1

Integrating SystemsSuccessful Strategies and Lessons Learned

Oral Health as Part of Total Health

Presented by

Dental Health Initiative of San Diego

Share the Care

County of San Diego

Health and Human Services Agency

2

This program is brought to you by a grant from the U.S. Department of Health and Human Services, Health Resources and

Services Administration

3

Speakers• Laura Castaneda

Moderator

• Nancy Bowen, MD, MPH

Public Health Officer, County of San Diego

Health and Human Services Agency

• Phyllis Elkind, MPH

Children, Youth and Families Coordinator,

County of San Diego Health and Human

Services Agency

4

Speakers continued

• Peggy Yamagata, RDH, MEd

Dental Health Specialist and Share the Care

Program Manager, County of San Diego

• Cindy Muehleisen

California Children’s Dental Disease Prevention

Program Coordinator, San Diego County Office

of Education

• Parvathi Pokala, DDS

Pediatric Dentist and Share the Care Advisory

Board Member

5

Overview of San Diego County

• Size of County – 42,000 mi2

• Urban and rural areas

• Population – 3 million residents (SANDAG, 2002)

• Ethnically and culturally diverse – borders Mexico, large refugee population

6

Overview of San Diego County continued

• 742,000 children (0-17 years of age) (SANDAG, 2002)

• 269,000 children in households with income of <185% FIG (Census, 2000)

• 11.5% of children are medically uninsured (UCLA, 2001) and we know that even more children lack dental insurance.

7

Oral Health Issues in San Diego County

• Tooth decay is the most common diagnosis – Reported through Child Health and Disability

Prevention (CHDP) Program well child exams

• Most frequent treatment paid by CHDP-Treatment Reimbursement Program with a value equal to all other medical payments

• Denti-Cal spends $60 million annually on dental care for San Diego County residents

8

Oral Health Issues in San Diego County continued• Visual screenings of 4,451 local 2nd – 5th graders

in 1999 revealed:– 30% untreated cavities – 74% active gum disease

• Unequal distribution of dentists– Several areas are designated as dental shortage

areas

• Non-fluoridated county

• United Way survey found 285,428 children, approximately 40%,have dental disease (based on census 2000 – 722,602 children 0-17 years)

9

How Did San Diego County Address Oral Health?

• Community forum held in 1992 identified specific issues:– Lack of emergency access for low-income children

with no dental resources– Lack of fluoridation– High rate of Baby Bottle Tooth Decay (BBTD) and no

prevention education programs

• Participants continued to meet forming the Dental Health Coalition (DHC)

10

Addressing Oral Health continued

– Members: dental, medical, public health, educators, community clinics, nurses, PTA, Community Based Organizations (CBO)

• DHC, San Diego County, and local dental societies formed Dental Health Initiative/Share the Care (STC)– Housed at County– Initially funded by small grants– Currently funded by grants and state, federal, EPSDT,

MCH funds

11

Addressing Oral Health continued

• Share the Care implemented 2 of 3 top issues– Emergency dental care for children with no resources

• Network of pro bono dental professionals who provide emergency care. Currently: 292 DDS, 91 RDH, 81 DA, 15 Labs = 479

– Preventative Education• Integrate oral health into existing programs

targeting children, adults, professionals

12

Addressing Oral Health continued• Within Children, Youth and Families

– Maternal and Child Health• Dental bulletin • Addressing low birth weight babies• Added to training to prevent infant mortality

– CHDP Providers

– Foster care

– Access to care – San Diego Kids Health Assurance Network (SD-KHAN)

• Dental as part of total health

13

Oral Health in the Schools

• California Children’s Dental Disease Prevention Program (CCDDPP) Collaborates with Share the Care who provides:– Emergency access to dental care for children with no

dental resources

– Sealant Clinics• Community collaborative with CCDDPP, dental

societies, and local hygiene school• Private funding or grants• Provide screening, sealants, education, access to

care for families• Reduce emergencies

14

Oral Health in the Schools continued

– Additional support for classes for teen parents

– School nurses• Resources and trainings

– School Events• Health and safety fairs, parent nights

– Peer to peer training for students and parents• 7th and 8th grade students trained to teach K-2nd

graders• Private and public schools• Schools that CCDDPP can not reach due to limited

funding

– After school and summer programs

15

Reaching Children Outside Schools

• Educational pieces developed for traditional and non-traditional settings

• Curriculum, Arts and Crafts Manual, Activity Book

• Libraries – Promote literacy and dental health

• County run, temporary shelter care for children – At-risk children taught in small groups

• Juvenile detention facility for girls– Young girls are to be released soon – Oral health is part of teaching life skills

16

Reaching Parents

• Peer to peer training for adults

• Oral Health Ambassador Program – Senior volunteer

• Healthy Start and Head Start– Parents and staff

• Women, Infants, and Children (WIC)– Parents and staff

• Aging and Independent Services (AIS)– Grandparents/kinship program

17

Reaching Community Based Organizations

• Community events– Health and safety community fairs

• Look for areas beyond brushing and flossing– Acid Foods display and brochure– Coffee display and brochure

• Community Forums– First forum held in 1992– Second oral health forum held in 2000 – 143 attended– Senior oral health forum held in 2001 – 127 attended

18

Reaching community based organizations cont.

• Professional Meetings – Not just dental related

– Girls Summit – addressed issues effecting the young girls of today

– Statewide Obesity Conference – WIC and Head Start state wide conferences– American Cancer Society Head and Neck Conference

19

Reaching Professionals• University of California, San Diego (UCSD)

pediatric medical residency program– Monthly trainings

• American Academy of Pediatrics (AAP) and the American Academy of Pediatric Dentists (AAPD)– Annual dinners– Grand rounds at Children’s Hospital

• Medical staff for County programs

– Foster care– MCH– Public health nurses

20

Reaching Professionals continued

• Nursing Kit developed to better equip professionals who work out in the community

• Outreach Worker Kit– Contents modified for professionals who would not be

looking into the oral cavity

• Future professionals– Student interns

• Disciplines – nutrition, health promotion, public health, dental hygiene

• As many as 40 a year• Various requirements – semester to one week

rotations

21

Media• Movie slides

– Series of three PSAs shown prior to start of movies

• Bus boards– Message on the back of a bus

• Weekly Advertisement Mailer– “Penny Saver” ad

• Website – www.sharethecaredental.org– Information on Share the Care, community events,

and ability to download materials

• Bookmarks– Various oral health messages

22

Systems Changes• Pilot project

– Adjust Report of Health Examination for school entry– Question added regarding medical, dental, and vision

insurance– Permission asked to contact parents/guardians– Provide insurance information– Database tracked utilization

• Worked closely with organizations that address access to care– Assure literature stated medical/dental insurance

• San Diego Kids Health Assurance Network (SD-KHAN) brochure

• School lunch form– Welfare Eligibility Techs

23

Systems Changes continued

• County wide programs use our educational materials– Waiting rooms and resource areas of STD/TB clinic,

Immunization, Lead Poisoning, AIS

• Oral health is part of Juvenile Hall Well-Being Program

• Welfare to work job clubs

• United Way Outcomes and Community Impact Surveys now ask oral health questions– This lead to integration of oral health into County

Report Card

24

Lessons Learned

• Collaborate

• Start small

• Utilize non-traditional settings

• Do not isolate oral health - Integrate with what is “hot”

25

Thank You For Joining Us!

26

Contact UsDental Health Initiative of San Diego

Share the Care

County of San Diego

Health and Human Services Agency3851 Rosecrans Street

PO Box 85222 (MS: P511H)

San Diego, CA 92186-5222

619-692-8858

Fax: 619-692-8827

Website: sharethecaredental.org

Email:peggy.yamagata@sdcounty.ca.gov