Improving the Oral Health of School-Aged Children: Promising Approaches for Linking Them With Dental Homes Washington, DC May 11-12, 2006

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Improving the Oral Health of School-Aged
Children Promising Approaches for Linking Them
With Dental HomesWashington, DCMay 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

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HistoryPre 2004

• Pre 1982 - Inner-City
• School-linked/based hybrid clinics
• 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

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Sealant Program Results1984 - 2000

• 31-47 of participants needed treatment
• 78 of those received no care after one year

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Referral Failures

• Dental Assistant phone calls
• Lists to school nurses
• Letters to parents
• Intensive case management

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2004Give Kids A Smile Day

• Linked one school with one 6-chair CHD clinic and
  two mobile vans
• 40 dentist volunteers

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Give Kids A Smile Day Organization

• 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

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Subsequent Years

• 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.

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Numbers for 2005

• 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
• 2/3 Medicaid (140,000)
• Medicaid pays about ½ of fees (70,000)
• Thus, break even (only for costs shown)

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• Utilized current facility and staff
• -
• Doesnt increase community capacity, but may
  increase individual provider production

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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

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Lessons LearnedSchool-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

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Alternative Model Mobile Van

• 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

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2004

• Initiated Mobile Van Program
• Two chairs (1 Dentist, 2 Assistants, 1
  Driver/Receptionist/Manager)
• Dentrix, direct digital radiography

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Funders

• My godfather at the Ohio Department of Health
• Anthem Foundation of Ohio
• Mayerson Foundation
• United Way

Mark
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Capital Costs

• Van 315,000
• Dental Equipment 80,000
• Digital/Electronics 80,000
• TOTAL 475,000

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School-Based Clinic

• Construction
• 100/sq. ft. x 400 40,000
• Equipment 80,000
• Electronics?
• TOTAL 120,000

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Targeting

• Blanket school with consent forms
• Sealant kids
• Kids who come to school nurse
• Nurse screenings

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Van Operations2005

• 1,230 school children (users)
• 497 (40) diagnostic/preventive only
• 733 (60) diagnostic/preventive/treatment
• 713 Head Start children (users)
• 492 (69) diagnostic/preventive only
• 221 (31) diagnostic/preventive/treatment

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School Children

• Enrolled 3,060 (6 schools)
• Children participating 1,230 (40)
• Much higher participation in early grades
• Function of school principal and nurse

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Lessons Learned About Vans

• 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

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Lessons Learned About Vans

• Need sound plan for provision of care and
  generation of revenue on days schools arent
  available
• Need more vans
• 16/62 schools in 2.5 years with only 40
  participation