California’s Dental Medicaid program has a low utilization rate for children (<50%). Barriers causing this low utilization are related to three major factors: patients, providers, and systems. The Dental Transformation Initiative enabled Alameda County Office of Dental Health to conduct a county-wide intervention using a systems approach to address these barriers.

Alameda County’s model 1) created a dental care coordination workforce (addressed client factors), 2) created a dentist network (addressed provider factors), and 3) created an online HIPAA compliant data collection database (addressed systems factors).

26 culturally and linguistically sensitive care coordinators from 14 agencies (county, community-based organizations, federally qualified health centers) received an 8-week training to enable them to educate families about children’s dental needs, assist families in scheduling and keeping dental appointments, and collect-enter data.

January 2018 to December 2019 data show: A network of 163 mostly general dentists provided preventive dental services to children; (FQHC=132 dentists/29 locations; Private=29 dentists/23 locations). They are trained by UCSF pediatric dental specialists (no cost CE 16 units/year), and get small financial incentives from the County for educating families.

8,685 children saw a dentist (most for the first time, half are aged 0-5 years); 24,107 dental appointments were made; no-show rate is 26% (FQHC is <15%) because of the care coordination.

This model reflects the necessary intersections of clients, providers, and databases through a system of care that could facilitate-mediate a connection which increased access to dental care for Medicaid children in Alameda County, California. This is worth replicating nationwide.

The Sonoma County Dental Health Program was awarded $4.1 million by the California Department of Health Care Services (DHCS) to demonstrate a 4-year pilot project focused on oral health disease prevention and management for Medi-Cal enrolled children ages 0-6. The project is funded through California’s Section 1115(a) Medicaid Waiver, as part of the Dental Transformation Initiative.

The goal of the project is to create a comprehensive system of care that prevents, diagnoses and manages treatment of early childhood caries in a culturally and linguistically supportive setting, employing three innovative strategies:

1. A community of practice comprised of all federally qualified health centers implements the DHCS’s Standard Caries Risk Assessment (CRA). For the first time, dental providers for Medi-Cal enrollees employ a standard assessment tool to guide patient care.
2. Bi-lingual CDHWs, a new workforce employed by the dental clinics, meet with families in private conversation, using motivational interviews to customize oral health and nutrition education, and to set family-specific behavioral goals.
3. A Sonoma Smile Mobile Application (Sonoma Smile App) serves as a family’s personal bi-lingual dental record and behavioral goal tracker. Outcomes:
   1. By January 2020, over 18,000 children received CRAs in participating dental clinics, followed by risk-based care coordination.
   2. 2019 Data:
      • All clinical partners continue to participate in the project
      • Over 8,000 unduplicated 0-6 year olds seen in participating clinics
      • Forty percent of these children met with a Community Dental Health Worker
      • Dental surgery under general anesthesia decreased by 20%

Background: California ranks in the lowest quartile of dental health indicators in the country. In 2017, the California Department Public Health gained funding and legislative authority to build capacity and infrastructure to improve oral health statewide, including grants for Local Health Jurisdictions (LHJs) to develop or expand their local oral health program. Fifty-eight LHJs received funding to plan, implement, and evaluate a program tailored to their local needs, supported by technical assistance (TA) provided by the California Oral Health Technical Assistance Center (COHTAC) at the University of California, San Francisco. COHTAC develops state-wide resources and trainings and responds to TA requests from individual LHJs.

Methods: To assess the operational effectiveness and reach of COHTAC, all TA and activities provided to LHJs were logged in a spreadsheet and categorized by topic: research methods/needs assessment, water fluoridation, tobacco cessation, school programs, community engagement/partnership development, reducing sugary drinks, and communication/oral health literacy.

Results: In 2019, COHTAC supported all LHJs, with over 780 individualized TA interactions. LHJs received TA between 2-26 times, usually across multiple topics. COHTAC managed and produced state-wide resources and trainings for all LHJs, including a website with over 130 resources, regional meetings, Lunch and Learns, general trainings on how to make a website, how to customize and obtain Parent Kits from First Five, and how to use the Smile California campaign.

Conclusion: A centralized TA center helps build local public health capacity, while also coordinating activities across the state for maximum impact. Rural and small counties especially benefited from TA.

Background: California’s low-income children suffer high prevalence and severity of tooth decay but have low dental care utilization. To overcome the barrier of low dental provider capacity and willingness to serve children on public insurance, Alameda County’s Dental Transformation Initiative Pilot: Healthy Teeth Healthy Communities (HTHC) created and evaluated a dental provider Community of Practice.

Methods: General dental providers were invited to join HTHC and receive free dental continuing education (CE), care coordination, and administrative support for serving children on public insurance. Surveys were administered following CE events and data analyzed using Stata. Focus groups were conducted with different stakeholder groups: private dentists, health center directors, health center dentists, and non-dentist providers/staff. Focus groups were transcribed and thematically analyzed with NVivo.

Results: 132 dental providers completed baseline surveys (63% general dentists, 24% dental assistants; 46% in private practice). Providers were most confident in their ability to provide family oral health education (59% extremely confident) but less confident in their ability to accept public insurance referrals (52%) and provide care to children under 5 (49%). Four focus groups were conducted (N=36; range 5-15 participants). Care coordination services were perceived as very helpful for serving this population, especially for language support, increasing patient attendance, and increasing referrals of young children. CEs increased provider confidence to treat young children. Private practices faced financial barriers. Some administrational inefficiencies and a need for more anesthesia services were also identified.

Conclusion: Dental providers felt care coordination and CEs helped increase their capacity to serve low-income children.