HEAD START HAWAII ORAL HEALTH STRATEGIC PLAN JANUARY 2003 Head Start State Collaboration Project Head Start Association of Hawaii Department of Health WIC Services Branch Department of Human Services 99 Mahalani Street 1700 Lanakila Ave., #203 235 S. Beretania St., #701 Benefit, Employment, & Support Services Div. Wailuku, Hawaii 96793 Honolulu, Hawaii 96817 Honolulu, Hawaii 96813 Haseko Center, 820 Mililani St., #606 Lyn McNeff, President Dental Health Division: Linda Chock, Chief Honolulu, Hawaii 96813-2936 Dr. Mark H.K. Greer, D.M.D. M.P.H., Chief Jacqueline Rose, Director Dental Hygiene Branch: Susan L. Tengan, Chief
Transcript
HEAD START HAWAII ORAL HEALTH STRATEGIC PLAN
JANUARY 2003
Head Start State Collaboration Project Head Start Association of Hawaii Department of Health WIC Services Branch Department of Human Services 99 Mahalani Street 1700 Lanakila Ave., #203 235 S. Beretania St., #701 Benefit, Employment, & Support Services Div. Wailuku, Hawaii 96793 Honolulu, Hawaii 96817 Honolulu, Hawaii 96813 Haseko Center, 820 Mililani St., #606 Lyn McNeff, President Dental Health Division: Linda Chock, Chief Honolulu, Hawaii 96813-2936 Dr. Mark H.K. Greer, D.M.D. M.P.H., Chief Jacqueline Rose, Director Dental Hygiene Branch:
ISLAND: OAHU MAUI MOLOKAI LANAI HILO KONA KAUAI ALL ISLANDS I. INCREASE ACCESS TO URBAN & RURAL PROVIDERS THROUGH SYSTEM, PROFESSION, AND HEAD START PROGRAM
CHANGES Objective:
A. Improve Medicaid System Accountability Schedule Resources Feedback System
Strategy & Action Steps Primary Others Start Complete Money Time Other Measure Frequency Mechanism1. Increase medicaid reimbursement
to dental providers
• Discuss with Department of Human Services (DHS) to determine action steps
• Report to Head Start Task Force
2. Simplify claims process for Dentists
• Discuss with DHS to determine action steps
3. Improve Medicaid verification process
4. Implement pregnancy related only dental coverage
• Provide information to Med-Quest regarding oral conditions could negatively affect the pregnancy outcome.
NOTE: Rural only strategies are identified as (R) 5
ISLAND: OAHU MAUI MOLOKAI LANAI HILO KONA KAUAI ALL ISLANDS I. INCREASE ACCESS TO URBAN & RURAL PROVIDERS THROUGH SYSTEM, PROFESSION, AND HEAD START PROGRAM
CHANGES Objective continued: A. Improve Medicaid System Accountability Schedule Resources Feedback System
Strategy & Action Steps Primary Others Start Complete Money Time Other Measure Frequency Mechanism5. Legislation to restore adult dental benefits
6. Develop an Early Periodic Screening Diagnosis Treatment (EPSDT) Memorandum of Understanding (MOU) between DHS and Head Start*
7. Train Head Start staff to become Med-Quest Outreach workers to expedite application process (R)
8. Quest intake workers assist Head Start (HS) families to fill out applications at Head Start sites (R)
NOTE: Rural only strategies are identified as (R) *See addendum F for EPSDT Periodic Screening Guidelines
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ISLAND: OAHU MAUI MOLOKAI LANAI HILO KONA KAUAI ALL ISLANDS I. INCREASE ACCESS TO URBAN & RURAL PROVIDERS THROUGH SYSTEM, PROFESSION, AND HEAD START PROGRAM
CHANGES Objective: B. Develop partnerships with providers to meet the needs of Head Start Children & Families Accountability Schedule Resources Feedback System
Strategy & Action Steps Primary Others Start Complete Money Time Other Measure Frequency Mechanism1. Mobilize committed dentists to
mentor/motivate/influence/educate other dentists to participate in treating special at risk populations including our children with special needs and children 0-6 (R)
• Statewide by county publicized campaign (R)
• Collect Head Start oral health data to substantiate needs to share with community, state & federal policy makers (R)
• Additional training for dentists to treat young children 0-6 and children with special needs (R)
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ISLAND: OAHU MAUI MOLOKAI LANAI HILO KONA KAUAI ALL ISLANDS I. INCREASE ACCESS TO URBAN & RURAL DENTAL PROVIDERS THROUGH SYSTEM, PROFESSION, AND HEAD START PROGRAM
CHANGES Objective continued: B. Develop partnerships with providers to meet the needs of Head Start Children & Families Accountability Schedule Resources Feedback System
Strategy & Action Steps Primary Others Start Complete Money Time Other Measure Frequency Mechanism2. Reduce barriers to provider
participation
• Develop methods/procedures to reduce missed appointments
• Approach other dentists to encourage their peers to provide services to children
Chairside manners (standards of behavior/rural dentistry) (R)
3. Develop plans for clinic days that are devoted to prevention, young children, pregnant women
• Convene committee
• Develop the concept for clinic
days
• Present concept to dental
professionals
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ISLAND: OAHU MAUI MOLOKAI LANAI HILO KONA KAUAI ALL ISLANDS I. INCREASE ACCESS TO URBAN & RURAL DENTAL PROVIDERS THROUGH SYSTEM, PROFESSION, AND HEAD START PROGRAM
CHANGES Objective continued: B. Develop partnerships with providers to meet the needs of Head Start Children & Families Accountability Schedule Resources Feedback System
Strategy & Action Steps Primary Others Start Complete Money Time Other Measure Frequency Mechanism4. Improve relationship with
pediatricians to increase involvement for early identification of dental problems
• Training to identify dental disease
• Training to complete oral health portion of health form
• CEU for pediatrician on early intervention for oral health
5. Head Start programs to establish relationship with dental professionals (dentist or hygienist) to assist with identification of oral disease and referrals
• Licensed dental professional employed by Head Start programs (R)
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ISLAND: OAHU MAUI MOLOKAI LANAI HILO KONA KAUAI ALL ISLANDS I. INCREASE ACCESS TO URBAN & RURAL DENTAL PROVIDERS THROUGH SYSTEM, PROFESSION, AND HEAD START PROGRAM
CHANGES Objective continued: B. Develop partnerships with providers to meet the needs of Head Start Children & Families Accountability Schedule Resources Feedback System
Strategy & Action Steps Primary Others Start Complete Money Time Other Measure Frequency Mechanism6. Head Start programs establish &
promote Dental Home Concept
7. Volunteer service learning model for Hawaii Dental Association (HDA), Hawaii Dental Hygienists’ Association (HDHA), University of Hawaii School of Nursing and Dental Hygiene, University of Hawaii School of Medicine, city and counties)
• Convene stakeholders
• Develop a feasible plan
• Bring dentist to program with dental chair
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ISLAND: OAHU MAUI MOLOKAI LANAI HILO KONA KAUAI ALL ISLANDS I. INCREASE ACCESS TO URBAN & RURAL DENTAL PROVIDERS THROUGH SYSTEM, PROFESSION, AND HEAD START PROGRAM
CHANGES Objective continued: B. Develop partnerships with providers to meet the needs of Head Start Children & Families Accountability Schedule Resources Feedback System
Strategy & Action Steps Primary Others Start Complete Money Time Other Measure Frequency Mechanism8. Reduction of school debt incentive
to work with Medicaid patient (AMERICORPS) (R)
9. Work with HDA to see children 6 months – 5 years of age
10. Appeal to local dentists to assist children/family in their community (donate space & equipment if they don’t serve low-income) Molokai, Lanai, Hilo, Kona, Maui
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ISLAND: OAHU MAUI MOLOKAI LANAI HILO KONA KAUAI ALL ISLANDS I. INCREASE ACCESS TO URBAN & RURAL DENTAL PROVIDERS THROUGH SYSTEM, PROFESSION, AND HEAD START PROGRAM
CHANGES Objective: C. Provide services in various clinical settings (including West Oahu) Accountability Schedule Resources Feedback SystemStrategy & Action Steps Primary Others Start Complete Money Time Other Measure Frequency Mechanism1. Community clinics that include
dental care on every island (R)
• Legislation to fund dental clinics on every island
• Build a community clinic with dental services on West Oahu
2. Increase number of mobile dental
units “Tooth Mobile” (R)
• Hawaii (Big Island) Mobile van service – once a week per site
• Kauai Mobile van – once a week – primary clinic
• Maui Mobile van – partner with dental assistant school
3. One stop service center (medical,
dental, & mental) (R)
• Community needs assessment
• Apply for funding
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ISLAND: OAHU MAUI MOLOKAI LANAI HILO KONA KAUAI ALL ISLANDS I. INCREASE ACCESS TO URBAN & RURAL DENTAL PROVIDERS THROUGH SYSTEM, PROFESSION, AND HEAD START PROGRAM
CHANGES Objective: D. Head Start Association to define policy on State Legislative Issues Accountability Schedule Resources Feedback SystemStrategy & Action Steps Primary Others Start Complete Money Time Other Measure Frequency Mechanism1. Develop legislative Task Force
Committee.
• Dental Hygienist Practice Act
• Dental licensure issues
• Restore adult dental benefits
• Fluoridation
• Economic incentive for providing services in high need areas and to children (R)
• Pre-kindergarten dental clearance
• Funding for additional dental clinics (R)
• Funding for one-step service centers (medical, dental, mental) (R)
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ISLAND: OAHU MAUI MOLOKAI LANAI HILO KONA KAUAI ALL ISLANDS II. INCREASE ACCESS TO RECOURCES AND INFORMATION FOR USERS URBAN & RURAL Objective: A. Identify & increase utilization of current resources Accountability Schedule Resources Feedback System
Strategy & Action Steps Primary Others Start Complete Money Time Other Measure Frequency Mechanism 1. Develop one stop shop concept
linking families to resources in community
2. Utilize Department of Human Service’s (DHS) process to help families access care at intake
3. Identify & assist families who under utilize their insurance coverage
4. Use Keiki play groups to education/dental screening (screening library/mini workshops) (R)
5. Assist families to be more effective participants in Medicaid (R)
• Medicaid dental card
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• Other processes
ISLAND: OAHU MAUI MOLOKAI LANAI HILO KONA KAUAI ALL ISLANDS II. INCREASE ACCESS TO RESOURCES AND INFORMATION FOR USERS URBAN & RURAL Objective:
B. Improve assurance of care within every Head Start Program
Accountability Schedule Resources Feedback SystemStrategy & Action Steps Primary Others Start Complete Money Time Other Measure Frequency Mechanism
1. Establish follow-up strategy for oral health tracking i.e. Activity/Service Delivery Tracking (ASDT)
2. Head Start Programs share strategies to meet federal mandates
3. Provide incentives to Head Start families to seek regular dental care
• Support legislation for dental clearance at kindergarten entry
4. Locate resources for gap groups (under-or-uninsured)
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ISLAND: OAHU MAUI MOLOKAI LANAI HILO KONA KAUAI ALL ISLANDS II. INCREASE ACCESS TO RESOURCES AND INFORMATION FOR USERS URBAN & RURAL Objective: C. Partner with agencies to develop new resources
Accountability Schedule Resources Feedback System
Strategy & Action Steps Primary Others Start Complete Money Time Other Measure Frequency Mechanism1. Train & develop protocol for
Women, Infants and Children (WIC) to provide pre-natal, post birth and ongoing assessment of good oral health
• Identify trainer/training
• Provide the training
• Add educational/assessment to
WIC protocol
• Add dental incentive program to assure success
• Explore dental hygienist as alternative to staff trainer
2. Train para-professionals & parents to provide oral screenings
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ISLAND: OAHU MAUI MOLOKAI LANAI HILO KONA KAUAI ALL ISLANDS II. INCREASE ACCESS TO RESOURCES/INFORMATION FOR USERS URBAN & RURAL Objective continued C. Partner with agencies to develop new resources Accountability Schedule Resources Feedback SystemStrategy & Action Steps Primary Others Start Complete Money Time Other Measure Frequency Mechanism3. Train medical students, interns, &
residents in oral health screening & referral techniques
4. Explore development of protocol in dental hygiene school to provide oral screenings
5. Develop county transportation plans to transport Head Start children/families to providers
6. Request National Health Service Corps (NHSC), a federal program to assign dentists to work in Hawaii’s underserved areas (R)
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ISLAND: OAHU MAUI MOLOKAI LANAI HILO KONA KAUAI ALL ISLANDS II. INCREASE ACCESS TO RESOURCES/INFORMATION FOR USERS URBAN & RURAL Objective continued: C. Partner with Agencies to develop new resources Accountability Schedule Resources Feedback System
Strategy & Action Steps Primary Others Start Complete Money Time Other Measure Frequency Mechanism7. Provide training & seminars to
increase & support partnerships statewide (R)
• Establish an Oral Health Task Force Committee
• Plan and convene a Statewide Head Start Oral Health Conference
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ISLAND: OAHU MAUI MOLOKAI LANAI HILO KONA KAUAI ALL ISLANDS III. ORAL HEALTH EDUCATION FOR HEAD START & COMMUNITY
Objective: A. Develop partnerships to increase educational opportunities
Accountability Schedule Resources Feedback System Strategy & Action Steps Primary Others Start Complete Money Time Other Measure Frequency Mechanism1. Med-Quest pays for dental
hygienists to teach dental care in schools/preschools/parent groups/service providers
• Approach Dental Hygiene Association regarding interest
• Solicit funding from Area Health Education Centers (AHEC) to cover transportation costs for outreach
• Suggest State Collaboration Project present Head Start need and dental plan to Med- Quest
2. Med-Quest to offer reward system to Head Start families for good dental practices and participation in educational activities
• Approach Med-Quest regarding value of prevention; present Head Start information & data to substantiate need for prevention education
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ISLAND: OAHU MAUI MOLOKAI LANAI HILO KONA KAUAI ALL ISLANDS III. ORAL HEALTH EDUCATION FOR HEAD START & COMMUNITY Objective continued: A. Develop partnerships to increase educational opportunities Accountability Schedule Resources Feedback System
Strategy & Action Steps Primary Others Start Complete Money Time Other Measure Frequency Mechanism2. continued
• Approach American Dental Association to collaborate with Med-Quest regarding the value of prevention and develop promotion/incentives for best preventive practices (ie. minimum standards of service)
• Approach corporate sponsors for incentive prizes
3. Media coverage/awareness
statewide
• Public Service Announcements (PSA’s) on baby bottle mouth & importance of good oral health
a. Collaborate with DOH, Community Health Division and the Living Healthy Hawaii Campaign
b. Na Leo and Limon Medeiros on West Hawaii help with campaign
c. Identify “champions” and assist their efforts
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ISLAND: OAHU MAUI MOLOKAI LANAI HILO KONA KAUAI ALL ISLANDS III. ORAL HEALTH EDUCATION FOR HEAD START & COMMUNITY Objective continued: A. Develop partnerships to increase educational opportunities Accountability Schedule Resources Feedback System
Strategy & Action Steps Primary Others Start Complete Money Time Other Measure Frequency Mechanism3. Media coverage/awareness
statewide continued
d. Submit articles to the newspapers
e. Olelo type community messages-public television
f. Radio Stations
g. Find local artists to do promotion for oral health
4. Hawaii Dental Association/Hawaii
Dental Hygienists’ Association
• Publish in their newsletter
• Create a linkage with Head Start
• Reach providers in their own professional meetings or gatherings
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ISLAND: OAHU MAUI MOLOKAI LANAI HILO KONA KAUAI ALL ISLANDS III. ORAL HEALTH EDUCATION FOR HEAD START & COMMUNITY Objective continued: A. Develop partnerships to increase educational opportunities Accountability Schedule Resources Feedback System
Strategy & Action Steps Primary Others Start Complete Money Time Other Measure Frequency Mechanism5. Utilize Head Start Association of
Hawaii (HSAH) for dissemination of information
6. Utilize Head Start State Collaboration Project for dissemination of information
7. Utilize Head Start Health Services Advisory Committees
• Encourage local dentists to participate on the Health Services Advisory Committee
• Send dental Head Start information to local dentists on a consistent basis to encourage their involvement
a. Identify funding sources
b. Develop mailing list
c. Design and determine content of materials
d. Consistent with mailing items
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ISLAND: OAHU MAUI MOLOKAI LANAI HILO KONA KAUAI ALL ISLANDS III. ORAL HEALTH EDUCATION FOR HEAD START & COMMUNITY Objective continued: A. Develop partnerships to increase educational opportunities Accountability Schedule Resources Feedback System
Strategy & Action Steps Primary Others Start Complete Money Time Other Measure Frequency Mechanism7. Utilize Head Start Health Services
Advisory Committees continued
e. Periodic acknowledgement of participating dentists using media
8. Quest Outreach
• Each Head Start to identify a contact person to attend quarterly Quest meetings and report Head Start concerns
• Educate parents on coverage for increased utilization
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ISLAND: OAHU MAUI MOLOKAI LANAI HILO KONA KAUAI ALL ISLANDS III. ORAL HEALTH EDUCATION FOR HEAD START & COMMUNITY Objective continued: A. Develop partnerships to increase educational opportunities Accountability Schedule Resources Feedback System
Strategy & Action Steps Primary Others Start Complete Money Time Other Measure Frequency Mechanism9. Educate dental professionals,
legislators and partners on oral health regarding:
• Family needs
• Dental home concept
• Oral health data
• Existing Head Start collaborations
• Integrated health (body, teeth, overall health)
10. Educate Medical Professionals
• Approach University of Hawaii School of Medicine (Dyson Project) regarding the development and inclusion of a dental component for medical interns ie: a practicum in schools including an outreach to neighbor islands
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ISLAND: OAHU MAUI MOLOKAI LANAI HILO KONA KAUAI ALL ISLANDS III. ORAL HEALTH EDUCATION FOR HEAD START & COMMUNITY Objective: B. Provide educational resources Accountability Schedule Resources Feedback SystemStrategy & Action Steps Primary Others Start Complete Money Time Other Measure Frequency Mechanism1. Research current oral health
curriculum for Early Head Start & Head Start
• Review by program criteria
• Select
• Purchase
• Distribute
2. Develop “family friendly” brochures on dental care
• Translate as needed
• Make available everywhere
3. Develop lending library of dental videos & other resources for families/staff to access
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ISLAND: OAHU MAUI MOLOKAI LANAI HILO KONA KAUAI ALL ISLANDS III. ORAL HEALTH EDUCATION FOR HEAD START & COMMUNITY Objective continued: B. Provide educational resources Accountability Schedule Resources Feedback SystemStrategy & Action Steps Primary Others Start Complete Money Time Other Measure Frequency Mechanism4. Replicate dental “Adopt-A-Center”
program in all Head Start programs
5. Participate in health fairs
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ISLAND: OAHU MAUI MOLOKAI LANAI HILO KONA KAUAI ALL ISLANDS III. ORAL HEALTH EDUCATION FOR HEAD START & COMMUNITY Objective: C. To increase Head Start parents knowledge of oral health & support their ability to pass it on to their children &
to each other Accountability Schedule Resources Feedback System
Strategy & Action Steps Primary Others Start Complete Money Time Other Measure Frequency Mechanism1. Parent education on oral health
basics
• Utilize current curriculum with parents
• Monthly parent group meeting & home visits
2. Parents teaching parents (talk story style)
• Identify and incorporate parent training programs to work with Head Start staff to educate Head Start parents (train the trainers)
• Establish a “buddy system” to provide support to the parent presenters when parents provide oral health education
• Establish a point system/reward for parent volunteers with recognition for their efforts (recognition ceremony)
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ISLAND: OAHU MAUI MOLOKAI LANAI HILO KONA KAUAI ALL ISLANDS III. ORAL HEALTH EDUCATION FOR HEAD START & COMMUNITY Objective continued: C. To support Head Start parents knowledge of oral health & support their ability to pass it on to their children &
community Accountability Schedule Resources Feedback System
Strategy & Action Steps Primary Others Start Complete Money Time Other Measure Frequency Mechanism3. Parent “”Champions” that are
willing to spread information
• Identify parents and growing parent champions and assist them to spread the information
• Head Start help nurture these parent champions
4. Provide incentive for parents
Make trainings “family friendly”
Complete oral health activities
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ISLAND: OAHU MAUI MOLOKAI LANAI HILO KONA KAUAI ALL ISLANDS IV. PREVENTION Objective:
A. Fluoride delivery Accountability Schedule Resources Feedback System
Strategy & Action Steps Primary Others Start Complete Money Time Other Measure Frequency Mechanism 1. Community water fluoridation
• Legislation
• Educate Head Start community to benefits
2. Bottled water with fluoride
3. Fluoride supplementation
4. Fluoride rinse
5. Fluoridated toothpaste
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ISLAND: OAHU MAUI MOLOKAI LANAI HILO KONA KAUAI ALL ISLANDS IV. PREVENTION Objective: B. Preventive strategies other than fluoride Accountability Schedule Resources Feedback System
Strategy & Action Steps Primary Others Start Complete Money Time Other Measure Frequency Mechanism 1. Sealants
2. Connect nutrition to oral health
• Work with school food service program to ensure healthy, nutritious meals
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ISLAND: OAHU MAUI MOLOKAI LANAI HILO KONA KAUAI ALL ISLANDS IV. PREVENTION Objective: D. Provide continuance of Head Start oral health standards into public schools/private school system* Accountability Schedule Resources Feedback System
Strategy & Action Steps Primary Others Start Complete Money Time Other Measure Frequency Mechanism 1. Support continuation of Head Start
oral health standards in on-going educational setting for all children
• Pre-entry kindergarten dental
exam
• Regular dental visits with documented completion
• In-school support for oral hygiene preventive practices during school hours
• Classroom education
*See Addendum E for Head Start Performance Standards Related to Oral Health
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ISLAND: OAHU MAUI MOLOKAI LANAI HILO KONA KAUAI ALL ISLANDS IV. PREVENTION Objective: C. Locate funding for oral health prevention Accountability Schedule Resources Feedback System
Strategy & Action Steps Primary Others Start Complete Money Time Other Measure Frequency Mechanism1. Redistribute dental division funding
among islands on a per capita basis
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ADDENDUM A
RESOURCES
• Working with State Dental Taskforce – remove old dental clinic. Statewide: • New dentist on island. • Collaboration DOH/HS/Tri-county Oral Health task force. • Community Heath Center/FQHC’s
Hawaii: • Native Hawaiian Healthcare Systems (Case Mgt). • 2 Mobile dental/caravans. • WOMEN, Infant and Children (WIC) • CHC’s – 3 sites : open in Kea’au next Honokaa • Toll free # for Medicaid/Quest for dental service and transportation. • Collaboration DOH/HS/Tri-county Oral Health task force. • Head Start Health Services Advisory Committees. • Hawaii Dental Association
Maui: • Hawaii Dental Hygienists’ Association • Head Start Association of Hawaii • CHC – CCM • Good Beginnings Alliance Coordinators • Hana • Good Beginnings Alliance Keiki Playgroups • Renovating clinic • O’lelo Public Television • Opening CHC on Molokai. • Catholic Charities • Ronald McDonald
Oahu: • Primary Care • Native Hawaiian Health System/Ho’ola • Waianae CHC • Hawaii Medical Service Association • Waimanalo CHC • Hawaii Dental Services • Kahuku Hospital/clinic • Hawaii State Oral Health Coalition • More dentists on Oahu than other islands • Boys and Girls Clubs of Hawaii (BGCH) • Dental Samaritans “Saving young smiles Day” • University school of Nursing and Dental Hygiene
• Hawaii Dental Education Center
Kauai: • Community Health Clinic (CHC) in Waimea.
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ADDENDUM B
HEAD START STATE ORAL HEALTH PLAN
BARRIERS
Governmental Policies:
• No community fluoridation support. • Medicaid reimbursement rate and paperwork/payment process, no show problem, co-payment, only allow 30 day prescriptions. • No kindergarten entry requirement for dental certificate.
Access Barriers:
• Limited services available on Molokai i.e. families have to travel to Maui/Oahu. • Families have to pay co-payment. • Separate provider for adult and child. • Lack of information about dental resources/services for families. • # Of Pediadontists in community clinics. • Providers in community lack training in child development. • Providers do not recognize Oral Health needs of 0-3 yr. Olds i.e. “wait till later”. (prevention versus examination/treatment). • Difficulty getting appointments in timely manner. • Lack of emergency care system. • No Hawaii dental school. • Lack of private & public providers/clinics. • Dentists are selective with clients (insurance, # of patients, etc.) • Providers unfamiliar with Head Start. • Lack of adult dental services. • Hygienists not allowed to go into schools.
Cultural barriers:
• Mothers chew food to give to babies – possible transmission of disease/bacteria. • Immigrant families unaccustomed to preventive care practices. “crisis” dental care (access services only for emergencies). • Late use of bottles even into 3rd – 5th year of life. • “Juice” is good – therefore juice in baby bottles vs. water or milk.
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• Ashamed to ask for help. • Fear of using state services. • Missing and/or decayed teeth are not a stigma. • Language ESL i.e. 27 languages and translated materials. Economics: • Affects accessibility/availability of dental care. • Lack of insurance or under insurance (e.g. only covers cleaning). • Priority of dental care vs. medical care, housing, food & clothing.
Location:
• No transportation to services and pharmacy. Education:
• Finding Dental professionals to conduct training at times workable for parents & Head Start staff. • Literacy-unable to read information • Do not understand oral disease is infectious and transmittable • Lack of parent education regarding usage of Med-Quest, dental office, manners, oral hygiene practice, and compliance with using fluoride tablets. • Past experience with dentists – painful, fearful memories • Lack of monitoring of EPSDT dental screenings (may be training issue). • Lack of education regarding general health and dental health (disconnect). • Lack of updated Head Start dental curriculum materials. • Adequate time to provide training for parents and staff. • Motivating parents to attend training. • Educate policy makers on oral health issues faced by Head Start families.
Other:
• Friction between primary care provider and dentist as to who’s role is what. • Lack of good nutrition with food service providers. • Lack of Dental provider’s representation on Head Start Association Hawaii Board.
