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Invisible Children: Access to oral health care for children with developmental disabilities from migrant farm worker famil...
Background <ul><li>U.S. Surgeon General’s Report on Oral Health  (2000) </li></ul><ul><li>Children of farm workers experie...
www.inn-california.com/maps/mapallca.html   Wandering Lizard California An online magazine with information related to att...
Background <ul><li>San Andreas Regional Center </li></ul><ul><li>Community-based, private nonprofit corporation for people...
Objectives <ul><li>Gain insight into the oral health care of migrant children with developmental disabilities  </li></ul><...
Definitions <ul><li>Developmental Disabilities  refers to: </li></ul><ul><li>A severe and chronic disability that is attri...
Definitions <ul><li>Migrant farm worker  refers to: </li></ul><ul><li>Hired farm worker </li></ul><ul><li>Seasonally chang...
Methods <ul><li>Systematic Literature Review </li></ul><ul><li>Interviews </li></ul><ul><li>Surveys </li></ul>
Methods: Literature Review <ul><ul><li>Key search words   </li></ul></ul><ul><ul><ul><li>Developmental disabilities </li><...
Methods: Interviews <ul><li>Oral health researchers and specialists </li></ul><ul><ul><li>University of California San Fra...
Methods: Interviews <ul><li>Do you know if the children with developmental disabilities and special needs (CDDSN) you serv...
Methods: Interviews <ul><li>1)Do you know if the children with developmental disabilities and special needs (CDDSN) you se...
Methods: Survey <ul><li>Survey </li></ul><ul><ul><li>Instrument developed based on  </li></ul></ul><ul><ul><ul><li>Literat...
Methods: Survey <ul><li>Identification Process </li></ul><ul><ul><li>California Dental Association, Greater Bay Area Denta...
Results: Literature Review <ul><li>California produces most of the nations fruit and vegetables, wine, and nuts  </li></ul...
Results: Literature Review <ul><li>Oral Health Care Barriers </li></ul><ul><ul><li>Major one is cost for the farm worker f...
Results-Literature Review <ul><li>Environmental Hazards </li></ul><ul><ul><li>Farm work is one of the most hazardous job <...
Results: Literature Review <ul><li>2.2% of all California children </li></ul><ul><li>Hispanics/Latinos comprise the second...
Results: Literature Review <ul><li>Developmental disabilities California children </li></ul><ul><ul><li>82,001 Female – 39...
Results: Interviews University of California San Francisco (UCSF) University of the Pacifica Dental School <ul><ul><li>Pri...
Results: Interviews University of California San Francisco (UCSF) University of the Pacifica Dental School <ul><ul><li>Yes...
Results: Interviews Administrators and Directors:  San Andreas Regional Center <ul><ul><li>Private Dental Practices (limit...
Results: Interviews Administrators and Directors:  San Andreas Regional Center <ul><ul><li>The collection of limited data ...
Results: Survey <ul><li>Oral healthcare providers </li></ul><ul><li>24% response rate to date </li></ul><ul><li>Majority i...
Conclusions <ul><li>Reporting and tracking data for children with developmental disabilities and special needs (CDDSN) are...
Policy Recommendations <ul><li>Enhance oral health provider training </li></ul><ul><li>Develop comprehensive oral healthca...
Policy Recommendations <ul><li>Educate Stakeholders: </li></ul><ul><li>To have citizens with developmental disabilities an...
Acknowledgements <ul><li>Dr. Saskia Estupian-Day, Preceptor, PAHO </li></ul><ul><li>Dr. Chester Douglas, Advisor, Harvard ...
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Invisible Children: Access to oral health care for children ...

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

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

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