of Priority Population Programming: Lessons Learned from the Health Smiles Program in Brant County Sinton, J. & Vamos, C.
Background Ontario s Poverty Reduction Strategy
Background Financing of dental care (Ontario) The life course of dental caries
A Bit About Brantford 125 000 population Urban/rural mix Lost manufacturing base Average-ish on most health indicators
What Brant Tried To Do With Our NEW Oral Health Program A multi-strategy population health approach Focus on Reducing health inequities Health promotion Early identification and intervention Sound evidence base Informed by principles of community development and empowerment (elements)
Specific elements of our program Healthy Smiles Ontario: Logic Model Components Health Promotion Outreach & Marketing Professional Development Clinical Services Delivery Low income families, dental professionals, non-dental health and social service providers, community stakeholders Priority populations: Aboriginal communities, babies and pre-school children, children, teens and families living in the shelter system Community Engagement Target Groups. Activities Short Term Objectives Intermediate Term Objectives Long Term Objectives Families residing in identified high risk neighbourhoods; Food Bank and Good Food Box Program participants - Distribute oral hygiene supplies to families using the Food Bank and participating in the Brant Good Food Box Program - Mail oral hygiene supplies (i.e. toothbrushes) to new parents living in selected high caries risk neighbourhoods - Provide health information and resources (i.e. books, videos, DVDs, early literacy workshops, etc.) to parents and caregivers via City and County Library - access and utilization to information, resources and supplies (toothbrushes, toothpaste) regarding children s oral health - knowledge, attitudes and skills regarding children s oral health - dental hygiene behaviors Families residing in identified high risk neighbourhoods? Health and social workers - Develop referral pathways with external and internal community partners - Implement media campaign - awareness of the HSO Program - the number of referrals, including high risk populations, to the HSO Program - access to oral health care for low income families Dental professionals; non-dental health and social service providers; BCHU staff - Provide skill building and training workshops for nondental health and social service providers (i.e. early identification tools; motivational interviewing) - Provide health information and tools to child care, health and social service professionals (print/video resources, web-based curriculum, referral pathway tools) - Provide training workshops and education tools (i.e. flip chart) to dental professionals regarding providing oral health care to young patients (<3 yrs) - access and utilization to information and resources to dental, non-dental health and social service providers - knowledge, attitudes and skills among dental, nondental health and social service providers regarding oral health prevention, early identification and treatment - community capacity for oral health prevention, early identification and treatment BCHU Dental Team; Dental professionals; non-dental health and social service providers - Provide dental assessments and referral services at BCHU and in community settings (i.e. clinical screenings, dental companion to the Nipissing) - Provide preventive/treatment clinical services - Provide fluoride varnish preventative treatment - Provide Xylitol chewing gum for parents of young children - Continue surveillance activities - Coordinate specialty GA services - access to oral health care for low income families - the proportion of low income children who receive oral health prevention, early identification and treatment services - incidence of dental caries - morbidity associated with untreated tooth decay in low income children - childhood oral health inequities - CINOT treatment costs Oral health stakeholders - Coordinate Oral Health Advisory meetings - To understand community s needs and perspectives in order to develop effective programming - To support linkages to community programs and services - awareness of the HSO Program - To deliver communitytailored and accepted services - community capacity for policy, advocacy and service delivery efforts focused on oral health prevention, early identification and treatment among children Goal To improve oral health and overall well-being among children and families age 0 to 17 years in Brant County and Brantford ( social and economic costs associated with untreated tooth decay, including family poverty) Revised 8-26-11
If You Build It, They Will Come. Right?
Some Things Worked Well Our Fluoride Varnish Program Started small Consumer involvement in design, launch & evaluation Focus on teeth was secondary (PHOTO OPS!) Attachment theory
Some things worked moderately well BABY ORAL HEALTH PROGRAM 1. Professional Development for dental care providers Change in knowledge & attitudes (> 6/12) NOT behaviours Systemic barriers (e.g. payment mechanisms) Public attitudes lack of demand/ not valued Lack of knowledge Professional attitudes
Some things worked moderately well 2. Using the local Food Bank to distribute self care supplies 97% of recipients reported using supplies BUT some un-anticipated Wrong assumptions Logistical barriers Waiting room issues Volunteer confusion Need for mid-course corrections
Some things didn t work at all Using Health Unit s own staff to recruit clients a dismal failure! Planned as best we could pre-consultation, feedback loops Assumed that staff could connect the dots Early ID/ intervention. Reducing depth of child poverty Sidelined by the unexpected
Combined Barriers at all System Levels Lack of knowledge translation Key health messages & clinical guidelines not translated to frontline service providers Lack of holistic view of public health Inter-disciplinary & inter-sectorial programming occurring in silos Prevention & early Interventions and life-span impacts not valued Individual/practice barriers -low knowledge, attitudes & behaviours re: early interventions (Parents and providers)
Putting It All Together Where barriers anticipated & planned for things went well Some barriers are beyond our control work-around necessary Never make assumptions without attempting to verify barriers we didn t expect caused problems