District of Columbia Head Start Oral Health Project

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District of Columbia Head Start Oral Health
Project

• Emanuel Finn, DDS, MS
• Chief, Oral Health Division
• DC Department of Health
• Rachel Augustin, MPH

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DC DOH Oral Health Division

• MISSION
•  
• To promote and improve the oral health of all
  District of Columbia residents in the context of
  total health, through the development of public
  policy and collaborations with entities which
  help to assure adequate access to oral health
  care, and through the development and
  implementation of early detection, disease
  prevention and treatment programs targeting high
  risk populations.

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Head Start Oral Health Project Purpose

• To reduce early childhood caries, and improve
  oral health, general health and confidence, of
  the District of Columbias Early Head Start and
  Head Start children by increasing access to care.

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Background - Impact on Children

• Poor food (nutrition) choices
• Chewing problems
• School absences
• Approximately 52 million hours per year
• Uninsured are
• 2.5 times less likely to receive dental care than
  insured
• 3 times as likely to have dental needs than
  insured
• Children from low-income households are 3-5 times
  more likely to have untreated decay
• This is even higher for racial/ethnic minorities
  (NHANES III)
• From Jim Crall, DDS, ScD Director, MCHB
  National Oral Health Policy Center, UCLA School
  of Dentistry

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Background Impact on Children

• Access to dental services for children covered by
  Medicaid has been a chronic problem (OIG, 1996
  GAO, 2000)
• Medicaid program data show that only 1 in 5
  eligible Medicaid children received preventive
  services in 1993
• Slight decrease from the 22 in 1992
• Were now at about 1 in 4
• 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)
• DHHS OIG Report on Childrens Dental Services
  under Medicaid Access and Utilization.
  OEI-09-93-00240, April, 1996.

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Background Impact on Children

• ¾ of the States provided preventive dental
  services lt 30 of eligible children
• No State provided preventives services to more
  than 50 of eligible children

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Results of a MD State-wide Survey of Head Start
Children

• 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

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Transdisciplinary Health Care

• Holistic approach to patient assessment
  treatment
• Cross disciplinary and education helps breakdown
  barriers between professionals
• Begin to address oral health disparities in DC
  and country
• PCPs will incorporate anticipatory guidance in
  their practice

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Oral Health Screening for Non-Dental Health Care
Providers

• How to evaluate the oral health of an infant
• Position the child in the caregivers lap facing
  the caregiver
• Sit with your knees touching the knees of the
  caregiver
• Lower the childs head onto your lap
• The childs mouth will most times open
  automatically

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Dental/Oral Health Screening for Non-Dental
Providers

• What To Look For
• Oral hygiene status - presence of
• plaque, and oral development
• Presence of dental caries, abscess
• Presence of tooth defects,
• other oral pathologies
•  

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Child Health Certificates Oral Health
Assessment Forms

• The outcome
• A standardized enrollment process for entry into
  all DC Public Schools, Head Start, Childcare,
  camp, after school and sports/athletic programs
• Convenient for parents and providers
• Improved collection of data to better assist DOH
  in developing and improving the healthcare
  delivery system in the DC

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CHC/OHA Dissemination Flow
PROGRAMS
PROVIDERS
PARENTS
Schools Public Private Charter Day Care, Head
Start Camps, After School Athletics
SCHOOL ADMIN School Nurse Program Parents
DCPS
DOH
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Early Head Start/ Head Start Program
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DC Head Start Programs

• 4,000 children
• Approx. 117 Head Start Sites
• 96.89 with health insurance
• Medicaid 72.37
• SCHIP 7.44
• Private 13.08
• No Health Insurance 3.11

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DC Head Start Children with Health Needs

• Total Children Enrolled 2,510

Data based on May 10, 2004 Federal Program
Information Report
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Head Start - Oral Health Services

• Head Start program specialists, directors,
  staff, and parents report that the number one
  issue affecting Head Start programs nationwide is
  access to oral health services
• Early childhood caries affects 11 of Head Start
  Children
• Most severe cases may sometimes cost more than
  3,000 per child to treat

,
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EHS/HS Oral Health Program Goals

• Educate and change the Head Start (HS) and Early
  Head Start (EHS) communitys perceptions
• Assist in developing an effective oral health
  infrastructure at DC DOH
• Remove barriers between young children and oral
  health services
• Complete a District-wide oral health needs
  assessment for HS/EHS

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Head Start Needs Assessment Study Goal

• Identify the dental problems
• Treatment for EHS/HS children in DC
• Improve parents knowledge of oral health problems
• Look at dental workforce issues
• Medicaid reimbursement
• Dental access provider issues

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Head Start Needs Assessment Study Design

• Dental Assessments
• District of Columbia Oral Health Form
• Association of Clinicians for Underserved
  training for Health Services Staff and Family
  Services staff for EHS screening
• Dental Exams for HS children without Dental homes
• Work with dentists who provided examinations as
  an advisory team to develop policy
  recommendations to the DC Department of Health
  DC Oral Health Coalition
• Facility Questionnaire
• Telephone survey conducted by Rachel Augustin
• Findings lt5 of Medicaid Dentists serve children
  under age 5

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Partners/Cultural Competency Collaborative
Relationships

• DC Department of Health
• Association for the Clinicians for the
  Underserved (ACU)
• Howard University College of Dentistry

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Fun Times
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Winter on the Potomac
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END
Thank-You!