Title: An Interdisciplinary Approach to Oral Health Promotion: AR 60063 and the Community Health Promotion
1An Interdisciplinary Approach to Oral Health
Promotion AR 600-63 and the Community Health
Promotion Council
- LTC Georgia dela Cruz, DMD, MPH
2Purpose
- 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.
3Outline
- 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
4Army 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.
5Scope
- 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
6Chapter 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
7Army 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.
8Health Promotion Concepts
- Four major factors that affect health
- Behavior/lifestyle
- Environmental factors (social, physical, and
economic) - Human biology
- Medical Services Health Care system
9Figure 11. Health-related factors
- Health promotion programs must consider a broad
range of health-related factors and should
address the following functional areas
10Army 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.
11Figure 12. CRM Process
- Command supervision and enforcement of
interventions is critical. - Reassessment enables determination of success or
adjustments as needed.
12Army 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.
13Responsibilities
- 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
14DCS, 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).
15USACHPPM 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.
16Chapter 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.
17CHPC 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,
18CHPC 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
19CHPC 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
20CHPC 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.)
21Functional Areas
- Health education/health promotion process
- Behavioral health interventions
- Physical programs
- Spiritual programs
- Environmental social programs
22Chapter 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
23Chapter 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
24Tobacco 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.
25Chapter 5
- Physical Health
- General
- Fitness and Health Program
- Injury prevention
- Ergonomics
- Oral health
- Nutrition
- Weight management
26Injury 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.)
27Oral 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.
28Oral Health
- Dental Readiness Program
- Clinical Oral Health and Dental Health Promotion
Program - Community Oral Health Promotion and Disease
Prevention Program
29Dental 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
30Clinical 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
31Community 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
32Oral 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
33Nutrition
- WHY
- Resources
- Opportunities
- CHPC role
34Nutrition 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
35Nutrition 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
36Community 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
37Weight Management
- Is weight a health risk?
- compromised performance and readiness
- decreasing injuries
- health benefits
- Underweight/ Overweight
- Strategies and Resources
- CHPC Role
38Both Sides Matter
- Underweight
- Disease Process
- Anorexia/ Bulimia
- Overweight and Obesity
- Risks of Overweight and Obesity
- Improved Readiness
39Chapter 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
40Chapter 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
41Environmental 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
42Environmental Health Programs
- Pro-active public health policies
- Reduce risk from environmental exposures and
encourage healthy lifestyles.
43Environmental 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
44Environmental 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
45Collaboration/Community Partnerships
- Enhance
- Knowledge
- Experience
- Resources
- Minimize duplication of efforts
- Healthy People 2010
46Collaboration/Community Partnerships
- Improve not only health but other areas as well
- Empower individuals
- Tailor approaches
- Multidisciplinary approach
47Collaboration/Community Partnerships
- Characteristics for Success
- Being informed
- Flexibility
- Negotiation
48Example of an Integrated Approach to a Community
Health Problem
49Early 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.
50Phase 1
Phase 4 Phase 3
Phase 2 Phase 1
Administrative
Educational Epidemiological
Social policy
assessment ecological
assessment assessment
and Intervention
assessment
alignment
51Phase 2
Phase 4 Phase 3
Phase 2 Phase 1
Administrative
Educational Epidemiological
Social policy
assessment ecological
assessment assessment
and Intervention
assessment
alignment
52Phase 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
53Phase 3
Phase 4 Phase 3
Phase 2 Phase 1
Administrative
Educational Epidemiological
Social policy
assessment ecological
assessment assessment
and Intervention
assessment
alignment
54Phase 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
55Phase 4
Phase 4 Phase 3
Phase 2 Phase 1
Administrative
Educational Epidemiological
Social policy
assessment ecological
assessment assessment
and Intervention
assessment
alignment
56Phase 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
57Range 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
58Phase 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
59Phase 4 Intervention Alignment
- Increase access to dental care
Providers (Pediatrician, Family Practice, NP, PA)
Dental Officer
Unit
RAP
TDP
SWS
Civilian dental treatment
60Phase 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)
61Phase 4 Intervention Alignment
Dental Officer
FRGs
DPW
ACS WIC/NPSP
Commissary/AAFES
Providers (Pediatrician, Family Practice, NP, PA)
Acid-resistant teeth
62Phase 4 Intervention Alignment
- What interventions are needed most?
- Health Education
- Policy development
- Which ones can the community support?
63Collaboration/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
64Summary 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.
65Summary 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
66Summary Review
- Army Health Promotion
- Health education/ health promotion process
- Behavioral health
- Physical programs
- Spiritual programs
- Environmental/ social programs
Well Being
Health
67 68Materials Developed by
- LTC Georgia dela Cruz, DMD, MPH
- LTC Wayne Combs, AN, PhD
- LTC Teresa I. Hall, AN, MS, RNC
- MAJ Nancy Saddler, AN,