Strengthening School-based Dental Sealant Programs Webinar

ORAL HEALTH AMERICA

Strengthening School-based Dental Sealant Programs through Partnerships, Policy Development and Innovation

September 23, 2014

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OUR MISSION Oral Health America changes lives by connecting communities with resources to increase access to care, education, and advocacy for

all Americans, especially those most vulnerable.

OHA PRIORITIES Our Programs and Campaigns must have the capacity – short term or longer term – to influence health literacy, improve access to services and to advocate for systemic changes that will impact the oral and overall health of all Americans – particularly those most vulnerable.

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EDUCATION

ADVOCACY

Grant Funding

Product Donation

Sealant Initiative

Technical Assistance

Supportive Research

Strengthening School-based Dental Sealant Programs Through Partnerships, Policy Development, and Innovation Smiles Across America Webinar Series

Shanie Mason, Oral Health Program Manager Laurie Johnson, School Oral Health Programs Coordinator Amy Umphlett, Public Health Educator

Tuesday, September 23, 2014

Oregon’s Oral Health Status

†6- to 9-year-olds, primary and permanent teeth *Statistically different from the statewide average of 52%

Oregon’s Practice Act • Amended June 12, 2007 • Registered Dental Hygienists (RDHs): − Provide screenings − Determine the need for and apply fluoride and sealants •

Expanded Practice Dental Hygienists (EPDHs): − Provide screenings − Determine the need for and apply fluoride and sealants − Write prescriptions for all applications of fluoride − Provide prophies

Oregon’s Practice Act • Amended August 2, 2011 • EPDHs with a collaborative practice agreement with a dentist: − Administer local anesthesia − Administer temporary restorations without excavation (ART/ITR not allowed) − Prescribe prophylactic antibiotics and non-steroidal anti-inflammatory drugs − Conduct overall dental risk assessment and referral services

Oregon School-based Dental Sealant Program • Screenings and dental sealants • Schools with 50% or more FRL eligibility • 1st and 2nd graders (1st – 5th in small schools)

• Dental sealant program (2006-2007) − 11 schools; 451 children screened − 327 children sealed; 1,201 sealants provided • Dental sealant program (2013-2014) − 159 schools; 7,577 children screened − 5,162 children sealed; 16,502 sealants provided

Local Program Partnerships (2014-15) • 460 schools in Oregon are eligible (50% FRL) • Eligible schools served by school-based dental sealant programs:

− State program = 151 schools (32.8% of eligible) − Local programs = 202 schools (43.9% of eligible) − Combined = 353 schools (76.7% of eligible) • Schools not yet served = 107 eligible schools • Schools served that are no longer eligible = 39 schools

Certification Program • Certification from the state – HRSA workforce development grant activity • Training for local programs providing school-based oral health programs • School programs are now held to specific standards

• Memorandums of Agreement (MOAs): − Consistent data collection − Reporting requirements to the state

Health System Transformation in Oregon • Coordinated Care Organizations (CCOs) for Medicaid population • HealthCare.gov (Cover Oregon) – insurance exchange for individuals, families, and small employers • Early Learning System for a seamless education system from birth through college − Early Learning Council provides oversight and guides efforts to streamline state programs and policies to meet statewide goals

Coordinated Care Model Best practices to manage and coordinate care

Transparency and clear information

Payment for outcomes and health

Shared responsibility for health

Performance is measured

Coordinated Care Organizations • 16 CCOs serving 90% of Oregon Health Plan • Local health partnerships that administer Medicaid services to their communities and are paid per capita by OHA • Agreements with local public health • Mental, physical, dental care held to one budget • Responsible for health outcomes • Receive monetary incentives for quality

Dental Care Integration • Prior to health transformation, Dental Care Organizations (DCOs) served Medicaid population • Dental integrated into CCOs on July 1, 2014 – CCOs must contract with DCOs until 2017 • Oregon Metrics and Scoring Committee considering two dental health metrics as 2015 incentive measures for CCOs: − Sealants on permanent molars for children provided by dentist or non-dentist − Members receiving any dental service by a dentist or under the supervision of a dentist

Next Steps for Policy Development • Potential for collaboration between the state sealant program and CCOs to provide services • Reimbursement policies and practices • System-based approaches • Ensuring consistency • Quality assurance • Implementation of evidence-based practice

EPDH Expanded Services Delivery Model • Services provided over three visits: − Screenings − Dental sealants − Prophies − Two fluoride varnish applications

− Hands-on education (disclosing solution, flossing) − Limited case management • Electronic data collection on an iPad

Limited Case Management • Partnership with school nurse, Medicaid office, Coordinated Care Organizations (CCOs) • Child’s parent contacted to discuss ongoing needs for dental care • Encourage to enroll in or utilize dental insurance • Help caregivers find a dental home • Understand barriers to care to help overcome them

Data Collection • Quality practice is integrated into policies and procedures − Weekly huddles − Dental sealant metrics • New SmartMouth database captures data for school-based programs (sealants, fluoride, etc.)

• iPad usage in the field − Electronic transfer of SEALS data into SmartMouth • Evaluation of expanded services delivery model

Electronic Data Collection Application • 5 hygienists using an iPad (2014-15 school year) • Application built on iOS FileMaker platform • Sync button for easy data submission • Using third party host to allow for secure transmission of data from the field past the state firewall

• Automatic time capture • Alerts built-in for medical history, expanded services, proper completion, etc.

Home Screen

Child Search Home Screen

Screening Triage

Screening Chart

Sealant Placement

Additional Services – Part 1

Additional Services – Part 2

Contact Information Shanie Mason, MPH, CHES Oral Health Program Manager CP&HP Oral Health Program OHA Public Health Division Phone: 971-673-0338 shanie.m.mason@state.or.us Amy Umphlett, MPH Public Health Educator 2 CP&HP Oral Health Program OHA Public Health Division Phone: 971-673-1564 amy.m.umphlett@state.or.us

Laurie Johnson, RDH, MA School Oral Health Programs Coordinator CP&HP Oral Health Program OHA Public Health Division Phone: 971-673-0339 laurie.johnson@state.or.us