Abstract

Oral health forum: Oral health and population health management in Chicago, IL

Tooka Zokaie, MPH¹ and Alejandra Valencia, DDS, MPH, MS²
(1)Johns Hopkins School of Public Health, Baltimore, MD, (2)The Oral Health Forum, Heartland Alliance Health, Chicago, IL

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Dental caries are the most prevalent chronic disease in children in the United States, although they are largely preventable (NIDCR). Good oral health is related to the whole mouth being free of tooth decay and gum disease, but also free of chronic oral pain (IDPH). This is directly related to good overall health, for the mouth is connected to the rest of the body. Across Illinois, there are disparities to receiving quality preventative oral care and tooth decay disproportionately impacts children in poor and rural communities. In the 2016 Illinois statewide oral health assessment, poor oral health was one of the most pressing, unmet health care issues facing Illinois children (OralHealthIllinois). Illinois children living in poverty are five times more likely to have fair or poor oral health and only 55 percent of children on Medicaid even saw a dentist in the previous year. The Chicago Department of Public Health (CDPH) developed a school-based, public-private partnership oral health program (SBSP – School-Based Sealant Program) for the Chicago Public School (CPS) system involving dental examinations, sealant placement, and dental care referral. The primary focus of the population health management program is disease prevention aimed at dental caries and designated high-need zip codes that targeted children who would benefit from dental referrals. The Oral Health Forum (OHF) developed interventions to enable students of highest need in the weakest schools/communities to gain access to the SBSP and ultimately improve children’s oral health status. OHF set focused goals for their program including: 1) increase participation of children in the CDPH SBOHP targeting 2-3 highly needed zip code areas in Chicago, 2) Provide Oral Health Case Management to 60 Chicago Public Schools, and 3) Provide Oral Health Case Management to 2,800 CPS Children.

Oral Health Forum’s Case Management Intervention successfully targeted communities with high rates of child oral disease with the CDPH’s School Based Oral Health program. Children are first screened by the SBOH program and those who are identified at needing urgent dental treatment are referred to OHF for case management services. The case management team utilizes the principles of motivational interviewing (MI), trauma informed care (TIC), and harm reduction (HR) practices to facilitate access and referral to dental services.

After 5 years as a pilot program, the Oral Health Forum demonstrated improved percentage of change rates for children from schools with targeted intervention compared to zip code or SBSP level changes. Case Management activities have been shown to facilitate access to dental services when perceived barriers previous led to unmet care needs. By October 2017, CM has 3,862 referrals for CM and 81% successful contracts. By 2018, case management outreach services had impacted 78 Chicago Public Schools, 5,159 households were contacted, and 81% of those led to successful calls. 55% of those calls were with a family dentist, 28% scheduled a follow-up appointment, and 17% accepted referrals. Implications for case management intervention are significant, as common barriers regarding insurance status and lack of access to dental services are addressed. There was an upward trend in those seeking dental referral over time (7%, 17.1%, 22.2%) over three years. In addition, Oral Health Forum is widely integrated in programs across Illinois with partners in diverse sectors. Their reach is designed to assist communities in receiving the oral health disease prevention and care they deserve.

The Oral Health Forum School Based Sealant Program and Case Management activities have tremendous opportunities for growth and sustainability. The program model has been developed since its pilot intervention to target those most at need, seamlessly integrate into the education system, and break down oral health barriers for communities. There is opportunity for continued growth to other communities across Illinois with the proper support. In January 2020, the Illinois Senate proposed Bill 2520, that if passed, would provide the Department of Healthcare and Family Services to administer a school-based dental program that allows for the out-of-office delivery of preventative dental services in a school setting to children under 19 years of age. The Oral Health Forum program would inform the Department on how to establish guidelines for participation by providers and set requirements for follow-up referral care based on each caries risk assessment code required for each student (TrackBill). Oral Health Forum has designed the model, pilot tested the intervention in Chicago zip codes, successfully impacted the oral health of highest need communities, and has the infrastructure and opportunity to expand.

Administer health education strategies, interventions and programs Chronic disease management and prevention Implementation of health education strategies, interventions and programs Program planning Systems thinking models (conceptual and theoretical models), applications related to public health