Action StepsA variety of governmental, professional, child-health, and coalition groups -including the Association of MCH Programs - have developed recommendationsfor action to address poor oral health among US children.One of the most comprehensive efforts to date, was a March 2000 US SurgeonGeneral’s invitational Workshop on Children and Oral Health. This forumconvened 100 experts from a variety of disciplines to make recommendations togovernment and the public. Its 8 major proposals (Mike: link to the proposals iswww.cdhp.org/downloads/Face/Forward.pdf ) were presented at the June 2000Surgeon General’s Conference, The Face of the Child (Mike: link ishttp://www.nidcr.nih.gov/AboutNIDCR/SurgeonGeneral/Children.htm. In March2000, a forum of experts from a variety of disciplines, convened for the SurgeonGeneral’s Workshop on Children and Oral Health to discuss how to address thedisparities in oral health and dental care for America’s children. Eight majorrecommendations arose from the deliberations, and were presented at the June2000 Surgeon Generals’ Conference entitled The Face of a Child (52).Background papers and fact sheets prepared for the Workshop (Mike: link ishttp://www.cdhp.org/Index.asp?PA=2&XX=115&XX=179&XX=130&XX=81 )include contributions on oral health disparities, ethical issues in pediatric oralhealth, US demographic and social trends affecting the health of young children,workforce issues, dental care delivery systems, science-based trends, strategiccommunications, and a review of state/ regional/ and national initiatives onpediatric oral health. (Mike, please provide a link to each of these 7 topics listedin the foregoing sentence. They are located on the link cited at the top of thisparagraph)These following recommendations can be used as initial action steps to help notonly our nation’s children, but other vulnerable populations,our nation’s childrenobtain and to enjoy the benefits of oral health. comprehensive oral health care,so they may enjoy sound, sustainable health. Within the general action stepsdescribed below are action steps specific to the MCH Title V Block Grant Porgram- Maternal and Child Health Federal Block Grant Programs. As suggested byAMCHP These specific action steps were published by the Association of Maternaland Child Health Programs and may be found in the issue brief, in its issue briefPutting Teeth in Children’s Oral Health Policy and Programs: The State ofChildren’s Oral Health and the Role of State Title V Programs (Mike: The web linkis www.cdhp.org/downloads/Publications/Policy/Putting_Teeth.pdf) .
Click on any step to jump down the page Includes establishing a child’s dental home at age one, identifying high-risk children and promoting individualized preventive regimens in both medical and dental practice, developing community-based health coordinators to promote ongoing integration of oral health with general health care, developing day-care accreditation standards on oral health, andaddressing the oral health needs of caregivers to promote more widespreadattention to oral health.Title V can ensure that the provision and promotion of dental and oral healthservices are integrated into all aspects of maternal and child health programimplementation, needs assessment, policies, and planning, including thoseaffecting children with special health care needs (CSHCN).
Oral health status should be incorporated into every prenatal care or public health clinic visit. Includes developing common core curricula on oral health for all health professionals and developing accreditation standards, guidelines, and performance measures that assure the inclusion of oral health promotion and, where appropriate, treatment inprofessional training and practice.Title V can assist in training private and public health care practitioners aboutthe oral health needs of children, pregnant women and other vulnerablepopulations, to ensure that these needs are covered in a comprehensive exam.Title V can utilize its knowledge of training to expand the capacity of private andpublic sectors, to ensure oral health needs are incorporated into routine primaryand preventive care. Includes promoting school-based prevention, education, screening , and referral programs on oral health and developing performance measures and tracking systems to ensure that these programs are effectively implemented. Title V can become involved in the development and/oracceptance of appropriate standards of care as well as more extensiveperformance measures to monitor what level of dental care children get.Performance measures can be used to assess and evaluate dental healthservices, for example, what percentage of children enrolled in Medicaid and CHIPactually get dental services, reparative services, or complete care. Includes developing activist coalitions that ensure stable-funded, community-based comprehensive health promotion and disease prevention and crafting messages that specifically target providers,policy makers, and the public. Title V can collaborate with oral public health programs, privatedental delivery systems, dental schools and associations and others, to raiseawareness of oral health needs of children (especially CSHCN), and pregnantwomen, to ensure access to care and to evaluate existing and new programapproaches.
Includes expanding the range and utility of science-based interventions; developing an evidence base on the effectiveness of oral disease management techniques; and developing a coordinated agenda across basic, applied , and health services research to promote oral health and effective dental care.In many states, Title V plays a significant role in the development of preventionprograms, such as fluoridation programs, screening and oral health education.However, some states do not have dental director or public health program.Thus, Title V can collaborate with the Association of Maternal and Child HealthPrograms (AMCHP) to ensure all states have a public oral health program. Includes demonstrating cost benefits of prevention and disease management, overhauling Medicaid Early and Periodic Screening Diagnostic and Treatment Program (EPSDT) dental programs, encouraging provider participation in Medicaid through various incentives, and enhancing the strength and viability of the dental safety net.Title V can allocate appropriate staff, time, training and funds to identify, target,and help treat high risk children, including CSHCN.By providing resources and technical assistance, MCHB can work with AMCHPand HRSA to assist in implementing oral health programs in states where noneexist. Includes prioritizing community-based educational experiences for dentists and hygienists in training; expanding the number of pediatric and public health dentists; engaging allied personnel more effectively, especially in health promotion and disease prevention, and encouraging an expanded number of minority providers in the dental professions.Through training and capacity building, Title V can help increase the numberand quality of dental health auxiliaries to alleviate the provider shortage inunderserved areas.Title V can use “Bright Futures” guidelines, which contain units dedicated toMaternal and Child Health and oral health, to train health care providers. Includes developing media and key-contact campaigns to translate oral health needs into demands for dental educational and treatment services; and using risk-based methods to tailor
care to the individual needs of children and their families while respecting familyand cultural determinants of health and health behaviors.Apply Title V expertise in providing outreach and other enabling services toensure that every pregnant women, child and adolescent has access to fullcomprehensive, oral health services.Regular Title V enabling services, such as transportation, translation, familysupport services and case management, can be used to assist families inaccessing dental care.Summary of State-Level Recommendations from theSurgeon General’s Workshop and Conference onChildren and Oral Health1. Hold state Medicaid program and legislatures accountable for adequate financial support of Medicaid and SCHIP dental programs;2. Consider revamping Medicaid administration, case management, and enabling services and make sure all who are eligible know of it.3. Hold state Medicaid programs accountable to certain practice guidelines and oral health performance measures, as in such Bright Futures or EPSDT4. Ensure continuous enrollment for children under Medicaid which has been proven to improve access to care5. Hold insurance companies accountable for covering all organ systems of the body6. Utilize definitions of medical necessity specific for children that include oral health care and other components of comprehensive care: require all insurers covering children to cover such care7. Leverage the organizational capacity of Medicaid, SCHIP and other managed care to improve basic screening and preventive oral health measures. As permitted by professional practice laws, managed health care and primary care case management systems could integrate oral health screening, education and preventive care into primary pediatric care. Medicaid agencies and other institutional purchases could use contract specifications to purchase appropriate services and hold plans and providers accountable.8. Examine state health professional practice laws and consider modifying to permit mid- level practitioners and primary care physicians to provide oral health counseling and simple preventive measures such as fluoride varnishes not under direct supervision of a dentist9. Monitor oral health in the child welfare system10.Require oral health component in services for CSHCN (through Title V agencies)11.Monitor use of dental sealants through Title V agencies12.Develop state-level legislation supporting water fluoridation13.Increase number of school nurses and include oral health in certification requirements14.Promote/mandate school prevention, education, screening and referral programs, and
15.establish performance measures for such efforts16. Require oral health promotion standards for those providing day care for infants and young children (accreditation standards)Mike: A new section starts here. It is comprised of additional sources of support forMCH program directors regarding action steps. I’ve provided an introductoryparagraph listing each of the subsequent sources and their attributes for our targetend users. It would be good to provide internal links so they can skip from the introdown to whichever source they want to see.In addition to recommendations made by the Surgeon General’sWorkshop and Conference and AMCHP’s suggested action steps,recommendations for national, state, and local action have beenproposed by:o US Surgeon General’s National Call to Action to Promote Oral Healtho CDC’s Division of Oral Health State Resourceso Association of State and Territorial Dental Directors’ Compendium of Best State Practiceso Association of Clinicians for the Underserved links to state-by-state oral health programs.o MCHB’s Oral Health Resource Center’s posting of information on Bright Futures, MCHB data, Head Start/Early Head Start, and a variety of publicationso American Dental Association’s Compendium of State Innovations to Improve Access to Oral Health Care for Low-Income Childreno The Washington State Access to Baby and Child Dentistry Initiativeo Children’s Dental Health Project’s Interfaces, News*Bytes, Perinatal Oral Health, State Database, and Dental Care Considerations for Young Children projectso American Academy of Pediatric’s PedsCare Project on Oral Health of Young Childreno American Academy of Pediatric Dentistry’s Policies and Guidelines for Children’s Oral Healtho Volunteers in Healthcare’s Oral Health ToolboxSurgeon General’s National Call To Action To PromoteOral Health(Mike: web link ishttp://www.nidcr.nih.gov/AboutNIDCR/SurgeonGeneral/NationalCallToAction.htm)In May of 2003, the US Surgeon General again highlighted oral health in a Callto Action that envisions a national effort “To advance the general health andwell-being of all Americans by creating critical partnerships at all levels of society
to engage in programs to promote oral health and prevent disease. Proposedaction steps for these public-private partnerships are: 1. Changing perceptions of oral health 2. Overcoming barriers by replicating effective programs and proven efforts 3. Building the science base and accelerating science transfer 4. Increasing oral health workforce diversity, capacity, and flexibility 5. Increasing collaborationsCDC’s Division of Oral Health State ResourcesCDC’s publication Oral Health: Preventing Cavities, Gum Disease, and ToothLoss; At-a-Glance, 2005. (Mike the link ishttp://www.cdc.gov/nccdphp/aag/aag_oh.htm) describes a variety of state-levelresources including:o State Information and Infrastructure Development Tools o State Oral Health Plans (Mike: link is http://www.cdc.gov/OralHealth/state_reports/OH_plans/index.htm ) o State-specific reports on oral health programs from AK | AR | CO | IL | MI | NV | NY | ND | OR | Republic of Palau | RI | SC | TX (Mike: Link is http://www.cdc.gov/OralHealth/state_reports/cooperative_agreements/index.htm) o Oral Health Infrastructure Development Tools (Mike: link is http:// www.cdc.gov/OralHealth/library/infrastructure.htm)o State and County Water Fluoridation Information o Compendium of state and local fluoridated water sources (Mike: link is http://apps.nccd.cdc.gov/MWF/Index.asp)o Oral Health Maps o CDC’s Oral Health Maps provide up-to-date information on the fluoride content of water in 25 participating states as well as children’s caries experience, untreated decay, and sealant rates. (Mike: link is http://apps.nccd.cdc.gov/gisdoh/default.asp)o Scientific Review of Evidence for Prevention o Promoting Oral Health: Interventions for Preventing Dental Caries, Oral and Pharyngeal Cancers, and Sports-related Craniofacial Injuries (Mike: link is http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5021a1.htm )
Association of State and Territorial Dental Directors(ASTDD) Best Practices (Mike: link ishttp://www.astdd.org/bestpractices/proj_purgoal.htm)_As the association of state dental directors that is analogous to the Association ofState and Territorial Health Directors (ASTHO), ASTDD has compiled “best statepractices.”According to ASTDD, “Best Practice is based on a simple maxim: dont reinvent the wheel, learnin order to improve it, and adapt it to your terrain to make it work better. If we can demonstratesuccess and share what we know, it can enable us to go forward in different ways that may leadto innovation and establish other best practices.”Best practices are categorized and described under three public health principles: Assessment,Policy Development, and Assurance. (Mike: Link is http://www.astdd.org/statepractices/index.htm)ASTDD also provides a directory of state oral health officials (Mike, link isAssociation of Clinicians for the Underserved Links toState-by-State Oral Health Programshttp://www.clinicians.org/programsandservices/oralhealth/oral_health_state_programs.shtmlThe ACU has compiled web links to each state’s oral health programs, most of whichare housed within the state’s MCH Title V program.HRSA’s MCH Oral Health Resource Center atGeorgetown UniversityThis resource center is a repository of information for policymakers and clinicianson: o Bright Futures Oral Health (Mike: http://www.mchoralhealth.org/Toolbox/ind ex.html) o MCH-relevant Oral Health Data (Mike:http://www.mchoralhealth.org/data.html) o Head Start and Early Head Start (Mike: http://www.mchoralhealth.org/HeadStart/headstart.html o Publications: (Mike: http://www.mchoralhealth.org/HeadStart/headstart.html)
American Dental Association Compendium of StateInnovations to Improve Access to Oral Health Care forLow-Income Children (Mike: Link is atwww.prnewswire.com/mnr/ada/20973)This state-by-state report considers both public health and public finance approachesto improving children’s oral health and access to dental care. It reports each state’sdental public health infrastructure, administrative policies and procedures, workforceresources, education/ communications/ and patient care facilitation, with a particularfocus on Medicaid and SCHIP programs.Access to Baby and Child Dentistry (The WA StateABCD Program) (Mike: link is http://www.abcd-dental.org/ )For over a decade the WA state government, dental educators, advocates, dentists,and local communities have worked together to develop a program for youngchildren that includes oral health education, service, and health promotion. A varietyof media resources (Mike: link is http://www.abcd-dental.org/res.html) are offeredto assist program development and implementationChildren’s Dental Health Project (CDHP) Resources(Mike: link is http://www.cdhp.org/)CDHP is an independent non-profit research, policy, and technical assistanceorganization committed to improving children’s access to oral health. Of particularinterest to MCH policymakers are: 1. CDHP’s Interfaces Project (Mike: link is http://www.cdhp.org/Index.asp? PA=3&XX=115&XX=179&XX=149&XX=136) examines the roles of medical and dental providers in promoting the oral health of young children. An executive summary and White paper (link iswww.cdhp.org/downloads/Interfaces/Exec_Summary_and_WP.pdf ) reviewfindings of commissioned papers on six related topics: 1. Children with special health care needs (pdf) 2. Delivery systems and financing issues (pdf) 3. Dental caries epidemiology, mechanisms, prevention and care delivery (pdf) 4. Education and training issues (pdf) 5. Health care policies (pdf)
6. Legal opportunities and constraints (pdf)2. CDHP’s NewsBytes State Press Clipping Service: News*Bytes is CDHPsbiweekly email newsletter that collects and disseminates press reports on childrens oral healthand dental care. The newsletter gives a sense of how the public and policymakers view theseissues and provides decision makers with information on what the public is learning about oralhealth access. A searchable database (by state, topic, paper, reporter etc) (Mike: link is athttp://cdhp.org/newsbytes/newsbytes.asp) facilitates finding articles pertinent to MCH anddental professionals_3. Perinatal Oral Health Project: CDHP is the program office for the American Academy ofPediatric Dentistry’s $1M MCHB 2005-2010 grant to advance the oral health of pregnantwomen and very young children including those in Head Start, WIC, and MCH programs acrossthe country.4. Dental Care Considerations for Young Children: (Mike: link iswww.cdhp.org/downloads/Publications/Access/burt_special_needs.pdf) This HRSA Bureau ofHealth Professions commissioned paper reviews the oral health status of young children andmakes a series of recommendations regarding medical and dental workforce to addressdisparities.5. State Oral Health Database: (Mike: link is www.cdhp.org ) This database compilesinformation from public sources on each state’s workforce, demographics, Medicaid/SCHIPprograms, safety net, and access andutilization.American Academy of PediatricsAAP’s web-based oral health resources (Mike: link is www.aap.org/commpeds/dochs/oralhealthThis site provides extensive information on o oral health risk assessment training for primary medical care providers (http://www.aap.org/commpeds/dochs/oralhealth/screening.cfm ) o AAP Policy Statements on Oral Health http://www.aap.org/commpeds/dochs/oralhealth/policy.cfm o Bright Futures for public health professionals http://brightfutures.aap.org/ web/publicHealthProfessionalsInPractice.asp o AAP’s national and state oral health programming through CATCH Programs, Healthy Tomorrows, and State Chapter oral health programming http://www.aap.org/commpeds/dochs/oralhealth/activities.cfm o Resources and links on pediatric oral health http://www.aap.org/commpeds/dochs/oralhealth/links.cfmAmerican Academy of Pediatric Dentistry Policies andGuidelines Mike: link is: www.aapd.org/media/policies.asp
AAPD’s Policies and Guidelines detail the recommendations of pediatric dentalspecialists on a variety of topics germane to early childhood oral health including: o Definitions of dental neglect, dental disability, early childhood caries, medically necessary care, and persons with special healthcare needs. o Policies on oral healthcare programs for infants and children, the dental home, child identification programs, school entrance examinations, emergency services, caries risk assessment, use of fluorides, dietary recommendations, oral habits, use of sedation and anesthesia in dental care for young children, o Clinical Guidelines on child abuse and neglect, infant oral health care, periodicity of preventive services, dental trauma management, o Resources including a caries risk assessment tool.Volunteers in Healthcare Oral Health ToolboxMike: link is http://www.volunteersinhealthcare.org/resource.htm#DentalVolunteer efforts can complement MCH programs and can demonstrate newapproaches worthy of institutionalization or incorporation into Title V and other stateoral health programming. VIH has posted a range of useful materials for voluntaryprograms including: o Guides to starting a dental program and recruiting dentists o Field reports on clinic and van programs, public-private partnerships, and management tips o Resource tips for developing a volunteer program o Presentations on volunteer programs o Descriptions of local community collaborations for oral health care