HS-EHS Forum Final Report - ASTDD
FINAL REPORTHead StartEarly Head StartOral Health ForumReaching ConsensusStrategies for ImplementationPlan of ActionMondayJune 23, 2003Aqua TurfSouthington, ConnecticutReport prepared by theConnecticut AHEC Program
Head StartEarly Head StartOral Health ForumFINAL REPORTTable of ContentsPage1Table of Contents2Narrative Summary5Forum Brochure7Head Start in Connecticut (PowerPoint slides)10Issues and Activities Tables25Evaluation Results29Forum Participants1
As part of its ongoing efforts to improve access to quality dental care services for Connecticut’schildren, the Oral Health Unit at the Connecticut Department of Public Health (DPH) conducteda one-day forum on June 23, 2003, to develop strategies for improving the oral health of childrenenrolled in Head Start and Early Head Start. The Forum was co-sponsored by the ConnecticutHead Start State Collaboration Office. Its planning and implementation involved multiplestakeholder groups, and it was supported by a grant from the Association of State and TerritorialDental Directors.BackgroundA 2001 survey of Head Start managers in Connecticut documented widespread problems inobtaining follow-up care for children in need o dental treatment. The Department of PublicHealth had previously identified barriers facing Head Start children that include; A lack of dental providers, A lack of education for dental providers related to the treatment of young children fromdiverse populations, and Cultural and social issues in the client population that result in an undervaluing of dentalcare.The Oral Health Unit at the Department of Public Health has a long history of initiatingcommunity-based and statewide programs to promote oral health and improve access to dentalservices. Prominent examples are the Community Integrated Oral Health Service Systems(CISS) project and OPENWIDE (Oral Health Program to Engage Non-dental Health and HumanService Workers in Integrated Dental Education). Through these and other initiatives DPH hasdeveloped the requisite network of relationships to successfully plan and implement an oralheath forum specifically directed at the Head Start/Early Head Start population.In the fall of 2002, DPH submitted a grant proposal to the Association of State and TerritorialDental Directors for the purpose of conducting a one-day forum to develop a concrete actionplan for oral health promotion and disease prevention in early childhood. While the focus of theproposal was on Head Start and Early Head Start sites, it was anticipated that the resultant planwould benefit a much larger population of children in Connecticut. The proposal was widelysupported by the key stakeholder groups. On December 20, 2002, the Department of PublicHealth was informed by the ASTDD that the proposal would be funded.Forum PlanningForum planning meetings took place on February 3, 2003 and March 3, 2003. The initialmeeting included a broadly representative group of stakeholders including several Head Startsites, the Connecticut Head Start Statewide Collaborative, the Connecticut Health Foundation,the UConn School of Dental Medicine, the Tunxis Community College Dental HygieneProgram, the Connecticut AHEC Program, WIC, and DHHS Region 1. At this initial planningmeeting, the issues and challenges facing Head Start sites in screening and referring children fordental care were well laid out. The difficulties in complying with federal requirements were aparticular focus of discussion. In addition to the groups represented at the first meeting, thesecond planning meeting on March 3 included representatives of the Connecticut Oral Health2
Initiative, the Department of Social Services, a managed care payer. After reviewing the existingprograms in Connecticut addressing oral health needs, the group defined the objectives and basicformat for the Forum. The objectives were:1. Advocacy (first priority);FORUM PLANNING COMMITTEE2. Direct services through RDH on siteLynnAbrahamson,Central AHEC, Inc.(short-term); andJerry Bressin, Child and Family Early Head Start3. Develop a system of assessment,Gladys Calderon, LULA Head StartPat Carolan, BeneCaremonitoring, and evaluation (long-term).A smaller working group subsequentlymet to work out the details of theForum. The Connecticut AHECProgram was retained to handle thelogistics of the meeting. In order tomaximize discussion amongparticipants, Forum attendance waslimited to 100 people. A conferencebrochure (page 5) was prepared andsent to a group targeted to ensurerepresentation from the key stakeholdergroups (Head Start site managers, HeadStart parents, oral health professionals,policy makers, and others).Maryellen Connos, U.S. Department of Health and Human ServicesJoanna Douglass, UConn School of Dental MedicineTina Dugdale, Connecticut Department of Public HealthJohn Frassinelli, Connecticut Department of Public HealthMarlo Greponne, Human Resource Agency of New Britain, Inc.Charles Huntington, Connecticut AHEC ProgramSusan Jackman, Connecticut Department of Public HealthMary Kilka, Enfield Head StartTom Killmurray, U.S. Department of Health and Human ServicesKenneth Lambert, Connecticut Department of Social ServicesJean Lewis, Tunxis Community CollegeHoward Mark, Connecticut Oral Health InitiativeLinda Miklos, Education ConnectionPam Painter, Connecticut Department of Public HealthJoan Pina, Human Resource Agency of New Britain, Inc.Martha Okafor, Connecticut Department of Public HealthLisa Ricciuti, Bristol Head StartRobert Slate, Connecticut Oral Health InitiativePatricia Strout, New Opportunities, Inc.Cathy Walter, EASTCONN,Grace Whitney, Connecticut Head Start Statewide Collaborative OfficeStanton Wolfe, Connecticut Department of Public HealthForum DescriptionThe purpose of the Connecticut Department of Public Health’s Head Start / Early Head StartOral Health Forum was to solicit input from a multidisciplinary group of stakeholders indeveloping an action plan to improve Head Start oral health, the components of which includeenhancing prevention and oral health education and increasing access to oral health services. Indeveloping the action plans, Forum attendees considered activities and outcomes related to: Improved leadership, collaborations, and communication among stakeholders; Increased access to regular and appropriate preventive and treatment services; Expansion of evidence-based prevention in Head Start programs; Use of up-to-date, scientifically sound, developmentally, and culturally appropriate healtheducation/health promotion approaches and materials; and Innovative leveraging of resources for technical assistance and funding.The Forum was designed to minimize plenary discussions and to maximize the opportunity forattendees to provider their individual input in small group settings. After greetings from DeputyCommissioner Norma Gyle, RN, PhD and Ardell Wilson, DDS, MPH, Chief of the Bureau ofCommunity Health, Grace Whitney, PhD, MPA, Director of the Connecticut Head Start StateCollaboration Office, reviewed the history and status of Head Start and Early Head Start inConnecticut. Copies of the PowerPoint slides used by Dr. Whitney in her presentation areincluded with this report.3
Following the brief plenary session, attendees were divided into six groups of 12-15 participantsfor the sessions that took place from 10:30 a.m. through lunch to 2:30 p.m. The composition ofeach group was determined randomly. Each group had a facilitator and a scribe. The discussionwithin each small group was organized around a specific set of questions, and each group had asomewhat different set of questions. Each group was asked to identify and prioritize the majorneeds and issues, propose at least one activity to address the need or issue, specify a timeline foraction, identify short-term and long-term outcomes, designate the agency responsible forimplementing the activity, and develop evaluation measures. The questions assigned to each ofthe six groups are shown below.Group 1: Oral health screening, preventive interventions, and referral from the perspective ofHead Start – Early Head Start facilities, oral health providers, and parents and families.Group 2: Oral health screening, preventive interventions, and referral from the perspective ofcommunity partnerships and collaborations and finding the necessary resources.Group 3: Oral health promotion and disease prevention (education) from the perspective ofHead Start – Early Head Start facilities, oral health providers, and parents and families.Group 4: Oral health promotion and disease prevention (education) from the perspective ofcommunity partnerships and collaborations and finding the necessary resources.Group 5: Data, Assessment, and Evaluation from the perspective of Head Start – Early HeadStart facilities, community partnerships and collaborations, and finding the necessary resources.Group 6: Advocacy from the perspective of Head Start – Early Head Start facilities, communitypartnerships and collaborations, and finding the necessary resources.Following the small group discussions, Stanton Wolfe, DDS, MPH, Director of the DPH OralHealth Unit, conducted a brief wrap-up session. He described the process by which the results ofthe small group discussions would be compiled into a set of proposed activities. Representativesof the stakeholder groups that participated in the Forum planning will reconvene to refine therecommendations and develop implementation workgroups.The notes from each group were compiled into the issues and activities tables included in thisreport (page 10). These tables are the basis of the follow-up described above.Forum EvaluationA summary of the evaluation and comments is included in this report (page 26). Overall,attendees rated the Forum highly in terms of motivating participation and providing anopportunity to contribute to the improvement of the oral health of Head Start children. Notsurprisingly, the most highly rated portion of the Forum was the small group discussions.Forum ParticipantsA list of Forum Participants can be found on page 29.4
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HEAD START – EARLY HEAD START ORAL HEALTH FORUMJune 23, 2003Draft Final LONGTERM OUTCOMESAGENCYRESPONSIBLE FORIMPLEMENTINGACTIVITYEVALUATIONCOMMENTS1. Increasedpercentage of HeadStart youth willreceive regular oralhealth exams.2. Increasedpercentage of youthreceivingrestorative dentalservices.3. School nurses willsee fewer dentalproblems.4. There will be areduction in thenumber of days lostdue to oral healthproblems (not easyto measure sinceschools don’tdifferentiatebetween absencesrelated to medicalversus dentalproblems)5. ICD9 (diagnosticHead Start site canhelp with the paperwork. CHCs cancollect whatever theycan on it.Oral Health Screening, Preventive Interventions, and ReferralLack of dentalproviders who acceptHUSKY and MedicaidEnhance collaborationbetween CHCs andinsurance industryregarding oral healthcare of Head Startchildren.1-2 yearsPetition ConnecticutState DentalAssociation forassistance in recruitingdentists to see HeadStart children3-4 monthsShort-term – Initiationof discussion betweenMCOs and CHCsregarding oral healthneeds of Head Startchildren.Long-term – Coverageand reimbursementissues regardingprovision of oralhealth care to HeadStart children at orthrough CHCproviders resolved.Short-term - Initiationof discussion betweenCSDA and Head StartLong-term –Agreements betweenlocal dentists andHead Start sites to seechildren on referralLong-term – Numberof private dentistsseeing patients atCHCs10Connecticut Head StartState CollaborationOffice, CPCA.CSDA, ConnecticutHead Start StateCollaboration Office
RM OUTCOMESLocate a volunteerdental provider withinthe community.1-2 yearsShort-term – Conveneplanning group toinitiate recruitmenteffortLong-term –Agreements betweenlocal dentists andHead Start sites to seechildren on referralUtilize dental studentsat head Start sites.1-2 yearsAssign an exam code toreimburse dentalhygienist for theirservices.1-3 yearsShort-term – Initiatediscussion withUConn School ofDental Medicineregarding studentrotations at Head Startsites.Long-term – Initiationof dental studentrotations at Head Startsites.Short-term – Identifyspecific changesneeded in dental examcodes.Short-term – Convenekey stakeholders toplan and initiatestrategy to obtainchange.Long-term – Examcode for dentalhygienists established.11AGENCYRESPONSIBLE FORIMPLEMENTINGACTIVITYCOHI, CtHSSCO,CSDAUConn School ofDental MedicineCtHSSCOConnecticut DentalHygienists’Association, COHI,CSDA, MCOsEVALUATIONCOMMENTScoding) willdecrease inemergency rooms.6. The Department ofSocial Services costwill increaseinitially butdecrease in thelong-term.Provide incentivesand recognition. Thiswill require somelegislative advocacy.Reduced /waivedlicensure feels, loanrepayments, tax writeoff for donatedservices. Utilizeretired dentists.Student servicelearning is alreadyoccurring, howeverthere could be more.Legislative advocacy.Needs to be doneshort term due tocarve-out. VickyNardello is a naturaladvocate in theGeneral Assembly.
NEEDS/ISSUESPROPOSEDACTIVITIESTIMELINEPromote ADA’s “GiveKids a Smile Day” inConnecticut1-2 yearsIncrease the number ofprivate dentists andhygienists who contractwith CHCs.1 yearIdentify and addressliability barriers toproviding voluntarydental services1-5 yearsSHORT/LONGTERM OUTCOMESShort-term – Initiateplanning with keygroups on promoting“Give Kids a SmileDay.”Long-term – Annual“Give Kids a SmileDay” conducted in allHead Startcommunities.Short-term – Initiationof discussion betweenstakeholders on dentistand dental hygienistrecruitment.Long-term: Largernumber of dentists andental hygienistsunder contract withCHCsShort –term –Identification ofliability-relatedbarriers to accessingoral health care forHead Start children.Long-term –Articulation ofadvocacy plan toaddress liabilityrelated barriers.12AGENCYRESPONSIBLE FORIMPLEMENTINGACTIVITYCSDA, DPH, CDHA,CtHSSCOCPCA, DPH, COHI,CSDA, CDHACOHI, CSDA,CtHSSCOEVALUATIONCOMMENTSRecord of number ofproviders, surveys ofproviders and clients,referral surveyDevelop a MOA.Identify liaison toserve on HealthAdvisory Committee.List possibilities forpartnership.
NEEDS/ISSUESPoor communicationbetween medical anddental homeMedical providers lackawareness of oral healthissues.Lack of awarenessamong general publicPROPOSEDACTIVITIESTIMELINESHORT/LONGTERM OUTCOMESIncrease cultural andlinguistic competenceof oral health providers.1-2 yearsMake dental/oral healthexams a requirementfor Head Startparticipation.1-2 yearsProvide Open Widetraining to medicalproviders, especially atCommunity HealthCenters.Create a statewidesocial marketingcampaign1-2 yearsShort-term – OpenWide trainingprovided for all CHCpediatric providers.1-2 yearsShort-term – Convenestakeholders to planand seek funding forsocial marketingcampaign.Long-term – Ongoingimplementation of asocial marketingcampaign relative tooral health care ofyoung children.Short-term – Conveneevent planning groupLong-term – Initiateregular schedule ofevents.13Coordinate HealthFairs. Sealantprograms withgiveaways.1-2 yearsShort-term – Developcultural competencecurriculum thataddresses issues ofcommunicationbetween medical anddental homes.Long-term – Delivercurriculum to jointmedical-dentalaudiences.Short-term – Identifyif requirement is atstate or federal level.Long-term – Initiateadvocacy effort tochange requirement.AGENCYRESPONSIBLE FORIMPLEMENTINGACTIVITYConnecticut Chapter ofthe American PediatricAssociation.Interagency based atDPH (MedicaidCouncil). HS AdvisoryCouncil, LegislativeMandate. Paul Flinterat Connecticut StateDepartment ofEducationDPH, CPCA, AHECDPH, COHI, CSDA,CDHADPH, Local healthdepartments, CSDA,CDHA, AHECEVALUATIONCOMMENTSMake dental examsmandatory oncedental access is equalto that of medicalcare.
NEEDS/ISSUESPROPOSEDACTIVITIESTIMELINEProvide training toteachers and day careproviders on makingoral health part of theirdaily activities.1-2 yearsHead Start staff,parents, and schoolhealth staff do notknow how to navigatethe oral health caresystem.Educate Head Startstaff, parents, andschool health staffabout navigating theoral health care system.1 yearIneffective workingrelationships betweenHead Start sites andCHCsInitiate referralagreements betweenHead Start sites andCHCs.1-2 yearsPlace CHCrepresentatives on HeadStart Advisory Boards.Revise agreementsbetween Head Start andMCOs1 yearNote: Need or issueunderlying thisrecommendation wasnot identified.1-2 yearsSHORT/LONGTERM OUTCOMESShort-term – ModifyOpen Wide curriculumfor teachers and daycare providersShort-term – Conveneplanning group todevelop trainingprogramLong-term – Initiatetraining for teachersand day care providersShort-term - Initiationof training programsfor Head Start staff,parents, and schoolhealth staff.Long-term – Morefamilies have access tooral health care.AGENCYRESPONSIBLE FORIMPLEMENTINGACTIVITYCOMMENTSChild Health andDevelopmentInstitute ofConnecticut,Connecticut Charts aCourseHead Start sites, MCOs,health consultants,social service managersShort term – Initiatenegotiation betweenkey players in HeadStart and CHCs.Long term – Modelagreement developed.Long-term –Agreements executed.Head Start, CHCs,CPCAShort-term – Educatekey players in HeadStart and MCOs onopportunities toimprove agreements.Long-term – Revisedagreements finalized.MCOs, Head Start14EVALUATIONSurveys of parents,supervisors, and staffon effectiveness oftraining. Referralsatisfaction form.Evaluate staffeffectiveness ingetting childrenreferrals.Number of HeadStart childrenreceiving oral healthcare at CHCs.Resource tool hasbeen developed.Parent educationalmaterials are needed.Referral form fortracking.
RM OUTCOMESAGENCYRESPONSIBLE FORIMPLEMENTINGACTIVITYEVALUATIONOral Health Promotion and Disease PreventionIncrease parentalmodeling of proper oralhealthUse Colgate “BrightStart, Bright Smiles”activity kit1-2 yearsEducate parents aboutoral health and dentalcare when they are inthe Head Start facility1-2 yearsProvide incentives andrewards to parents forreturning dental forms1-2 yearsUse daily remindersand newsletters toremind parents aboutoral health1-2 yearsConduct one-on-oneeducation during homevisits1-2 yearsShort-term – Kitsobtained and used byevery Head Start siteLong-term Short-term – At leastone oral healthpromotion workshopconducted duringenrollment, openhouse, etc.Long-term – EveryHead Start site willconduct at least 10oral health promotionsessions during withparents per year.Short-term – Identifyand obtain appropriaterewards for returningdental forms.Long-term – Thoserewards evaluated andproven effective usedroutinely.Short-term – Dailyreports to parentscontain tips on oralhealth promotion.Long-term Short-term – Everyhome visit includesdiscussion of oralhealth promotion.Long-term -15Head Start and EarlyHead Start sites, CSDA,CDHA, healthconsultantsHead Start and EarlyHead Start sites, CSDA,CDHA, healthconsultantsHead Start and EarlyHead Start sites, CSDA,CDHA, healthconsultantsHead Start and EarlyHead Start sites, CSDA,CDHA, healthconsultantsHead Start and EarlyHead Start sites, CSDA,CDHA, healthconsultantsParent feedbackthrough surveys toassess how their oralhealth behavior haschanged.Pre- and Post-test ofparents to assessacquisition ofknowledge related tooral healthpromotion.Self-assessment,similar in format tocurrent selfassessments, at HeadStart and Early HeadStart sites related tooral health promotionactivities.Health AdvisoryBoards discuss andevaluate on-site andcollaborative eventsto determineeffectiveness.COMMENTS
NEEDS/ISSUESPROPOSEDACTIVITIESTIMELINECollaborate with othergroups (e.g., WIC) toeducate consistentlyabout oral health1-2 yearsPlace oral healthinformation in CHCsand Ob/Gyn offices.1-2 yearsPut fliers in grocerystores and createcoupon books to remindparents about oralhealth1-2 yearsSH
proposal was on Head Start and Early Head Start sites, it was anticipated that the resultant plan would benefit a much larger population of children in Connecticut. The proposal was widely supported by the key stakeholder groups. On December 20, 2002, the Department of Public Health was informed by the ASTDD that the proposal would be funded.
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