actions or program requirements identified during the review. At this time, the grantee also may request TA to aid in meeting their action plan objectives. The finalized action plan is intended to become a basis for future conversation between the grantee and their Project Officer. This collaborative process of program improvement enables HRSA to encourage the development of synergy among its various grant programs and to enhance program outcomes. At the same time that HRSA seeks to eliminate stove piping within its own Bureaus, it seeks to enhance greater collaboration between the various Department of Health and Human Services agencies that grantees must contend with. OPR walks the walk itself with its own internal performance measures in the form of a balanced score card that includes post review grantee performance improvement, number of performance reviews completed, policy impact, and OPR employee satisfaction. SOHCS grantees asked Dr. Geiermann how to identify other HRSA grantees in their States. He referred grantees to the HRSA Data Warehouse Web site to generate that data. The OPR Web site will provide information on which HRSA programs are slated for review in Emerging Issues: Early Childhood Caries James J. Crall, Director of the National Oral Health Policy Center (OHPC) at the University of California Los Angeles, was the next presenter, speaking on The Development & Integration of Oral Health Service Delivery Systems. Dr. Crall prefaced his remarks by saying that the core of his presentation reviews MCHB s long-term commitment to integrating all aspects of the health Health Systems Research, Inc. Page 11

14 care service delivery system. In fact, the OHPC is funded in part with MCHB dollars which enable Dr. Crall to serve as an advisor to many oral health policy and program efforts. This presentation began with a quick overview of the disease of ECC. Cavities are a consequence of this disease and are highly prevalent, with the most recent National Health and Nutrition Examination Survey data indicating that between 30 and 40 percent of children surveyed suffer from ECC. Unfortunately, Dr. Crall pointed out that the lower a family s income, the higher the unmet need for treatment of oral disease. Race and ethnicity are also leading factors in likelihood of disease, with children of color having the greatest disparities in oral health status. Since this is the case, Dr. Crall noted that Head Start and Early Head Start children since they often meet certain economic and race/ethnicity standards are a population with a heavy disease burden. He cautioned about the impact of the soon to be released Children s Health Survey chart book data referred to by Dr. Van Dyck, since it minimizes the extent of the problem. He urged that grantees prepare for the release of the report with data documenting the extent of the disease in their communities. Dr. Crall was clear that he did not want to contradict the findings in the chart book, but rather he wanted to highlight the fact that parental reports are often inconsistent with data from less subjective sources. Next, Dr. Crall discussed the fact that dental caries is an infectious transmissible disease that is also chronic and complex. It involves genes, self-care practices, and numerous environmental factors. Although recent CDC data indicate that improvements have been made in many childhood diseases, the prevention and treatment of ECC in the United States is not showing progress. He referred to a textbook by O. Ferjerskov and acknowledged that Europeans are making significant progress in studying the disease. He suggested that it was critical that practitioners, policymakers, and families increase their awareness of the infectious and transmissible nature of the disease but also learn that it is preventable and often reversible. He continued with a discussion of the caries balance between risk and protective factors and that no simple solution exists to curb this chronic disease. However, by addressing caries at the very earliest stages of early childhood, an impact can be achieved. Health Systems Research, Inc. Page 12

15 Dr. Crall noted that challenges exist that prevent addressing the problem of ECC effectively. These include: Current system gaps High rates of disease among the uninsured and underinsured Disjointed/fragmented delivery system One-size-fits-all, dated approaches that do not take varying levels of risk into account. Dr. Crall noted that a recent American Academy of Pediatric Dentistry (AAPD) symposium in Chicago indicated that routine care is not fixing the problem. This is despite the fact that health care is an increasing percentage of the Gross National Product. Even within MCH Block Grants, oral health is not a priority. One solution presented by Dr. Crall was the use of a primary care approach. Well-child care is comprehensive, coordinated, and widely available although not to all at-risk populations and it continues longitudinally. If oral health screening and referral can be integrated into primary care, oral health outcomes could be improved. One example of this partnership between primary care and dental care is the AAPD s Interfaces Project, which includes oral health risk assessment, counseling, anticipatory guidance, preventive services, and referrals to dental homes. The American Academy of Pediatrics Bright Futures project is an attempt to provide care to underserved populations through targeted interventions. An ECC meeting in May 2005 convened 20 oral health practitioners and other stakeholders to discuss promising practices for addressing this epidemic. Recommendations included the following: Oral health instruction must be age appropriate and at the proper health literacy level. Distribution of oral health materials such as toothbrushes and fluoride toothpaste is effective. Caregivers should be trained in risk assessment behavior such as lift the lip. Practitioners must model proper oral health behaviors for parents. Health Systems Research, Inc. Page 13

16 Nurses and social workers should incorporate oral health assessments into home visits. Clinical providers and others must be trained to treat very young children. Risk assessment tools and anticipatory guidance for general dentists and pediatricians are necessary. To impact policy, data should be collected and analyzed electronically. Dr. Crall noted that Head Start and WIC programs have early and continuous exposure to families and could be significant partners in this effort, since these programs are well-trusted by communities. He suggested that the following activities will improve oral health outcomes: collaboration, multilevel initiatives, strategic approaches, comprehensive surveillance, and the development of evidence-based guidance. By addressing ECC when children are very young, practitioners will be taking a prevention approach rather than a disease treatment approach. This will improve the health and well-being of the child and is ultimately cost effective. Building political will for change and developing a diverse and culturally competent workforce are significant challenges, according to Dr. Crall. Since oral health care has been historically underfunded, addressing these needs is a significant challenge. Funding is also needed to support collaborative partnerships, fund prevention and treatment options, and develop an assessment tool that can be used to apply the principles of risk management to dental disease. In closing, he urged that ECC be taught in dental schools and that resources be allocated to develop a culturally competent diverse workforce. He suggested building political will through strategic partnerships, perhaps with senior citizens groups, as a possible strategy for raising visibility of the problem. Increased public awareness of the prevalence and severity of ECC will begin to develop the leverage needed to improve the oral health of vulnerable MCH populations. Children s Dental Health Project Mary Foley, Project Director for the Improving Perinatal and Infant Oral Health Project spoke during the luncheon on this 5-year effort funded by MCHB. The project, awarded to the Health Systems Research, Inc. Page 14

17 American Academy of Pediatric Dentistry and administrated by the Children s Dental Health Project, has three main goals: Expand the availability of dental care for pregnant women Expand the availability of dental care for infants and toddlers Increase awareness among the general public about the importance of oral health care for pregnant women, new mothers, infants, and toddlers. Echoing the concepts presented by Dr. Crall, Ms. Foley noted that the prevention, the treatment, and in particular the management of ECC is critical in order to address the prevalence of oral disease in MCH populations. Her program seeks to collaborate with a variety of MCH providers in order to implement cohesive strategies and practices to ensure comprehensive oral health education and services to improve the oral health of pregnant women, infants, and toddlers. Ms. Foley further stressed that oral health risk assessments by age 1 and evidence-based anticipatory guidance are key components to successful professional practice strategies. Ms. Foley reviewed the disease model of ECC from the acquisition of Streptococcus mutans to the development of cavitated lesions. Oral diseases in pregnant women include enamel erosion, dental caries, pregnancy gingivitis, periodontal disease, and tooth mobility. Although pregnant women are at no greater risk of periodontal disease than women in general, recent studies suggest that if left untreated, periodontitis, a more advanced form of periodontal disease in pregnant women, may affect pregnancy outcomes adversely. Some studies under review further suggest a relationship between periodontal disease and prematurity and low birth weight. The Improving Perinatal and Infant Oral Health Project will address these issues through the education and mobilization of multiple stakeholders, including Federal, national, and other organizations committed to the oral health of pregnant women, infants, and toddlers as well as health providers, including OB-GYNs, pediatricians, family physicians, pediatric dentists, general dentists, dental hygienists, and nurse practitioners. As Project Director, Ms. Foley will work with these partners to gather and disseminate information, attend national and State chapter meetings, conduct surveys and literature reviews, raise awareness through policy development, Health Systems Research, Inc. Page 15

18 develop consensus statements, and maximize various strategies to transfer knowledge about the oral health of these populations into practice. She concluded her remarks with the following summary statements: Dental caries is not the same thing as cavities. Risk assessment is key to all programs, directed to both individuals and the broader public. All programs must aim to educate, prevent, manage, and treat disease. Disease management practices must be ongoing whether cavities are present or not. There are no silver bullets for management of dental caries (e.g., fluoride varnish is only one of the components in a comprehensive oral health program). States should establish dental Early and Periodic Screening, Diagnosis, and Treatment guidelines to increase access to care for Medicaid-eligible children. Ms. Foley that the Children s Dental Health Project will monitor the outcomes of two prospective intervention studies on perinatal outcomes due in 2006 and 2007 and will disseminate the results to oral health stakeholders when they become available. Day 2 Plenary Presentations The Electronic Handbook (EHB) HRSA, in order to integrate data and performance collection systems with the bureaus, has implemented an online EHB to facilitate the grants management process. Christopher Dykton, MCH Task Lead for Science Applications International Corporation, began the second day of presentations with an overview of the EHB and offered SOHCS grantees an opportunity to ask questions about the new process. He began by explaining that the EHB will complement the grants.gov grant application site by enabling grantees to search for grant opportunities. In addition, the EHB will enable HRSA to gather outcome data across programs in order to inform policy and funding decisions. In the future, the SOHCS grantees will be required to submit their applications and reports to MCHB Health Systems Research, Inc. Page 16

19 through the EHB. The EHB will enable grantees to manage their workflow and will report performance measures and program-specific information online at the Web address Mr. Dykton informed grantees of how the EHB can help in the management of their grants with two key times for entering data: when applying for continued funding with a Progress Report, and when inputting final data each time that a grant year is completed. He reminded grantees that they all must register in the system and link themselves to an organization. The Project Director then authorizes the grantees with the appropriate level of functionality, such as View Only or Edit. Grantees should be aware that the Notice of Grant Award must match the name, credentials, and organization exactly. Grantees need to register only once, but passwords must be modified every 90 days. Mr. Dykton noted that only about half of the SOHCS grantees had registered, and he asked them to do so upon their return home, since the deadline for the next report is either January 15 or February 6, depending on the grantees particular cycle. He urged grantees to plan ahead and take time to learn the process. Once the initial information is inputted, subsequent reporting is simpler. He noted that postaward reporting will enable grantees to adjust original assumptions, and he then briefly reviewed the different narrative, budget, and financial forms and fields that need to be completed. Mr. Dykton remarked that it is a somewhat complex system but that it reflects the difficulty of what HRSA is trying to achieve. He next outlined the 37 Office of Management and Budgetapproved performance measures which will generate cross-cutting data across all grants that will demonstrate the effectiveness of MCH programs for Congress. With regard to oral health outcomes, the EHB will track Performance Measures 12 and 34: PM12: The percent of children under age 21 enrolled in Medicaid for at least 6 months continuously during the year who received any preventive or treatment dental service PM34: The number of States that include in their oral health plans at least 5 of the 10 essential elements of the guidelines included in ASTDD s Building Infrastructure & Capacity in State and Territorial Oral Health Programs. Health Systems Research, Inc. Page 17

20 He noted that one measure is a percentage and the other is a scale-based number. Medicaid will provide the information for PM12 and the grantees are responsible for the scoring of PM 34. Mr. Dykton noted that the HRSA Call Center is available at 877-GO-4-HRSA or callcenter@hrsa.gov and can be accessed Monday to Friday from 9 a.m. to 5:30 p.m. EST. He also urged grantees to contact him directly if they had any unresolved questions. A Plan for Reporting: Annual Project and Budget Updates Pam Vodicka, Project Manager at MCHB, next reviewed the SOHCS grants sequence of events with a focus on the timeline for report submissions. Most grantees are now entering their final year of reporting and have undergone the following report requirements each year: Notice of award Noncompetitive application Year end report. The year end report includes financial status reports and possible carryover requests. As grantees enter their fourth and final year, carryover requests that have exceeded 2 years will be offset by the award amount. Grantees may request a no-cost extension in year 4 (the final project year) as well. Ms. Vodicka offered guidance for the completion of several components of the SOHCS grantee application and continuation process, including a workplan detailing project goals and objectives, activities planned, and means for measuring progress towards these goals. Resources allocated to each activity and the impact on systems development, if notable, should be included in the workplan as well. The workplan, if in a table format, can be an appendix to the annual application. In addition to the workplan, it was suggested that the grantees augment their year end report with the following sections: Health Systems Research, Inc. Page 18

21 Overview Systems Development Products Impact. She noted that MCHB cannot require grantees to submit their reports in this format, but it will aid in the analysis of the overall impact of the initiative. She encouraged grantees to forward hardcopies of any products developed during the course of the project to the MCH Oral Health Resource Center for the future reference of other grantees. Finally, she reviewed the financial status report and the process for requesting carryover funds and no-cost extensions. She urged additional documentation on the source of the unspent funds and the reasons why the dollars went unspent. In addition, MCHB would like to see a line item budget identifying the unspent funds in one column and the plan for the expenditure of carryover requests in the other. Requests for carryover are due, as is the Financial Status Report (FSR), 90 days after the end of the budget period for the previous year. With regard to the requests for an extension, they must be made 10 days prior to the end of the project period and include the same information. She thanked grantees for their efforts to meet the new requirements and noted that this additional specificity will help demonstrate the collective success of the SOHCS grants and support Dr. Nehring s future requests for funding. Emerging Issues: Competencies for Nontraditional Oral Health Professionals Jack Dillenberg, Dean of the Arizona School of Dentistry & Oral Health, spoke about the role of nontraditional oral health providers in a changing workforce environment. As a dentist with significant public health and dental practice experience, he noted that limited access to oral health care will be a reality in the future, especially for underserved populations. In his opinion, dental education is at a crossroads, and the Arizona School of Dentistry & Oral Health is looking for students who are interested in giving back to the community. He noted that with an aging population that is increasing and increasingly keeping its teeth, the dental public health focus has shifted away from MCH populations. He also reviewed statistics that indicated that poverty, Health Systems Research, Inc. Page 19

22 ethnicity, and being a CSHCN mean poor access to care across the country. For Dr. Dillenberg, an aggressive prevention focus and the active recruitment of nontraditional providers will help to address these oral health disparities. According to Dr. Dillenberg, dental education should be working to identify specific oral health competencies in oral health that can be of use to physicians, pediatricians, physicians assistants, OB-GYNs, and nurse practitioners in order to expand the capacity of others in the health field to address the oral health needs of underserved populations. He noted that general doctors usually go from lips to tonsils and overlook teeth. He said that for outcomes to be improved, the mouth needs to be integrated back into the body. Dr. Dillenberg said that alternative providers need information about what is normal and abnormal and a ready source of referrals so they can manage incipient disease. CHCs were recommended as partners in disseminating information about ECC and the need to screen children by age 1. He concluded that a grassroots effort is needed to support alternative providers with the etiology of common diseases of the oral cavity and methods for identifying the appropriate prevention strategy. He urged SOHCS grantees to be a catalyst in connecting the dental and medical professions in their communities. At the Arizona School of Dentistry & Oral Health, Dr. Dillenberg sees the application process as key to recruiting dentists who will be committed to serving the public. He looks for caring and compassionate people who can be trained in oral health and encourages his staff not to be dissuaded by appearances. His students engage in community service hours throughout their education and often have a connection to underserved communities. In some instances, CHCs identify local individuals with commitment and talent and provide them with scholarships if they promise to return to their community. The school also supports a new clinic with 81 chairs. Students are observed while they are treating clinic patients and also required to participate in Integrated Community Service Partnerships that place students in community settings to complete a portion of their clinical training during their fourth year. Dr. Dillenberg is proud of the number and quality of applicants for the third class at the school. His hope is to create a Health Systems Research, Inc. Page 20

23 model curriculum that can be shared one that will create dental public health leadership for the future. Head Start and the Maternal and Child Health Bureau Robin Brocato, Program Specialist in the Health and Disabilities Branch of the Head Start Bureau, began her remarks with a brief overview of the Head Start and Early Head Start programs, since the planning committee felt it was important for the SOHCS grantees to be informed about this potential collaborative partner. Since oral health is integral to overall health and school readiness, Head Start programs are often willing and able collaborators for oral health projects that address the needs of young and very young children. Ms. Brocato summarized the goals of the Head Start program as follows: Promote school readiness by enhancing the social and cognitive development of lowincome children. Support parents in their role as primary educators of their children and empower families. Provide a supportive learning environment for children, staff members, and parents. Meet basic health needs including prevention. Respect children and adults: As individuals With roots in many cultures and languages As members of a community. She noted that in 1965, Head Start began as an 8-week summer program to get children ready for kindergarten. In addition to focusing on low-income children, the program provided services to American Indian/Alaska Native children in that year. In 1969, a Migrant and Seasonal Farmworkers Head Start program was instituted for children from birth to mandatory school age for at least 5 full days a week. In 1994, Early Head Start began to address the developmental needs of low-income children from birth to age 3. Health Systems Research, Inc. Page 21

24 Next, Ms. Brocato reviewed the structure of the program that includes 12 Regional Offices and more than 157 Head Start Grantees and their Delegate Agencies. She noted that more than 1,061,339 children served in 2004, the majority of whom were 4 years of age. Among the services provided by Head Start programs are the following: School readiness skills and attitudes Medical screening Dental screening Disabilities Nutritious meals Mental wellness Parent education. Home visits Staff development Community connections Parent involvement in decision making Socialization Referrals Due to the fact that dental screening is one area of concern to Head Start programs, MCHB became interested in formalizing a relationship between the two bureaus. John Rossetti, Regional Dental Consultant for Head Start Region XI and Oral Health Expert Consultant to MCHB, spoke next about the importance of the Intra-Agency Agreement (IAA) that began in Based on a Head Start and Partners Oral Health Forum held that year, strategies were identified for increasing access to oral health services at the Federal, State, and locals levels. One outcome of the forum was that HRSA and the Administration for Children and Families re-established the formal partnership that had existed from 1966 to the mid-1990s. An IAA was signed in September 2001 and renewed July Dr. Rossetti noted that the overall goal of the IAA is to achieve optimal oral health for Head Start children. Among the activities supported by the IAA were 10 Regional Head Start Forums; Professional Organization Forums, including Head Start materials and information on the National Oral Health Policy Center and National Oral Health Resource Center work; and the ability to make presentations at a number of National Conferences to emphasize the importance of this important partnership. Health Systems Research, Inc. Page 22

25 In 2005, the IAA expanded to include MCHB-funded part-time regional oral health consultants to augment the TA resources at the Head Start Regional Offices. Dr. Rossetti indicated that all the consultants were in attendance at this meeting and that the remainder of the luncheon time was allocated for discussion between the SOHCS grantees and this TA resource. Contact information for the consultants can be found in Appendix D: Emerging Issues: Dental Sealants Margherita Fontana, D.D.S., Ph.D., from the Indiana University School of Dentistry, provided the final plenary presentation of the meeting, entitled Techniques of Tooth Surface Assessment Indications for Sealant Placement. The objective of her presentation was to address some of the controversy surrounding the application of dental sealants. In her words, To seal or not to seal, Dr. Fontana began her remarks with a quote from Jane Weintraub s presentation in the National Institutes of Health Consensus Development conference on the diagnosis and management of dental caries throughout life in 2001: Improved caries detection and diagnostic methods would help determine the appropriate cut point or threshold separating the clinical decisions to do nothing or preventively seal, or to therapeutically seal or surgically treat and restore. She followed this by reviewing a series of questions that were raised by an Expert Panel assembled by CDC in to revise sealant guidelines for school-based sealant programs. These questions included the following: What degree of accuracy in assessing the existence of dental caries is necessary before sealants can be placed? What should be done about hidden caries? What visual signs (color, opacity, stain, translucency, or other physical characteristics) determine dental caries status into established categories of disease (sound/caries-free, questionable, enamel caries, and dentin caries)? Although there is consensus that prevention efforts are effective, many questions remain regarding the application of dental sealants by nondental professionals. To address this issue, Dr. Fontana outlined her presentation as follows: Health Systems Research, Inc. Page 23

26 Overview of Caries Detection/Diagnosis Traditional Caries Detection Methods Hidden Caries New Methods of Caries Assessment: Visual Technology-based Caries Lesion Activity Status Diagnostic Thresholds for Placing Sealants Sound Carious Incipient Cavitated. She shared a diagram of the process for the management of dental caries that indicated that detection, diagnosis, and risk assessment of dental disease should be used in combination to determine whether to utilize a surgical and/or nonsurgical intervention to prevent and/or treat caries. She shared slides with participants asking them to assess visually the state of the disease on teeth that were both wet and dry. (This task demonstrated to the audience how difficult it is to make an accurate and detailed assessment on a wet tooth.) She also showed the negative consequences of using a sharp explorer and urged participants to use sharp eyes and blunt instruments. (in other words, use explorers with caution). She concluded with data showing the sensitivity and specificity aspects of visual detection and noted that traditional visual detection can result primarily in the undertreatment and underdiagnosis of caries. However, Dr. Fontana reassured participants that cariologists are looking for ways to increase the accuracy of the traditional method of a visual diagnosis, so it is understandable that nondental professionals are as well. In the past, detection consisted of finding and assessing a lesion. But for a truly accurate diagnosis, Dr. Fontana noted that it is important to know if the disease is active, progressing rapidly or slowly, or already arrested. Since caries is not a static process, this variable is critical in making the most effective treatment decision. Fortunately, Dr. Fontana Health Systems Research, Inc. Page 24

27 noted that as the science evolves, dental providers will be able to determine the progression of the disease more accurately and make better decisions regarding preventive or surgical treatments. Next, she gave a brief overview of the core criteria of the International Caries Detection and Assessment System (ICDAS). ICDAS provides criteria that describe the characteristics of clean, dry teeth in such a way as to promote valid comparisons of results among studies, settings, and locations. They are now in place and are recommended for use as they provide an evidencebased framework to validate and explore the impact of existing and new-technology aids to caries detection and diagnosis. Assessment criteria currently are being researched and should assist with unifying standards of care. Dr. Fontana then reviewed some of the new technologies that will enhance radiographic and visual examinations. She noted that since radiographs are a point-in-time measure, they are able to show a certain degree of demineralization but cannot indicate if it is active or dormant. However, technology is emerging that can address some of the deficiencies of radiographs and traditional visual examination. For example, technology already available to clinicians includes: Fluorescence methods Transillumination Electrical conductance Digital radiography. She presented the circumstances in which a practitioner would use each technology and their advantages and disadvantages. These and other new technologies under research will enable dental professionals to see the progress of disease better and, according to Dr. Fontana, have the potential, if used adequately, to change the practice of dentistry fundamentally. In the future, she contends that practitioners will be able to determine severity and activity of dental disease, to treat it, and hopefully never to see cavitation. Health Systems Research, Inc. Page 25

28 Until these technologies are widely available, dentists and other nondental providers will need to determine whether it is appropriate to seal teeth if there is evidence or a possibility of cavitation. Since many of the school-based sealant programs are established in communities with heightened risk for caries, the question becomes whether there are any adverse effects from the application of sealants on teeth that are possibly demineralized but not cavitated. Dr. Fontana concluded by citing a number of studies that support the application of sealants on carious teeth, most notably Handelman s 1991 review of radiographic and bacteriologic studies (several years of followup) on the therapeutic use of sealants. This review concluded that caries is inhibited and in fact may regress under intact sealants. Earlier studies, including Handelman et al., 1976; Handelman, 1982; and Mertz-Fairhurst et al., 1986, 1995, also demonstrate no evidence of caries progression under sealed teeth. On the basis of these data and all the existing data on effectiveness of sealants, Dr. Fontana concluded that the use of dental sealants improves oral health outcomes for at-risk children. Her final suggestion was to develop consensus around the need to change the thresholds for applying sealants. She urged changes in training and education, as well as in insurance reimbursement for usage of newer diagnostic equipment and disease management techniques. She contends that dental caries is preventable and practice must change to treat this disease, rather than just focusing on treating the consequences of the disease at the level of cavitation. Day 3 Plenary Presentations On the final day of the meeting, Dr. Nehring provided grantees with an overview of the future direction of the SOHCS program. He said that he wants to provide training and TA to grantees in order to improve program outcomes. New reporting suggestions and the EHB will enable MCHB to understand better the strengths and weakness of the SOHCS program. In order to achieve a broader perspective, however, the Bureau has invested in an evaluation process that will provide guidance as to the future direction of the program. He asked the evaluation team from Health Systems Research, Inc. (HSR) to provide the grantees with an overview of the evaluation process. Health Systems Research, Inc. Page 26

29 Evaluation of the SOHCS Grant Program The HSR Evaluation Team includes Rebecca Ledsky as the evaluation Director and Anne Hopewell as Project Manager. The evaluation will be conducted under the oversight of Pam Vodicka at MCHB. The evaluators described the goals of the evaluation as being to: Detail successes and barriers for internal and external policymakers Provide evidence for funding requests to continue State-level oral health initiatives Maximize effective use of resources. The evaluation will ensure accountability, isolate and disseminate promising practices, and provide information to improve program outcomes. The evaluation will assess the grantees against the goals they identified for themselves and report on both individual and collective successes. The evaluation sample will be all SOHCS grantees with continuous activity since , and preliminary results are due at the Bureau in the spring of This tight time frame requires the utmost cooperation of the grantees in the various components of the evaluation process. The evaluation consists of three phases: preparatory activities, data collection and analysis, and the drafting and dissemination of final reports. In addition to the review of the grantee applications and progress reports, there will be key-informant interviews and site visits. MCHB will assist HSR to identify the criteria for the nine site visits. Those grantees that will not be visited will be asked to participate in key-informant telephone interviews. The Evaluation Team noted that the first component of the evaluation will be logic model conference calls to be conducted in early January. They requested that volunteers contact HSR regarding their willingness to participate in a 90-minute call that will provide insight into some of the activities and outcomes anticipated by SOHCS grantees. Following these calls, grantees will be contacted to schedule a key-informant interview with local partners to obtain qualitative data regarding their infrastructure-building challenges and successes. Nine grantees also will be selected for site visits. Due to limited resources, HSR will be able to send only one evaluator to each site visit and therefore will need onsite support by the grantee regarding the logistics of the Health Systems Research, Inc. Page 27

30 site visits. Grantees were assured that sufficient notice would be given prior to these activities and that despite the tight timeline, consideration will be given to their schedules. Through this evaluation, MCHB anticipates results that will: Improve the SOHCS process Provide data for MCHB s future funding requests for the SOHCS program Identify TA and training needed Inform future data collection processes. Echoing the importance of evaluation, Bev Isman, the Executive Director of ASTDD, offered the support of her coworkers to this evaluation process. In many cases, the State Dental Director is the Project Director of the SOHCS grant; however, in those instances where they are not, she urged grantees to contact the Dental Director to discuss their infrastructure efforts. She assured the grantees that ASTDD and its membership were available for support and consultation. Group discussion indicated that although grantees are very supportive of the evaluation process, a number of States are recipients of CDC infrastructure grants and have already participated in logic model training and site visits. HSR assured grantees they would do everything possible to minimize any duplication of effort for these States. Closing Remarks Dr. Nehring thanked attendees for their active participation in this annual meeting. He reminded grantees that Federal funding dollars are currently very strained and that collecting data to support objective outcomes is very important. He noted that requests for carryover dollars receive intense scrutiny and that one component of the evaluation will be to identify the reasons or patterns behind carryover requests in order for MCHB to develop and offer TA to address them. He remarked that he is committed to the SOHCS initiative but that he also wants to be able to modify and enhance it to make the best use of the funding he has available. Health Systems Research, Inc. Page 28

31 In closing, Dr. Nehring reminded grantees to forward products developed through these grants to Katrina Holt for inclusion in the Oral Health Resource Center archives. He encouraged rigorous data collection efforts and the timely submission of reports, especially requests for no-cost extensions or to carryover funds. He expressed pride in the efforts of grantees to make a difference in the oral health outcomes of MCH populations and said he looked forward to seeing everyone next year at the final annual meeting for this cycle of the SOHCS grant program. Health Systems Research, Inc. Page 29

32 Appendix A: Participants List Health Systems Research, Inc. Appendix A

33 Annual MCHB Oral Health Grantee Meeting Health Resources and Services Administration L Enfant Plaza Hotel Washington, DC December 5 7, 2005 Participant List Grantees Linda Marie Altenhoff, D.D.S. Primary Contact/Investigator/Manager Oral Health Group Texas Department of State Health Services 1100 West Forty-Ninth Street, Mail Code 1938 Austin, TX Phone: (512) x3001 Fax: (512) linda.altenhoff@dshs.state.txus Joseli A. Alves-Dunkerson, D.D.S., M.B.A., M.P.H., M.S., M.H.A. Supervisor OH Program/State Dental Director Washington State Department of Health P.O. Box Olympia, WA Phone: (360) Fax: (360) joseli.alves-dunkerson@doh.wa.gov Helen E. Arthur, R.D.H. Oral Health Grant Administrator Division of Public Health Health Systems Management Blue Hen Corporate Center 655 South Bay Road, Suite 206 Dover, DE Phone: (302) Fax: (302) helen.arthur@state.de.us J. Steve Arthur, D.D.S., M.P.H. Program Director/Director Office of Oral Health Vermont Department of Health 108 Cherry Street, P.O. Box 70 Burlington, VT Phone: (802) Fax: (802) sarthur@vdh.state.vt.us Elizabeth Barrett, D.M.D., M.S.P.H. Oral Health Promotion Unit Supervisor Division of Dental Health Virginia Department of Health 109 Governor Street, Ninth Floor Richmond, VA Phone: (804) Fax: (804) elizabeth.barrett@vdh.virginia.gov Lynn Ann Bethel, M.P.H., R.D.H. Interim Director Office of Oral Health Massachusetts Department of Public Health 250 Washington Street, Fifth Floor Boston, MA Phone: (616) lynn.bethel@state.ma.us Maija Beyer, R.D.H. Oral Health Program Director North Dakota Department of Health 600 East Boulevard Avenue, Department 301 Bismarck, ND Phone: (701) Fax: (701) mbeyer@state.nd.us Participant List Appendix A Page 1

34 Greg Black, D.D.S. Dental Director, State of West Virginia OMCFH 350 Capitol Street, Room 427 Charleston, WV Phone: (304) Carol A. Brown Coordinator, Children's Dentistry Project WVDHHR/BPH/OMCFH Oral Health Program 350 Capitol Street, Room 427 Charleston, WV Phone: (304) Fax: (304) Diane Brunson, M.P.H., R.D.H. Director, Oral Health Colorado Department of Public Health and Environment 4300 Cherry Creek Drive South Denver, CO Phone: (303) Fax: (303) Jim Cecil, D.M.D., M.P.H. State Dental/Project Director Kentucky Department for Public Health Oral Health Program 275 East Main Street, HS2W-B Frankfort, KY Phone: (502) x3774 Fax: (502) Cheryl A. Chapman Director UALR Children International 2510 Fair Park Little Rock, AR Phone: (501) Lorie Wayne Chesnut, M.P.H. Business Manager Kentucky Department for Public Health 275 East Main Street, HS2W B-75 Frankfort, KY Phone: (502) x3760 Fax: (502) Tim Cooke, M.P.H. School Based Program Coordinator Bureau of Dental Health New York State Department of Health Room 542, Tower, ESP Albany, NY Phone: (518) Fax: (518) Harry W. Davis, D.D.S., M.P.H. Project Director, Florida Department of Health Public Health Dental Program 4052 Bald Cypress Way, Bin #A14 Tallahassee, FL Phone: (850) Fax: (850) Karen C. Day, D.D.S., M.P.H., M.S. Director, Division of Dental Health Virginia Department of Health 109 Govenor Street, Ninth Floor Richmond, VA Phone: (804) Fax: (804) Pamela Donovan, R.D.H. Massachusetts Head Start Oral Health Consultant Massachusetts Department of Public Health 250 Washington Street, Fifth Floor Boston, MA Phone: (617) Fax: (617) Participant List Appendix A Page 2

35 Thomas E. Duval, D.D.S. Director, State of Georgia Oral Health Program DHR/DPH/FHB Oral Health Section Two Peachtree Street, NW Suite Atlanta, GA Phone: (404) Fax: (404) Julie Ann Ellingson, R.D.H. Project Coordinator South Dakota Department of Health 615 East Fourth Street Pierre, SD Phone: (605) Fax: (605) Gordon Empey, D.M.D., M.P.H. State Dental Director Office of Family Health Oregon Department of Human Services 800 Northeast Oregon Street, Suite 825 Portland, OR Phone: (971) Fax: (971) Carrie L. Farquhar, R.D.H. Co-Project Director Bureau of Oral Health Services Ohio Department of Health 246 North High Street Columbus, OH Phone: (614) Fax: (614) Judith A. Feinstein, M.S.P.H. Director, Oral Health Program Maine Department of Health and Human Services 11 Statehouse Station 286 Water Street, Fifth Floor Augusta, ME Phone: (207) Fax: (207) Emanuel Finn, D.D.S., M.S. Project Director DC Department of Health 825 North Capitol Street, NE, Suite 3110 Washington, DC Phone: (202) Fax: (202) Joyce Flieger, M.P.H. Grant Project Director Arizona Department of Health Services 1740 West Adams, Room 205 Phoenix, AZ Phone: (602) Fax: (602) Christine Forsch, R.D.H. Oral Health Program Manager Nevada State Health Division 3427 Goni Road, Suite 108 Carson City, NV Phone: (775) Fax: (775) Pam Frisby Coordinator University of Wyoming - WIND 1000 East University Department 4298 Laramie, WY Phone: (307) frisby@uwyo.edu Participant List Appendix A Page 3

36 Deborah Fuller, D.M.D., M.S. Dentist Consultant Rhode Island Department of Health Oral Health Program 3 Capitol Hill Providence, RI Phone: (401) Fax: (401) deborah.fuller@health.ri.gov Sherry Goode, R.D.H. Associate Project Officer Alabama Department of Public Health 201 Monroe Street, #1364 Montgomery, AL Phone: (334) Fax: (334) sgoode@adph.state.al.us Wynne Grossman, M.S.W. Dental Health Foundation 520 Third Street, Suite 205 Oakland, CA Phone: (510) Fax: (510) wgrossman@tdhf.org Kelly Haupt, R.D.H., M.H.A. Pre-School Oral Health Coordinator Oral Health Section, Division of Public Health North Carolina Department of Health and Human Services 1910 Mail Service Center Raleigh, NC Phone: (919) Fax: (919) kelly.haupt@ncmail.net Tanya Kels Executive Director Chester County Community Dental Center 1131 Olive Street Coatesville, PA Phone: (610) Fax: (610) communitydental@verizon.net Rebecca King, D.D.S., M.P.H. Chief, Oral Health Section Division of Public Health North Carolina Department of Health and Human Services 1910 Mail Service Center Raleigh, NC Phone: (919) Fax: (919) rebecca.king@ncmail.net Jayanth V. Kumar, D.D.S., M.P.H. Project Director/Director, Oral Health Surveillance and Research Bureau of Dental Health New York State Department of Health 542, ESP Corning Tower Albany, NY Phone: (518) Fax: (518) jvk01@health.state.ny.us Kim Laiden Dental Assistant Ministry of Health Majuro Hospital Majuro, MH Phone: (692) x ddsmohe@ntamar.net Lewis N. Lampiris, D.D.S., M.P.H. Illinois Department of Public Health Division of Oral Health 535 West Jefferson Street, Floor 2 Springfield, IL Phone: (217) Fax: (217) llampiri@idph.state.il.us Keith Conrad Larson, D.D.S. Project Director Ministry of Health Box 6027 Koror, PW Phone: (680) Fax: (680) dental@palaunet.com Participant List Appendix A Page 4

37 David Lees, D.D.S., J.D. Director, Oral Health Division South Carolina Department of Health and Environmental Control 1751 Calhoun Street Mills/Jarrett Complex Columbia, SC Phone: (803) Fax: (803) Carolyn Link, J.D., M.P.A., M.P.A. Missouri Department of Health and Senior Services 930 Wildwood Drive, P.O. Box 570 Jefferson City, MO Phone: (573) Fax: (573) Stuart A. Lockwood, D.M.D., M.P.H. Project Officer Alabama Department of Public Health 201 Monroe Street, #1364 Montgomery, AL Phone: (334) Fax: (334) Joan M. Lowbridge, R.D.H. Oral Health CSHCN Consultant Massachusetts Department of Public Health P.O. Box 286 Berlin, MA Phone: (508) Mark E. Mallatt, D.D.S., M.S.D., F.A.C.D., F.I.C.D. Principal Investigator Indiana State Department of Health 2 North Meridian Street Indianapolis, IN Phone: (317) mmallatt@isdh.in.gov Florence R. Martin Tribal Oral Health Educator Oglala Sioux Tribe P.O. Box 5011 Pine Ridge, SD Phone: (605) Fax: (605) flo_mart6685@yahoo.com Nancy Martin, M.S., R.D.H. New Hampshire Oral Health Program Manager Oral Health Program New Hampshire Department of Health and Human Services 29 Hazen Drive Concord, NH Phone: (603) Fax: (603) nmartin@dhhs.state.nh.us Megan Martinez, M.P.H. Sealant Coordinator Colorado Department of Public Health and Environment 4300 Cherry Creek Drive South Denver, CO Phone: (303) Fax: (303) megan.martinez@state.co.us Gregory B. McClure, D.M.D., M.P.H. State Dental Director Division of Public Health Health Systems Management Blue Hen Corporate Center 655 South Bay Road, Suite 206 Dover, DE Phone: (302) Fax: (302) greg.mcclure@state.de.us Participant List Appendix A Page 5

38 Kimberly K. McFarland, D.D.S., M.H.S.A. Nebraska State Dental Health Director Nebraska Department of Health and Human Services 301 Centennial Mall South Lincoln, NE Phone: (402) Fax: (402) Dawn McGlasson, R.D.H. Deputy Director, Office of Oral Health Kansas Department of Health and Environment 1000 SW Jackson, Suite 220 Topeka, KS Phone: (785) Fax: (785) Nancy McKenney, M.S. Project Administrator Wisconsin Department of Health and Family Services One West Wilson Street, Room 665 Madison, WI Phone: (608) Fax: (608) Michael L. Morgan, D.D.S., M.P.A. Project Director Oklahoma State Department of Health 1000 Northeast Tenth Street Oklahoma City, OK Phone: (405) Fax: (405) Nicholas G. Mosca, D.D.S. Dental Director Mississippi Department of Health 570 East Woodrow Wilson, Room A-107 Jackson, MS Phone: (601) Fax: (601) Lynn Douglas Mouden, D.D.S., M.P.H. Project Director Arkansas Division of Health Office of Oral Health P.O. Box 1437, H41 Little Rock, AR Phone: (501) Fax: (501) Jolene Perkins Dental Clinic Manager Arkansas Department of Health and Human Services P.O. Box 1437, Slot H 41 Little Rock, AR Phone: (501) jkperkins@ualr.edu Margaret Perry, M.B.A., R.D.H. Grantee Arizona Department of Health Services/Pima County 1740 West Adams, Room 205 Phoenix, AZ Phone: (602) Fax: (602) margaret.perry@pimahealth.org Susan L. Potter Project Coordinator Oklahoma State Department of Health 1000 Northeast Tenth Street Oklahoma City, OK Phone: (405) Fax: (405) susanp@health.ok.gov Dionne Johnson Richardson, D.D.S., M.P.H. Principal Investigator/Director State Oral Health Program LSU Health Sciences Center LSU School of Dentistry P.O. Box Atlanta, GA Phone: (504) dricha@lsuhsc.edu Participant List Appendix A Page 6

39 Tracy Rodgers, R.D.H. Project Director Iowa Department of Public Health Lucas State Building, Fourth SW 321 East Twelfth Street Des Moines, IA Phone: (515) Fax: (515) Mildred Hottmann Roesch, M.P.H., R.D.H. State Dental Director Minnesota Department of Health PO Box St. Paul, MN Phone: (651) Ronald J. Romero, D.D.S., M.P.H. State Dental Director Office of Dental Health New Mexico Deparatment of Health Colgate Building 2040 South Pacheco Street, Room 314 Santa Fe, NM Phone: (505) Fax: (505) Bobby Russell, D.D.S. Iowa Department of Public Health Lucas State Office Building 321 East Twelfth Street Des Moines, IA Phone: (515) Fax: (515) Kelly Sage, M.S. Program Director/Chief Office of Oral Health Maryland Department of Health and Mental Hygiene 201 West Preston Street, Third Floor Baltimore, MD Phone: (410) Fax: (410) Louisa Santos Ministry of Health Box 6027 Koror, PW Phone: (680) Fax: (680) Cheri E. Seed Oral Health Consultant Montana Department of Public Health 1400 Broadway, C314 Helena, MT Phone: (406) Fax: (406) Rhonda Sledge, R.D.H., M.H.S.A. Program Manager Office of Oral Health Arkansas Department of Health and Human Services P.O. Box 1437, Slot H 41 Little Rock, AR Phone: (501) rsledge@healthyarkansas.com Paula Kathryn Smith, M.B.A. Project Director Southern NH AHEC 128 State Route 27 Raymond, NH Phone: (603) x1 Fax: (603) psmith@snhahec.org Participant List Appendix A Page 7

40 Margaret Snow, D.M.D., M.B.A. Dental Director New Hampshire Department of Health and Human Services 34 Angela Way Concord, NH Phone: (603) Fax: (603) Steven J. Steed, D.D.S. State Dental Director Utah Department of Health P.O. Box Salt Lake City, UT Phone: (801) Fax: (801) Ohnmar K.Tut, D.D.S. Project Director, SOHCS Grant Ministry of Health Majuro Hospital P.O. Box 16 Majuro, MH Phone: (692) x2102 Fax: (692) Bradley J. Whistler, D.M.D. Dental Officer Alaska Department of Health and Social Services Oral Health Program 130 Seward Street, Room 508 Juneau, AK Phone: (907) Fax: (907) hss.state.ak.us/dph/wcfh/oralhealth Ardell A. Wilson, D.D.S., M.P.H. Project/Dental Director Connecticut Department of Public Health 410 Capitol Avenue Hartford, CT Phone: (860) Fax: (860) John Thomas Zimmer, D.D.S. Pine Ridge Hospital I.H.S. P.O. Box 1201 Pine Ridge, SD Phone: (605) Fax: (605) Anaise Maree Uso Children's Oral Health Coordinator American Samoa Government Department of Health Maternal and Child Health Program Department of Health Pago Pago, AS Phone: (684) Fax: (684) Participant List Appendix A Page 8

41 Speakers and Staff Julie Allen Manager, Federal Affairs American Dental Association 1111 Fourteenth Street, NW Washington, DC Phone: (202) Fax: (202) Jay R. Anderson, D.M.D., M.H.S.A. Chief Dental Officer Bureau of Primary Health Care Health Resources and Services Administration 5600 Fishers Lane, Room 17C-26 Rockville, MD Phone: (301) Yolanda Baker Maternal and Child Health Bureau Health Resources and Services Administration 5600 Fishers Lane, Room 18A-39 Rockville, MD Phone: (301) Fax: (301) Jolene M. Bertness, M.Ed. Health Education Specialist National Maternal and Child Oral Health Resource Center Box Washington, DC Phone: (202) Fax: (202) Brian James Bookman Meeting Coordinator McKing Consulting Corporation Parklawn Drive, Suite 260 Rockville, MD Phone: (410) Fax: (240) James J. Crall, D.D.S., Sc.D. Director National Oral Health Policy Center 1100 Glendon Avenue, Suite 850 Los Angeles, CA Phone: (310) Fax: (310) Allen Conan Davis, D.M.D., M.P.H. Chief Dental Officer Centers for Medicare and Medicaid Services 7500 Security Boulevard Baltimore, MD Phone: (410) Fax: (410) Jack Dillenberg, D.D.S., M.P.H. Dean Arizona School of Dentistry and Oral Health 5850 East Still Circle Mesa, AZ Phone: (480) Fax: (480) Participant List Appendix A Page 9

42 M. Ann Drum, D.D.S., M.P.H. Director, DRTE Maternal and Child Health Bureau Health Resources and Services Administration 5600 Fishers Lane, Room 18A-55 Rockville, MD Phone: (301) Fax: (301) Christopher T. Dykton, M.A. Maternal and Child Health Task Lead Science Applications International Corporation Parklawn Drive, Suite 350 Rockville, MD Phone: (301) Fax: (301) Robin A. Flint, M.P.H. Center Coordinator National Oral Health Policy Center 1100 Glendon Avenue, Suite 850 Los Angeles, CA Phone: (310) Fax: (310) Mary E. Foley, M.P.H., R.D.H. Program Director Improving Perinatal and Infant Oral Health Children's Dental Health Project 1990 M Street Washington, DC Phone: (202) x202 Fax: (202) mfoley@cdhp.org Margherita Fontana, D.D.S., Ph.D. Indiana University School of Dentistry 415 Lansing Street Indianapolis, IN Phone: (317) Fax: (317) mfontan@iupui.edu Steve Geiermann, D.D.S. Regional Dental Consultant Office of Performance Review Chicago Regional Division Health Resources and Services Administration 233 North Michigan Avenue, Suite 200 Chicago, IL Phone: (312) Fax: (312) steven.geiermann@hrsa.hhs.gov David E. Heppel, M.D. Director, DCAFH Maternal and Child Health Bureau Health Resources and Services Administration 5600 Fishers Lane, Room 18A-39 Rockvillle, MD Phone: (301) Fax: (301) david.heppel@hrsa.hhs.gov Katrina Holt, M.P.H., M.S., R.D. Director National Maternal and Child Oral Health Resource Center Georgetown University Box Washington, DC Phone: (202) Fax: (202) kholt@georgetown.edu Anne Hopewell, M.S.W. Project Manager Health Systems Research, Inc Eighteenth Street, NW, Suite 700 Washington, DC Phone: (202) x174 Fax: (202) ahopewell@hsrnet.com Participant List Appendix A Page 10

43 Jeff Human, M.A. Vice President McKing Consulting Corporation Parklawn Drive, Suite 260 Rockville, MD Phone: (301) Fax: (240) Beverly Ann Isman, M.P.H., R.D.H., E.L.S. Consultant Association of State and Territorial Dental Directors 212 Huerta Place Davis, CA Phone: (530) Fax: (530) Mary Kay Kenney, Ph.D. Statistician Maternal and Child Health Bureau Health Resources and Services Administration 5600 Fishers Lane Rockville, MD Phone: (301) Fax: (301) Sarah M. Kolo Health Communications Specialist National Maternal and Child Oral Health Resource Center Georgetown University Box Washington, DC Phone: (202) Fax: (202) Raymond F. Lala, D.D.S. Health Resources and Services Administration 5600 Fishers Lane, Room 9A-21 Rockville, MD Phone: (301) Fax: (301) Rebecca Ledsky, M.B.A. Director Evaluations and Research Methods Practice Area Health Systems Research, Inc Eighteenth Street, NW, Suite 700 Washington, DC Phone: (202) x136 Fax: (202) Beth Lowe, M.P.H. Project Manager Health Systems Research, Inc Eighteenth Street, NW, Suite 700 Washington, DC Phone: (202) x176 Fax: (202) Kelly Murillo Meeting Coordinator The Nakamoto Group, Inc Eclipse Drive Jefferson, MD Phone: (301) x282 Fax: (240) Mark Evan Nehring, D.M.D., M.P.H. Chief Dental Officer Maternal and Child Health Bureau Health Resources and Services Administration 5600 Fishers Lane, Room 18A-39 Rockville, MD Phone: (301) Fax: (301) Participant List Appendix A Page 11

44 Dean Perkins, D.D.S., M.P.H. Executive Director Association of State and Territorial Dental Directors 322 Cannondale Road Jefferson City, MO Phone: (573) Fax: (573) Felicia Pratt Meeting Coordinator McKing Consulting Corporation Parklawn Drive, Suite 260 Rockville, MD Phone: (301) x234 Fax: (240) Randy Pruitt Digerati, Inc Meridien Drive, Suite 131 Raleigh, NC Phone: (888) Fax: (919) Jennifer Lynn Roberts Meeting Coordinator McKing Consulting Corporation Parklawn Drive, Suite 260 Rockville, MD Phone: (301) x290 Fax: (240) Cindy J. Sego Office of Performance Review Health Resources and Services Administration 5600 Fishers Lane, Room 13A-55 Rockville, MD Phone: (301) Fax: (301) Steve Smith Senior Advisor Office of the Administrator Health Resources and Services Administration 5600 Fishers Lane, Room 14A-05 Rockville, MD Phone: (301) Fax: (301) Peter van Dyck, M.D., M.P.H., M.S. Associate Administrator Maternal and Child Health Bureau Health Resources and Services Administration 5600 Fishers Lane, Room Rockville, MD Phone: (301) Fax: (301) Pamella K. Vodicka, M.S., R.D. Public Health Analyst Maternal and Child Health Bureau Health Resources and Services Administration 5600 Fishers Lane, Room 18A-39 Rockville, MD Phone: (301) Fax: (301) Barry H. Waterman, D.M.D. Chief Dental Officer HIV/AIDS Bureau Health Resources and Services Administration 5600 Fishers Lane, Room 7A-30 Rockville, MD Phone: (301) Beth Zimmerman, M.H.S. Project Director Health Systems Research, Inc Eighteenth Street, NW, Suite 700 Washington, DC Phone: (202) x106 Fax: (202) Participant List Appendix A Page 12

45 Appendix B: MCHB State Oral Health Collaborative Systems Grants State Presentations Health Systems Research, Inc. Appendix B

46 Overview of MCHB State Oral Health Collaborative Systems Grants Presenter Program Focus Successes Challenges Lessons Learned Collaborations Arkansas Future Smiles Dental Clinic Jolene Perkins Dental Clinic Manager Arkansas Department of Health and Human Services Work with parents and partners to provide benefits that help children grow into healthy, educated, and independent adults. Conducted 10,160 dental screenings between 2000 and Placed 2,044 sealants on 696 students between 2002 and Established a new schoolbased dental clinic at Wakefield Elementary School. Coordinating efforts among 13 organizations, their missions, and reporting requirements. Coordinating parent involvement. Operating the Wakefield Clinic full time. Opening a dental clinic in Helena/West Helena. Colorado Colorado Oral Health Program and Colorado Early Childhood Comprehensive Systems (ECCS) Collaboration Megan Martinez, M.P.H. Sealant Coordinator/Health Education Specialist Delaware Seal a Smile Program Gregory B. McClure, D.M.D. State Dental Director Helen Arthur, R.D.H., B.S.D.H. Oral Health Grant Administrator Division of Public Health (DPH) Delaware Health and Social Services Address the lack of an oral health component in several comprehensive health systems for children and the difficulties in getting very young children into safety net dental clinics owing to the lack of pediatric dentists. The project also will integrate oral health performance measures into emerging health systems for children. Develop and implement a statewide school-based dental sealant program with volunteers and develop a State oral health plan. Collaborated with other State teams. Included oral health in a set of indictors in ECCS to measure readiness of children, families, communities and schools. Developed the Community Needs Assessment Toolkit Demonstration Project. Developed oral health indicators for communities. Increased oral health s visibility in the State. Sealant Program Legislation on registered dental hygienist (RDH) supervision has been introduced. The American Dental Hygienists Association offered to volunteer, followed by the same offer from the State Dental Society. Established Seal-A-Smile. Collaboration with other partners spreads the oral health program staff too thin at times. Sealant Program Legislation on RDH supervision. The Dental Society s position on the RDH supervision legislation. Licensure laws. No RDH position in the State Merit System. Lack of funding or staff members to administer the program. The Department of Sealant Program Scheduling matters. DDS was primarily available on Fridays. There were not enough RDH volunteers, so they needed to supplement the volunteers with DPH dental staff members. Train volunteers. Keep open communication and document it. Successful partnerships are key to success. University of Arkansas, Little Rock Child International Arkansas Department of Health, Office of Oral Health Little Rock School District Arkansas Children s Hospital United Way of Pulaski County Delta Dental Diabetes teams Cancer teams Coordinated school health program Smart Start program Local dental community and professional organizations State Department of Education Overview of SOHCS Grants Appendix B Page 1

47 Overview of MCHB State Oral Health Collaborative Systems Grants Presenter Program Focus Successes Challenges Lessons Learned Collaborations Delaware (continued) Oral Health Plan Developed a State oral health plan. Leveraged a State Oral Health Collaborative System (SOHCS) grant with other resources. Increased oral health s visibility and awareness. Held Oral Health Summit in December 2005 and Head Start (HS) Forum in Established an oral health coalition. Dental Health Foundation Caries Simulation Model: Preliminary Mapping Wynne Grossman, M.S.W. Executive Director Dental Health Foundation Iowa Tracy Rodgers, R.D.H., B.S. Project Director Iowa Department of Health Develop a systems thinking approach that: o Focuses on the dynamics of complex systems o Bases itself on the premise that a system s structure determines its behavior o Uses systems mapping and simulation modeling as its primary tools. Build a State and community oral health infrastructure through: o ABCD E grants o Educational supplies o An HS/Early Head Start (EHS) oral health workgroup o An ECCS grant and workgroup o Regional oral health forums o An environmental scan. Conducted stakeholder meetings to identify systems requirements. Conducted 12 regional forums as part of an environmental scan on how to integrate oral health into general health programs. Worked with ECCS to develop a strategic plan for including oral health in program activities. Conducted a pilot project in four ABCD E programs and developed a best-practices manual on what can be done Education requires followup care if children were screened in school. The State Medicaid program is requiring all children up to age 12 to be in a dental home Recruiting local dentists to participate in program. Use the American Dental Association s Give Kids A Smile Day to start working with community dentists. Consider new groups to partner with such as Delta Dental and others. Use of dental hygienists as care coordinators increases the success of programs. HS/EHS ECCS grantees WIC Local maternal and child health (MCH) programs Delta Dental Plan of Iowa Local public health DHS Overview of SOHCS Grants Appendix B Page 2

48 Overview of MCHB State Oral Health Collaborative Systems Grants Presenter Program Focus Successes Challenges Lessons Learned Collaborations to integrate oral health at the Iowa (continued) local level with little funding. Developed education supplies for HS; Women, Infants, and Children (WIC); and others. Conducted an oral health workshop for HS and EHS. Kentucky Kentucky Oral Health Surveillance Project Jim Cecil, D.M.D., M.P.H. State Dental Director Oral Health Program Kentucky Department for Public Health Commonwealth of Massachusetts Lynn Bethel, M.P.H., R.D.H. Interim Director Office of Oral Health Pamela Donovan, R.D.H. HS Oral Health Consultant Joan Lowbridge, R.D.H. Oral Health Children with Special Health Care Needs (CSHCN) Implement a children s oral health surveillance system and conduct a statewide oral health workforce study to measure supply and demand during the past decade and make projections for the future. Assure that known preventive measures, particularly the use of fluorides and sealants are adopted by Massachusetts residents; that special population groups that are dentally underserved have access to needed services; and that publicly supported dental programs are efficiently managed and Developed a screening tool for use on a personal digital assistant (PDA). Calibrated screeners. Conducted a pilot test and gathered a sample to collected data over the next 3 years. Height and weight were added as data elements on behalf of staff members working on obesity issues. U.S. Department of Education encouraged Kentucky schools to cooperate with the program. Data from a pilot survey resulted in a legislative change that allows dental hygienists to practice in public health settings without the direct supervision of a dentist. HS Initiative 2004: Completed a statewide survey of HS Children. Collaborated with Tufts University to provide onsite dental services (eight sites). The Adopt A Smile program matches RDHs with EHS/HS families. CSHCN Task Force Developed a coalition of 20 public and private Cumbersome Institutional Review Board process Lost two Principal Investigators University of Kentucky attorneys want to establish contracts with individual schools Parents require education to relay self-reported data accurately Qualifying for and accessing dental insurance. Finding a dental home for continuity of care. Addressing dental shortage areas across the State. Improve awareness of oral health issues with nondental health care providers. Educating parents and caregivers on importance of early preventive dental care University of Kentucky Schools of Dentistry and Public Health Association of State and Territorial Dental Directors U.S. Department of Education Tufts University School of Dentistry State WIC program HS/EHS Boston school district State Department of Mental Retardation Boston School Department Boston school nurses Massachusetts Dental Hygienists Association Overview of SOHCS Grants Appendix B Page 3

49 Overview of MCHB State Oral Health Collaborative Systems Grants Presenter Program Focus Successes Challenges Lessons Learned Collaborations Consultant Commonwealth of Massachusetts (continued) coordinated. organizations and educational institutions, both dental and nondental. Planning a 2006 statewide survey of parents and caregivers. School and Adolescent Programs Year 1, Boston Sealant Project (BSP): 20 elementary schools, 548 second-graders screened, 440 received 1,368 sealants. Year 2, BSP: program expanded to include a total of 40 schools. August 2005: hosted a statewide meeting for all school-based and schoollinked sealant programs. HCFA vs Massachusetts Added dental coverage for pregnant women and women with children under age 5. before 3 years of age. HCFA vs Massachusetts July 14, 2005: The court ruled the MassHealth dental program violated Federal law and that 450,000 children have been receiving substandard care. Mississippi Nicholas Mosca, D.D.S. Dental Director Mississippi Department of Health Conduct an oral health survey of children in Mississippi and report the results to the National Oral Health Surveillance System. Risk assessment Web application developed and used to collect data for 2005 MCH needs assessment. Converted Web application for use with PDAs to geocode data. Oral health data will be included in the State s new public health information management system. Hurricane Katrina increased the visibility of oral health within the State. Shifting public health priorities. Staffing priorities and motivation. Validity/reliability Establishing trust in collaboration with Medicaid. Concerns among the dental community about the role of regional oral health consultants Regional oral health consultants (contract staff members who perform needs assessment, prevention services, and technical support) Overview of SOHCS Grants Appendix B Page 4

50 Overview of MCHB State Oral Health Collaborative Systems Grants Presenter Program Focus Successes Challenges Lessons Learned Collaborations New Hampshire Nancy Martin, R.D.H., M.S. Oral Health Program Manager New Hampshire Department of Health and Human Services Paula Smith, M.B.A. Project Director Southern New Hampshire Area Health Education Center Assess perceived challenges and implementation issues in utilizing primary care providers to deliver oral health assessments, education, and prevention. Established strong relationships with partners. Developed an oral health curriculum on preventing ECC and oral health for highrisk pregnant women. Conduct oral health trainings For pediatricians, family physicians, prenatal providers, nurse practitioners, physician assistants, DDS, and RDHs. Designed and implemented a Web-based survey of providers. Conducted two focus groups of medical/dental providers and consumers. Conducted 20 in-depth telephone interviews with Web-based survey participants. New York Involving Stakeholders in Achieving Legislative Change Timothy Cooke, B.D.S., M.P.H. School-based Program Coordinator Bureau of Dental Health New York State Department of Health New York (continued) New York s grant activities are involved with strengthening the State s school dental system. Our presentation illustrated how a group of stakeholders were able to influence legislative change that facilitated the grant activities. Work with key stakeholders and other key advocates to deliver consistent oral health messages to legislators that eventually would result in legislative changes that would: o Allow school-based Advocates participated in the 2003, 2004, and 2005 Oral Health Days at the State Capitol to deliver key oral health messages to legislators. School-based sealant programs can now operate under the legislative authority of school-based health centers, independent of comprehensive school-based health centers. The State Dental Practice Act was changed to allow limited licensure for foreign dentists and hygienists if they fulfill the other requirements for licensure. Learning how to assist medical offices with systems changes to accommodate oral health assessment, education, and prevention interventions. 15-minute prenatal or wellchild visits are too short to include oral health assessment, education, and prevention interventions. Medical providers have competing priorities for their time. Dentists and medical providers are not familiar with the new policy on first dental visits. Medical providers need dentists who will treat young children they refer Conducting advanced planning (tight security at the State Capitol slowed down access to the building and inhibited quick movement between meetings). Getting the right mix of advocates requires a constant need to identify and reach out to more diverse groups of advocates. Evaluating the impact of Oral Health Days has not been possible, although participant advocates have been pleased and legislative staffers are more knowledgeable about the Collaboration is key to success. More providers are integrating oral health care into their visit protocols. Keep Provider training simple (3 to 4 messages). There is a strong interest in advocating for better oral health. Legislators and staff have been very responsive to advocacy efforts. A balance is needed between educating advocates on issues and participating in actual legislative visits. Adjustments are needed to accommodate a mix of new and experienced advocates. Ensure a consistent message is presented by advocates. Record legislative and staff Health Resources and Services Administration (SOHCS 1-year grant to Department of Health and Human Services Home visiting New Hampshire NH Area Health Education Centers NH Community Health Access Network for CHC s NH Minority Health Coalition NH HS Lamprey Health Care, Inc./Ronald McDonald Foundation Endowment for Health New York State Public Health Association Schuyler Center for Analysis and Advocacy Dental Hygienist s Association of New York Overview of SOHCS Grants Appendix B Page 5

51 Overview of MCHB State Oral Health Collaborative Systems Grants Presenter Program Focus Successes Challenges Lessons Learned Collaborations dental clinics to operate under the legislative authority for schoolbased health centers o Have school-based dental care specifically mentioned in law o Require children to have dental exams upon entry into school and followup exams every 1 to 2 years North Carolina Into the Mouths of Babes Section 414 of the Education Law was amended with specific mention of schoolbased dental services provided by outside organizations. The higher profile of oral health has resulted in dentists being appointed to the Governor s Rural Health Advisory Council, Medicaid Advisory Council, and the MCHB Block Grant Advisory Council. importance of oral health. responses. Encourage advocates to make appointments with their own representatives, particularly those on key committees. Invite a legislator to speak at the pre-oral Health Day briefing for advocates. Invite legislators to visit oral health care offices and other settings. Tailor information to legislator s particular interest on oral health. Rebecca King, D.D.S, M.P.H. Chief Oral Health Section Kelly Haupt, R.D.H., M.H.A. Project Coordinator North Carolina Department of Health Train medical providers to deliver oral preventive care to very young high-risk children in an effort to reduce early childhood caries. Improved access to oral preventive care. Approximately 40% of those eligible for Medicaid receive services. Early analysis indicates reduction in caries treatment needs. Oklahoma Oklahoma Initiative for Children s Oral Health Improvement Increasing access to over 40 percent: o Eliminating Medicaid time interval requirements. o Increasing participation of low-volume Medicaid providers. o Working closely with agencies targeting children ages 0 3. Advocating for transition into a dental home. Must have: Collaboration and commitment of partners Buy-in of medical leadership Support of dental community Reimbursement for services Training on providers terms Ongoing support for providers Flexibility State Medicaid program North Carolina Pediatric Society North Carolina Academy of Family Physicians University of North Carolina School of Public Health University of North Carolina School of Dentistry State HS/EHS programs Michael Morgan, D.D.S., M.P.A. Project Director Oklahoma State Department of Health Develop community-based action through partnerships and coalitions focusing on oral health access, dental caries experience, dental sealant use, and data collection to produce successful oral health models Medicaid-enrolled children, aged 3 8, receiving dental services rose by percent from 2003 to 2004 in Oklahoma County. The number of dentists who are Medicaid providers in Oklahoma County rose from 77 to 108 (40.3%). It is expected that the model developed in Oklahoma Country can also be used throughout the State. Plan to introduce loan forgiveness legislation for dentists working in underserved areas and Accept recommendations from stakeholder groups, and coordinate untapped expertise among health professions, businesses, education, public health, citizen groups, and the faith community. University of Oklahoma Colleges of Dentistry and Public Health Oklahoma Turning Point Program Oklahoma Children s Oral Health Coalition Overview of SOHCS Grants Appendix B Page 6

52 Overview of MCHB State Oral Health Collaborative Systems Grants Presenter Program Focus Successes Challenges Lessons Learned Collaborations Oklahoma (continued) that can be implemented on a statewide basis. From 2003 to 2004 the number of third-graders with active decay decreased by 6.9 percent, with decay experience decreased by 1.4 percent. Passed legislation to address tobacco use prevention. Worked with the Oklahoma Dental Association and the Health Care Authority to encourage the Medicaid dental program to change from capitated reimbursement to a fee-for-service system. providing care for an appropriate percentage of Medicaid clients. Share responsibility for a community s health infrastructure. Find ways to share available resources among agencies at the State and local levels. Oklahoma Medicaid Program State HS/EHS Programs State MCH Program Oklahoma Dental Association South Dakota Aberdeen Area Indian Health Services John Zimmer, D.D.S. Director Oral Health Department Pine Ridge Hospital Indian Health Service Reduce dental decay through interventions with noncariogenic sweeteners and fluoride varnish in HS and MCH programs. Community collaboration with oral health through: o Wellness Network o Children s Wellness Network o South Dakota State oral health coordinator visits to Tribal oral health o School fluoride mouthrinse program o Parent and grandparent requests for fluoride and xylitol. Collaboration with National Institutes of Health (NIH)- grantee community-based participatory research program. Poverty increases the risk of caries development and three of South Dakota s counties have the lowest income in the United States. As nature demonstrates in both wellness and disease, collaboration works. WIC EHS/HS Indian Health Service NIH Wellness Network Children s Wellness Network South Dakota State Oral Health program Department of Education Families Overview of SOHCS Grants Appendix B Page 7

53 Overview of MCHB State Oral Health Collaborative Systems Grants Presenter Program Focus Successes Challenges Lessons Learned Collaborations Texas Oral Health Early Intervention Project in Rural Texas Linda Altenhoff, D.D.S. Manager Oral Health Group Texas Department of State Health Services Target EHS/HS participants and WIC enrollees in rural Texas to provide oral health education and preventive services. A steering committee formed in December Identified EHS/HS Partners. Developed a memorandum of understanding with EHS/HS Partners. Provided oral health services to 729 children aged 6 months to 5 years. Local dentists are more informed about role or oral public health. Misconceptions within dental community about oral public health programs and how they can complement the private-sector provision of oral health care. Early communication with anticipated partners is critical. Identification of participating EHS/HS sites. Flexibility: o Rural vs. semirural vs. urban needs o Timing of visits to assist EHS/HS sites with meetings dental performance measures and Early and Periodic Screening, Diagnosis, and Treatment dental periodicity schedule Texas HS Collaboration Office Texas Dental Hygienist s Association Texas Dental Association Texas Dental Hygiene Educators Association University of Texas Health Science Center, San Antonio Texas Department of State Health Services Texas State Health and Human Services Commission Wisconsin Nancy McKenney, R.D.H., M.S. State Dental Hygiene Officer Wisconsin Department of Health and Family Services Integrate oral health prevention, education, and services into primary care and public health systems. By August 31, 2005, over 315 medical and dental personnel serving Medicaid-eligible, underserved, and unserved children in 19 counties have received maternal and early childhood oral health training. Medicaid-eligible, underinsured and uninsured children and families in 19 counties have access to medical/dental homes for primary prevention. Regional oral health consultants provided technical assistance for oral health program development in 19 local health departments, 1 community-based health center, 4 Tribal clinics, 1 CSHCN regional center, and 3 medical education programs in Wisconsin. The referral source for children must be identified with early and urgent treatment needs: o Challenge all over the State o Four Michigan community health centers offer services to Wisconsin Medicaid and BadgerCare eligible families o Federally Qualified Health Centers (FQHCs) have prioritized referrals. The need for services exceeds available resources: o Training priority: local health departments that are HealthCheck The program successfully demonstrates a method to increase oral health infrastructure capacity, providing communities with oral health training and technical assistance. Office of the Governor Local/county health departments Tribal health centers Medical and dental communities Wisconsin Technical College System Dental Hygiene Programs SmileAbilities (caregiver program for CSHCN) Medical clinics University of Wisconsin Medical School Wisconsin Nurses Association Overview of SOHCS Grants Appendix B Page 8

54 Overview of MCHB State Oral Health Collaborative Systems Grants Presenter Program Focus Successes Challenges Lessons Learned Collaborations Wisconsin (continued) Released Report of the Governor s Task Force to Improve Access to Oral Health on June 13, o Providers, Tribal entities, FQHCs, and medical practices that perform HS and EHS examinations. During , establish Medicaid/BadgerCare annual measures to track training integration: o Preventive services for children aged 0 6 and 0 20 Restorative services for children aged 0 6 and Overview of SOHCS Grants Appendix B Page 9

55 Appendix C: Meeting Agenda Health Systems Research, Inc. Appendix C

56 MCHB Oral Health Grantee Meeting MONDAY, December 5 8:30 9:00 a.m. Registration and Morning Refreshments 9:00 10:30 HRSA s Role in Oral Health The Agency s Vision (Steve Smith) MCH Impact (Peter van Dyck) Bureau Presentations BPHC (Jay Anderson) BHPr (Ray Lala) HAB (Barry Waterman) MCHB (Pam Vodicka) 10:30 10:45 Break 10:45 11:30 HRSA s Role in Oral Health (continues) Office of Performance Review (Cindy Sego & Steve Geiermann) 11:30 12:30 p.m. Emerging Issues Early Childhood Caries (Jim Crall) 12:30 2:00 Lunch Lecture Children s Dental Health Project: Perinatal and Infant Oral Health (Mary Foley) 2:00 3:15 Grantee Project Accomplishments and Lessons Learned Along the Way 3:15 3:30 Break 3:30 4:45 Grantee Project Accomplishments and Lessons Learned Along the Way continued 4:45 5:00 Break 5:00 6:00 Annual Grantee Assembly: Networking & Dissemination Agenda Appendix C Page 1

57 TUESDAY, December 6 8:30 9:00 a.m. Morning Refreshments 9:00 10:00 The Electronic Handbook (Chris Dykton) 10:00 10:45 A Plan for Reporting: Annual Project & Budget Updates (Pam Vodicka) 10:45 11:00 Break 11:00 12:00 p.m. Emerging Issues Emerging Competencies for Non-Traditional Oral Health Professionals (Jack Dillenberg) 12:00 1:30 Head Start - MCHB Luncheon Head Start Bureau - MCHB Interagency Agreement a model for collaborative initiatives Head Start Technical Assistance Review Lunch with Head Start Oral Health Consultants 1:30 2:30 Emerging Issues Dental Sealants (Margherita Fontana) 2:30 4:00 Grantee Project Accomplishments and Lessons Learned Along the Way continued 4:00 4:15 Break 4:15 5:30 Grantee Project Accomplishments and Lessons Learned Along the Way concludes WEDNESDAY, December 7 8:30 9:00 a.m. Morning Refreshments 9:00 10:30 SOHCS Evaluation Project Review Health Systems Research, Inc. (Rebecca Ledsky) ASTDD (Bev Isman) 10:30 11:00 Closing Questions & Answers (Mark Nehring) Agenda Appendix C Page 2

58 Appendix D: Head Start Regional Oral Health Consultants Health Systems Research, Inc. Appendix D

59 U.S. Department of Health and Human Services Health Resources and Services Administration Maternal and Child Health Bureau Website: Head Start Regional Oral Health Consultants Mary Foley, R.D.H., M.P.H. Region I Head Start Oral Health Consultant ACF Regional Office JFK Federal Building, Room 2000 Boston, MA Telephone: mfoley@cdhp.org Neal Herman, D.D.S. Region II Head Start Oral Health Consultant Department of Pediatric Dentistry New York University College of Dentistry 345 E. 24th Street New York, NY Telephone: Fax: ngh1@nyu.edu Harold Goodman, D.M.D., M.P.H. Region III Head Start Oral Health Consultant ACF Regional Office 150 S. Independence Mall, W., Suite 864 Philadelphia, PA Telephone: Fax: hgoodman@acf.hhs.gov E. Joseph Alderman, D.D.S., M.P.H. Region IV Head Start Oral Health Consultant ACF Regional Office Sam Nunn Federal Center 61 Forsyth Street, S.W., Suite 3M60 Atlanta, GA Telephone: Fax: ejalderman@hrsa.gov Karen Yoder, Ph.D. Region V Head Start Oral Health Consultant Indiana University, School of Dentistry 415 Lansing Street Indianapolis, IN Telephone: kmyoder@iupui.edu Kathy Geurink, R.D.H., B.S., M.A. Region VI Head Start Oral Health Consultant ACF Regional Office 1301 Young Street, Room 914 Dallas, TX kgeurink@satx.rr.com Lawrence Walker, D.D.S., M.P.H. Region VII Head Start Oral Health Consultant ACF Regional Office Federal Office Building, Room E. 12 th Street Kansas City, MO lwalker17@kc.rr.com Valerie Orlando, R.D.H., B.S. Region VIII Head Start Oral Health Consultant ACF Regional Office 1961 Stout Street Denver, CO Telephone: Fax: valerie.orlando@acf.hhs.gov Oral Health Consultants Appendix D Page 1