Improving the Oral Health of School-Aged Improving the Oral Health of School-Aged Children: Promising Approaches for Linking Children: Promising Approaches for Linking

Them With Dental HomesThem With Dental HomesWashington, DCWashington, DCMay 11-12, 2006May 11-12, 2006

Cincinnati Health Department/Cincinnati Health Department/Greater Cincinnati Oral Health CouncilGreater Cincinnati Oral Health Council

School-Linked Clinic and Mobile Dental VanSchool-Linked Clinic and Mobile Dental VanLawrence F. Hill, DDS, MPHLawrence F. Hill, DDS, MPH

Cincinnati Health Department, Dental DirectorCincinnati Health Department, Dental Director

Nancy L. Carter, RDH, MPHNancy L. Carter, RDH, MPHCincinnati Health Department, Assistant Dental DirectorCincinnati Health Department, Assistant Dental Director

HistoryHistoryPre 2004Pre 2004

Pre 1982 - Inner-CityPre 1982 - Inner-City School-linked/based hybrid clinicsSchool-linked/based hybrid clinics

Excellent in school-basedExcellent in school-based Not good in linkedNot good in linked

11 clinics – all antiquated11 clinics – all antiquated Neighborhood health centers monopolized by adult Neighborhood health centers monopolized by adult

emergencies and adult careemergencies and adult care

1982 – All school clinics closed1982 – All school clinics closed

Sealant Program ResultsSealant Program Results1984 - 20001984 - 2000

31-47% of participants needed treatment31-47% of participants needed treatment 78% of those received no care after one year78% of those received no care after one year

Referral FailuresReferral Failures Dental Assistant phone callsDental Assistant phone calls

Lists to school nursesLists to school nurses

Letters to parentsLetters to parents

Intensive case managementIntensive case management

20042004“Give Kids A Smile Day”“Give Kids A Smile Day”

Linked one school with one 6-chair CHD Linked one school with one 6-chair CHD clinic and two mobile vansclinic and two mobile vans

40 dentist volunteers40 dentist volunteers

““Give Kids A Smile Day” Give Kids A Smile Day” OrganizationOrganization

Four Fridays in FebruaryFour Fridays in February Consents to all kidsConsents to all kids Screened all with consentsScreened all with consents Organized by number of decayed teeth per Organized by number of decayed teeth per

classroomclassroom ~ 300 kids and $80,000 gross~ 300 kids and $80,000 gross

Subsequent YearsSubsequent Years Dental Society dropped out (now have their Dental Society dropped out (now have their

own volunteer clinic)own volunteer clinic) We now move dentists and assistants from We now move dentists and assistants from

other clinics to supplement the Crest Smile other clinics to supplement the Crest Smile Shoppe instead of volunteersShoppe instead of volunteers

We have paid transportationWe have paid transportation Coordinated effort of the project coordinator, Coordinated effort of the project coordinator,

school-based health center, and the dental school-based health center, and the dental clinic.clinic.

Numbers for 2005Numbers for 2005 Number of days = 21 (5 hour days)Number of days = 21 (5 hour days) Number of users = 425; encounters = 578Number of users = 425; encounters = 578 Gross production = $216,118Gross production = $216,118 Cost = $57,625 (salary + fringe + supplies + Cost = $57,625 (salary + fringe + supplies +

transportation)transportation)

Assumption:Assumption: 2/3 Medicaid ($140,000)2/3 Medicaid ($140,000) Medicaid pays about ½ of fees ($70,000)Medicaid pays about ½ of fees ($70,000) Thus, break even (only for costs shown)Thus, break even (only for costs shown)

++Utilized current facility and staffUtilized current facility and staff

--Doesn’t increase community capacity, Doesn’t increase community capacity,

but may increase individual provider but may increase individual provider productionproduction

Lessons Learned Lessons Learned School-Linked ProgramSchool-Linked Program

Requires:Requires: Intense organizationIntense organization Reliable transportationReliable transportation Cooperation of school staff (health center Cooperation of school staff (health center

nurses) to coordinate consents/getting kids on nurses) to coordinate consents/getting kids on buses, etc.buses, etc.

Resources of multiple providers at one place at Resources of multiple providers at one place at one timeone time

Lessons LearnedLessons LearnedSchool-Linked ProgramSchool-Linked Program

Requires:Requires: Can be done with volunteers or paid staff Can be done with volunteers or paid staff

(volunteer staff takes additional planning and (volunteer staff takes additional planning and coordination and is less reliable!)coordination and is less reliable!)

Can provide continuous care for children in Can provide continuous care for children in participating schoolsparticipating schools

Impractical to do with a solo private practitioner Impractical to do with a solo private practitioner because of cost of coordinator and transportationbecause of cost of coordinator and transportation

Only works for schools that are in close Only works for schools that are in close proximity to safety net clinicproximity to safety net clinic

Alternative Model: Mobile VanAlternative Model: Mobile Van High level of frustration in community over High level of frustration in community over

access to care for kidsaccess to care for kids Oral Health Regional Assessment and Oral Health Regional Assessment and

Planning Project (RAPP) – community requestPlanning Project (RAPP) – community request School nurses and Head Start staff asked for a School nurses and Head Start staff asked for a

mobile vanmobile van

20042004 Initiated Mobile Van ProgramInitiated Mobile Van Program Two chairs (1 Dentist, 2 Assistants, 1 Two chairs (1 Dentist, 2 Assistants, 1

Driver/Receptionist/Manager)Driver/Receptionist/Manager) Dentrix, direct digital radiographyDentrix, direct digital radiography

FundersFunders My godfather at the Ohio Department of My godfather at the Ohio Department of

HealthHealth Anthem Foundation of OhioAnthem Foundation of Ohio Mayerson FoundationMayerson Foundation United WayUnited Way

Capital CostsCapital Costs

VanVan $315,000$315,000 Dental Equipment Dental Equipment 80,000 80,000 Digital/ElectronicsDigital/Electronics 80,000 80,000

TOTAL TOTAL $475,000$475,000

School-Based ClinicSchool-Based Clinic ConstructionConstruction

$100/sq. ft. x 400$100/sq. ft. x 400 $ 40,000$ 40,000

EquipmentEquipment $ 80,000$ 80,000

Electronics?Electronics?

TOTALTOTAL $120,000$120,000

TargetingTargeting Blanket school with consent formsBlanket school with consent forms Sealant kidsSealant kids Kids who come to school nurseKids who come to school nurse Nurse screeningsNurse screenings

Van OperationsVan Operations20052005

1,230 school children (users)1,230 school children (users) 497 (40%) – diagnostic/preventive only497 (40%) – diagnostic/preventive only 733 (60%) – diagnostic/preventive/treatment733 (60%) – diagnostic/preventive/treatment

713 Head Start children (users)713 Head Start children (users) 492 (69%) – diagnostic/preventive only492 (69%) – diagnostic/preventive only 221 (31%) – diagnostic/preventive/treatment221 (31%) – diagnostic/preventive/treatment

School ChildrenSchool Children Enrolled: 3,060 (6 schools)Enrolled: 3,060 (6 schools) Children participating: 1,230 (40%)Children participating: 1,230 (40%) Much higher participation in early gradesMuch higher participation in early grades Function of school principal and nurseFunction of school principal and nurse

Lessons Learned About VansLessons Learned About Vans Needs one strong dental staff person to Needs one strong dental staff person to

provide liaison with schoolsprovide liaison with schools Need a cooperative, designated school person Need a cooperative, designated school person

to coordinate from inside (i.e. school nurse, to coordinate from inside (i.e. school nurse, office personnel, etc.)office personnel, etc.)

Need linkages to pediatric specialists and to a Need linkages to pediatric specialists and to a private practice, safety net program, or dental private practice, safety net program, or dental school to provide back-up when van is not school to provide back-up when van is not availableavailable

Lessons Learned About VansLessons Learned About Vans Need sound plan for provision of care and Need sound plan for provision of care and

generation of revenue on days schools aren’t generation of revenue on days schools aren’t availableavailable

Need more vansNeed more vans 16/62 schools in 2.5 years with only 40% 16/62 schools in 2.5 years with only 40%

participationparticipation