Transcript Prevention & DPH Infrastructure: A State Oral Health

Prevention & Dental Public Health
(DPH) Infrastructure:
A State Oral Health Program Perspective
DON MARIANOS, DDS, MPH
ORAL HEALTH 2014
INITIATIVE WEBINAR
MAY 11, 2012
Webinar Agenda
 Prevention
 Prevention and DPH Infrastructure Linkage
 ASTDD – Infrastructure Enhancement Project 2012
 Discussion – Oral Health 2014 Initiative Challenges
 Key Messages Summary
Dental Disease Prevention
ACCESS = SUPPLY – DEMAND
DECREASED COSTS
OPTIMAL ORAL HEALTH
The Community Focus
 Define the Community of Interest
 Know the Community
 Engage the Community
 Define the Problem(s) to be Addressed
 Evaluate the Impact of Programs on the Community
Evidence Based Prevention Strategies
 Community Water Fluoridation
 School Based/Linked Sealant Programs
 Fluoride Varnish Programs
 Fluoridated Toothpaste
 Health Education Programs
 Oral Health Literacy
 Behavior Change
 Others. . .
Prevention Strategies
Having defined the community of interest; collected
and analyzed relevant data; engaged the community;
defined the problem to be addressed; selected the
prevention strategies to be implemented or
enhanced, then
what?
The Prevention & Infrastructure
Linkage
INFRASTRUCTURE
THE BASIC PHYSICAL AND
ORGANIZATIONAL STRUCTURE AND
SUPPORT NEEDED FOR THE
OPERATION OF A SOCIETY,
CORPORATION OR COLLECTION OF
PEOPLE WITH COMMON INTERESTS.
The Prevention & Infrastructure
Linkage
INFRASTRUCTURE FACILITATES THE
PRODUCTION OF SERVICES & PROVIDES
RESOURCES REQUIRED TO PERFORM A
FUNCTION.
INFRASTRUCTURE IS REQUIRED TO PROVIDE
THE ORGANIZATIONAL STRUCTURE AND
SUPPORT FOR THE OPERATION OF
PREVENTION PROGRAMS.
DPH Infrastructure
 Complex
 Dynamic
 Variable
 Fragile
 Coordinated
DPH Infrastructure Components
 Public (Governmental, Safety Net Clinics, etc.)
 Private (Individual practices, Local dental societies)
 Federal
 State
 Local
 Medical and other Health/Wellness
 Philanthropic
 Advocacy Organization
 Others (Religious, Educators, Civic Groups, etc.)
DPH Infrastructure
DPH Infrastructure Goals
 Identify partners that can contribute some unique
and vital aspect to assist in attaining optimal oral
health for all.
 To facilitate enhancing the connections between
these partners to each other and to the overarching
mission and vision.
 Continual coordination, nurturing and evaluating of
the infrastructure.
Association of State and Territorial Dental
Directors (ASTDD) Infrastructure
Enhancement Project (IEP) 2012
OBJECTIVE:
TO LOOK AT STATE ORAL HEALTH
PROGRAM (SOHP) INFRASTRUCTURE
FROM 2000 TO 2010 AND THE
CAPACITY OF THOSE PROGRAMS TO
ADDRESS CORE PUBLIC HEALTH
FUNCTIONS AND DELIVER THE 10
ESSENTIAL PUBLIC HEALTH
SERVICES.
FUNDED BY THE CDC
ASTDD – IEP 2012 Goals
 Review a decade of infrastructure and capacity
building efforts
 Provide new information and recommendations to
help state agencies and policymakers, funders,
advocates and others better understand how to build
and sustain SOHP infrastructure
 How to effectively use this infrastructure to leverage
additional resources to improve oral health
ASTDD – IEP 2012
Methods:
Review of articles in scientific literature, governmental
publication and reports and data from the the
ASTDD State Synopses from 2000 - 2010 as well as
numerous surveys. Conducted targeted interviews
with key informants. Analyzed quantitative and
qualitative information to identify key elements
contributing to successful programs.
ASTDD – IEP 2012
Summary Findings:
 Has been significant investment of resources during
the decade
 Prior to 2000 very limited Oral Health (OH) data by
the end of 2011 – 44 states had submitted data to the
National OH Surveillance System
 In 1999 only 16 states had OH improvement plans,
by 2009 30 states had plans and 10 were in process
 States with full-time SOHP Directors increased from:
61% in 2000 to 80% in 2010
ASTDD – IEP 2012
Summary Findings (continued):
 The percentage of states with 2 or fewer FTE staff
decreased from 41% in 2000 to 12% in 2010
 The percentage of states with 5 - 20 OH staff
increased from 20% in 2000 to 41% in 2010
 In 2000 ~ 193,000 children received dental sealants
through 25 state programs while in 2011 40 states
had programs serving almost 400,000 children
 States are now focusing on prevention strategies for
women, young children and the elderly
ASTDD – IEP 2012
Conclusions:
 SOHP’s have significantly improved OH surveillance
capacity
 Many SOHP’s have enhanced their infrastructure
and capacity to perform essential public health
functions
 Not all states have seen improvements and much
remains to be done
ASTDD –IEP 2012
SOHP’s require strong leadership, adequate resources,
internal and external support, diverse and
formalized partnerships, sound plans, policies, and
evaluation to support their programs.
SOHP’s must be resilient to withstand economic
instability and meet current and future needs.
No one model meets the needs of all SOHP’s.
SOHP Infrastructure Elements
 Resources: Funding, Technical Assistance, Program




Authority
Leadership/Staffing, Partnerships, Collaborations,
Coalitions, Champions and Advocates
Surveillance Capacity
State Planning and Evaluation Capacity
Policy Work, Evidence-Based Prevention and
Promotion Programs
Goal – Improved Oral Health Outcomes
ASTDD Resources
www.astdd.org for the complete report and
additional information of State Oral Health
Programs.
 Guidelines
 Competencies
 Best Practices
 Policy Statements
 Basic Screening Survey
 National Oral Health Surveillance System
Oral Health 2014 Initiative
What are some unique Prevention and Dental
Public Health Infrastructure challenges
facing the Oral Health 2014 initiative?
Key Messages
 No one group or organization is capable of assuring
optimal oral health for all
 Importance of defining and knowing your
community, their needs and desires, and the barriers
to improved oral health and prevention
 Develop individualized prevention programs
appropriate to the needs and desires of the
community
Key Messages
 To develop and maintain a strong vibrant prevention
program it is critical to have a robust DPH
infrastructure in place that is resilient and flexible
 Nurture, refine, evaluate and coordinate the DPH
infrastructure and the prevention programs
developed
 Develop OH improvement plans and strong
leadership/staff
Key Messages
 Community-based oral disease prevention programs,
access to comprehensive and coordinated oral health
services and financing systems that create affordable
oral health care and sustainable oral health
programs are crucial to ensuring oral health and
overall health.
 Good infrastructure requires high levels of
investment, expertise and political will.