Transcript Improving the Oral Health of School

Improving the Oral Health of School-Aged
Children: Promising Approaches for Linking
Them With Dental Homes
Washington, DC
May 11-12, 2006
Cincinnati Health Department/
Greater Cincinnati Oral Health Council
School-Linked Clinic and Mobile Dental Van
Lawrence F. Hill, DDS, MPH
Cincinnati Health Department, Dental Director
Nancy L. Carter, RDH, MPH
Cincinnati Health Department, Assistant Dental Director
History
Pre 2004
Pre 1982 - Inner-City
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School-linked/based hybrid clinics
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Excellent in school-based
Not good in linked
11 clinics – all antiquated
Neighborhood health centers monopolized by adult
emergencies and adult care
1982 – All school clinics closed
Sealant Program Results
1984 - 2000
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31-47% of participants needed treatment
78% of those received no care after one year
Referral Failures
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Dental Assistant phone calls
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Lists to school nurses
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Letters to parents
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Intensive case management
2004
“Give Kids A Smile Day”
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Linked one school with one 6-chair CHD
clinic and two mobile vans
40 dentist volunteers
“Give Kids A Smile Day”
Organization
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Four Fridays in February
Consents to all kids
Screened all with consents
Organized by number of decayed teeth per
classroom
~ 300 kids and $80,000 gross
Subsequent Years
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Dental Society dropped out (now have their
own volunteer clinic)
We now move dentists and assistants from
other clinics to supplement the Crest Smile
Shoppe instead of volunteers
We have paid transportation
Coordinated effort of the project coordinator,
school-based health center, and the dental
clinic.
Numbers for 2005
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Number of days = 21 (5 hour days)
Number of users = 425; encounters = 578
Gross production = $216,118
Cost = $57,625 (salary + fringe + supplies +
transportation)
Assumption:
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2/3 Medicaid ($140,000)
Medicaid pays about ½ of fees ($70,000)
Thus, break even (only for costs shown)
+
Utilized current facility and staff
Doesn’t increase community capacity,
but may increase individual provider
production
Lessons Learned
School-Linked Program
Requires:
 Intense organization
 Reliable transportation
 Cooperation of school staff (health center
nurses) to coordinate consents/getting kids on
buses, etc.
 Resources of multiple providers at one place at
one time
Lessons Learned
School-Linked Program
Requires:
 Can be done with volunteers or paid staff
(volunteer staff takes additional planning and
coordination and is less reliable!)
 Can provide continuous care for children in
participating schools
 Impractical to do with a solo private practitioner
because of cost of coordinator and transportation
 Only works for schools that are in close
proximity to safety net clinic
Alternative Model: Mobile Van
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High level of frustration in community over
access to care for kids
Oral Health Regional Assessment and
Planning Project (RAPP) – community request
School nurses and Head Start staff asked for a
mobile van
2004
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Initiated Mobile Van Program
Two chairs (1 Dentist, 2 Assistants, 1
Driver/Receptionist/Manager)
Dentrix, direct digital radiography
Funders
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My godfather at the Ohio Department of
Health
Anthem Foundation of Ohio
Mayerson Foundation
United Way
Capital Costs
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Van
Dental Equipment
Digital/Electronics
$315,000
80,000
80,000
TOTAL
$475,000
School-Based Clinic
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Construction
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$ 40,000
$100/sq. ft. x 400
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Equipment
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Electronics?
$ 80,000
TOTAL
$120,000
Targeting
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Blanket school with consent forms
Sealant kids
Kids who come to school nurse
Nurse screenings
Van Operations
2005
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1,230 school children (users)
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497 (40%) – diagnostic/preventive only
733 (60%) – diagnostic/preventive/treatment
713 Head Start children (users)
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492 (69%) – diagnostic/preventive only
221 (31%) – diagnostic/preventive/treatment
School Children
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Enrolled: 3,060 (6 schools)
Children participating: 1,230 (40%)
Much higher participation in early grades
Function of school principal and nurse
Lessons Learned About Vans
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Needs one strong dental staff person to provide
liaison with schools
Need a cooperative, designated school person
to coordinate from inside (i.e. school nurse,
office personnel, etc.)
Need linkages to pediatric specialists and to a
private practice, safety net program, or dental
school to provide back-up when van is not
available
Lessons Learned About Vans
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Need sound plan for provision of care and
generation of revenue on days schools aren’t
available
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Need more vans
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16/62 schools in 2.5 years with only 40%
participation