Phase I Planning Grant Application Issued by: Caring for Colorado Foundation Application Deadline: July 1, 2015, 5:00 PM
Executive Summary Caring for Colorado is currently accepting applications for SMILES Dental Home Planning Grants. The purpose of the SMILES Dental Home is to increase opportunities for underserved populations to receive preventive oral health care in community settings where people live, work and congregate and to improve oral health for rural and underserved children and seniors in Colorado. What: SMILES Dental Home Project -- Spanning Miles In Linking Everyone to Services -- is a community-based initiative of Caring for Colorado Foundation designed to expand access to oral health care for Colorado s most vulnerable populations. Challenge: As many as half of all Coloradans do not receive routine, preventive oral health care most of whom live in low-income, rural communities and are unable to conveniently access dental care in a traditional dental office. Solution: In 2015, Caring for Colorado Foundation launched SMILES Dental Home Project a fiveyear, $3.5 million initiative to bring oral health care to underserved Coloradans with a particular focus on addressing the preventive and therapeutic dental health needs of pregnant women, children, seniors and people with disabilities in communities across Colorado. Approach: The SMILES Dental Home Project deploys Registered Dental Hygienists (RDHs) into community settings (community centers, schools and Head Start programs, nursing homes and assisted living facilities, places of worship, etc.) to provide routine, preventive dental services. The RDHs communicate with an off-site dentist via telehealth technology for patient assessments, treatment planning, and to facilitate treatment for patients identified with more complex dental health needs. This is a planning grant opportunity to support interested communities in conducting a comprehensive readiness assessment, developing an operational plan and budget, and developing and/or strengthening community partnerships that are necessary to successfully apply for and receive implementation funding from Caring for Colorado for the SMILES Dental Home Project. Due Date for Phase I Planning Grant Applications July 1, 2015 Estimated Number of Awards Up to 6 Estimated Award Amount $30,000 - $50,000 Length of Project Period 9 months Project Contacts Colleen Lampron, SMILES Project Director clampron@caringforcolorado.org Linda Reiner, Caring for Colorado Foundation lreiner@caringforcolorado.org 2
Background In the winter/spring of 2014, Caring for Colorado convened an oral health leadership group comprised of public and private sector dentists, health advocates, state government representatives, health policy experts, and foundation program staff to discuss current and future oral health workforce needs in Colorado. This convening involved: Examination of the current Colorado oral health workforce landscape. Discussions with national experts on oral health workforce trends and realities. Examination of mid-level dental provider models. Examination of alternative delivery models. The leadership group met for two, 2-day retreats. The meetings were facilitated by the Colorado Health Institute with the goal of moving toward practical solutions in addressing workforce shortages in Colorado. After considering national trends, political realities, infrastructure needs, workforce readiness, and community readiness, the group recommended that Colorado move forward in piloting the Virtual Dental Home model, developed in California by Dr. Paul Glassman from the University of the Pacific, Arthur A. Dugoni School of Dentistry. For the purposes of Colorado s work, the project has been renamed SMILES Dental Home Spanning Miles in Linking Everyone to Services. The goals of implementing the SMILES Dental Home model in Colorado are to: Ensure that underserved and high-risk Colorado children, pregnant women, people with disabilities and vulnerable seniors have access to preventive services and a dental home. Reach Coloradans that are either unable to, or do not, access the current system of dental care within the traditional dental office. Expand the oral health infrastructure to provide services and education in the most appropriate community setting. Strengthen Colorado s oral health workforce by expanding the scope of care a dental hygienist is licensed to perform. Virtual Dental Home Description i (as developed by Dr. Paul Glassman, University of the Pacific) The Virtual Dental Home creates a community-based oral health delivery system in which people receive preventive and simple therapeutic services in community settings where they live or receive educational, social or general health services. It utilizes the latest technology to link practitioners in the community with dentists at remote office sites. The goal is to have tele-health connected dental teams working in communities, keeping people healthy by providing education, preventive care, interim therapeutic restorations, triage, and case management. Where more complex dental treatment is needed, the Virtual Dental Home connects patients with dentists in the area. 3
This system promotes collaboration between dentists in health centers and/or dental offices with the community based dental team comprised of registered dental hygienists (RDH), dental assistants and case managers. Most importantly, it brings much-needed services to individuals who might otherwise receive no care. This model relies on the advanced training and community-based practice of a group of oral health professionals. In the Virtual Dental Home, the RDH collaborates with a dentist to provide care. Technology helps bridge the geographic gap between the community based RDH and dentist. Equipped with portable imaging equipment and an internet-based dental record system, the RDH collects electronic dental records including x-rays, oral photographs, charts of dental findings, and dental and medical histories, and uploads the information to a secure website where they are reviewed by a collaborating dentist. The dentist reviews the patient's information and creates a dental treatment plan. The RDH then carries out the aspects of the treatment plan that can be conducted in the community setting. These services include: Health promotion and prevention education. Dental disease risk assessment. Preventive procedures such as application of fluoride varnish, dental sealants, dental prophylaxis and periodontal scaling. Placing carious teeth in a holding pattern using interim therapeutic restorations (ITR) to stabilize patients until they can be seen by a dentist for definitive care. An Interim Therapeutic Restoration is a restoration placed on teeth to prevent the progression of caries. The treatment is provided without local anesthetic, using fluoride-releasing glass ionomer on teeth diagnosed with neither necrotic nor irreversible pulpitis. ITRs are placed after radiographic review, diagnosis and the ITR being prescribed by a licensed dentist. ITRs are indicated for children and adults in situations a dentist decides that it is beneficial to use minimal intervention to stop the progression of decay. Tracking and supporting the individual's need for and compliance with recommendations for additional and follow-up dental services. The RDH refers patients to dental offices for procedures that require the skills of a dentist. When such visits occur, the patient arrives with a diagnosis and treatment plan already determined, preventive practices in place and preventive procedures having been performed. The patient is likely to receive a successful first visit with the dentist as the patient's dental records and images have already been reviewed. All of this adds up to a well-planned and successful dentist visit. In some cases the dentist may come to the community site and use portable equipment to provide restorations or other services that only a dentist can provide. In either case, the majority of patient interactions and efforts to keep people healthy are performed by the RDH in the community setting, thus creating a true community-based dental home. 4
Rationale for Pursuing The Institute of Medicine report, Improving Access to Oral Health Care for Vulnerable and Underserved Populations, calls for research and demonstrations of new systems to improve oral health for vulnerable and underserved populations that emphasize prevention and early intervention and use new methods and technologies such as: Bringing care to where people are by delivering oral health services in nontraditional settings. Engaging non-dental professionals. Developing expanded duties for existing oral health professionals or creating new types of dental professionals. Using technologies such as tele-health. The IOM report also calls for research and demonstrations of delivery systems that are based on measures of access, quality, and outcomes, and for incorporating these measures in payment and regulatory systems. ii This is critically important because each year in Colorado, tens of thousands of low- income children, adults and families, go without seeing a dentist. This lack of access to dental care is a complex problem fueled by a number of factors including: An uneven distribution of dentists statewide means many parts of Colorado do not have an adequate supply of these practitioners. As a result, access to care is limited for people in these communities regardless of income or insurance coverage. The relatively small number of dentists who participate in Medicaid and a small proportion who will treat young children means that many low-income children are not receiving early, preventive dental care. The issue of a lack of Medicaid participating dentists is now compounded by the new adult Medicaid dental benefit that began July, 2014. Over 1 million Coloradans now have a dental benefit from Medicaid. Low-income, uninsured children and adults are often left out of the oral health care system completely. Nationwide, up to 60% of adult Americans do not visit dental offices and clinics on a regular basis due to cost and geographic, cultural and linguistic barriers. This leads to high health care costs, through emergency room visits for pain and infection, as well as high treatment costs due to lack of preventive care. Colorado has a growing elderly population. Colorado current has 990,000 seniors (ages 60 to 90). By 2030 this will grow to 1.6 million; Colorado s population as a whole is expected to grow from 5.27 million (current) to 6.92 million in 2030. The Virtual Dental Home demonstration project is now operating in thirteen sites in California. The project has successfully demonstrated the ability to deploy geographically distributed, collaborative, tele-health facilitated dental teams who are seeing patients, performing prevention and early intervention services including ITR, and making and supporting referrals for treatment that needs to be performed by dentists. After 5 years of operating the system, close to 2/3 of both 5
child and adult populations are being kept healthy by services performed in the community by hygienists. iii Caring for Colorado Initiative SMILES Dental Home In January of 2015, the Caring for Colorado Board of Directors voted to direct Foundation resources to pilot the SMILES Dental Home model in 4-6 Colorado communities. The Board has earmarked $3.5 million for this effort over a five year period. The initiative includes the following steps and timeline: May 15, 2015 May 27, 2015 July 1, 2015 September 15, 2015 October 1, 2015 May, 2016 June 1, 2016 July 1, 2016 October, 2016 RFP for Planning Grants Issued; Grant Application Portal Open Applicant Webinar Grant Proposals for Phase I Planning are due to Caring for Colorado Planning grants awarded Planning efforts begin RFP for Implementation Grants Issued Deliverables from Phase 1 Planning Grants are due Implementation grants awarded Three-year projects begin Up to six Phase 1 Planning Grants will be awarded ranging in amount from $30,000 - $50,000. Four to six Phase 2 Implementation Grants will be awarded totaling $300,000 - $500,000 over a three year period. Only communities who have completed Phase 1 of the project will be eligible to apply for Phase 2. Grantees must be willing to participate in an ongoing Learning Collaborative and external evaluation as part of the work. Caring for Colorado will conduct site visits or phone calls to ask clarifying questions regarding the applicant s Phase 1 submission. Revisions to the submission may be requested. Participating communities will receive significant technical assistance during the Phase 1 planning grant. Support will include access to background and other resource materials, personalized technical assistance in conducting a readiness assessment and the development of an operational plan and budget. 6
Deliverables Phase I grantees will be responsible for submitting the following deliverables to Caring for Colorado by June 1, 2016: Community Readiness Assessment* Operational Plan* Three-year project budget* *Templates and assistance will be provided. Eligibility Eligible applications for this planning grant opportunity include: Non-profit dental clinics Federally-qualified health centers School-based health centers Local Departments of Public Health and/or Human Services Community Colleges University of Colorado School of Dental Medicine Ineligible applicants include: For-profit entities, unless working with a non-profit fiscal sponsor. Corporate or franchised dental practices. Organizations without a direct dental service component to their work. ONLY COLORADO OWNED AND OPERATED ORGANIZATIONS ARE ELIGIBLE TO APPLY High Priority Applicants for the SMILES Dental Home Pilot Applicant serves a high-need, underserved population. High priority will be given to projects that are able to bring dental services into communities without dental providers; with lowparticipation by dental providers in the Medicaid program; that have populations that face barriers in accessing oral health care such as transportation, geographic, language/culture and insurance status. Applications that propose to build on already successful community programs/projects, such as school-based sealant programs or services that are delivered in community settings such as Nursing Homes, Day care facilities, Head Start centers, etc. Applications that propose to work either regionally (across counties for rural regions) or in urban settings with a large number of potential clients. 7
Applicants that have strong leadership, strong community partnerships, and a long history of working to improve oral health access and outcomes for underserved communities. Strong commitment from organization leadership to devote time and resources in developing a new system of care. Commitment to participating in a multi-year initiative that includes an external evaluation, learning communities, and a willingness to share lessons learned during the initiative. A track record of securing resources to ensure the success and sustainability of new projects and programs. Strong business practices and an organizational value of quality improvement. Application Content Applications must be completed via the Caring for Colorado SMILES on-line grant application located at www.caringforcolorado.org. The application is due on July 1, 2015 by 5:00 PM. Planning grants will be determined by September 15, 2015 and grant awards will begin on October 1, 2015. A complete application includes: 1) Proposal Narrative 2) Project Plan 3) Budget (Form 1 and Form 2) 4) Budget Detail 5) Attachments The grant application can be found at www.caringforcolorado.org/smiles-dental-home. Learn More Learn more about the SMILES Dental Home Project by visiting http://www.caringforcolorado.org/smiles-dental-home A webinar will be held on May 27 th, 10:00 AM to describe this funding opportunity more. Interested applicants are highly encouraged to attend the webinar. A recording of the webinar will be posted on the Caring for Colorado website by May 30 th, 2015. Registration is required to participate. For specific questions, please contact Colleen Lampron, SMILES Project Director at clampron@caringforcolorado.org. 8
i http://dental.pacific.edu/documents/community/special_care/acrobat/virtualdentalho me_ovierviewresults_policybrief_may_2013.pdf ii http://www.ncbi.nlm.nih.gov/pmc/articles/pmc3477859/ iii http://www.ncbi.nlm.nih.gov/pmc/articles/pmc3477859/ 9