Invisible Children: Access to oral health care for children ...
Upcoming SlideShare
Loading in...5
×
 

Invisible Children: Access to oral health care for children ...

on

  • 462 views

 

Statistics

Views

Total Views
462
Views on SlideShare
462
Embed Views
0

Actions

Likes
0
Downloads
3
Comments
0

0 Embeds 0

No embeds

Accessibility

Categories

Upload Details

Uploaded via as Microsoft PowerPoint

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment
  • The U.S. Surgeon General’s Report on Oral Health shows that people living below the poverty level and those with mental retardation and physical disabilities have poorer oral health Agnews is closing as well as many of the states developmental centers. These were state hospitals. 11 in total?
  • To gain insight into the oral health care of migrant children with developmental disabilities with a focus on migrant farm worker families in Northern California To bring attention to this undocumented population and their oral health care needs To identify the barriers that oral health care providers face when treating the target population
  • Travels at least 75 miles to work Relocate at least every 6 months Undocumented 70%+ Central america predominately Mexico
  • I’m unclear on who was interviewed. Consider putting the name of the institution first and the titles of people were interviewed or vice versa. Use the “general dentist and specialist” piece as an example Interviews: San Andreas Regional Center Pan American Health Organization American Academy of Developmental Medicine and Dentistry General dentists and specialists University of California, San Francisco University of the Pacific
  • I’m unclear on who was interviewed. Consider putting the name of the institution first and the titles of people were interviewed or vice versa. Use the “general dentist and specialist” piece as an example Interviews: San Andreas Regional Center Pan American Health Organization American Academy of Developmental Medicine and Dentistry General dentists and specialists University of California, San Francisco University of the Pacific
  • I’m unclear on who was interviewed. Consider putting the name of the institution first and the titles of people were interviewed or vice versa. Use the “general dentist and specialist” piece as an example Interviews: San Andreas Regional Center Pan American Health Organization American Academy of Developmental Medicine and Dentistry General dentists and specialists University of California, San Francisco University of the Pacific
  • Oral health care providers includes dentist and hygienist Health Admin dental directors/ head nurses/ health clinic directors Selected based on referrals/county dental boards/phone directory List of county hospitals BAY AREA//SAN ANDREAS select oral health providers working with underserved communities EXISTING SURVEY------PAUL GLASSMAN Designed 2 surveys but will discuss the provider. Other is still coming in.
  • Oral health care providers includes dentist and hygienist Health Admin dental directors/ head nurses/ health clinic directors Selected based on referrals/county dental boards/phone directory List of county hospitals BAY AREA//SAN ANDREAS select oral health providers working with underserved communities EXISTING SURVEY------PAUL GLASSMAN Designed 2 surveys but will discuss the provider. Other is still coming in.
  • California produces at least ½ the nations food, wine, cotton, beef, milk, and cheese Strawberries is largest employer crop California migrant farm worker population is approximately 900,000 U.S. migrant farm worker population is approximately 2.5 million Man hours=1,612 /acre----increased for strawberries nuts fruits and vegetables 40% traditional migrants/new migrants 60% from southern states Oaxaca Guerreo(Zapotec and Mixtec Indians) “ Farm workers in California by Bugarin and Lopez/ Center for Chicano Studies, by palerm
  • Find income for avg California family????? “ Farm workers in Calif” , by bugarin and lopez PICTURE OF DENTAL SERVICES BEING PROVIDED
  • PICTURE OF WOMEN AND CHILDREN WORKING IN HAZARDOUS SITUATION Working Family groups increase risks for pesticides to affect births Bacterian + E.Coli and spinach
  • Should I compare other groups/ create a table/ use %?
  • 2 specialist ( pedo and ortho) 2 hygienist
  • Children in this population with developmental disabilities are significantly undocumented There is not data on this population There are many barriers that make these children “invisible”. Vulnerable families often do not have access to care. The state of California has a responsibility to children and adults with developmental disabilities An intensive and comprehensive study needed
  • Tufts dental facilities----1976/8clinics for children with 14,000 served annually/ general residency program/ 7 hygienist who go to adult day centers, classrooms,workshops etc.

Invisible Children: Access to oral health care for children ... Invisible Children: Access to oral health care for children ... Presentation Transcript

  • Invisible Children: Access to oral health care for children with developmental disabilities from migrant farm worker families in a Northern California region Brian Swann, DDS California Endowment Fellow Joseph L. Henry Oral Health Fellow in Minority Health Policy May 18, 2007
  • Background
    • U.S. Surgeon General’s Report on Oral Health (2000)
    • Children of farm workers experience a rate of tooth decay 2x the general population of children.
    • Children with developmental disabilities have increased risk of
      • Poor oral hygiene
      • Broken teeth
      • Filled teeth/extractions
    • Untreated dental disease leads to pain, abscesses, decay, infections, malnutrition, death
    Source: National Survey of Children with Special Health Care Needs, 2001
  • www.inn-california.com/maps/mapallca.html Wandering Lizard California An online magazine with information related to attractions, lodging, dining, and travel resources in selected areas of the Western United States                                                                                                                                                California Regions
  • Background
    • San Andreas Regional Center
    • Community-based, private nonprofit corporation for people with developmental disabilities funded by the state of California
    • Four county area- San Benito, Monterey, Santa Clara, Santa Cruz
    • Provides diagnostic and prevention services and confidential screening
    • Dental referrals
    • Serves 12,000 clients (adults and children)
  • Objectives
    • Gain insight into the oral health care of migrant children with developmental disabilities
    • Bring attention to this unreported population
    • Identify the barriers that oral health care providers face
  • Definitions
    • Developmental Disabilities refers to:
    • A severe and chronic disability that is attributable to a mental or physical impairment that begins before an individual reaches adulthood
    • These disabilities include mental retardation, cerebral palsy, epilepsy, autism and disabling conditions closely related to mental retardation or requiring similar treatment
    Source: California Department of Developmental Services
  • Definitions
    • Migrant farm worker refers to:
    • Hired farm worker
    • Seasonally changes jobs and seasonal locations
    • Relocates from country or state
    • A subpopulation of farm workers
    Source: California Research Bureau
  • Methods
    • Systematic Literature Review
    • Interviews
    • Surveys
  • Methods: Literature Review
      • Key search words
        • Developmental disabilities
        • Migrant farmers
        • Oral health
        • California
        • Children
      • Resources
        • PubMed
        • ERIC
        • Google
        • Medline
  • Methods: Interviews
    • Oral health researchers and specialists
      • University of California San Francisco
      • University of the Pacific Dental School
      • Tufts Dental Facilities Special Needs Program
      • Children’s Hospital Boston
    • Administrators and directors
      • Pan American Health Organization
      • San Andreas Regional Center
      • American Academy of Developmental Medicine and Dentistry
  • Methods: Interviews
    • Do you know if the children with developmental disabilities and special needs (CDDSN) you serve are from a migrant farm worker family?
    • Who provides the oral health services to CDDSN in general?
    • Do you have demographic information as it relates to the number of CDDSN of migrant farmers in your region?
    • Do you think it is important to maintain this demographic data on CDDSN?
    • Oral health researchers and specialists
  • Methods: Interviews
    • 1)Do you know if the children with developmental disabilities and special needs (CDDSN) you serve are from a migrant farm worker family?
    • 2)Who provides the oral health services to CDDSN in general?
    • 3)Do you have demographic information as it relates to the number of CDDSN of migrant farmers in your region?
    • 4)Do you think it is important to maintain this demographic data on CDDSN?
    • 5)How do you establish trust among migrant farm workers who may be undocumented immigrants?
    • Administrators and directors
  • Methods: Survey
    • Survey
      • Instrument developed based on
        • Literature review
        • Interviews
        • Existing surveys
  • Methods: Survey
    • Identification Process
      • California Dental Association, Greater Bay Area Dental Society, References from interviews
      • Selection Criteria
        • Type of facility – Clinics, private practices, hospital-based
        • Geographic area – Bay Area, Silicon Valley (sub-region of San Andreas), Central Coast, San Joaquin Valley
        • Disciplines – Oral health care providers (generalists, specialists, hygienists) and health administrators
    • Survey Distributed to
      • 22 health administrators
      • 50 oral health care providers
  • Results: Literature Review
    • California produces most of the nations fruit and vegetables, wine, and nuts
      • Strawberries is the largest employer crop
      • Increased demand for labor
      • $25 billion agricultural industry
    • 2.5 million migrant farm workers in the U.S.
      • 36% work in California (900,000)
    • California farm workers
      • 4 of 5 workers are males
      • 29 years median age
      • 20% under 17 years of age
      • 80% Latino
      • 70% are undocumented
      • 66% children are citizens
  • Results: Literature Review
    • Oral Health Care Barriers
      • Major one is cost for the farm worker family
        • Farm worker median income for family of 4 = $17,700
        • Non-farm worker median California family of 4 = $68,500
      • Patients pay out-of-pocket cash for dental services
      • 40% uninsured
      • 45% of residents are insured (MediCal)
      • 38% below poverty level
      • 30% not seen by doctor
    Source: California Research Bureau
  • Results-Literature Review
    • Environmental Hazards
      • Farm work is one of the most hazardous job
        • 12 injuries per 100 people annually
        • 1/3 injuries are on children
      • Exposure to bacteria, viruses, pesticides
      • Extended work hours
      • Adverse weather conditions
      • Repetitive work methods
      • Family working units
    Source: National Survey of Children with Special Health Care Needs
  • Results: Literature Review
    • 2.2% of all California children
    • Hispanics/Latinos comprise the second largest group of children with developmental disabilities. (32%)
    208,048 California Children with Developmental Disabilities
  • Results: Literature Review
    • Developmental disabilities California children
      • 82,001 Female – 39%
      • 126,047 Male – 61%
    • Latino children with developmental disabilities
      • 22,528 Female - 40%
      • 33,698 Male – 60%
      • Underreporting highest in Latino families
    Source: National Survey of Children with Health Care Needs
  • Results: Interviews University of California San Francisco (UCSF) University of the Pacifica Dental School
      • Private Dental Practices (limited services)
      • Community Health Center Clinics
      • Hospital Emergency Rooms
      • Dental Schools
    Who provides the oral health care services to CDDSN in general?
          • No
    Do you know if the children with developmental disabilities and special needs (CDDSN) you serve are from a migrant farm worker family?
  • Results: Interviews University of California San Francisco (UCSF) University of the Pacifica Dental School
      • Yes, it is under consideration to add collection of such data at the time of screening for dental care services
    Do you think it is important to collect this demographic data on CDDSN?
        • No
    Do you have demographic information as it relates to the number of CDDSN of migrant farmers in your region?
  • Results: Interviews Administrators and Directors: San Andreas Regional Center
      • Private Dental Practices (limited services)
      • Community Health Center Clinics
      • Hospital Emergency Rooms
      • Dental Schools
    Who provides the oral health care services to CDDSN in general?
      • No. Question not asked out of respect for patient and family confidentiality.
    Do you know if the children with developmental disabilities and special needs (CDDSN) you serve are from a migrant farm worker family?
  • Results: Interviews Administrators and Directors: San Andreas Regional Center
      • The collection of limited data that is pertinent to health services is collected.
    Do you think it is important to collect this demographic data on CDDSN?
      • Culturally sensitive
      • Continuity of care
      • History of relationship with the community
    How do you establish trust among migrant farm workers who are undocumented immigrants?
      • No
    Do you have demographic information as it relates to the number of CDDSN of migrant farmers in your region?
  • Results: Survey
    • Oral healthcare providers
    • 24% response rate to date
    • Majority identify as private practices and clinics
    • 60% currently treating children with disabilities
    • 50% have minimal training
    • 100% have a willingness to treat
    • Barriers
      • Education
      • Space
      • Equipment
    • Methods of reimbursement for those seeing children with disabilities
      • Out of pocket cash payments (32%)
      • Private insurance (30%)
      • Other (DentiCal or free) (38%)
  • Conclusions
    • Reporting and tracking data for children with developmental disabilities and special needs (CDDSN) are very limited and in most cases, non-existent
    • The families of migrant children are the poorest in the state and very vulnerable to causal factors such as environmental hazards
    • CDDSN of migrant farmers have limited access to oral healthcare
    • More than 60% of migrant children, which includes CDDSN, are eligible for oral, medical, and educational services
    • Oral health providers face many barriers that result in limited accessibility to CDDSN
    • Greater provider participation may require greater reimbursements
  • Policy Recommendations
    • Enhance oral health provider training
    • Develop comprehensive oral healthcare models (PAHO)
    • Direct more funding towards oral healthcare treatment centers
    • Identify and track vulnerable populations with safeguards against deportation
    • Improve communication between existing institutions, agencies, and organizations
  • Policy Recommendations
    • Educate Stakeholders:
    • To have citizens with developmental disabilities and special needs appropriately recognized as a federally designated medically underserved population.
    Source: American Association of Developmental Medicine & Dentistry
  • Acknowledgements
    • Dr. Saskia Estupian-Day, Preceptor, PAHO
    • Dr. Chester Douglas, Advisor, Harvard School of Dental Medicine
    • Dr. Joan Reede, Director, Harvard Medical School
    • DCP Staff
    • Dr. Paul Glassman, UOP
    • Dr. Steve Pearlman, AADMD
    • Dr. John Morgan, Tufts Dental Facilities
    • Dr. Barry Waldman
    • San Andreas Regional Center
    • Dr. Myron Allukian
    • Drs. Nelson & Ng, Children’s Hospital
    • Dr. Jane Weintrab, UCSF