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An Interdisciplinary Approach to Oral Health Promotion: AR 60063 and the Community Health Promotion

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Title: An Interdisciplinary Approach to Oral Health Promotion: AR 60063 and the Community Health Promotion


1
An Interdisciplinary Approach to Oral Health
Promotion AR 600-63 and the Community Health
Promotion Council
  • LTC Georgia dela Cruz, DMD, MPH

2
Purpose
  • Provide an overview of AR 600-63 Army Health
    Promotion Regulation and the Community Health
    Promotion Council (CHPC), discuss the value of
    collaborative partnerships in health promotion
    efforts, and provide examples of recruitment and
    integration of partners from various disciplines.

3
Outline
  • Introduction to AR 600-63
  • Objectives and scope of Army Health Promotion
    Programs
  • Responsibilities
  • Overview of Functional Areas
  • The Community Health Promotion Council-Implementat
    ion Guidance
  • Collaborative Partnerships
  • Multidisciplinary Recruitment
  • Summary and Review
  • Questions

4
Army Health Promotion ProgramGoal and Objectives
  • Goal maximize readiness, warfighting ability,
    and work performance.
  • Objectives
  • Enhancing the well-being of all Soldiers, Army
    civilians, Family members, and retirees
  • Encouraging lifestyles that improve and protect
    physical, behavioral, and spiritual health.

5
Scope
  • Facilitate behavioral and environmental
    alterations
  • Include directives from the Army Surgeon General,
    Healthy People 2010 objectives, to include
  • Physical and dental examinations
  • Self-reported health information
  • Physical fitness facilities
  • Recreation and leisure education
  • Activities and initiatives to promote social and
    emotional well-being

6
Chapter 1
  • Introduction to AR 600-63
  • Prescribes policy, responsibilities, and
    procedures for the Army Health Promotion Program
  • Defines Army Health Promotion
  • Outlines five functional areas for health
    promotion programs
  • Establishes policy for tobacco control for the
    Department of the Army

7
Army Health Promotion Definition
  • Any combination of health education and related
    organizational, political, and economic
    interventions designed to facilitate behavioral
    and environmental changes conducive to the health
    and well-being of the Army community. Health is
    the product of many personal, environmental, and
    behavioral factors.

8
Health Promotion Concepts
  • Four major factors that affect health
  • Behavior/lifestyle
  • Environmental factors (social, physical, and
    economic)
  • Human biology
  • Medical Services Health Care system

9
Figure 11. Health-related factors
  • Health promotion programs must consider a broad
    range of health-related factors and should
    address the following functional areas

10
Army Health Promotion
  • Similar to the composite risk management (CRM)
    process (FM 519)
  • Risk management definition - the process of
    identifying, assessing, and controlling risks
    arising from operational factors and making
    decisions that balance risk costs with mission
    benefits.

Identifying, assessing, and controlling health
risks arising from operational factors and making
decisions that balance health risk costs with
well-being.
11
Figure 12. CRM Process
  • Command supervision and enforcement of
    interventions is critical.
  • Reassessment enables determination of success or
    adjustments as needed.

12
Army Health Promotion
  • Is implemented and enhanced at the community
    level through a Community Health Promotion
    Council (CHPC), as provided for in the regulation
  • Involves
  • Identifying community health needs and setting
    priorities.
  • Developing and implementing health promotion
    programs to meet identified needs.
  • Evaluating the effectiveness of these programs.

13
Responsibilities
  • DCS G-1
  • DCS G-3
  • DCS G-4
  • TSG
  • CPA
  • CCH
  • JAG
  • COE
  • Chief NGB
  • USAR
  • CG - USACHPPM
  • CG CFSC
  • CG TRADOC
  • MACOM Commanders
  • Installation Commanders
  • MEDCEN/MEDDAC Commanders
  • Commanders at all levels

14
DCS, G-1 Responsibilities
  • Army Staff proponent for
  • Army Health Promotion Program policy and
    implementing Department of Defense Directive
    (DODD) 1010.10.
  • Army Substance Abuse Program (ASAP).
  • Tobacco Control Program.
  • Army Weight Control Program.
  • Suicide prevention, to include coordination and
    monitoring of the Army Suicide Prevention Program
    (ASPP).
  • Identification, surveillance, and administration
    of personnel infected with Human Immunodeficiency
    Virus (HIV).

15
USACHPPM Responsibilities
  • Recommend Army Health Promotion policy
    implementation and change.
  • Define the role and identify training
    requirements and training opportunities for
    Health Promotion Coordinators in support of
    CHPCs.
  • Develop and disseminate standardized,
    evidence-based programs and tools.
  • Serve as a consultant for the development of
    population-based comprehensive and integrated
    military health information systems.
  • Develop science-based metrics for program
    evaluation and health promotion outcomes.
  • Provide subject matter expert (SME) consultation,
    education, and training for Army Health Promotion
    programs and CHPCs.
  • Serve as an information source for current issues
    and best practices for health promotion
    initiatives.
  • Provide recommendations for population- and
    community-based research.

16
Chapter 2
  • Community Health Promotion Program
  • Implementation guidance
  • Effective, comprehensive and integrated program
    at the installation, community, and garrison
    leader levels is key
  • USACHPPM serves as health promotion advisor and
    consultant for Army Health Promotion Program
  • Community Health Promotion Council
  • Initiate preventive interventions that directly
    impact the total population
  • Assist, develop, and implement means to allow
    commanders to monitor program goals and
    objectives.
  • Ensure necessary health promotion knowledge,
    skills, and training will be available for the
    community.

17
CHPC Membership
  • Installation commander or community leader.
  • Health Promotion Coordinator.
  • Senior mission/garrison command sergeant major.
  • Director, Human Resources Directorate (Civilian
    Personnel Advisory Center, Military Personnel
    Services, Education, and Alcohol and Drug Control
    Officer).
  • Family Advocacy Program Manager (FAPM).
  • Commander, MTF.
  • Director of Logistics.
  • Director for Plans, Training, and Mobilization.
  • Commander, Dental Activity/Director of Dental
    Services.
  • Staff Chaplain.
  • Public Affairs Officer.
  • Major tenant commanders.
  • Consultants, as needed. For example, this
    category could include representatives from the
    installation safety, public affairs, and civilian
    personnel offices ASAP, medical/dental/
    veterinarian,

18
CHPC Administration
  • CHPC chairperson - commander, community leader,
    or designee from the command group
  • Community Health Promotion Coordinator - provides
    logistical and advisory support to the commander
    and the CHPC
  • CHPC will convene at least quarterly
  • CHPC members serve for a minimum of 1 year,
    subject to reappointment

19
CHPC Roles
  • Principal tasks
  • Assess community needs
  • Analyze the data
  • Inventory resources
  • Develop, implement, and evaluate a course of
    action to address identified community needs
  • Integrate all existing health promotion programs
    with other installation and community programs
  • Develop a comprehensive marketing plan based on
    existing resources and demographics
  • Report progress, challenges and successes to the
    Community Well-Being Council as defined by IMA

20
CHPC Roles
  • Integration of Collaborative partnerships among
    community agencies
  • Enhances knowledge, experience, resources
  • Minimizes duplication of efforts.
  • Include potential community partners, such as
    local and state health departments, school
    systems, and organizations (American Red Cross,
    American Heart Association, etc.)

21
Functional Areas
  • Health education/health promotion process
  • Behavioral health interventions
  • Physical programs
  • Spiritual programs
  • Environmental social programs

22
Chapter 3
  • Health Education/Health Promotion Process
  • A planned process that promotes, maintains, and
    improves individual, Family, and community health
    by raising awareness, enhancing knowledge, and
    inspiring readiness to change through healthy
    lifestyle choices.
  • Framework - assessment, planning, implementation,
    evaluation, and communication of health
    information needs and resources.
  • Resources

23
Chapter 4
  • Behavioral Health
  • General
  • Stress management
  • Combat and operational stress control
  • Suicide prevention and surveillance
  • Responsible sexual behavior
  • Army Substance Abuse Program
  • Tobacco Control Program

24
Tobacco Control Program
  • Tobacco use controlled during IET
  • Commanders supervisors encourage anti-tobacco
    activities by Family Members Retirees
  • Screen for tobacco use during all routine exams
    and refer for cessation assistance
  • Installations will provide tobacco cessation
    programs for all health care beneficiaries and as
    resources permit, for civilian employees.

25
Chapter 5
  • Physical Health
  • General
  • Fitness and Health Program
  • Injury prevention
  • Ergonomics
  • Oral health
  • Nutrition
  • Weight management

26
Injury Prevention
  • Unit Commanders will
  • Foster a culture of injury risk reduction
  • Coordinate with the medical/dental treatment
    facility commander to receive SME consultation
    regarding all unit staff functions related to
    injury prevention (such as dental readiness
    meetings and appropriate use of mouthguards.)

27
Oral Health
  • Includes all initiatives to
  • Increase the overall fitness and dental readiness
    of Soldiers,
  • Reduce the incidence of dental disease in the
    community
  • Identify community members in need of dental
    treatment
  • Direct members to sources of appropriate care.

28
Oral Health
  • Dental Readiness Program
  • Clinical Oral Health and Dental Health Promotion
    Program
  • Community Oral Health Promotion and Disease
    Prevention Program

29
Dental Readiness Program
  • Annual Examination required
  • Encourage Soldiers to maintain Dental Fitness
    Class 1 (Dental Wellness)
  • Minimum readiness standard Dental Fitness Class
    2
  • Dental Fitness Class 3 or 4 are non-deployable
  • Commanders will require and enforce mouthguard
    use during certain training or unit sports
    activities

30
Clinical Oral Health and Dental Health Promotion
Program
  • Screenings
  • Hypertension, oral disease risks, orofacial
    injury risk, family abuse
  • Dental Classification
  • Oral prophylaxis (dental cleaning)
  • Fluoride prescription
  • Counseling as appropriate
  • Hygiene, nutrition, tobacco
  • Mouthguard fabrication
  • Dietary counseling referral

31
Community Oral Health Promotion and Disease
Prevention Program
  • Fluoridation of community water supplies
  • Alternative fluoride administration
  • Community education programs
  • School-based programs
  • System for reporting child neglect or abuse

32
Oral Health
  • Proponent for oral health ensures community oral
    health promotion carried out
  • CDR or CHPC may designate PAT to review Oral
    Health Promotion activities
  • Ensure PAT membership is cross-sectional

33
Nutrition
  • WHY
  • Resources
  • Opportunities
  • CHPC role

34
Nutrition Resources
  • Collaborative Assets
  • The Army Registered Dietitian (65C)
  • The Army Nutrition Care Specialist (91M)
  • Army Regulations
  • AR 40-25
  • AR 30-1
  • AR 600-9

35
Nutrition Opportunities
  • Healthy Weight Management
  • Dietary Supplement Usage
  • http//usachppm.apgea.army.mil/dhpw/Wellness/dieta
    ry.aspx
  • Food Safety
  • Meal Planning
  • Special nutrition concerns
  • Elevated Blood Sugar
  • Cholesterol
  • Blood Pressure

36
Community Health Promotion Councils Role in
Nutrition
  • Use RD as valued consultant
  • Multidisciplinary Team Member
  • Nutrition Experts and Clinicians
  • Market Experts
  • Evidenced Based and Outcomes Oriented
  • Encourage use of distance learning opportunities
  • Ensure community educational programs are offered
  • Support nutrition related efforts of installation
    and MTF commander

37
Weight Management
  • Is weight a health risk?
  • compromised performance and readiness
  • decreasing injuries
  • health benefits
  • Underweight/ Overweight
  • Strategies and Resources
  • CHPC Role

38
Both Sides Matter
  • Underweight
  • Disease Process
  • Anorexia/ Bulimia
  • Overweight and Obesity
  • Risks of Overweight and Obesity
  • Improved Readiness

39
Chapter 6
  • Spiritual Fitness
  • General
  • Spiritual fitness

Strong Bonds Battlemind Training Spiritual
Health Assessment Instrument Blue Box (Initiative
at USAEUR) Suicide Prevention, Intervention, and
Postvention programs
40
Chapter 7
  • Environmental Health
  • General
  • Guidance for controlling tobacco use in DA
    controlled areas
  • Policy for controlling tobacco use
  • Signs for controlling tobacco use
  • Enforcement for controlling tobacco use

41
Environmental Health Programs
  • Goals
  • Create and maintain a supportive, safe, and
    healthy environment
  • Protect from biological, chemical and physical
    hazards
  • Secure from adverse effects of environmental
    threats

42
Environmental Health Programs
  • Pro-active public health policies
  • Reduce risk from environmental exposures and
    encourage healthy lifestyles.

43
Environmental Health Programs
  • Tobacco use is prohibited in all DA-occupied
    workplaces to include recreation facilities
    except for designated smoking areas as authorized
    by DODI 1010.15, Smoke-Free DoD recreation
    Facilities
  • Use of all Tobacco products is prohibited in all
    military vehicles and aircraft and all official
    vans and buses
  • Health care providers will not use any tobacco
    products in the presence of patients

44
Environmental Health Programs
  • Future trends in tobacco control
  • Tobacco use is a high visibility issue. Use is on
    the rise
  • TRADOC has lifted ban in AIT (increased
    opportunities for interventions)
  • Current research partnerships with Research
    Triangle Institute (RTI)
  • Social norming campaigns hold promise

45
Collaboration/Community Partnerships
  • Enhance
  • Knowledge
  • Experience
  • Resources
  • Minimize duplication of efforts
  • Healthy People 2010

46
Collaboration/Community Partnerships
  • Improve not only health but other areas as well
  • Empower individuals
  • Tailor approaches
  • Multidisciplinary approach

47
Collaboration/Community Partnerships
  • Characteristics for Success
  • Being informed
  • Flexibility
  • Negotiation

48
Example of an Integrated Approach to a Community
Health Problem
49
Early Childhood Caries
  • AER financial aid request
  • Pediatrician at MTF
  • About 1 out of 6 children under the age of 5 have
    untreated tooth decay
  • About twice a month she sees a child that has
    extensive decay
  • Many have had at least one visit to the emergency
    room.

50
Phase 1
Phase 4 Phase 3
Phase 2 Phase 1
Administrative
Educational Epidemiological
Social policy
assessment ecological
assessment assessment
and Intervention
assessment
alignment
51
Phase 2
Phase 4 Phase 3
Phase 2 Phase 1
Administrative
Educational Epidemiological
Social policy
assessment ecological
assessment assessment
and Intervention
assessment
alignment
52
Phase 2 Epidemiological Assessment
  • Genetics
  • Developmental defects of enamel
  • Poor quality saliva
  • Poor resistance
  • Early eruption
  • Environment
  • Water fluoridation
  • Access to dental care
  • Community awareness
  • Behavior
  • Sharing practices
  • Feeding practices
  • Snacking behavior
  • Oral habits

53
Phase 3
Phase 4 Phase 3
Phase 2 Phase 1
Administrative
Educational Epidemiological
Social policy
assessment ecological
assessment assessment
and Intervention
assessment
alignment
54
Phase 3
  • Predisposing Factors
  • Oral health knowledge
  • Perception of the value of oral health
  • Belief in the effectiveness of preventive
    practices
  • Family values
  • Enabling Factors
  • Fluoridated water
  • Availability of oral health care products
  • Relative cost
  • Oral hygiene Skills
  • Stress
  • Reinforcing Factors
  • Rewards feedback
  • Attitudes behaviors
  • Health care personnel
  • Peers
  • Parents

55
Phase 4
Phase 4 Phase 3
Phase 2 Phase 1
Administrative
Educational Epidemiological
Social policy
assessment ecological
assessment assessment
and Intervention
assessment
alignment
56
Phase 4 Health Education
  • Increase access to dental treatment
  • Reduce sugar exposure
  • Timing and frequency
  • Healthy snack choices
  • Decrease sugared beverage consumption
  • Decrease bacteria
  • Eliminate sharing practices
  • Correct oral hygiene aids
  • Xylitol gum
  • Increase fluoride intake
  • Toothpaste
  • Water
  • Supplements

57
Range of Disciplines
Pediatrician
Laboratory technician
DeCA Manager
Audiologist
Family Practice Physician
Optometrist
Army Community Service
TRICARE
Physicians Assistant
AAFES Manager
Child and Youth Services
Dental Clinic
Social Worker
Chaplain
Nurse Practitioner
Dietitian
Public Health Nurse
Psychologist
Preventive Medicine Physician
58
Phase 4 Policies and Regulations
Stakeholders/Contact Opportunities
  • TRICARE - bulletins
  • ACS
  • Women, Infants and Children Program (WIC)
  • New Parent Support Program (NPSP)
  • Family Advocacy Program
  • SITES
  • CYS CDC/FCC
  • AAFES community events
  • Commissary Healthy Choices
  • Unit Commanders-orientation
  • Family Readiness Groups (FRGs)-social events
  • OB/FP- Prenatal counseling
  • Peds-Well-child visits and immunizations
  • Dental Clinic annual exam
  • United Concordia TRICARE Dental Program (TDP)
  • Army Emergency Relief

59
Phase 4 Intervention Alignment
  • Increase access to dental care

Providers (Pediatrician, Family Practice, NP, PA)
Dental Officer
Unit
RAP
TDP
SWS
Civilian dental treatment
60
Phase 4 Intervention Alignment
  • Reduce sugar exposure
  • Decrease bacteria

Dental Officer
Dietician
CYS CDC/FCC
ACS WIC/NPSP
TRICARE
FRGs
Commissary/AAFES
Healthy snacks/drinks Regular Oral Hygiene
Providers (Pediatric and OB)
61
Phase 4 Intervention Alignment
  • Increase fluoride intake

Dental Officer
FRGs
DPW
ACS WIC/NPSP
Commissary/AAFES
Providers (Pediatrician, Family Practice, NP, PA)
Acid-resistant teeth
62
Phase 4 Intervention Alignment
  • What interventions are needed most?
  • Health Education
  • Policy development
  • Which ones can the community support?

63
Collaboration/Community Partnerships
  • Potential Partners
  • The US Army Center for Health Promotion and
    Preventive Medicine http//chppm-www.apgea.army.
    mil
  • The Centers for Disease Control (CDC) www.cdc.gov
    1-800-311-3435
  • The Department of Health and Human Services
    www.hhs.gov 1-877-696-6775
  • The Deployment Health Clinical Center
    www.deploymenthealth.mil 202-782-6563
  • The Navy Environmental Health Center
    www.nehc.med.navy.mil/hp 757-953-0700
  • The Air Force Institute of Operational Health
    (AFIOH) http//www.brooks.af.mil/afioh
    210-536-5454 DSN 240-5454 1888-232-ESOH (3764)
  • The National Institutes of Health
    http//www.nih.gov 301-496-4000

64
Summary Review
  • AR 600-63, Army Health Promotion, defines health
    promotion and prescribes policy,
    responsibilities, and procedures for Army health
    promotion programs.
  • Five functional areas are critical to ensure the
    success and effectiveness of health promotion
    programs health education/health promotion
    process, behavioral health interventions,
    physical, spiritual, and environmental and social
    programs
  • The CHPC serves as the framework and structure
    for assessing, developing, implementing, and
    evaluating community health promotion programs.

65
Summary Review
  • Identify a range of disciplines that may be able
    to influence the factors that are producing an
    oral health problem
  • Know how to identify the major stakeholders in a
    community, and existing partnerships/networks

66
Summary Review
  • Army Health Promotion
  • Health education/ health promotion process
  • Behavioral health
  • Physical programs
  • Spiritual programs
  • Environmental/ social programs

Well Being
Health
67
  • QUESTIONS???

68
Materials Developed by
  • LTC Georgia dela Cruz, DMD, MPH
  • LTC Wayne Combs, AN, PhD
  • LTC Teresa I. Hall, AN, MS, RNC
  • MAJ Nancy Saddler, AN,
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