Oral Health Collaboration in Humboldt Co. Perspectives from a rural county

1. Oral HealthCollaborationin Humboldt Co.Perspectives from a rural county Laura McEwen, MS, RD

2. Agenda • Story of oral health in a Public Health model • Guidelines for State and Territorial Oral Health Programs by ASTDD, 2005 • Assessment • Policy Development – Develop a plan • Assurance – Do what you planned • Foundation of Collaboration

3. Size of Rhode Island Population: 128,000 Humboldt County - Lost Coast

4. Rural and Isolated 45% of the county population live away from main services in small, unincorporated communities of 3,000 or less Six hours by car to San Francisco, Sacramento or Portland High Poverty Rates Overall 18%, but 24% of children 0-17 years old live in poverty High Drug, Alcohol, & Tobacco Use County has high methamphetamine use and manufacturing, highest binge drinking rate in the state, and ranks among the worst in the state for drug-related deaths

5. Non-profits make up 12% of economy - 5th largest employer • Eureka and Arcata voted best small towns in America for artists • Beautiful environment

6. Learning from the Community1999-2000 • Local foundation receives small two-year grant to address children’s health issues • Anemia and dental disease • Public Health and Foundation as partner • Caesar Chavez Community Service Award • Dental disease in children and youth • California Conservation Corps as partner

7. Bringing the Partners Together2000 • Early Idealism • Roundtable included Head Start, Public Health, Private Practice Dentists, Dental Clinics, School Nurses, retired doctors and local Foundations • We think we have a children’s dental crisis • Didn’t have a clue as to what everyone did • It was always someone else’s problem

8. AssessmentData as Catalyst for Change2000-2001 • Start simple • One pediatric practice did oral health screenings on all children for one month • about 1500 children screened • 11% overall had at least one untreated carie • 4% of private insurance • 20% of those on Medi-Cal or CHDP

9. AssessmentData as Catalyst for Change2000-2001 • Dental van did oral health assessments on all 57 children in a low-income rural isolated community • 91% needed further treatment • 85% have untreated caries • Average of 5 teeth affected per child

10. AssessmentData as Catalyst for Change2000-2001 • Oral Health in America – A Report of the Surgeon General • Oral health is essential to overall health • Put the mouth back in the body

11. Policy DevelopmentDeveloping a plan • Local Foundation said, “We will fund a facilitator for the dental partners to develop a a strategic plan”. • Creation of Task Force • Ten members – broad based • Foundation involvement implied future funding based on strategic plan

12. Policy DevelopmentDeveloping a plan • Very contentious • Dentists, Public Health, Non-profits, and Foundations had never worked together • Broke into two ideological groups • Pay private practice DDS to treat Medi-Cal children • Build the infrastructure of preventive services

13. Framework for Action rather than strategic plan Mosaic approach where everyone can move ahead Non-linear Target children age 0-12 years old Framework for Action Sustainability/Partnership Treatment/Access Recruitment/Retention Prevention Case Management Monitoring Advocacy Policy DevelopmentDeveloping a plan

14. Policy DevelopmentDeveloping a plan Humboldt County Children’s Oral Health Report included the Needs Assessment and Framework for Action Produced in July 2001 Printed as full report and as executive summary Glossy print job

15. Assurance Phase I 2001 • Raising awareness about the children’s dental crisis • Newspapers • Radio • Television • Community Groups • First 5 Humboldt • Foundations, Non-profits

16. AssurancePhase II2002-2005 • Circle of Smiles Partnership – 2002 - 2005 • Access to Care • New 11-operatory dental clinic, expanded mobile dental services, coordinator for hospital-based services • Preventive Education • CCC mimicked CDDPP for 2 years, Quack & Wabbit Puppeteers, Mobile dental van from Santa Clara • Collaboration • Oral Health Coordinator at Public Health, annual sealant clinics, develop the Dental Advisory Committee

17. AssurancePhase II2002-2005 • The California Endowment awarded the Circle of Smiles Partnership almost $1 million over three years in August 2002

18. AssurancePhase II2002-2005 • Great successes with COS • CCC joined CDDPP – 5,000 children • Sealant Clinic – 250 children annually at no cost using volunteer dental professionals • Dental Advisory Group became a very engaged well-networked collaborative • In the final analysis this was the legacy of COS

19. AssurancePhase II2002-2005 • Extensive collaboration led to halo activities • AAP Oral Health Preceptorship Award • Grants for Saturday dental clinics for Head Start and Foster Care children • Red Carded program provides case management for the ADA Class III & IV children identified in sealant clinic screening • WIC is strong partner in oral health education • Small grant to Paso a Paso to provide longer credit terms to undocumented families who want care at private practice dentists

20. AssurancePhase II2002-2005 Other Halo Activities • Dental Angel Fund • Another hospital-based dental program • CCC TOOTH gets large AmeriCorps grant with 14 more FTEs • First Smiles Training for medical and dental professionals

21. AssurancePhase II2002-2005 Sealants & Smiles at College of the Redwoods President of CR HBMWD Fluoridation GM CDDPP at Elementary Schools Superintendent of Instruction Eureka Rotary supports Sealants & Smiles

22. AssurancePhase III2005-2010 • In 2005 a move was started to remove the fluoride from Arcata’s water • It has been fluoridated for over 40 years • Very coordinated response from medical, dental, and health advocates • Election in Nov ‘06

23. AssurancePhase III2005-2010 • What next? • Early Smiles, Forever Smiles (Pending 2007-2010) • Establish the Well Child Dental Visit for children 0-5 years old on Medi-Cal at medical and dental clinics • Expand the CCC TOOTH program to address targeted needs • Establish a promatora program to address oral health and diabetes awareness with Latino families • Continue case management of Red Carded program • Sociospatial evaluation

24. AssurancePhase III2005-2010 Well Child Dental Visit • Based on the six-steps from the First Smiles Dental Initiative • Anticipatory guidance, knee-to-knee position, toothbrush prophy, oral health assessment, fluoride varnish, and counseling • Goal: 70% of all children 0-5 years old on Medi-Cal have three WCDV per year by 2010 • Sociospatial evaluation of Head Start dental data over time

25. CCC TOOTH Expansion Fluoride Special Education Classes Parent outreach Two outlying high-need communities Service Project to develop a corps of volunteers AssurancePhase III2005-2010

26. AssurancePhase III2005-2010 Promatora Program Identify and train Latina women of the community to use the natural social networks to raise awareness about oral health and diabetes

27. AssurancePhase III2005-2010 Red Carded Program • About 9% of all children screened for sealants are ADA Class III or IV • Data of 3,000 screened • About 70 students/year • Provide intensive case management for families • St Joseph Family Resource Centers

28. Sociospatial Evaluation Incorporates environmental and social factors GIS Maps Percent 0-5 year olds living in poverty by geographic indicator Our Evaluation Head Start dental severity data mapped by a sensitive geographic indicator over time Location and number of WCDV AssurancePhase III2005-2010

29. In Summary • Creative solutions based on a strong foundation of collaboration using a classic public health model Lmcewen@co.humboldt.ca.us 707-476-4980