Oral Health Collaboration in Humboldt Co. Perspectives from a rural county

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Oral HealthCollaboration in Humboldt
Co.Perspectives from a rural county

• Laura McEwen, MS, RD

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Agenda

• Story of oral health in a Public Health model
• Guidelines for State and Territorial Oral Health
  Programs by ASTDD, 2005
• Assessment
• Policy Development Develop a plan
• Assurance Do what you planned
• Foundation of Collaboration

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Size of Rhode Island Population 128,000
Humboldt County - Lost Coast
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• Rural and Isolated
• 45 of the county population live away from
  main services in small, unincorporated
  communities of 3,000 or less
• Six hours by car to San Francisco, Sacramento or
  Portland
• High Poverty Rates
• Overall 18, but 24 of children 0-17 years
  old live in poverty
• High Drug, Alcohol, Tobacco Use
• County has high methamphetamine use and
  manufacturing, highest binge drinking rate in the
  state, and ranks among the worst in the state
  for drug-related deaths

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• Non-profits make up 12 of economy - 5th largest
  employer
• Eureka and Arcata voted best small towns in
  America for artists
• Beautiful environment

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Learning from the Community1999-2000

• Local foundation receives small two-year grant to
  address childrens health issues
• Anemia and dental disease
• Public Health and Foundation as partner
• Caesar Chavez Community Service Award
• Dental disease in children and youth
• California Conservation Corps as partner

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Bringing the Partners Together2000

• Early Idealism
• Roundtable included Head Start, Public Health,
  Private Practice Dentists, Dental Clinics, School
  Nurses, retired doctors and local Foundations
• We think we have a childrens dental crisis
• Didnt have a clue as to what everyone did
• It was always someone elses problem

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AssessmentData as Catalyst for Change2000-2001

• Start simple
• One pediatric practice did oral health screenings
  on all children for one month
• about 1500 children screened
• 11 overall had at least one untreated carie
• 4 of private insurance
• 20 of those on Medi-Cal or CHDP

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AssessmentData as Catalyst for Change2000-2001

• Dental van did oral health assessments on all 57
  children in a low-income rural isolated community
• 91 needed further treatment
• 85 have untreated caries
• Average of 5 teeth affected per child

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AssessmentData as Catalyst for Change2000-2001

• Oral Health in America A Report of the Surgeon
  General
• Oral health is essential to overall health
• Put the mouth back in the body

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Policy DevelopmentDeveloping a plan

• Local Foundation said, We will fund a
  facilitator for the dental partners to develop a
  a strategic plan.
• Creation of Task Force
• Ten members broad based
• Foundation involvement implied future funding
  based on strategic plan

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Policy DevelopmentDeveloping a plan

• Very contentious
• Dentists, Public Health, Non-profits, and
  Foundations had never worked together
• Broke into two ideological groups
• Pay private practice DDS to treat Medi-Cal
  children
• Build the infrastructure of preventive services

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Policy DevelopmentDeveloping a plan

• Framework for Action rather than strategic plan
• Mosaic approach where everyone can move ahead
• Non-linear
• Target children age 0-12 years old

• Framework for Action
• Sustainability/Partnership
• Treatment/Access
• Recruitment/Retention
• Prevention
• Case Management
• Monitoring
• Advocacy

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Policy DevelopmentDeveloping a plan
Humboldt County Childrens Oral Health Report
included the Needs Assessment and Framework for
Action Produced in July 2001 Printed as full
report and as executive summary Glossy print job
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Assurance Phase I 2001
Raising awareness about the childrens dental
crisis Newspapers Radio Television Community
Groups First 5 Humboldt Foundations, Non-profits
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AssurancePhase II2002-2005

• Circle of Smiles Partnership 2002 - 2005
• Access to Care
• New 11-operatory dental clinic, expanded mobile
  dental services, coordinator for hospital-based
  services
• Preventive Education
• CCC mimicked CDDPP for 2 years, Quack Wabbit
  Puppeteers, Mobile dental van from Santa Clara
• Collaboration
• Oral Health Coordinator at Public Health, annual
  sealant clinics, develop the Dental Advisory
  Committee

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AssurancePhase II2002-2005

• The California Endowment awarded the Circle of
  Smiles Partnership almost 1 million over three
  years in August 2002

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AssurancePhase II2002-2005

• Great successes with COS
• CCC joined CDDPP 5,000 children
• Sealant Clinic 250 children annually at no cost
  using volunteer dental professionals
• Dental Advisory Group became a very engaged
  well-networked collaborative
• In the final analysis this was the legacy of COS

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AssurancePhase II2002-2005

• Extensive collaboration led to halo activities
• AAP Oral Health Preceptorship Award
• Grants for Saturday dental clinics for Head Start
  and Foster Care children
• Red Carded program provides case management for
  the ADA Class III IV children identified in
  sealant clinic screening
• WIC is strong partner in oral health education
• Small grant to Paso a Paso to provide longer
  credit terms to undocumented families who want
  care at private practice dentists

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AssurancePhase II2002-2005

• Other Halo Activities
• Dental Angel Fund
• Another hospital-based dental program
• CCC TOOTH gets large AmeriCorps grant with 14
  more FTEs
• First Smiles Training for medical and dental
  professionals

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AssurancePhase II2002-2005
Sealants Smiles at College of the
Redwoods President of CR
HBMWD Fluoridation GM
CDDPP at Elementary Schools Superintendent of
Instruction

Eureka Rotary supports Sealants Smiles
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AssurancePhase III2005-2010

• In 2005 a move was started to remove the fluoride
  from Arcatas water
• It has been fluoridated for over 40 years
• Very coordinated response from medical, dental,
  and health advocates
• Election in Nov 06

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AssurancePhase III2005-2010

• What next?
• Early Smiles, Forever Smiles (Pending 2007-2010)
• Establish the Well Child Dental Visit for
  children 0-5 years old on Medi-Cal at medical and
  dental clinics
• Expand the CCC TOOTH program to address targeted
  needs
• Establish a promatora program to address oral
  health and diabetes awareness with Latino
  families
• Continue case management of Red Carded program
• Sociospatial evaluation

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AssurancePhase III2005-2010

• Well Child Dental Visit
• Based on the six-steps from the First Smiles
  Dental Initiative
• Anticipatory guidance, knee-to-knee position,
  toothbrush prophy, oral health assessment,
  fluoride varnish, and counseling
• Goal 70 of all children 0-5 years old on
  Medi-Cal have three WCDV per year by 2010
• Sociospatial evaluation of Head Start dental data
  over time

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AssurancePhase III2005-2010

• CCC TOOTH Expansion
• Fluoride
• Special Education Classes
• Parent outreach
• Two outlying high-need communities
• Service Project to develop a corps of volunteers

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AssurancePhase III2005-2010

• Promatora Program
• Identify and train Latina women of the
  community to use the natural social networks to
  raise awareness about oral health and diabetes

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AssurancePhase III2005-2010

• Red Carded Program
• About 9 of all children screened for sealants
  are ADA Class III or IV
• Data of 3,000 screened
• About 70 students/year
• Provide intensive case management for families
• St Joseph Family Resource Centers

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AssurancePhase III2005-2010

• Sociospatial Evaluation
• Incorporates environmental and social factors
• GIS Maps
• Percent 0-5 year olds living in poverty by
  geographic indicator

• Our Evaluation
• Head Start dental severity data mapped by a
  sensitive geographic indicator over time
• Location and number of WCDV

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In Summary

• Creative solutions based on a strong foundation
  of collaboration using a classic public health
  model

Lmcewen_at_co.humboldt.ca.us 707-476-4980