Abstract
California's Dental Transformation Initiative: Six Local Dental Pilot Projects in Action
Paul Glassman, DDS, MA, MBA1 and Rolande Tellier2
(1)University of the Pacific School of Dentistry, San Francisco, CA, (2)University of the Pacific School of Dentistry, San Franicsco, CA
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
The US Oral Health System is undergoing profound change. The role of public payers in increasing with a 400% incerase in the contribution of public pauyers to total oral health expenditures in the last decasde. Thus, publicpyaers are becoming incerasingly interested in outcomes and value derived from publically funded oral health programs.
The California Medicaid program received an $750 federal waiver in 2015 to create a Dental transformation Initiative (DTI). It included the ability to test innovative strategies in providing oral health services to Medicaid beneficiaries.
This proesenbtation will describe the experiences from the inside six of the Local Dental Pilot Projects funded by the DTI.
Administer health education strategies, interventions and programs Administration, management, leadership Program planning Provision of health care to the public Public health administration or related administration Public health or related public policy
Abstract
A community-based effort in New York State to help make dental care more affordable for the uninsured population
Stephen D. Hooper, MBA1 and Mark LaVigne, Ph.D.2
(1)Health Economics Group, Inc., Rochester, NY, (2)New York State Association of Counties, Albany, NY
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Approximately 1/3 of the US population do not have dental benefit plan coverage.
Dental patients without “insurance” are at a double disadvantage: they have no financial help, and typically they are billed more than “in network” fees that dentists accept as full payment when patients are insured.
To help make dental care more affordable, the New York State Association of Counties, with Health Economics Group, introduced a network access (“discount”) program that gives uninsured patients access to a large nationwide network of dentists who accept the same fee levels, sometimes even lower than, they accept with insurance company contracts. While the network access program is not unique (many “dental discount” programs are available nationwide), this outreach approach is unusual, and the annual cost to individuals and families is substantially lower.
To illustrate the program’s value: in the lower Hudson region of NY the area median fee for a porcelain fused to high noble metal crown is $1,400 and the 80th percentile is $1,850. Network dentists accept $782 as payment in full. This pattern is similar across the state and throughout the US.
County executives, legislators, as well as Health Department and Office for the Aging professionals, have helped publicize the program. A major outreach focus is Medicare-eligible citizens who do not have dental coverage but whose oral health needs tend to be significant. To date, citizens in 59 of 62 counties have enrolled, and officials in 38 counties have endorsed the program.
This effort to improve dental care affordability continues.
Administration, management, leadership Advocacy for health and health education Planning of health education strategies, interventions, and programs
Abstract
Developing an Effective Community Oral Health Workers Program for Early Head Start
Hamida Askaryar, RDH, MPH1, Francisco Ramos-Gomez, DDS, MPH, MS2, Inese Verzemnieks, PhD, RN, PHN, CNL3, Jennifer Villalta, DDS1 and Vickie Kropenske, PHN, MSN4
(1)UCLA School of Dentistry, Los Angeles, CA, (2)University of California, Los Angeles, CA, (3)UCLA, Los Angeles, CA, (4)Hope Street Family Center, part of California Hospital Medical Center, Los Angeles, CA
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Purpose: Early childhood caries (ECC) is the most common chronic disease in young children, yet it is entirely preventable, This project's goal is to help reduce the burden of ECC in young children, focusing on Latino children. Ten caregivers will be trained and mentored to become Community Oral Health Workers (COHWs) who will provide oral health promotion workshops to the community (train-the-trainer model). This project utilizes an enhanced curriculum and builds on project results from the 2016 pilot study.
Methods: Ten caregivers enrolled in Hope Street Family Center Early Head Start (EHS) Program will participate in five 2-hour in-person bilingual (Eng,/Span.) oral health training sessions instructed by a UCLA pediatric dental resident (PDR), dental students, and prelicensure nursing students. Upon completion of training, and under supervision of the PDR, trained COHWs will instruct EHS Home Visitors and other caregivers in anticipatory guidance and preventive oral health practices to help alleviate ECC. Process, impact, and outcome evaluation will be conducted to assess changes in knowledge, practices and attitudes of caregivers regarding children’s oral health.
Results: Comprehensive project results will be available October 2018.
Conclusions: Combined with the pilot study results, this project hopes to show that caregiver knowledge and practices regarding children’s and pregnant women’s oral health can be significantly positively changed with a train-the-trainer model. COHWs can help reduce oral health disparities and ultimately improve ECC rates for vulnerable populations. Efforts to train and utilize COHWs for ECC prevention is a viable option that must be expanded.
Chronic disease management and prevention
Abstract
Understanding factors associated with parental acceptance of Silver Diamine Fluoride in underserved populations in the United States
Anjali Kumar, BDS, MPH, Jay Balzer, DMD, MPH and Dana Cernigliaro, MPH, PhD
NYU Langone Dental Medicine, Brooklyn, NY
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
The clinical effectiveness of silver diamine fluoride (SDF) has been well studied and is growing in popularity for treating early childhood caries (ECC) in the United States. In 2017, a cross-sectional study was conducted to identify factors associated with caregiver acceptance of SDF treatment for children presenting with caries at 7 Community Health Centers across the U.S. affiliated with the NYU Langone Dental Medicine Pediatric Dentistry Residency Program. A caregiver survey collected information on sociodemographic and acculturation characteristics, perceived benefits and barriers of SDF treatment and perceived health-related knowledge. Information on clinical data, insurance and SDF acceptance were collected through chart reviews. Descriptive statistics were assessed and logistic regression models developed for acceptance of SDF treatment. A total of 546 caregivers participated. Results showed that nearly all (93.8%) participants had public health insurance, nearly half (46.3%) were Hispanic and more than half had high school education or less (55.1%). Caregiver acceptance of SDF treatment was high (79.5%), especially for children with higher caries experience and ECC. A significant interaction was found between acculturation and acceptance of SDF treatment dependent upon whether caregivers were born in the U.S (p=0.042); greater acculturation was associated with SDF acceptance among caregivers who were U.S. born and lower acculturation was associated with SDF acceptance among caregivers born elsewhere. Given the complex interplay of acculturation with country of birth, providers need to be prepared to communicate risks and benefits of evidence-based dental treatments in nuanced and culturally sensitive ways.
Advocacy for health and health education Assessment of individual and community needs for health education Diversity and culture Implementation of health education strategies, interventions and programs Provision of health care to the public Public health or related research