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
[email protected] 707-476-4980