The Role of Home Visitors in Improving Oral Health Jenny Kattlove, MS Senior Director of Programs The Children s Partnership Jennifer Byrne, BA Project Manger California Department of Public Health Dr. Jayanth V. Kumar, DDS, MPH State Dental Director California Department of Public Health Oral Health Image Source: Delta Dental of California 2 1
Oral Disease Nationally Tooth decay is the leading chronic disease in children far more common than asthma and hay fever but it can be prevented! Image Source: Pediatric Dentistry East 3 Oral Disease in California 58% of pregnant women did not receive dental care during their pregnancies Yet, 53% of pregnant women had a dental problem while pregnant 54% of kindergarteners and 70% of third graders experience tooth decay Over50%ofinfants0 2yearsofagehavenever been to the dentist 4 2
Oral Disease in California s Medicaid Population Approximately 50% of women are covered by Medi Cal during their pregnancy Only 30% of pregnant women received a dental visit during pregnancy Over 40% of the infants, children, and adolescents in CA are enrolled in Medi Cal Only 52% of infants, children, and adolescents saw a dentist Only 27% of infants 0 3 years of age utilized dental services 5 70.0 Oral Health Disparities in Pregnant Women in California 60.0 White Prevalence (%) 50.0 40.0 30.0 20.0 Asian/Pacific Islander Latina 10.0 Black 0.0 All Women Private Insurance Medi Cal 6 3
Oral Health Disparities in Infants and Children in California Tooth decay is more common among Latinos and African American children American Indian/Alaska Native children are also at a greater risk for tooth decay Children of all age groups who live below 100 percent of the Federal Poverty Level are twice as likely to have untreated tooth decay 7 Poor Oral Health Leads to Poor Health Outcomes Acute infections in mouth can spread to other organs Severe gum infections are associated with complications Diabetes control Cardiovascular disease Aspiration pneumonia in nursing home residents Oral health during pregnancy is linked to birth outcomes Low birthweight Premature births Cavity causing germs are transmitted from mothers and caregivers to children 8 4
Poor Oral Health Leads to Poor Health Outcomes Untreated tooth decay can cause Pain, difficulty chewing, and difficulty speaking Impair a child s intellectual and social development Prohibit children from going to school (Caregivers miss workdays too!) Can lead to an increased risk of poor oral health in adulthood Adverse Childhood Experiences, also known as ACEs 9 Barriers that Create Disparities Lack of dental insurance Lack of knowledge of dental coverage Perceived lack of need for dental care Cost of dental procedures Fear of dental procedures Belief that some oral health care habits are unsafe Logistical barriers such as transportation or child care Nutritional practices Parental education and health literacy Intergenerational cycles of poor oral health 10 5
Oral Health Guidelines California Guidelines http://www.cdafoundation.org/portals/0/pdfs/poh_guid elines.pdf Summary of Practice Guidelines http://mchoralhealth.org/pdfs/summary_practiceguidel National Consensus Statement http://mchoralhealth.org/pdfs/oralhealthpregnancyconse nsus.pdf ines.pdf 11 Funded Projects Title V Maternal and Child Health Services Block Grant Program Perinatal and Infant Oral Health Quality Improvement (PIOHQI) Initiative 12 6
California s PIOHQI Project: 2015 2019 Two Long Term Outcomes Perinatal and Infant Oral Health National Learning Network Project Advisory Board Streamlining the Use of Data Pilot Project in Sonoma County Community of Practice Rapid Cycle Quality Improvement Projects 13 Covered Oral Health Care Benefits for Medi Cal Beneficiaries Pregnant Women Full scope Medi Cal coverage, includes dental coverage All the partially restored benefits, plus the preventative Pregnancy only Medi Cal or limited scope Medi Cal During the pregnancy, women get all the benefits partially restored plus preventative benefits (oral exam, application of fluoride, general and deep cleaning). Also have benefits related to jaw bone, tissue damage (emergency care for major trauma to mouth/face during the pregnancy) Covered CA no adult dental benefits, can purchase 14 7
Covered Oral Health Care Benefits for Medi Cal Beneficiaries Children Children enrolled in Medi Cal and Covered California have comprehensive dental benefits Medi Cal reimburses providers (MDs and NPs) for providing fluoride varnish to children under 6 15 Oral Health and Home Visiting Making the Case More than 22% of California s children had a dental problem in the last year, making California the 47th worse state in the nation for children s oral health status, with only four states performing worse California s children enrolled in Medi Cal are not utilizing the dental care they need Recognition of the role oral health plays in overall health Recognition that all care providers play a role in meeting the oral health needs of children, pregnant women, and adults 16 8
Oral Health and Home Visiting Making the Case Achieving good oral health for pregnant women and children contribute to meeting the goals of early home visiting programs Dental disease is a chronic health problem that can be treated in ways that match the activities of home visitors Early intervention Parent education and family engagement Anticipatory guidance Adoption of beneficial behaviors Community and health system support 17 Evidence for Providing Oral Health Care/Education during Home Visits Dental Education in the home can lead to reduced dental disease and better oral health among young children and mothers Anticipatory guidance to first time mothers during pregnancy and after the child s birth lead to lower incidence of dental caries In home preventive dental services can lead to families seeking and receiving oral health care 18 9
Oral Health and Home Visiting Why Now? Major state efforts are underway to address California children s oral health needs State Oral Health Program Dental Transformation Initiative Virtual Dental Home California Children's Dental Disease Prevention Program Child Health Disability Prevention Program requirement to refer children to dental providers by age 1 Perinatal and Infant Oral Health Quality Improvement Expansion Grant 19 Oral Health and Home Visiting Why Now? ACA s inclusion of money to support state home visiting programs MIECHV calls greater attention to the role home visiting plays in addressing the comprehensive needs of families First 5 has invested greatly both in improving the oral health of young children and in home visiting Home visiting programs recognize the importance of the oral health of pregnant women, children, and families 20 10
Oral Health in Home Visiting Programs All home visiting programs value oral health Home visiting programs engage in oral health activities at varying degrees Depends on model, needs of the family, and resources Early Head Start: http://eclkc.ohs.acf.hhs.gov/hslc/ttasystem/ehsnrc/ Healthy Families America: www.healthyfamiliesamerica.org Nurse Family Partnership: www.nursefamilypartnership.org Parents as Teachers: www.parentsasteachers.org 21 Incorporating Oral Health into Home Visits: What it Looks Like Assessing families oral health behaviors Promoting the importance of oral health Visual oral health screenings Lift the Lip Providing health education on optimal oral health habits Breastfeeding Brushing teeth Nutrition Navigating families to oral health care services 22 11
Assessing Oral Health Behaviors: Risk Assessments Elevated risk of tooth decay if: Previous caries High parental caries levels Low socioeconomic and education status Poor access to health care Special health care needs High frequency of sugar containing foods Inadequate fluoride Poor oral hygiene 23 Promoting the Importance of Oral Health: Motivational Interviewing Open ended questions that frame the agenda Affirmations Reflective listening Summarize Motivational Interviewing for Kids Healthy Smiles by Tooth Talk: vimeo.com/94031424 24 12
Visual Oral Health Screenings: Lift the Lip Lay the baby on a blanket on the floor or if you have someone to help, try the knee to knee position Gently move the baby s lips up and look at all the teeth Check to see if you see white or light brown spots If you do, call your dentist for an appointment Image Source: Tasmania Department of Health and Human Services Adapted from the University of Washington School of Dentistry Lift the Lip Flipchart 25 Providing Health Education on Optimal Oral Health Habits: Breastfeeding Encourage breast feeding but caution against ad libitum Breastfeeding can cause tooth decay Night nursing can increase the risk of tooth decay Not breastfeeding? Mixing instant formulas with fluoridated water is a good practice. Image Source: SheKnows.com 26 13
Providing Health Education on Optimal Oral Health Habits: Brushing Teeth Infants (beginning a few days after birth) Wipe the baby s gums with a clean, moist gauze pad or washcloth every day Toddlers (or the eruption of the first tooth) Brush teeth 2 times a day with a smear of fluoride toothpaste Young Children Help them brush their teeth until they are 6 years old Image Sources: Wiki How and Healthy Children.Org 27 Providing Health Education on Optimal Oral Health Habits: Dietary Practices Sugar causes tooth decay Drink water, not soda or juice Eat foods you can pronounce Fruits and vegetables Whole grains Lean sources of protein such as poultry, fish, and beans Eat meals, not snacks 28 14
Navigating Families to Oral Health Care Services InsureKidsNow.Gov: find a dentist www.insurekidsnow.gov/state/ ca/find a dentist/index.html The CA Dept. of Health Care Services Denti Cal provider referral list www.denti cal.ca.gov/wsi/ Bene.jsp?fname=ProvReferral Welltopia, the place of wellness www.mywelltopia.com 29 Oral Health Curriculum for Home Visitors Parents as Teachers Foundational Training Curriculum: Dental Health Your Baby s Teeth www.parentsasteachers.org Partners for a Healthy Baby Curriculum: Five Volume Series www.cpeip.fsu.edu/phb Beginnings Guides Curriculum: Pregnancy Guide & Parent s Guide www.beginningsguides.com Adapted from the Oral Health Educational Resources for Early Head Start and Head Start Home Visitors and Families: Environmental Scan produced by the National Center on Health, and the Association of State and Territorial Dental Directors, Early Childhood Oral Health Committee, Home Visiting Subcommittee 30 15
Strengthening the Role of Oral Health in Home Visiting Provide home visitors with resources Curricula/education/protocols for home visitors Educational materials for families Tooth brushes and other collateral items Support home visitors with training and technical assistance Collect oral health data Create stable funding streams for home visiting leverage funding for community oral health programs for oral health components of home visiting programs 31 For more information Healthy Mouth, Healthy Start: Improving Oral Health for Young Children and Families Through Early Childhood Home Visiting www.childrenspartnership.org 32 16
Acknowledgements Association of State and Territorial Dental Directors American Dental Association California Dental Association California Home Visiting Program, California Department of Public Health Children s Dental Health Project Children Now Colorado Office of Early Childhood Delta Dental of California Early Head Start and Head Start First 5 Association of California First 5 LA First 5 Riverside First Focus Health Resources and Services Administration, Maternal and Child Health Bureau Healthy Families America LA Best Babies Network Los Angeles County Office of Education Head Start Los Angeles County Perinatal and Early Childhood Home Visitation Consortium (LACPECHVC) Maternal and Child Health Access Maternal and Infant Health Assessment Survey National Center on Health Nurse Family Partnership Pacific Center for Special Care, University of the Pacific, Arthur A. Dugoni School of Dentistry Parents as Teachers University of North Carolina University of Washington 33 Thank You! Jenny Kattlove, MS Senior Director of Programs The Children s Partnership jkattlove@childrenspartnership.org Jennifer Byrne, BA Project Manger California Department of Public Health Jennifer.Byrne@cdph.ca.gov Dr. Jayanth V. Kumar, DDS, MPH State Dental Director California Department of Public Health Jayanth.Kumar@cdph.ca.gov 17