Proceedings from the: HEAD START ORAL HEALTH FORUM June 3, 2005 Sponsored by Delaware Health and Social Services Division of Public Health 417 Federal St Dover, Delaware 19901 (302) 741-2960 Head Start State Collaboration Project and Early Childhood Assistance Program John G. Townsend Building 401 Federal Street Dover, Delaware 19901 Delaware Head Start Association 204 Georges Alley-2nd Floor Smyrna, DE 19977 Acknowledgements Head Start Oral Health Forum Planning Committee Helen Arthur, RDH, BSDH Suzanne Burnette Gregory B. McClure, DMD, MPH Gina B. Perez Betty Richardson The Head Start Oral Health Forum was funded by: Delawares Division of Public Health through grant funding from the Health Resources and Services Administration Maternal and Child Health Bureau Delawares Department of Education Early Childhood Assistance Program Head Start State Collaboration Project Delaware Head Start Association Corporate sponsors included: PNC Bank Oral B Forum facilitation and proceedings provided by: Advances in Management, Inc Lewes, Delaware (302) 645-1490 2 Table of Contents Acknowledgements..................................................................... 2 Table of Contents.................................................................... 2 Executive Summary.................................................................... 3 Agenda............................................................................... 5 General Session Presentations........................................................ 6 Welcoming and Opening Remarks........................................................ 6 Plenary Session: Strategies to Improve the Oral Health of Delawares Most Vulnerable Children.................................................................. 7 Overview of Dental Health Requirements and the Status of Delaware Head Start Dental Services...................................................................... 10 Setting the Stage for Action Planning................................................ 11 A Vision for School Readiness........................................................ 12 Concurrent Discussion Sessions: Putting the Strategies into Action............................................................................... 13 Evaluations.......................................................................... 17 Appendix A........................................................................... A1 Appendix B........................................................................... B1 Appendix C........................................................................... C1 Appendix D........................................................................... D1 Appendix E........................................................................... E1 3 Executive Summary The Head Start Oral Health Forum was held on June 3, 2005. The all-day event brought together 71 individuals representing a myriad of organizations from the public and private sectors with interest in improving oral health for Delawares Head Start enrolled children. Please refer to Appendix A for a list of Forum attendees. The purpose of the Forum was to improve the oral health of Head Start Children in Delaware. To achieve its goals, Delawares Head Start Oral Health Forum was intended to meet four primary learning objectives: To gain an understanding of how Delawares Head Start program measures against the national Head Start Performance Standard requirements on oral health. To learn about national strategies to improve oral health access, prevention and practitioner availability for Head Start enrolled children. To develop an action plan for putting six critical oral health strategies into practice for the benefit of Delaware children enrolled in Head Start. To gain an understanding of the impact of oral health on school readiness and public policy implications in reaching Delawares school readiness goals The Head Start Oral Health Forum built upon the work done at the Delaware Oral Health Summit 2004 held on December 8, 2004. Six critical oral health strategies were identified and Forum participants were asked to define action steps for putting these strategies into practice for the benefit of Delaware children enrolled in Head Start. Concurrent Sessions focusing on access, prevention and provider education strategies (described below) were repeated three times throughout the day and all Forum participants rotated through each concurrent session. Access Strategies Improve Head Start access to pediatric dentists, especially in Kent and Sussex Counties. Create financing opportunities for under-insured, un-insured and undocumented Head Start children and families. Prevention Strategies Prevent decay when Head Start children and families live in un-fluoridated communities Infuse dental education and prevention strategies in Head Start programming for children and families. Provider Education Strategies Improve the comfort level of general dentists in serving Head Start eligible children. Enhance the role of medical community (obstetricians, hospitals, pediatricians, and family practitioners) in oral health education, prevention, and treatment of Head Start children and families. Action Steps derived from the concurrent sessions centered on several key themes: Pregnant women need access to dental screening and treatment to prevent poor birth outcomes and transmission of dental disease to their infants. 4 Parents need to be made aware, informed and educated about the importance of oral health as a part of overall health for themselves and their children. Head Start and the Division of Public Health need to collaborate with other organizations and dental providers to ensure enrolled children receive early screening, prevention and treatment services. Dentists and dental hygienists need to provide more community-based prevention and treatment services with coordination by state agencies such as the Department of Education and the Division of Public Health Disparities that prevent access to dental services need to be addressed, including insurance status, income, race and ethnicity. Better coordination and communication among the dental community and with the public is needed. The Concurrent Session Section on page 13 of these proceedings provides a comprehensive listing of the recommended action steps derived from these sessions. An evaluation form (see Appendix B) was distributed to conference participants to assess the value of the information presented, the Forum outcome, and the overall effectiveness in meeting the objectives. Forty-five participants (63%) submitted an evaluation form. The evaluation results were good to excellent, with an average overall score of 3.55 on a four-point scale where excellent equates to 4.0 and poor equates to 1.0. A Summary of evaluation results are presented in the Evaluations Section on page 17 of these proceedings. Forum participants also were asked to complete a questionnaire, pledging their ongoing participation and support in Delawares oral health agenda (See Appendix C). Thirty-one of the Forum participants responded to the questionnaire and of those, 26 stated an interest in participating in an oral health coalition; 28 wanted to participate in developing an oral health plan; and all respondents wished to receive additional information. Of those, 87 percent of respondents stated yes to participating in all three activities. This report provides an overview of the data and information offered at the Forum; the ideas generated and the recommendations to be further explored and potentially implemented in Delaware. A copy of these Forum proceedings will be distributed to all Forum registrants. The next section provides an agenda from the Delaware Head Start Oral Health Forum. 5 Delaware Head Start Oral Health Forum Friday, June 3, 2005 Delaware Technical and Community College, Terry Campus Dover, Delaware Agenda 8:00 a.m. Lobby Registration & Continental Breakfast 8:30 a.m. Room 400 Welcome and Opening Remarks Gregory McClure, DMD, MPH - Delaware State Dental Director Suzanne S. Burnette - Delaware Head Start Association President 9:00 a.m. Room 400 Overview of Head Start Nurturing the Promise Video 9:15 a.m. Room 400 Plenary Session: Strategies to Improve the Oral Health of Delawares Most Vulnerable Children James J. Crall, DDS, ScD Chair, Pediatric Dentistry, UCLA School of Dentistry 10:00 a.m. Room 400 & Lobby Break 10:15 a.m. Room 400 Overview of Dental Health Requirements and the Status of Delaware Head Start Dental Services Harry S. Goodman, DMD, MPH Professor, Department of Health Promotion and Policy, Program of Pediatric Dentistry, University of Maryland Dental School 10:45 a.m. Room 400 Setting the Stage for Action Planning Gregory B. McClure, DMD, MPH 11:00 a.m. Concurrent Discussion Sessions: Putting the Strategies into Action Participants will rotate among session during each of three concurrent discussion sessions (morning and afternoon) Session 1 Room 407A Access Strategies Subject Matter Expert: Gregory B. McClure, DMD, MPH Facilitators: Kimberly A. Hickman- Bowen, RDH, BSDH, MA Session 2 Room 407B Prevention Strategies Subject Matter Expert: Harry S. Goodman, DMD, MPH Facilitators: Amy R. Requa MSN, CRNP Session 3 Room 411 Provider Education Strategies Subject Matter Expert: James J. Crall, DDS, ScD Facilitators: Helen Arthur, RDH, BSDH 12:00 p.m. Room 400 Lunch 12:30 p.m. Room 400 A Vision for School Readiness Valerie Woodruff, Secretary, DE Dept. of Education 1:15 p.m. Rooms 407&411 Concurrent Discussion Sessions: Putting the Strategies into Action 2:15 p.m. Rooms 407&411 Concurrent Discussion Sessions: Putting the Strategies into Action 3:15 p.m. Room 400 Closing Session: Wrap-up and Summary Gregory B McClure, DMD, MPH & Suzanne S. Burnette 3:30 p.m. Adjourn 6 General Session Presentations This section provides an overview of the central issues, topics and themes addressed by each of the general session speakers. Biographies for each of the Forum presenters may be viewed in Appendix D. Appendix E provides the presentations delivered by Drs. Crall and Goodman. Welcoming and Opening Remarks Gregory B. McClure, DMD, MPH, Delaware State Dental Director; Chief, Health Systems Management Section, Division of Public Health Suzanne S. Burnette, MA, President, Delaware Head Start Association Dr. Gregory McClure opened the Forum by thanking the audience for participating in Delawares first Forum to discuss oral health issues. He spoke of the silent epidemic of oral diseases that are affecting our most vulnerable citizens, including low-income children. He reviewed the program goal and learning objectives and encouraged the audience to participate fully in the concurrent session discussions so that a strong oral health plan can be developed for the State of Delaware. Suzanne Burnette encouraged the audience to be part of the solution for improving oral health for Delawares most vulnerable children, by establishing partnerships and working together to improve access to care and oral health education for children and families. Ms. Burnette introduced the Nurturing the Promise video, which featured children, staff, and families in Head Start and Early Head Start programs at several locations across the country illustrating Head Start's comprehensive approach and key principles of encouraging: a nurturing environment that supports the healthy growth and development of each child in the context of the child's family, culture, and community: parents as partners in the shared decision-making process and as active participants in policy groups; and recognition of the importance of strengthening linkages within communities. The Nurturing the Promise video is available for purchase at the Head Start Information and Publication Center at: http://www.headstartinfo.org/ 7 Plenary Session: Strategies to Improve the Oral Health of Delawares Most Vulnerable Children James J. Crall, DDS, ScD Chair, Pediatric Dentistry, UCLA School of Dentistry Dr. James J. Crall presented the plenary address entitled Head Start and Early Head Start: Establishing a Foundation for a Lifetime of Oral Health. The presentation focused on five major areas of discussion: Magnitude and significance of oral health problems in preschool children and contributing factors Emerging science and opportunities for improving oral & general health in Head Start Current systems gaps Challenges getting Head Start children connected to dental care + 3 successful models Key elements & strategies for creating effective Head Start oral health program The presentation is provided in Appendix E. The following is an overview of the key points made in the presentation: Magnitude and significance of oral health problems in preschool children and contributing factors Many children are not getting care early enough and their decay remains untreated due to access barriers. Dental decay may be decreasing in prevalence, but we cannot be complacent. Tooth decay is a chronic disease. Only two to three percent of all dentists are trained in pediatrics Access will continue to be a challenge: the workforce is busy; there is a decline in dentists coming out of school and the workforce is aging; conversely, the population is growing, especially among those more likely to have dental problems. Eighty percent of dental disease is experienced by 20 percent of the population and the lower the poverty level, the higher the chance of untreated decay. Educating parents and children early can prevent decay. Race and ethnicity also matter: African Americans and Hispanic children are more likely to have tooth decay and untreated decay; many of these children are enrolled in Head Start. Emphasis needs to be on getting education, screening and treatment to high-risk populations earlier. The progressive nature of disease is exemplified in the 20 percent difference between dental needs in three year olds versus four year olds. Keys to good oral health include: good eating & snacking practices; regular self-care practices, including daily brushing with fluoride toothpaste; and access to dental homesa regular, ongoing source of dental care We take for granted everyone is practicing these habits, but they are not. Brushing programs in schools are making a big difference Language, attitudes and behaviors (LAB) are important considerations. The words we use are important. For example, the words, baby teeth to many means that the teeth will fall out anyway so oral hygiene is not important; however, children keep these teeth until age 9. Children can have both baby teeth and permanent teeth from age five to nine. Good habits at an early age are important. 8 Prevention is another LAB problem. People hear the word prevention and think one visit to the dentist will take care of their decay. Ongoing prevention is needed85 percent of the population is still getting tooth decay by 18 years old. The healthcare system needs to connect the resources and provide continuity over time. Fluoride and sealants need to be part of an overall prevention and treatment program. They cannot stand alone. Children with untreated decay have the potential for breathing and sight problems. Blood flows through the mouth and the decayed tooth. Those bacteria then flow through other organs in the body, causing other health problems and learning delays. The rate of those uninsured for dental is almost three times that of medically uninsured Nationally, health care expenditures attributed to dental care is about 30 percent; Medicaid expenditures for dental services are about two percent. Dental Education needs to stress the importance of taking care of children (and understanding Head Start). General dentists are not trained to take care of children and should not be expected to do so; however, general dentist can provide screening and prevention for young children, referring restorative work to pediatric dentists. Emerging science and opportunities for improving oral & general health in Head Start Bacteria from dental disease can be transmitted from mother to baby after teeth appear. Pregnant women with periodontal disease are more likely to have poor birth outcomes. Clinical trials are currently underway to see if prevention and treatment can have an impact on birth outcomes. Current systems gaps Most Head Start parents report that their children have a dental home, have had a dental exam, and have received preventive care when needed; however, epidemiological data shows that 52 percent of these children have untreated decay in over 5 teeth. Our current dental care system includes a relatively high rate of oral disease; a disjointed system; and an outdated, one-size-fits-all approach to delivery. What is needed is: continuous, coordinated approach to controlling disease and promoting oral health; and strategic, data-driven approaches that respect diversity. Challenges getting Head Start children connected to dental care + 3 successful models The American Academy of Pediatrics (AAP) published a policy statement promoting an early caries risk assessment for children under 12 years old; referring those at high risk to a dental home. Visual screening for plaque and white spots should be done on all children because these problems are likely to become decay. These children are prime candidates for early prevention and treatment. Dental disease is a chronic disease; the risk for dental disease is never at zero and must be managed over a lifetime. Key elements & strategies for creating effective Head Start oral health program An efficient system for treating Head Start children is needed. Bringing dental care to Head Start center should be considered, rather than busing children to the dental office. Vision for Head Start Oral Health: Head Start families, communities and learning environments actively engaged in effective oral health promotion 9 Community-based systems that provide comprehensive care making efficient use of local providers Local dental groups linked to Head Start programs and providing dental homes for all Head Start children Other community service providers educated and linked to Head Start Strategies: Getting people to talk to each other is key: families and communities working together Engaging dental community on Head Start advisory committee Money can be spent on prevention and treatment, yet still save money by focusing resources on at-risk children. 10 Overview of Dental Health Requirements and the Status of Delaware Head Start Dental Services Harry S. Goodman, DMD, MPH Professor, Department of Health Promotion and Policy, Program of Pediatric Dentistry, University of Maryland Dental School Dr. Goodman presented a foundation for Head Start oral health requirements and strategies to improve oral health. He also provided data showing how Delaware compares to other states in the region as well as the nation with respect to these standards. Factors Affecting Oral Health: Poor children are much more likely to have more severe tooth decay than affluent children and are less likely to have access to dental care. Head Start enrolled children are three times more likely to have a dental screening than are other low-income children. Early childhood caries is a term that describes rampant dental caries in infants and toddlers; commonly referred to as nursing caries, nursing bottle caries and baby bottle caries. Early childhood caries occurs in children under age three; is an infectious disease transmitted from mother to baby; and is associated with inappropriate use of sugar. Program Information Report (PIR) All Head Start Programs must complete an annual PIR. The following provides an overview of how Delaware fares in comparison to the nation and other states in the region (Maryland, New Jersey, Pennsylvania, Virginia and Washington, DC) Delaware ranks better than the region and nation in: - Children having completed a dental exam. - Children in need of treatment. Delaware ranks lower in: - Children 0-3 years receiving a well-child exam - Pregnant women receiving a dental exam The likelihood a Delaware child will receive a follow up to the initial dental exam equates is better than the nation; which equates to ongoing and continuous access to care, once the child is in the system Delaware also is doing very well getting migrant and undocumented children into dental care through its Migrant Head Start programs in Georgetown and Smyrna. Family and provider education is an important key in improving access to care and improved oral health, especially for pregnant women. State Head Start Forums Oral health is a top priority for Head Start with 10 Regional Head Start Oral Health Consultants and regional and state forums in all but one region and six states. All but five states in the nation have been funded to conduct a Head Start Oral Health Forum. Forum goals include developing a state action plan to address oral health access, prevention and education. Funding sources are available for shared initiatives moving forward from the state plan. 11 Setting the Stage for Action Planning Gregory B. McClure, DMD, MPH Dr. McClure provided an overview of the concurrent session as a means to have all audience members participate and provide guidance and input on action items that will make each of the identified Head Start Oral Health strategies a practice in Delaware. He explained how the Head Start Oral Health Forum ties into the Delaware Oral Health Summit held in December 2004 and the findings and outcomes of both conferences will be the basis for Delawares Oral Health Plan. Dr. McClure further remarked that while disparities among race, ethnicity and income are tremendous factors in oral health; little attention has been paid to this issue. At a recent health disparities conference, there were no dentists present and oral health was not seen as part of overall health. The audience was urged to work together to create awareness for oral health disparities. 12 A Vision for School Readiness Valerie Woodruff, Secretary, DE Dept. of Education Secretary Woodruff presented an overview of the challenges that lie before us in improving oral health and ensuring school readiness for Delawares children, as follows: Dental care is not a way of life for many children Dental decay has an effect on learning, overall health and success Head Start goals must be married with the Department of Educations goals The information and education children receive in Head Start (i.e., brushing teeth after every meal) does not always follow through life Many low income families do not know how to access the healthcare system. They do not know who to call, especially when they do not have health insurance. Children with severe tooth decay often have failure to thrive issuesthey do not eat good foodthese factors impact their ability to learn and speak. Once the dental disease is cared for, these children show significant and rapid improvements in learning and development. Secretary Woodruff established several opportunities for addressing these issues: All dentists should accept Medicaid Recruit more pediatric dentists to Delaware Impress upon healthcare providers to stop talking and start doingthis is imperativea duty as citizens and professionals to care for all. Establish a safety net for children that do not have dental homes Everyone involved in this Forum must be an advocate for childrens oral healthand each one must bring one to support and further the cause In closing, Secretary Woodruff noted that good oral health and hygiene is not all about learning, but it is also about self-esteem, confidences, and being a whole person. 13 Concurrent Discussion Sessions: Putting the Strategies into Action Forum participants rotated among each of three concurrent discussion sessions on access, prevention and provider education strategies. The purpose of the sessions was to develop action steps for putting the identified strategies into practice. The following provides a summary of the action steps established in the concurrent sessions. General Recommendations: 1. Develop a committee representative of all constituencies to coordinate education, programs and services for Head Start families. Schedule dates for school-based services a year in advance. The committee should meet quarterly and include no more than two representatives from each of the following organizations: Christiana Care Dental Residency Program, Delaware State Dental Society, Delaware Dental Hygienists Association, Department of Education, Division of Public Health, Head Start, Federally Qualified Health Centers (FQHC) and School Nurses Association. 2. The Division of Public Health should schedule a follow up meeting to review action steps and develop an implementation plan. 3. Send a copy of the Forum proceedings to everyone in attendance. Access Strategies Subject Matter Experts: Gregory B. McClure, DMD, MPH & David Michalik Facilitator: Kimberly A. Hickman- Bowen, RDH, BSDH, MA Scribes: Rebecca Ruiz and Thowana Weeks Improve Head Start access to pediatric dentists, especially in Kent and Sussex Counties. 1. Promote non-traditional office hours for dental providers to see Head Start children. 2. Consider removing or changing licensing regulations to remove recruitment barriers 3. Promote dental case management programs for high-risk children 4. Promote private industry partnerships, corporate sponsorships, insurance companies, and other funding options (private grants, DE lottery, taxes, etc.) for dental education support for students who will later practice dentistry in Kent or Sussex County. 5. Establish partnerships with dental pediatric residency programs in other states in the region to rotate through Delawares underserved areas and provide treatment to Head Start children. 6. Schedule Head Start children in existing dental clinics/offices that have underutilized chair time. 7. Appropriate parental consent forms are needed to treat Head Start childrenHead Start should review consent forms before appointment; educate the child about what to expect; and promote the value of seeing the dentist and good oral health. 8. Develop a public awareness campaign with specific links to organizations that can coordinate access to dental care. 14 Create financing opportunities for under-insured, un-insured and undocumented Head Start children and families. 1. Provide financial incentives to recruit dentists to practice in underserved areas DIDER, State Loan Repayment Program. 2. Provide dental coverage through Delaware Healthy Children Program for eligible children of undocumented parents. 3. Develop partnerships with dental schools, dental hygienists, community health clinics, hospitals, and Nemours to provide services to uninsured and underinsured children. 4. Develop a dental assistance program with co-pays, similar to the Delaware Prescription Assistance Program, to provide financial assistance and/or discounted services to low- income families. 5. Increase Medicaid coverage to include dental screening and treatment for pregnant women as part of the Smart Start program. Prevention Strategies Subject Matter Expert: Harry S. Goodman, DMD, MPH Facilitators: Amy R. Requa, MSN, CRNP Scribe: Douglas Trader Prevent decay when Head Start children and families live in un-fluoridated communities 1. Topical applications of fluoride should be promoted, including rinses and varnishes. Where there is no fluoride at home and at school, prescriptions for fluoride tablets may be warranted. 2. Encourage families to have well water tested for fluoridation. Based on test results, families are provided information on oral health and prevention of tooth decay. If no fluoridation, refer family/children to a healthcare provider for prescription, further evaluation and education. 3. Publish water supply fluoridation levels to ensure that there is an optimal level of fluoridation based on state law. 4. Implement the Infant Mortality Task Force recommendation to promote oral health care, particularly the prevention and treatment of periodontal disease, as a component of comprehensive perinatal programs. 15 Infuse dental education and prevention strategies in Head Start programming for children and families. 1. Develop an education campaign (public service announcement) on the importance of oral health and prevention of tooth decay. Promote value of good teeth or oral health in overall health and well-being. 2. Educate Head Start parents about prevention and their role in helping children brush their teeth; using fluoride toothpaste and brushing at least twice a day. For early head start parents, encourage them to brush with water (or wipe the gums) early on and then add a smear of toothpaste as the child reaches two years of age. Inform parents about the duration of brushing and to set a timer to ensure the child brushes long enough. Teach parents how to floss their childs teeth. 3. Utilize Head Start parent policy councils and parent committees to increase value of oral health care and promote the role of parents. 4. Include information on low sugar foods and drinks in nutrition education programs for healthy teeth and weight control. 5. Utilize dentists, dental hygienists, and nursing students to conduct outreach programs to educate Head Start families and staff about oral health and prevention. 6. Educate pregnant women enrolled in Early Head Start should on the importance to oral hygiene for themselves and their baby as well as any older children. 7. Head Start and community organizations partners to distribute dental education and prevention information to pregnant women and parents of young children. Community organizations/programs should include: Medicaid, Healthy Start, Smart Start, Parents as Teachers, Home Visiting Program, March of Dimes, and Even Start. 8. Head Start collaborate with the Delaware Dental Hygienists Association, dental hygiene programs, Division of Public Health and the ADA to identify the parents role in oral health and use positive feedback to reinforce. 9. Teach children how to brush their teeth in Head Start and school. Encourage them to talk to their parents about what they learned about the importance of oral health. 10. Mentor parents to advocate for oral health assessments during well-child visits. 11. Promote community-wide oral health education and oral hygiene (e.g., Operation Smile) 12. Catalog, organize and coordinate the oral health information and education resources available. One site of interest is: www.mchoralhealth.org 13. Identify a champion for Head Start oral health advocacy efforts. 14. Promote the use of Medicaid/Delaware Healthy Children Program outreach services to help Spanish-speaking families access dental services (1-800-996-9969) 15. Enhance oral health education for Head Start and Early Head Start program enrollees through the American Dental Association (ADA), Delaware State Dental Society (Delaware State Dental Society) and Head Start Collaborative. 16. Make available multi-cultural education materials for patients from other cultures, such as Latino and Asian. 16 Provider Education Strategies Subject Matter Expert: James J. Crall, DDS, ScD Facilitators: Helen Arthur, RDH, BSDH Scribe: Erika Sherman Enhance the role of medical community (obstetricians, hospitals, pediatricians, and family practitioners) in oral health education, prevention, and treatment of Head Start children and families 1. Integrate oral health into well-child visits for children under three years. 2. Utilize nursing schools, dental hygiene programs, FQHCs and Dental Residency Program to promote oral health in the communityto Head Start and all children. 3. Create a collaborative among the Division of Public Health and Delaware State Dental Society should work with Daycare Licensing and Family and Workplace Connection to develop a training process on oral health education and prevention for daycare providers and encourage a change in the day care regulations to incorporate oral health. 4. Improve communication among all organizations and agencies targeting oral health improvement, especially Division of Public Health, Delaware State Dental Society, Delaware Dental Hygienists Association, the Medical Society of Delaware and the Delaware Chapter of the American Academy of Pediatrics. Improve the comfort level of general dentists in serving Head Start eligible children. 1. Division of Public Health, the Delaware State Dental Society and the Delaware Dental Hygienists Association (Delaware Dental Hygienists Association) should develop or adopt a dental education training module for healthcare providers and parents. A planning group should be gathered to devise a process, identify trainers and ensure multi-cultural focus. The target audience should be part of the planning process and should include Head Start/Early Head Start parents. 2. Dental providers should attend monthly Head Start meetings. 3. Division of Public Health, Head Start (Head Start) and the Delaware State Dental Society should work together to organize field trips to dental offices so young children will know what to expect when they go to the dentist. 4. Promote a Community Healthcare Access Program pilot for dental services in Kent and Sussex Counties. 17 Evaluations The Forum evaluation form was scored using a scale from excellent to poor. Participants were asked to rank the Forum on several criteria using this scale. The scoring associated with this scale is as follows: Excellent = 4 points Good = 3 points Fair = 2 points Poor = 1 point The evaluation form is provided below with an average participant evaluation score provided in the right column. Forty-four evaluation forms were completed. OVERALL QUALITY? Average Score 1. The presentations were: 3.61 2. The illustrative materials were: 3.49 3. The audiovisual quality was: 2.52 4. The meeting facilities were: 3.64 5. The registration process was: 3.67 HOW WELL WERE THE SUMMUT OBJECTIVES MET? 6. To gain an understanding of how Delawares Head Start program measures against the national Head Start Performance Standard requirements on oral health. 3.30 7. To learn about national strategies to improve oral health access, prevention and practitioner availability for Head Start enrolled children. 3.23 8. To develop an action plan for putting six critical oral health strategies into practice for the benefit of Delaware children enrolled in Head Start. 3.16 9. To gain an understanding of the impact of oral health on school readiness and public policy implications in reaching Delawares school readiness goals 3.14 GENERAL SESSION CONTENT/QUALITY? Plenary Session: Strategies to Improve the Oral Health of Delawares Most Vulnerable Children James J. Crall, DDS, ScD Overall Session Value 3.64 Content Usefulness 3.65 Ideas/Information Presented 3.87 Conference Materials Presented 3.93 Overview of Dental Health Requirements and the Status of Delaware Head Start Dental Services Harry S. Goodman, DMD, MPH Overall Session Value 3.59 Content Usefulness 3.57 Ideas/Information Presented 3.55 Conference Materials Presented 3.52 Setting the Stage for Action Planning Gregory B. McClure, DMD, MPH Overall Session Value 3.45 Content Usefulness 3.41 Ideas/Information Presented 3.41 Overall Session format 3.40 A Vision of School Readiness Valerie Woodruff Overall Session Value 3.52 Content Usefulness 3.50 Ideas/Information Presented 3.52 Overall Session format 3.45 18 CONCURRENT SESSION CONTENT/QUALITY? Access Strategies Overall Session Value 3.44 Overall Session Format 3.39 Opportunity for Audience Participation and Input 3.45 Facilitator Effectiveness 3.38 Subject Matter Expert Effectiveness 3.49 Potential for Putting Session Outcomes into Practice 3.28 Likelihood that you will participate in ongoing activities to put the Head Start Oral Health Plan into practice. 3.46 Prevention Strategies Overall Session Value 3.38 Overall Session Format 3.43 Opportunity for Audience Participation and Input 3.51 Facilitator Effectiveness 3.51 Subject Matter Expert Effectiveness 3.41 Potential for Putting Session Outcomes into Practice 3.41 Likelihood that you will participate in ongoing activities to put the Head Start Oral Health Plan into practice. 3.51 Provider Education Strategies Overall Session Value 3.36 Overall Session Format 3.36 Opportunity for Audience Participation and Input 3.46 Facilitator Effectiveness 3.46 Subject Matter Expert Effectiveness 3.38 Potential for Putting Session Outcomes into Practice 3.28 Likelihood that you will participate in ongoing activities to put the Head Start Oral Health Plan into practice. 3.46 A-1 Appendix A Head Start Oral Health Forum Attendees Zita Aquino Division of Public Health Robert Arm Christiana Care Wilmington Hospital Helen Arthur Division of Public Health Tina Ayala Southern Delaware Center Maryann Bailey Westside Health, Inc. Laurie Beauchamp Delaware Tech Jeff Benatti New Castle County Head Start Cherokee Bonilla Telamon Kent County Head Start Nancy Brohawn Delaware Dental Hygienists Association Alecea Bryant Delaware Psychiatric Center Suzanne Burnette DE Early Childhood Center Charles Calhoon Delaware State Dental Society Paul Christian Delaware Dental Society Brenda Coakley Migrant & Seasonal Head Start Collaboration Valerie Covington Telamon Kent County Head Start Cherrell Davids New Castle County Head Start Gloria Dunsmore DECC/ECAP Norma Everett Division of Public Health Juanita Farrington New Directions Early Head Start Carmelita Franco Division of Public Health Judith Gaston Eastern Shore Oral Health Outreach Project Doris Gonzalez Telamon Corporation Head Start Esther Graham Telamon Kent County Head Start Lindy Green-Hack New Castle County Head Start Cynthia Hall Telamon Kent County Head Start Amy Harter New Directions Early Head Start Kimberly Hickman-Bowen Delaware Dental Hygienists Association Jennifer Hudson Delaware Dental Hygienists Association Phyllice Jackson Telamon Kent County Head Start Melissa Jones Delaware Dental Hygienists Association Susan Kerwin Indian River Project VILLAGE Samantha Kiley Wilmington Head Start Maria Lopez Telamon Corporation Head Start Becky Luis Division of Public Health Debbie MacGregor Telamon Kent County Head Start A-2 Clara Martinez Telamon Kent County Head Start Gregory McClure Division of Public Health Tawana Medlin Dentist Dave Michalik Division of Social Services John Moore Bear-Glasgow Dental, LLC M. Lorraine Morris Southern Delaware Center Sharon Mossman Delaware Dental Hygienists Association Brian Murphy Oral-B Gilda Nieves-Knight Indian River Project VILLAGE Charita Okorafor Southern Delaware Center Margarita Olivencia Telamon Corporation Head Start Gina Perez Advances in Management, Inc. Ray Rafetto Delaware State Dental Society Irene Rees Delaware Early Childhood Center Betty Richardson Department of Education Vivian Rizzo Delaware Dental Hygienists Association Karen Rose Delaware Psychiatric Center Gwendolyn W. Sanders G & G Enterprise Milagros Santiago ECAP-Latin American Community Center Erika Sherman Division of Public Health Zachary Smith Southern Delaware Center Wendy Strauss GACEC Lacie Strauss Dental Hygiene Student/Del. Tech Kathy Taylor Kreative Kids Head Start Merith Taylor Delaware Dental Hygienists Association Deborah Thomas Wilmington Head Start Robbin Thompson Southern Delaware Center Douglas Trader Division of Public Health Edith Villasenor Division of Public Health Gail Wade New Directions Early Head Start Mary Watson ECAP Consultant Bridget Wheatley Delaware Early Childhood Center Sydney White New Directions Early Head Start Angela Williams Telamon Kent County Head Start Leonard Young Standford Children Delaware Rossana Zambrano Telamon Corporation Head Start Alan Zimble Private Dentist B-1 Appendix B Evaluation Form Please rate the overall quality of this program. Excellent Good Fair Poor 10. The presentations were: 11. The illustrative materials were: 12. The audiovisual quality was: 13. The meeting facilities were: 14. The registration process was: How well was each overall conference objective met? Excellent Good Fair Poor 15. To gain an understanding of how Delawares Head Start program measures against the national Head Start Performance Standard requirements on oral health. 16. To learn about national strategies to improve oral health access, prevention and practitioner availability for Head Start enrolled children. 17. To develop an action plan for putting six critical oral health strategies into practice for the benefit of Delaware children enrolled in Head Start. 9. To gain an understanding of the impact of oral health on school readiness and public policy implications in reaching Delawares school readiness goals 18. Overall comments and/or suggestions for future topics? ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ B-2 Please rate each general session presentation for quality and content. Plenary Session: Strategies to Improve the Oral Health of Delawares Most Vulnerable Children - Dr. James J. Crall, DDS, ScD Excellent Good Fair Poor Overall Session Value Content Usefulness Ideas/Information Presented Conference Materials Presented Overview of Dental Health Requirements and the Status of Delaware Head Start Dental Services - Harry S. Goodman, DMD, MPH Excellent Good Fair Poor Overall Session Value Content Usefulness Ideas/Information Presented Conference Materials Presented Setting the Stage for Action Planning - Gregory B. McClure, DMD, MPH Excellent Good Fair Poor Overall Session Value Content Usefulness Ideas/Information Presented Conference Materials Presented A Vision for School Readiness Valerie Woodruff Excellent Good Fair Poor Overall Session Value Content Usefulness Ideas/Information Presented Overall Session Format General Session Comments________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ B-3 Please rate each concurrent session for overall quality and content. Access Strategies Excellent Good Fair Poor Overall Session Value Overall Session Format Opportunity for Audience Participation and Input Facilitator Effectiveness Subject Matter Expert Effectiveness Potential for Putting Session Outcomes into Practice Likelihood that you will participate in ongoing activities to put the Head Start Oral Health Plan into practice. Prevention Strategies Excellent Good Fair Poor Overall Session Value Overall Session Format Opportunity for Audience Participation and Input Facilitator Effectiveness Subject Matter Expert Effectiveness Potential for Putting Session Outcomes into Practice Likelihood that you will participate in ongoing activities to put the Head Start Oral Health Plan into practice. Provider Education Strategies Excellent Good Fair Poor Overall Session Value Overall Session Format Opportunity for Audience Participation and Input Facilitator Effectiveness Subject Matter Expert Effectiveness Potential for Putting Session Outcomes into Practice Likelihood that you will participate in ongoing activities to put the Head Start Oral Health Plan into practice. Concurrent Session Comments________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Thank you for your time. C-1 Appendix C Oral Health Action Plan Participation Questionnaire 1. I would like to continue to participate in the development of Delawares oral health planning process _____ yes _____ no 2. I would like to receive information about Delawares Head Start Oral Health Plan and about the development of a Delaware Oral Health Coalition _____ yes _____ no 3. I would like to participate in a Delaware Oral Health Coalition _____ yes _____ no a. If yes, please indicate your area(s) of interest (check all that apply) _____Access Strategies ______ Population Oral Health Issues _____Prevention Strategies ______ Childrens Oral Health Issues _____Provider Education Strategies ______ Head Start Oral Health Issues If you answered yes to any or all of these statements, please provide your contact information so that we may include you in future activities and/or information dissemination: Mr. Ms. Mrs. Dr. First Name ______________________________________________________________ Last Name _____________________________________Suffix____________________ Title____________________________________________________________________ Organization_____________________________________________________________ Address__________________________________________________________________ City_________________________________ State____________ Zip code ________ Phone______________________Fax____________________Email__________________ Thank you for your time and interest! D-1 Appendix D Speakers Biographies Suzanne Burnette is the ECAP supervisor for the Delaware Early Childhood Center and is President of both the Delaware Head Start Association and the Sussex Health Advisory Council. Suzanne also is an early childhood trainer for the Family and Workplace Connection as well as a master trainer for Partners in Excellence. Previously, she was the deputy director for the Hilltop Lutheran Neighborhood Center. Suzanne has a Bachelors degree in Special Education and a Masters degree in curriculum and instruction. James J. Crall, DDS, ScD is Director of the HRSA/Maternal and Child Health Bureaus National Oral Health Policy Center and Professor and Chair of Pediatric Dentistry at UCLA. Prior to moving to UCLA in 2004, he held faculty appointments at Columbia University (2000-2004), the University of Connecticut (1986-2000) and the University of Iowa (1979-1986). Dr. Crall has been actively involved in national, state and professional policy development concerning oral health over the past 15 years, and has served as an advisor for numerous organizations including the: American Academy of Pediatric Dentistry, American Academy of Pediatrics, American Dental Association, Joint Commission on Accreditation of Health Care Organizations, Pew Health Professions Commission, Milbank Memorial Fund, National Committee on Quality Assurance, National Governors Association, Robert Wood Johnson Foundation, U.S. Department of Health and Human Services, and U.S. General Accounting Office. Dr. James J. Crall received a D.D.S., masters degree and certificate in pediatric dentistry from the University of Iowa, and is a (board-certified) Diplomate of the American Board of Pediatric Dentistry. He was selected to be a Robert Wood Johnson Foundation Dental Health Services Research Scholar at Harvard from 1984-86, and subsequently obtained masters and doctoral degrees in Health Policy and Management from the Harvard School of Public Health. In 1997, Jim was appointed as the first Dental Scholar-in-Residence at the Agency for Health Care Policy and Research (AHCPR), now the Agency for Healthcare Research and Quality (AHRQ). Harold S. Goodman, DMD, MPH is Professor in the Department of Health Promotion and Policy, Pediatric Dentistry Program, University of Maryland Dental School. Dr. Goodman directs the Pediatric Dental Fellowship program, which provides care to underserved children throughout Maryland. He also serves as the Region 3 Head Start Oral Health Consultant responsible for oral health training and technical assistance for programs in DE, MD, PA, VA, WV, & DC. Dr. Goodman previously served as the Maryland State Dental Director. Prior to that, he was the Dental Public Health Residency Director for the VA Maryland Healthcare System and was Clinical Director of a community health center dental program for indigent children in New Mexico. Dr. Goodman has given numerous presentations at national and local meetings and has published many articles with his primary interests in oral cancer and health services utilization. He rreceived his dental degree from the University of Medicine and Dentistry of New Jersey in 1975 and obtained a Masters in Public Health (MPH) degree from the Johns Hopkins School of Hygiene and Public Health in 1986. He also completed a one-year Dental Public Health residency program at the University of Michigan School of Public Health in 1989. D-2 Gregory B. McClure, DMD, MPH is the dental director for the Delaware Division of Public Health. He is responsible for the dental public health program, which includes managing the Divisions dental clinic system. Dr. McClure serves as dental consultant for the dental Medicaid program and is a Delaware Institute of Dental Education and Research Board member representing the Division of Public Health. He also is the clinical director for the Special Smiles program of Special Olympics. Prior to joining the Division of Public Health, Dr. McClure was in general practice in Binghamton, NY where he also completed his residency in Dental Public Health with the New York State Department of Health. His residency research focused on county and state dental public health programs to improve access to dental care, prevention, and coalition development. Valerie Woodruff, M.Ed. has served as Secretary of Education since July 1999. Prior to being appointed Secretary of Education, Mrs. Woodruff served as the Associate Secretary for Curriculum and Instructional Improvement for the Delaware Department of Education. She has been a teacher, counselor, assistant principal and principal in high schools in both Maryland and Delaware. Secretary Woodruff led the development of the first School Based Wellness Center in Delaware, has served as a Thomson Fellow for the Coalition of Essential Schools, and was selected as Delawares Principal of the Year in 1990. She currently serves as a member of several boards including the Delaware Workforce Investment Board and its Youth Council, Delaware Region National Council for Community and Justice and the State Chamber of Commerce Partnership. She is also a Delaware representative on the Southern Regional Education Board and serves on the Executive Committee of SREB. She has served on the Board of the Council of Chief State School Officers and was recently chosen as President-elect of CCSSO. E-1 Appendix E Speakers Presentations Head Start Oral Health Forum June 3, 2005 Welcome Gregory B. McClure, DMD, MPH Suzanne S. Burnette Forum Sponsors Delaware Head Start Association Delaware Head Start State Collaboration project Early Childhood Assistance Program Purpose of the Forum To Improve the Oral Health of Head Start Children in Delaware Forum Learning Objectives To gain an understanding of how DEs Head Start program measures against the national Head Start Performance Standard requirements on oral health. To learn about national strategies to improve oral health access, prevention and practitioner availability for Head Start enrolled children. To develop an action plan for putting six critical oral health strategies into practice for the benefit of Delaware children enrolled in Head Start. To gain an understanding of the impact of oral health on school readiness and public policy implications in reaching Delawares school readiness goals Head Start and Early Head Start: Establishing a Foundation for a Lifetime of Oral Health Jim Crall, DDS, ScD Director, MCHB National Oral Health Policy Center UCLA Center for Healthier Children, Families & Communities Delaware Head Start Forum June 3, 2005 Presentation Overview Magnitude & significance of oral health problems in preschool children and contributing factors Emerging science and opportunities for improving oral & general health in HS Current systems gaps Challenges getting HS children connected to dental care + 3 successful models Key elements & strategies for creating effective Head Start oral health programs Background and Environment Children eligible for Medicaid and SCHIP are 3-5x more likely to have untreated decay ( NHANES III) Access to dental services for children covered by Medicaid has been a chronic problem ( OIG, 1996; GAO, 2000) funding is not the only issue, but it IS a major issue Dental decay is highly preventable, but not simply or uniformly preventable ( SGROH, 2000) EPSDT requires prevention AND treatment Dental workforce is busy, diminishing and unorganized. . . but the population is growing, especially groups at higher risk for dental disease. Tooth Decay and Oral Health Problems in EHS/Head Start & Preschool Children Percent of Children with Decayed and Filled Primary Teeth by Household Income Level (by % of Federal Poverty Level) 0 10 20 30 40 50 Decayed 2-5 year olds 0-100% 101-200% 201-300% 301%+ Decayed Filled 2-5 Filled 6-12 year olds 6-12 year year olds olds Vargas, Crall, Schneider. Analysis of NHANES III data. JADA, 1998. Vargas, Crall, Schneider. Analysis of NHANES III data. JADA, 1998. Percent of Children with Caries by Income Level and Ethnicity 0 10 20 30 40 50 60 Percent of children Ethnic groups White African American Mexican American Permanent dentition Primary dentition 2-5 years 6-12 years 6-14 years 15-18 years Vargas, Crall, Schneider: JADA 1998;129:1229-1238. Vargas, Crall, Schneider: JADA 1998;129:1229-1238. Treatment Urgency Data California Needs Assessment - 1993-94 Results of a MD State-wide Survey 52% of children in Head Start centers had untreated tooth decay 43% of 3 year-olds 62% of 4 year-olds Over 5 decayed tooth surfaces per child with decay Vargas CM, Monajemy N, Khurana P, Tinanoff N. Oral health status of preschool children attending Head Start in Maryland, 2000.Pediatr Dent 2002 May-Jun;24(3):257-63. Vargas CM, Monajemy N, Khurana P, Tinanoff N. Oral health status of preschool children attending Head Start in Maryland, 2000.Pediatr Dent 2002 May-Jun;24(3):257-63. Keys to Good Oral Health Good eating & snacking practices Regular self-care practices Daily brushing with F toothpaste While health is a blessing, it doesnt work until it becomes a habit Dr. Ernest Smith Access to dental homes Regular, ongoing source of dental care Diagnostic, preventive, disease management & treatment services, ideally risk- based Baby Teeth: A LAB Problem for Parents & Professionals Source: National Center for Health Statistics, CDC. Third National Health and Nutrition Examination Survey, 1988-1994 Source: National Center for Health Statistics, CDC. Third National Health and Nutrition Examination Survey, 1988-1994 Its about much more than baby teeth What do you suppose the PET scan of this childs brain looks like? Its about much more than baby teeth This facial cellulitis resulted from a cavity in tooth. This child is in pain, cant eat and is suffering. If she is not treated, her ability to breathe could be compromised and she may lose her sight. Effective Coverage Is Important For every child who lacks health insurance there are 2.6 kids who lack dental insurance Coverage that doesnt provide access is of little value. U.S. Dental Care Financing Trends: Total and Public Funding ($M) $0 $10,000 $20,000 $30,000 $40,000 $50,000 $60,000 1960 1965 1970 1975 1980 1985 1990 1995 1997 Total Exp ($ Millions) Public Funds Medicaid Expenditures for Pediatric Dental Services Dental care expenditures account for over 20% of all pediatric health care expenditures and approximately 30% of all health care expenditures for children ages 6 to 18. Medicaid expenditures for pediatric dental services are estimated to be 2.3% of Medicaid expenditures for child health care ( 0.5% of overall program spending) State Medicaid Innovations: Delaware State-administered program Access report ( 1997) Dental Care Access Improvement Committee ( 1998) NGA Policy Academy Vision and Program Changes Electronic eligibility and claims submission; DE Dental Society Medicaid recruitment program; New provider office manual developed 1/1/98: Medicaid pays 85% of dentists usual charges Medicaid participation: 1 108 ( of 302) dentists 1998 1999 2000 2001 Number with any Visit ( Form 416-12A) 8,428 9,699 13,403 15,430[ Number Enrolled ( Form 416 line 1) 60,577 61,028 64,814 67,836 Improving Medicaid Is Essential, but . . . Additional education for dentists and dental professionals may be needed About Head Start About providing care for young children Need to create programs that identify and share promising approaches for getting Head Start kids, families & programs connected to services in their communities New Science & Opportunities for Early Head Start Bacteria (germs) that cause tooth decay generally are passed from mothers to infants after teeth appear opportunity to delay infection or change the mix of bacteria Mothers with periodontal disease are more likely to have babies that are born early ( pre-term) and at low birth weight potential to have healthier babies and improve mothers oral health in pregnancy Current Systems Gaps Data & Performance Standards: What PIR Data Show for Head Start Children About 74% have a dental home 78% completed a dental examination 60% received preventive care 22% were diagnosed as needing treatment Of those, 76% received treatment But Epidemiologic Surveys Suggest a Different Picture: Results of a MD State-wide Survey 52% of children in Head Start centers had untreated tooth decay 43% of 3 year-olds 62% of 4 year-olds Over 5 decayed tooth surfaces per child with decay Vargas CM, Monajemy N, Khurana P, Tinanoff N. Oral health status of preschool children attending Head Start in Maryland, 2000. Pediatr Dent 2002 May-Jun;24(3):257-63. Vargas CM, Monajemy N, Khurana P, Tinanoff N. Oral health status of preschool children attending Head Start in Maryland, 2000. Pediatr Dent 2002 May-Jun;24(3):257-63. Gaps In Oral Health & Oral Health Care What we have -------- Relatively high rates of oral diseases Those with the greatest needs & highest risk have least access to services Disjointed / fragmented delivery system Public Sector / Private Sector Dental Care / Primary Care Preventers / Treaters Clinicians / Communities Blind / one-size-fits-all / dated approaches to service delivery Gaps In Oral Health & Oral Health Care What we have --------What we need Relatively high rates of oral diseases Those with the greatest needs & highest risk have least access to services Disjointed / fragmented delivery system Public Sector / Private Sector Dental Care / Primary Care Preventers / Treaters Clinicians / Communities Blind / one-size-fits-all / dated approaches to service delivery Continuous, coordinated, riskbased use of effective measures that promote oral health, control oral diseases and restore damaged oral structures Gaps In Oral Health & Oral Health Care What we have --------What we need Relatively high rates of oral diseases Those with the greatest needs & highest risk have least access to services Disjointed / fragmented delivery system Public Sector / Private Sector Dental Care / Primary Care Preventers / Treaters Clinicians / Communities Blind / one-size-fits-all / dated approaches to service delivery Continuous, coordinated, riskbased use of effective measures that promote oral health, control oral diseases and restore damaged oral structures Strategic, data-driven approaches that recognize and respect diversity among people and communities, and engage a broad group of stakeholders to address local needs Dental Homes and Systems Integration: Concepts & Implementation Challenges AAP Policy Statement Oral Health Risk Assessment Timing and Establishment of the Dental Home AMERICAN ACADEMY OF PEDIATRICS Policy Statement Organizational Principles to Guide and Define the Child Health Care System and/or Improve the Health of All Children Section on Pediatric Dentistry ABSTRACT. . . . To prevent caries in children, high-risk individuals must be identified at an early age (preferably high-risk mothers during prenatal care), and aggressive strategies should be adopted, including anticipatory guidance, behavior modifications (oral hygiene and feeding practices), and establishment of a dental home by 1 year of age for children deemed at risk. Pediatrics 2003; 111 (5) :1113-1116. Oral Health Risk Assessment Timing and Establishment of the Dental Home AMERICAN ACADEMY OF PEDIATRICS RISK GROUPS FOR DENTAL CARIES If an infant is assessed to be within 1 of the following risk groups, the care requirements would be significant and surgically invasive; therefore, these infants should be referred to a dentist as early as 6 months of age and no later than 6 months after the first tooth erupts or 12 months of age (whichever comes first) for establishment of a dental home: Children with special health care needs Children of mothers with a high caries rate Children with demonstrable caries, plaque, demineralization, and/or staining Children who sleep with a bottle or breastfeed throughout the night Later-order offspring Children in families of low socioeconomic status Oral Health Risk Assessment Timing and Establishment of the Dental Home AMERICAN ACADEMY OF PEDIATRICS ESTABLISHING THE DENTAL HOME The concept of the "dental home" is derived from the American Academy of Pediatrics concept of the "medical home." . . . Pediatric primary dental care needs to be delivered in a similar manner. The dental home is a specialized primary dental care provider within the philosophical complex of the medical home. Referring a child for an oral health examination by a dentist who provides care for infants and young children 6 months after the first tooth erupts or by 12 months of age establishes the child's dental home and provides an opportunity to implement preventive dental health habits that meet each child's unique needs and keep the child free from dental or oral disease. Caries Risk Assessment Tools Source: American Academy of Pediatric Dentistry Reference Manual. Available at: www.aapd.org. AAPD Caries-Risk Assessment Tool ( CAT) Low Risk Moderate Risk High Risk No decayed teeth in past 24 months Decayed teeth in the past 24 months Decayed teeth in the past 12 months No enamel demineralization (enamel caries white-spot lesions) 1 area of enamel demineralization ( enamel caries white-spot lesions) More than 1 area of enamel demineralization ( enamel caries white-spot lesions) Radiographic enamel caries Clinical Conditions No visible plaque; no gingivitis GingivitisA Visible plaque on anterior ( front) teeth High titers of mutans streptococci Wearing dental or orthodontic appliancesB Enamel hypoplasiaC Optimal systemic and topical fluoride exposureD Suboptimal systemic fluoride exposure with optimal topical exposureD Suboptimal topical fluoride exposureD Consumption of simple sugars or foods strongly associated with caries initiationE primarily at mealtimes Occasional ( e.g., 1-2) between-meal exposures to simple sugars or foods strongly associated with caries Frequent ( e.g., 3 or more) betweenmeal exposures to simple sugars or foods strongly associated with caries High caregiver socioeconomic statusF Mid-level caregiver socioeconomic status (e.g., eligible for school lunch program or SCHIP) Low-level caregiver socioeconomic status ( e.g., eligible for Medicaid) Regular use of dental care in an established Dental Home Irregular use of dental services No usual source of dental care Environmental Characteristics Active decay present in the mother of a preschool child Caries Risk Indicators General Health Conditions Children with special health care needsG Conditions impairing saliva composition/flowH DIAGRAMATIC REPRESENTATION OF A MODEL SYSTEM PERIODIC ASSESSMENTS o RISK LEVEL (low, high) o DISEASE STATUS (none, initial, advanced) o NEED FOR TREATMENT (urgent, basic, advanced) o No Disease o Low Risk o Initial Disease Only o Advanced Disease o Recommend dental exam within 12 mos. o Counseling to maintain low risk o Anticipatory Guidance o Recommend primary prevention (e.g., fluoride, sealants) o Data Entry o Refer to dental home for dental examination & prevention within 6 mos. o Risk mgt. program to reduce risk o Anticipatory Guidance o Reassess compliance in 6 months o Data Entry o Refer to dental home for diagnosis to verify initial disease status o Initial disease mgt. program to control disease and reduce risk o Anticipatory Guidance o Reassess in 3-6 months based on risk level o Data Entry o Refer to dental home to develop and implement reparative treatment plan o Advanced disease mgt. program to control disease and reduce risk o Anticipatory Guidance o Reassess in 3-6 months based on risk level o Data Entry o No Disease o High Risk Adapted from: Crall JJ, Edelstein BL. Appendix II Systems Capacity and Integration. Available at: www.cthealth.org. Caries = An Infectious, transmissible disease; but also a chronic, complex disease. Fejerskov O. Changing paradigms in concepts on dental caries: consequences for oral health care. Caries Res 2004; 38:182-91. Challenges & Models for Connecting Kids to Dental Care Arranging for dental homes for HS children with a local pediatric dentist ( MS) Distributing care across local and remote resources ( PA) General dentists Pediatric dentists Efficient method for conducting exams and prevention backed up by a system committed to providing treatment and dental homes for HS children ( CT) Why Head Start? Kids need services low-income families Young kids chance to intervene early Manageable numbers of eligibles Program support scheduling, transportation, follow-up, payments Efficient use of personnel Opportunity for daily self care Opportunity to educate parents & teachers Potential halo effect for families Potential for meaningful and sustainable improvements in a relatively short time Vision for Head Start Oral Health Head Start families, communities and learning environments actively engaged in effective oral health promotion Sound nutrition and feeding practices Daily oral health self-care activities Brushing with fluoride toothpaste Oral health education for kids & parents Professional oral health screening, exams, risk assessment and individualized follow-up services for all needed services Oral health leadership, technical expertise & support services to connect kids to care Dental Homes for all children Vision for Head Start Oral Health Community-based systems that provide comprehensive care making efficient use of local providers On-site assessment and individualized prevention and disease managment In-office/clinic diagnosis, preventive services, risk mgt., disease mgt. and treatment services as needed Local dental groups linked to Head Start programs and providing dental homes for all Head Start children Other community service providers educated and linked to Head Start Broad Strategies / Goals Reduce the burden of disease Health promotion Preventive services Disease management Treatment services Expand access to ongoing diagnostic, preventive and treatment services in dental homes Application of risk assessment and targeted interventions Evidence of the Value of Early Childhood Oral Health Care Savage MF, Lee JY, Kotch JB, Vann WF Jr. Early preventive dental visits: effects on subsequent utilization and costs. Pediatrics 2004;114:418-23. Jokela J, Pienihakkinen K. Economic evaluation of a risk-based caries prevention program in preschool children. Acta Odontol Scand2003;61(2):110-4. Keys to Good Oral Health Good eating & snacking practices Regular self-care practices daily brushing with F toothpaste While health is a blessing, it doesnt work until it becomes a habit Dr. Ernest Smith Access to dental homes regular, ongoing source of dental care diagnostic, preventive & treatment services Key Elements & Strategies: Building Effective Partnerships Up and Down the Line HS/EHS Communities HS/EHS Learning Environments HS/EHS Families HS/EHS Children Health Professions Head Start - MCHB Thank you for all that you do for Head Start!!! Overview of Head Start Overview of Head Start Oral Health Requirements and Status of Oral Health Requirements and Status of Delaware Head Start Dental Services Delaware Head Start Dental Services Delaware Head Start Oral Health Forum Delaware Head Start Oral Health Forum June 3, 2005 June 3, 2005 Harry Goodman, DMD, MPH Harry Goodman, DMD, MPH Region III Head Start Oral Health Consultant Region III Head Start Oral Health Consultant Professor, University of Maryland Dental School Professor, University of Maryland Dental School Dental Factoids Dental Factoids Tooth decay is the single most common chronic Tooth decay is the single most common chronic childhood disease childhood disease Poor preschoolers (ages 2 Poor preschoolers (ages 2-5) have 5 times the 5) have 5 times the rate of tooth decay and 2 times the rate of rate of tooth decay and 2 times the rate of dental pain than their affluent peers dental pain than their affluent peers More extensive tooth decay More extensive tooth decay Only half as likely to access a dentist Only half as likely to access a dentist 1 in 5 two 1 in 5 two-to to-four year olds have visible cavities four year olds have visible cavities Low income Head Start preschoolers nearly 3 Low income Head Start preschoolers nearly 3 times as likely to obtain a dental screening than times as likely to obtain a dental screening than other low income children. other low income children. National Health and Nutrition Examination Survey (1988 National Health and Nutrition Examination Survey (1988- 1994) 1994) Head Start Program Information Reports Head Start Program Information Reports Surgeon Surgeons General Report on Oral Health, 2000 s General Report on Oral Health, 2000 Early Childhood Caries (E.C.C.) Early Childhood Caries (E.C.C.) Infectious disease Infectious disease Initially affecting Initially affecting primary incisors primary incisors Initiated prior to 36 Initiated prior to 36 months of age months of age Associated with Associated with inappropriate use of inappropriate use of sugar sugar Significant public Significant public health issue CDC Report on ECC, 1994 CDC Report on ECC, 1994 health issue ECC is Costly to Treat ECC is Costly to Treat ECC is Difficult to Treat ECC is Difficult to Treat ECC is Difficult to Treat ECC is Difficult to Treat Oral Health and Head Start Oral Health and Head Start Oral health is an integral component of Oral health is an integral component of Head Start Head Start Strategies are being developed at the Strategies are being developed at the national, state and local levels to national, state and local levels to integrate access to dental care, integrate access to dental care, prevention and education into Head prevention and education into Head Start program activities Start program activities National Maternal and Child Oral Health National Maternal and Child Oral Health Resource Center Resource Center www.mchoralhealth.org www.mchoralhealth.org Oral Health and Head Start Oral Health and Head Start National oral health initiatives have National oral health initiatives have been included in an Interagency been included in an Interagency Agreement (IAA) between the: Agreement (IAA) between the: Maternal and Child Health Bureau, Maternal and Child Health Bureau, Health Resources and Services Health Resources and Services Administration (HRSA) and the Administration (HRSA) and the Administration for Children and Administration for Children and Families (ACF)/Head Start Bureau Families (ACF)/Head Start Bureau ACF/HRSA IAA ACF/HRSA IAA Accomplishments Accomplishments ASTDD Head Start Committee ASTDD Head Start Committee Head Start included in Head Start included in National Oral Health Policy National Oral Health Policy Center and National Oral Center and National Oral Health Resource Center Health Resource Center Oral health in Head Start Oral health in Head Start Learning Center Learning Center Funding & grant opportunities Funding & grant opportunities Oral health a top priority for Oral health a top priority for Head Start Head Start 10 Regional Head Start Oral 10 Regional Head Start Oral Health Consultants Health Consultants Regional and State Forums Regional and State Forums Regional Head Start Regional Head Start Oral Health Consultants Oral Health Consultants Mary Foley, R.D.H., M.P.H (Boston, Mary Foley, R.D.H., M.P.H (Boston, Reg. I) Reg. I) Neal Herman, D.D.S. (New York, Neal Herman, D.D.S. (New York, Reg. II) Reg. II) Harry Goodman, D.M.D., M.P.H. Harry Goodman, D.M.D., M.P.H. (Philadelphia, Reg. III) (Philadelphia, Reg. III) E. Joseph Alderman,D.D.S., M.P.H. E. Joseph Alderman,D.D.S., M.P.H. (Atlanta, Reg. IV) (Atlanta, Reg. IV) Kathy Geurink, R.D.H., M.A. Kathy Geurink, R.D.H., M.A. (Dallas, Reg. VI) (Dallas, Reg. VI) Lawrence Walker, D.D.S., M.P.H. Lawrence Walker, D.D.S., M.P.H. (Kansas City, Reg.VII) (Kansas City, Reg.VII) Valerie Orlando, R.D.H. Valerie Orlando, R.D.H. (Denver,Reg. VIII) (Denver,Reg. VIII) Reginald Louie, D.D.S., M.P.H. (San Reginald Louie, D.D.S., M.P.H. (San Francisco, Reg. IX) Francisco, Reg. IX) Rebecca Slayton, D.D.S., M.P.H. Rebecca Slayton, D.D.S., M.P.H. (Seattle, Reg. X) (Seattle, Reg. X) Central Office: (Am. Indian, Alaska Central Office: (Am. Indian, Alaska Native,Reg.XI; Migrant Reg XII) Native,Reg.XI; Migrant Reg XII) Mark Nehring, D.D.S., M.P.H. & John Mark Nehring, D.D.S., M.P.H. & John Rossetti, D.D.S., M.P.H. Rossetti, D.D.S., M.P.H. MCHB/HRSA MCHB/HRSA Regs.XI & XII Wash, DC Regional Head Start Oral Health Consultants Regional Head Start Regional Head Start Oral Health Consultants Oral Health Consultants Participate in efforts that Participate in efforts that promote, advocate and promote, advocate and improve the oral health of improve the oral health of Head Start (HS) and Head Start (HS) and Early Head Start (EHS) Early Head Start (EHS) children and their families children and their families Regional Head Start Regional Head Start Oral Health Consultants: Oral Health Consultants: Responsibilities Responsibilities Provides oral health consultation, training and Provides oral health consultation, training and technical assistance (T/TA) to the Head Start technical assistance (T/TA) to the Head Start Regional Office to: Regional Office to: Educate Head Start Educate Head Start Regional managers and staff Regional managers and staff Assist in integrating oral health T/TA into Regional Assist in integrating oral health T/TA into Regional T/TA system T/TA system Explore potential formal Explore potential formal relationships with other relationships with other agencies, organizations, and programs agencies, organizations, and programs Provides T/TA to state dental programs, Provides T/TA to state dental programs, dental/dental hygiene schools, licensure boards, and dental/dental hygiene schools, licensure boards, and professional organizations to increase/enhance professional organizations to increase/enhance access to care and preventive services for HS/EHS access to care and preventive services for HS/EHS children. children. Provides planning and follow Provides planning and follow-up T/TA to regional and up T/TA to regional and state HS Oral Health Forums state HS Oral Health Forums Regional Head Start Regional Head Start Oral Health Consultants: Oral Health Consultants: Responsibilities Responsibilities Participate in consensus building for Participate in consensus building for FAQ FAQs asked by HS grantees & s asked by HS grantees & programs programs Provide assistance and/or participate in Provide assistance and/or participate in HS grantee site reviews (PRISM) HS grantee site reviews (PRISM) regarding HS Performance Standards regarding HS Performance Standards compliance compliance Review and provide recommendations Review and provide recommendations on PIR data on PIR data Head Start Dental Federal Head Start Dental Federal Requirements Requirements Determining whether a child has a Determining whether a child has a Dental Home Dental Home and helping to find one and helping to find one Provide oral examinations by health Provide oral examinations by health care professionals care professionals Assist families in scheduling an Assist families in scheduling an appointment with a dentist for appointment with a dentist for treatment treatment Follow Follow-up on identified oral health care up on identified oral health care including prevention and treatment including prevention and treatment Head Start Performance Standards Child Health and Development (1304.20) Ongoing source of continuous, accessible care Dental home Recommended schedule - preventive & treatment visits Follow-up services Education and Early Childhood Development (1304.21) Child Health and Safety (1304.22) Dental emergencies Child Nutrition (1304.23) Family Partnerships (1304.40) Pregnant women Oral Health Education Community Partnerships (1304.41) Health care practitioners EHS/HS EHS/HS Performance Standards Performance Standards No later than 90 calendar days from No later than 90 calendar days from the child the childs first day in EHS or HS: s first day in EHS or HS: Determine if a child is up Determine if a child is up-to to-date on a schedule date on a schedule of age appropriate oral health care services as of age appropriate oral health care services as determined by the State EPSDT program determined by the State EPSDT program If not up If not up-to to-date date, assist parents to bring the , assist parents to bring the child up child up-to to-date date If up If up-to to-date, ensure recommended schedule is date, ensure recommended schedule is maintained maintained Dental follow Dental follow-up including prevention (e.g., up including prevention (e.g., fluoride therapies) and treatment fluoride therapies) and treatment Program Information Report Program Information Report (PIR) Data (PIR) Data All programs must complete annual Program All programs must complete annual Program Information Report (PIR) data Information Report (PIR) data Oral health questions include: Oral health questions include: Number of HS children with a dental home; Number of HS children with a dental home; Number of EHS/HS children who completed dental Number of EHS/HS children who completed dental examinations examinations Number of HS children who received preventive care Number of HS children who received preventive care Number of EHS children who received well Number of EHS children who received well-child screenings child screenings Number of EHS pregnant women who received dental exams Number of EHS pregnant women who received dental exams or treatment or treatment The PIR also requires programs to report the The PIR also requires programs to report the number of HS children who are diagnosed as needing number of HS children who are diagnosed as needing treatment and the number of those children who treatment and the number of those children who actually receive treatment actually receive treatment Program Information Report Program Information Report (PIR) Data (PIR) Data 2003 2003-2004 2004 1 97.87 97.87 Washington, DC Washington, DC 4 81.39 81.39 West Virginia West Virginia 2 91.45 91.45 Virginia Virginia 5 78.65 78.65 Pennsylvania Pennsylvania 3 87.86 87.86 Maryland Maryland 6 77.99 77.99 Delaware Delaware x 83.92/84.10 83.92/84.10 REGION 3/US REGION 3/US Rank Rank % Children Completing % Children Completing Dental Exams Dental Exams State State Program Information Report Program Information Report (PIR) Data (PIR) Data 2003 2003-2004 2004 1 15.17 15.17 Washington, DC Washington, DC 6 29.98 29.98 West Virginia West Virginia 4 23.01 23.01 Virginia Virginia 5 24.31 24.31 Pennsylvania Pennsylvania 2 17.21 17.21 Maryland Maryland 3 20.74 20.74 Delaware Delaware x 22.93/26.83 22.93/26.83 REGION 3/US REGION 3/US Rank Rank % Children Needing % Children Needing Dental Treatment Dental Treatment State State Program Information Report Program Information Report (PIR) Data (PIR) Data 2003 2003-2004 2004 6 36.47 36.47 Washington, DC Washington, DC 2 81.23 81.23 West Virginia West Virginia 1 86.99 86.99 Virginia Virginia 3 73.71 73.71 Pennsylvania Pennsylvania 5 62.75 62.75 Maryland Maryland 4 71.69 71.69 Delaware Delaware x 73.15/52.40 73.15/52.40 REGION 3/US REGION 3/US Rank Rank % 0 % 0-3 Children w/ 3 Children w/ Well Well-Child Visit Child Visit State State Program Information Report Program Information Report (PIR) Data (PIR) Data 2003 2003-2004 2004 1 62.86 62.86 Washington, DC Washington, DC 5 10.91 10.91 West Virginia West Virginia 3 20.10 20.10 Virginia Virginia 2 22.15 22.15 Pennsylvania Pennsylvania 4 15.46 15.46 Maryland Maryland 6 7.41 7.41 Delaware Delaware x 20.24/34.08 20.24/34.08 REGION 3/US REGION 3/US Rank Rank % Pregnant Women w/ % Pregnant Women w/ Dental Examination Dental Examination State State Delaware Delaware Migrant Children Migrant Children Migrant and Seasonal Head Start Migrant and Seasonal Head Start Age: O Age: O-5 years old 5 years old Income: Low income, must qualify based on Income: Low income, must qualify based on income guidelines income guidelines Agriculture: Primary source of family income Agriculture: Primary source of family income must come from qualifying agricultural must come from qualifying agricultural activities activities Mobility: To qualify as a migrant Mobility: To qualify as a migrant farmworker farmworker, , the family must have relocated for the the family must have relocated for the purposes of engaging in agricultural work in purposes of engaging in agricultural work in the last 24 months. This does not apply to the last 24 months. This does not apply to seasonal seasonal farmworkers farmworkers. . Delaware Delaware Migrant and Seasonal Head Start Programs Migrant and Seasonal Head Start Programs East Coast Migrant Head Start Project East Coast Migrant Head Start Project Private, non-profit agency supported by Migrant programs Branch of the Head Start Bureau, ACF Telamon Corporation Smyrna Head Start Georgetown Early Head Start Excellent PIR dental data results Infants and toddlers (ages 0-3) Pre-school children (ages 3-5) Pregnant women ACF/HRSA IAA ACF/HRSA IAA Accomplishments Accomplishments ASTDD Head Start Committee ASTDD Head Start Committee Head Start included in Head Start included in National Oral Health Policy National Oral Health Policy Center and National Oral Center and National Oral Health Resource Center Health Resource Center Oral health in Head Start Oral health in Head Start Learning Center Learning Center Funding & grant opportunities Funding & grant opportunities Oral health a top priority for Oral health a top priority for Head Start Head Start 10 Regional Head Start Oral 10 Regional Head Start Oral Health Consultants Health Consultants Regional and State Forums Regional and State Forums Regional Forums on Enhancing Partnerships Regional Forums on Enhancing Partnerships for Head Start and Oral Health for Head Start and Oral Health WA OR ID MT ND SD WY UT CO CA NV AZ NM TX OK KS NE IA MO AR LA MN WI IL IN OH MI PA NY KY TN MS AL GA SC NC VA WV MD DE NJ CT RI VT NH ME MA FL HI Forum Held No Forum Held* PR VI AK II IX VI VII VIII X V II III IV I Region XII - Migrant and Seasonal Head Start Program Branch DC December 2004 Pacific Insular Areas Region XI - American Indian-Alaska Native Head Start Program Branch * Forum Planning in Process www.theodora.com/maps State and Territorial Head Start Oral Health Forums State and Territorial Head Start Oral Health Forums WA OR CA NV UT MT ND WY MN IA MO OK AZ NM AR LA SC PA IL IN KY WI CT RI HI Forum Funded (Cycles 1-6) No Forum Planned Region IX American Samoa Federated States of Micronesia, Pohnpei and Kosrae Republic of Palau Republic of Marshall Islands TX AK WA SD ID ND CO NE KS TN NC MS AL GA* FL VA WV MI OH ME VT NH MA NY NJ MD PA PR II VI X VIII V I II III VII VI IX IV DC DEL *Not Funded by ASTDD Commonwealth of the Northern Mariana Islands Federated States of Micronesia, Yap and Chuuk Guam December 2004 www.theodora.maps.com State and Territorial Head Start State and Territorial Head Start Oral Health Forums Oral Health Forums Supported by Association of State and Territorial Supported by Association of State and Territorial Dental Directors ( ASTDD) through the Inter Dental Directors ( ASTDD) through the Inter- Agency Agreement Agency Agreement 48 48 Initial Forums Funded Initial Forums Funded 17 17 Follow Follow-up Activities Funded up Activities Funded Lead Organizations: State Oral Health Programs, Lead Organizations: State Oral Health Programs, State Head Start Collaboration Offices, State State Head Start Collaboration Offices, State Head Start Associations, State Dental Association Head Start Associations, State Dental Association Several Dental Schools and Dental Hygiene Several Dental Schools and Dental Hygiene Programs participated in the Forums Programs participated in the Forums State Head Start Forums State Head Start Forums Goals 1) 1) Develop strategy plans through assessment Develop strategy plans through assessment of state issues, gaps, practices and of state issues, gaps, practices and problems problems 2) 2) Identify strategies and key roles of state Identify strategies and key roles of state agencies and others for future action agencies and others for future action 3) 3) Develop an Oral Health State Action Plan Develop an Oral Health State Action Plan to address issues on: to address issues on: ACCESS ACCESS PREVENTION PREVENTION EDUCATION EDUCATION State Head Start Forums State Head Start Forums Issues and Strategies Issues and Strategies Best practices Best practices Education of families, HS teachers/staff, Education of families, HS teachers/staff, dental and other health professionals dental and other health professionals Workforce development Workforce development Data and surveillance Data and surveillance Insurance and access (Medicaid/SCHIP) Insurance and access (Medicaid/SCHIP) Coordination, collaboration, and leadership Coordination, collaboration, and leadership Funding issues Funding issues Innovative Oral Health Innovative Oral Health and Head Start Programs and Head Start Programs Developed in Communities Developed in Communities Collaborative Resources/Partnerships Reported at Forums Collaborative Resources/Partnerships Reported at Forums Migrant and Community Health Centers Migrant and Community Health Centers Local Health Departments Local Health Departments Health and Hospital Systems Health and Hospital Systems Community Foundations Community Foundations Community Organizations Community Organizations Charitable and Civic Organizations Charitable and Civic Organizations Dental Schools and Dental Hygiene Programs Dental Schools and Dental Hygiene Programs Dental and Dental Hygienists Dental and Dental Hygienists Associations Associations Federal and State Government Federal and State Government Donations Donations Corporations (e.g., Colgate) Corporations (e.g., Colgate) Multiple Funding Sources Multiple Funding Sources Public grants (federal, state, local city/county Public grants (federal, state, local city/county government) government) Private grants Private grants Reimbursement / payment for dental care Reimbursement / payment for dental care (state, federal, local reimbursement, private (state, federal, local reimbursement, private insurance, sliding fee scale adjusted by ability insurance, sliding fee scale adjusted by ability to pay, personal to pay, personal out out-of pocket of pocket payment) payment) Volunteer providers Volunteer providers Dental & Dental Hygiene Programs Dental & Dental Hygiene Programs community community- based service learning based service learning Donations Donations equipment & supplies equipment & supplies Thank You! Thank You! Comments and Questions: Comments and Questions: Harry Goodman, DMD, MPH Harry Goodman, DMD, MPH Program of Pediatric Dentistry Program of Pediatric Dentistry University of Maryland Dental School University of Maryland Dental School Baltimore, MD 21201 Baltimore, MD 21201 (410) 706 (410) 706-7970 7970 hsg001@dental.umaryland.edu hsg001@dental.umaryland.edu hgoodman@acf.hhs.gov hgoodman@acf.hhs.gov DELAWARE HEALTH AND SOCIAL SERVICES DIVISION OF PUBLIC HEALTH DELAWARE HEAD START FORUM JUNE 3, 2005 SETTING THE STAGE FOR HEAD START ACTION PLANNING Delaware Oral Health Summit Division of Public Health December 8, 2004 Take the FIRST Partnerships Action Education Leadership for Oral Health in Delaware SURGEON GENERALS REPORT: ORAL HEALTH IN AMERICA THEMES: ORAL HEALTH IS MORE THAN HEALTHY TEETH ESSENTIAL TO GENERAL HEALTH A NATIONAL CALL TO ACTION TO PROMOTE ORAL HEALTH GOALS PROMOTE ORAL HEALTH IMPROVE QUALITY OF LIFE ELIMINATE DISPARITIES IN ORAL HEALTH A NATIONAL CALL TO ACTION TO PROMOTE ORAL HEALTH ACTIONS CHANGE PERCEPTIONS OF ORAL HEALTH OVERCOME BARRIERS USING EFFECTIVE AND PROVEN EFFORTS BUILD THE SCIENCE BASE AND ACCELERATE SCIENCE TRANSFER INCREASE ORAL HEALTH WORKFORCE DIVERSITY, CAPACITY, AND FLEXIBILITY INCREASE COLLABORATIONS DELAWARE ORAL HEALTH SUMMIT GOALS Increase Awareness and Support for Oral Health Initiatives Create Framework for Oral Health State Plan Stimulate Partnerships and Integrated Actions Action Plan for Implementing Critical Oral Health Strategies to Improve the Oral Health of Head Start Children in Delaware Access to Care Improve Access to Dental Care for Head Start Children, especially in Kent and Sussex Counties Develop financing opportunities for under-insured, un- insured, low income, and undocumented Head Start children and families Prevention Prevention of decay for Head Start children and families who live in non-fluoridated communities Infuse dental education and prevention strategies in Head Start Programming for Children and Families Provider Education Strategies Improve the comfort level of general dentists in serving Head Start children Enhance the role of the Medical Community for Obstetricians Hospitals Pediatricians Family Practitioners In Oral Health Education Prevention Treatment and Referral Elements of Action Plan Identification and Description of Activity Responsible Organization/ Individual - Federal/ State -Community -Head Start Program Prioritization Process Three Concurrent Sessions- One Hour Each Everyone rotates through each session Facilitator Subject Matter Expert Summary of Action Plans NEXT STEPS Oral Health Plan Recommendations Oral Health Advocacy- Coalition WE NEED YOU!!! Volunteers Gregory B. McClure, DMD, MPH, MHA Dental Director greg.mcclure@state.de.us 302-741-2960