Early Head Start Oral Health Initiative

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Early Head StartOral Health Initiative

Partnership Members NC Head Start Association,
East Coast Migrant Head Start, NC Division of
Child Development, NC Division of Medical
Assistance, NC Pediatric Society, NC Academy of
Family Physicians, NC Oral Health Section, UNC
Schools of Dentistry and Public Health
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How this all started!

• Smart Start staff in western counties worried
  about early childhood caries
• Smart Smiles - ARC Fluoride Varnish Program in
  western counties
• IMB Program Medicaid children statewide
• Early Head Start Oral Health Initiative

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Goal and Activities of the EHS Oral Health
Initiative

• Goal
• Improve the oral health of preschool-aged
  children in North Carolina reduce ECC
• Activities
• Assess needs of EHS staff and parents
• Design educational intervention for staff
• Train EHS staff
• Link EHS to trained community providers
• a work in progress

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Objectives of the EHS Initiative

• Evaluate knowledge, confidence, risk assessment
  and counseling behaviors related to oral health
  of EHS staff
• Evaluate knowledge of parents of EHS children
  regarding oral health practices
• Design a comprehensive educational intervention
  for EHS staff to include oral health knowledge
  and skills for counseling parents
• Link EHS centers and families to medical
  providers trained through IMB

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Phases of EHS Initiative

• Planning and design (spring 2004)
• Meetings with NCHS and OHS
• Review of literature and training modules
• Needs assessment (fall 2004-fall 2006)
• Focus groups
• Staff survey
• Telephone interviews (Health Coordinator and
  Program Directors)
• Parent survey
• Training and development (fall 2005-spring 2006)
• Health Coordinator training
• Curriculum development
• Implementation (fall 2006-spring 2007)
• Pilot training curriculum (Guilford EHS)
• Development of Spanish language materials (ECMHS)

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Overall Goal of Needs Assessment

• To gather information about the Early Head Start
  programs through focus groups, staff surveys,
  health coordinator interviews, and parent surveys
  in order to develop an oral health education
  curriculum for young children and their families.

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Data Collection Activities

• EHS Focus Groups
• EHS and Migrant Staff Survey
• Telephone interviews with EHS health coordinators
  and migrant center directors
• Health Coordinator Training and Feedback
• EHS Parent Survey
• Migrant Focus Group
• Migrant Parent Survey

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Survey Comparison
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Focus Group Themes

• Opinions and values placed on oral health of
  young children and pregnant women
• Current practices in EHS related to the oral
  health of children
• Beliefs about recommended dental practices
• Suggestions for potential training activities

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Focus Group Results Parents

• Believe caring for childrens teeth is important
• Express frustration in caring for childrens
  teeth
• Not sure why baby teeth are important
• Satisfied with the care their children receive at
  EHS centers
• Dont want to be made to feel guilty when their
  child has dental problems
• Lack understanding of the importance of dental
  care during pregnancy
• Migrants expressed little knowledge or experience
  with dental care

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Focus Group Results Staff

• Good general knowledge of oral health lack
  specifics related to young children
• Have seen first hand the effects of poor dental
  care in the children
• Express frustration in their ability to
  communicate with parents at times
• Want to be trained to better educate parents and
  care for children in their centers
• Lack understanding of importance of dental care
  during pregnancy

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Program Characteristics Reportedby Health
Coordinators

• 86 need educational materials in languages other
  than English
• Spanish, Cherokee, Arabic
• 72 responsible for developing educational
  materials for teachers and families
• 89 of programs serve pregnant women (migrant
  centers all serve pregnant women but not through
  a formal EHS type program)

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Where Children are Screened
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Who does the Screening?
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Dental Screening Activities

• On average during the last year
• (0-2 yr olds)
• 91 of children received a dental screening
• Ranged from 0-100
• 85 are screened within 90 days
• 19 of those screened needed treatment
• 56 of those needing treatment got it

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Gaps in EHS Dental Programs

• Screening not available for all home-based
  children and center-based infants
• Screening services not consistent year to year,
  often dependent upon provider willingness
• Some counties have no dentists so must cross
  county lines for services
• Many dentists will not see children under 3 yrs
  of age, or wont see Medicaid children
• Follow-up by EHS not always possible

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Strengths of EHS Dental Programs

• All local resources sought out and utilized, and
  providers often are willing to provide
  reduced-fee services
• 2 programs varnish childrens teeth
• Dental screenings often provided at medical
  offices
• EHS practices support good dental health
• Most health coordinators aware of IMB

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Staff Survey Themes
Interest Areas
Activities

• Knowledge
• Opinions
• Confidence
• Activities Outcomes
• Practices
• Barriers

• Classroom
• Family
• Dental care

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Teachers Dental Knowledge
Answering Correctly
Causes of Dental Disease
Fluoride
Poor are at HR for caries
Caries is infectious
Fluoride mouth rinse use
Fluoride toothpaste use
Fluoride tablet use
Fluoride varnish
CSHCN are at HR for caries
Gum ds. causes poor birth outcomes
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EHS Staff Awareness of IMB Services in Medical
Offices
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Teachers Expectations
Agree
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Parental Counseling by Teachers
Percent Frequently (3 items)
Mean34
18 EHS Programs
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Low Value on Domain High Variation among
Programs

• Knowledge of fluoride
• Practices
• Parent counseling
• Determining if child dental needs met
• Expected outcomes
• Parent counseling
• Barriers
• Lack of dentists
• Parent interest in child oral health

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Teachers Reported Obstacles
Agree
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Summary of Staff SurveysImplications for Staff
Education

• Place high value on classroom activities, parent
  counseling, and dental care
• Will be receptive to training programs
• Knowledge of recent advances in causes of disease
  is uniformly low and needs to be updated
• Knowledge of fluoride varies by program

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Summary of Staff SurveysImplications for Staff
Education

• Confident in ability to implement classroom
  activities and believe these prevent decay
• Need evidence-based guidelines
• Are less confident in ability to counsel parents,
  and have low expectations that these activities
  will have the intended outcome
• Requires skill and confidence building

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Parent Survey Themes

• Parent child perceived oral health
• Knowledge of
• Fluoride other preventive methods
• Pregnancy and oral health
• Importance of childs dental health
• Oral health practices of child, family pregnant
  women
• Dental use, including dental home
• Readiness to change
• Role of EHS in dental health
• Training suggestions for parents

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Value Placed on Baby Teeth

• A cavity in a baby tooth should be filled only
  when it hurts?
• Disagree 63.2
• Agree 12.1
• Dont know 24.7

Value teeth
36.8 Uncertain of value of teeth
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Value Placed on Prevention

• I like the idea of a health worker putting
  medicine on my babys teeth to prevent them from
  getting cavities.

• Agree 82
• Disagree 7
• Dont know 11

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Stages of Change
46
14
40
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Language A Major Challenge

• 18 Latino/Hispanic
• 86 read and speak Spanish only or Spanish more
  than English
• 90 speak only or mostly Spanish at home
• 16 completed Spanish questionnaire

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Summary of Parent SurveysImplications for
Parent Education

• Intervention should accommodate
• Low value on dental health
• Stages of change
• Language barrier

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Conclusions Of Needs Assessment

• Most parents and EHS staff believe dental care is
  important but lack specifics on why
• Spanish language education materials greatly
  needed
• Staff need information about IMB
• Parents and staff frustrated about how to
  communicate with each other
• Training should focus on updating dental
  knowledge and practices, but primarily on
  improving communication skills

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What did we learn?

• Dental health
• Current knowledge/science Everything about
  dental care
• Transfer classroom teaching home
• Classrooms
• Dental health materials activities
• How to make good dental health fun
• Tooth decay
• Warning signs/Prevention
• Health issues involved

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And more

• Toothbrushing
• How, when, what to use
• Healthy eating
• Dental nutrition
• Healthy classroom snacks
• Fluoride
• Why important/advantages/disadvantages
• Different types

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And more

• Dental care
• Age first checkup
• Preparing for dental visit Reducing fear
• How to find a dentist for the children
• Injury
• Emergency care
• Pregnancy
• Dental care during pregnancy
• Health of mom/health of baby

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EHS Oral Health Curriculum Development

• Research latest science
• Select relevant factual information
• Develop Curriculum
• Brief easy to read
• Flexible for program needs/staff use
• Develop classroom and home activities
• Brief easy to read
• Easy to do
• Fit into current activities
• Develop parent information
• Brief understandable
• Match classroom information
• Easy to duplicate Inexpensive

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Curriculum Modules

• Baby or Primary Teeth
• Tooth Decay
• Pregnancy
• Cleaning Childrens Teeth
• Healthy Foods
• Dental Visits
• Fluoride
• Oral Injury

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Each Module Contains

• Oral Health Facts (myths)
• Classroom activities
• Tested, practical
• Parent Information
• Topic handouts
• Parent brochures (home fun activities)
• Keys to Early Dental Health