Oral HealthCollaboration

in Humboldt Co.Perspectives from a rural county

Laura McEwen, MS, RD

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

Humboldt County - Lost Coast

Size of Rhode Island

Population: 128,000

Rural and Isolated 45% of the county population live away from main

services in small, unincorporated communities of 3,000 or lessSix 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 UseCounty 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

Non-profits make up 12% of economy - 5th largest employer

Eureka and Arcata voted best small towns in America for artists

Beautiful environment

Learning from the Community

1999-2000

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

Bringing the Partners Together

2000 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

AssessmentData as Catalyst for Change

2000-2001

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

AssessmentData as Catalyst for Change

2000-2001

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

AssessmentData as Catalyst for Change

2000-2001

Oral Health in America – A Report of the Surgeon General

Oral health is essential to overall health

Put the mouth back in the body

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

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

Policy DevelopmentDeveloping a plan

1. Framework for Action rather than strategic plan

2. Mosaic approach where everyone can move ahead

3. Non-linear4. Target children age

0-12 years old

Framework for Action2. Sustainability/Partnership3. Treatment/Access4. Recruitment/Retention5. Prevention6. Case Management7. Monitoring8. Advocacy

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

AssurancePhase I

2001Raising awareness about the children’s dental crisis

Newspapers

Radio

Television

Community Groups

First 5 Humboldt

Foundations, Non-profits

AssurancePhase II

2002-2005

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

AssurancePhase II

2002-2005

The California Endowment awarded the Circle of Smiles Partnership almost $1 million over three years in August 2002

AssurancePhase II

2002-2005

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

AssurancePhase II

2002-2005

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

AssurancePhase II

2002-2005

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

AssurancePhase II

2002-2005

Sealants & Smiles at College of the

Redwoods

President of CR

CDDPP at Elementary Schools

Superintendent of Instruction Eureka Rotary

supports Sealants &

Smiles

HBMWD Fluoridation

GM

AssurancePhase III

2005-2010

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

AssurancePhase III

2005-2010

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

AssurancePhase III

2005-2010

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

AssurancePhase III

2005-2010

CCC TOOTH Expansion Fluoride Special Education Classes Parent outreach Two outlying high-need

communities Service Project to develop

a corps of volunteers

AssurancePhase III

2005-2010

Promatora Program Identify and train

Latina women of the community to use the natural social networks to raise awareness about oral health and diabetes

AssurancePhase III

2005-2010Red 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

AssurancePhase III

2005-2010

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

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