Collective Engagement: Lifelong Smiles Coalition

Oral Health America Webinar Series

Collective Engagement: Lifelong Smiles Coalition

January 11, 2018

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CE Credit Available

ABOUT ORAL HEALTH AMERICA

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CAMPAIGN FOR ORAL HEALTH EQUITY Addresses oral health inequities in our society and identifies possibilities for closing the oral health divide in America.

The campaign strives to: Educate and engage the public, including policymakers, about the importance of oral health for overall health Emphasize the need to prioritize oral disease alongside other chronic health conditions Lead, participate and observe on legislative issues impacting oral health policies critical to OHA, our programs and stakeholders

Š 2017 Oral Health America

Di Findley

Executive Director, Iowa CareGivers

Suzanne Heckenlaible, MPA

Vice President of Public Affairs, Delta Dental of Iowa Executive Director, Delta Dental of Iowa Foundation

Tracy Rodgers, RDH

Executive Officer, Iowa Department of Public Health

Collective Engagement: Lifelong Smiles Coalition Suzanne Heckenlaible, Delta Dental of Iowa Foundation Di Findley, Iowa CareGivers Tracy Rodgers, Iowa Department of Public Health

OBJECTIVES 1. Lifelong Smiles Coalition – Collective Impact at work 2. Strategies and Learnings of the Mouth Care Matters and I-Smile Silver pilot project

Iowa’s Aging Population

Oral Health Needs of Aging Iowans When the Coalition was Formed:

• There were 457,738 adults over the age of 65 in Iowa.

• 1 in 3 of these adults had untreated tooth decay.

• 3 in 4 of these adults did not have dental insurance, which is often a barrier to access to care.

• Only 20% of long-term care facilities offer oral exams and screenings, but poor oral health can impact the health and well-being of nursing home and homebound older Iowans.

• Only 30% of those age 65 and older have seen a dental health professional within the past 12 months Left untreated, diseases of the mouth can lead to systemic health problems, especially in those with compromised immune systems.

*Framework adapted from International Association for Public Participation (IAP2) International Federation 2014.

INFORM ▪

Knowledge Learning Sessions (Educate, Motivate and Activate) to develop a learning community to address large scale system change • Initiated in November 2012

• Foundation Served as convener and funder

• Strategically guided the process of collective impact • Focused on improving the oral health of older adults, focusing on nursing home residents and homebound elderly.

• Hired consultant to conduct an oral health needs assessment of older frail Iowans

November 2012: “Educate” Session

CONSULT ▪

Two additional actionable knowledge sessions (Motivate and Activate) were held to identify key barriers and develop committees to address three overarching themes

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Subcommittees were formed: Education and training; outreach and coordination; and program and policy

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Facilitation and general coalition leadership support was provided by a consultant and funded by the Foundation, which continues today

Strategic Initiative Committees Committee Focus Education & Training

Coordination & Outreach

Program Policy & Reimbursement

Sustainability

Develop and promote training opportunities for oral health professionals, the direct care workforce and those providing care for older adults

Consider strategies to support older Iowans access to oral health care and to provide outreach to the public and other stakeholders about the importance of optimal oral health care for older Iowans

Stay abreast of legislative and policy activities related to oral health care and aging and examine innovative payment models

Consider strategies for sustainability for membership, stakeholders, leadership, and coalition retention and growth.

INVOLVE â–Ş

Recognizing the need among stakeholders to establish a statewide coalition, the Coalition was formed.

â–Ş

Stakeholders formally joined as partners and a workgroup was designed to create coalition structure guidelines, leadership structure, and key strategies for the coalition.

The mission of the Lifelong Smiles Coalition is to assure optimal oral health for aging Iowans.

Coalition Membership Membership is open, but not limited to:

• Public and private health/oral care providers and organizations • Health care support services • Government • Academic Institutions • Charitable and religious groups • Business and corporate entities • Citizen groups, associations, and individuals

Each voting member must sign the Commitment Letter. All members are encouraged to participate in Committee and Coalition meetings.

Coalition Partners As of Fall 2017 Iowa CareGivers

Iowa Public Health Association

Iowa Primary Care Association/Safety Net Iowa Collaborative

Iowa Health Care Association

Principal Financial Group

Iowa Department on Aging

Iowa Association of Area Agencies on Aging

Iowa Dental Hygienists’ Association

The University of Iowa College of Dentistry and Dental Clinics

LeadingAge Iowa Iowa Department of Public Health Delta Dental of Iowa Foundation Iowa Medicaid Enterprise Easter Seals Iowa Iowa Healthcare Collaborative

The University of Iowa College of Nursing Dental Connections, Inc. Office of State Long-Term Care Ombudsman Mid Iowa Community Action, Inc.

Visiting Nurses Services of Iowa Telligen

COLLABORATE â–Ş

A collective action plan was created and agreed upon by all partner organizations.

â–Ş

The Foundation slowly began the process of transitioning from leading the initiative to the goal of becoming the backbone organization for the Coalition, while providing content expertise and ongoing engagement.

Lifelong Smiles Coalition Committees

Steering Committee

Strategic Initiative Committees

Education and Training

Coordination and Outreach

Program and Policy Reimbursement

Sustainability

Sustainability Committee COMMITTEE FOCUS: Consider strategies for sustainability for membership, stakeholders, leadership, and coalition retention and growth.

COMMITTEE PROJECTS: • Membership/Stakeholder orientation • Retention and engagement • Research of Coalition resource options

EMPOWER â–Ş

The coalition began the process of vetting project grants from the action plan thru subcommittees which were submitted to the Foundation Board for approval.

â–Ş

Through funding of three projects aimed at improving access to care for nursing home and homebound Iowans, more than $1 million has been invested by Delta Dental of Iowa Foundation since 2013 to support oral health projects for older adults in Iowa.

Program Policy & Reimbursement

Program Policy & Reimbursement Committee COMMITTEE FOCUS: Stay abreast of legislative and policy activities related to oral health care and aging and examine innovative payment models

COMMITTEE PROJECTS: • State Legislative and State Department Education – Provide State Legislative education opportunities (e.g., Legislative Breakfasts, Legislative Committee Updates and Medicaid Solutions Document) • Surveillance of Oral Health Assessments – Monitor these assessments and participate in creation or changes as opportunities arise to advocate for appropriate representation of the aging population’s oral health needs • Evidence Based Protocols- Maintaining awareness and providing support

Maintaining Adult Dental Medicaid Benefits • Utilizing Statewide Care Engagement Teams (I-Smile Silver) • Diverse and Integrated Oral Health Delivery System Team • Maximize Oral Health Service Delivery and Reimbursement Innovative approaches • Transportation • Oral Health Education

Education and Training Di Findley, Iowa CareGivers

Education and Training Committee COMMITTEE FOCUS: Develop and promote training opportunities for oral health professionals, the direct care workforce and those providing care for older adults

COMMITTEE PROJECTS: • Office of Education and Training Development of training opportunities for oral health professionals, the direct care workforce, and those providing care for older adults • Mouth Care Matters - Oral health curriculum and training for direct caregivers • Dental and Medical Integration – Working with medical professionals to integrate oral health • Conference Presentations and Story Collection

Access to Oral Health for Older Adults • Specifically nursing home residents and homebound • Direct Service Workforce Shortages • Patterns of High Worker Turnover • Lack of Standardized Education and Training Across Care & Support Settings • Overall Lack of Awareness About the Importance of Oral Health

Prepare to Care & Mouth Care Matters Building Upon An Extensive Body of Work •

Direct Care Worker Task Force • •

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Charge – Educational Standards Recommendations

Lifelong Smiles Coalition endorsed project

• State-recognized curriculum with state-issued certificate • Competency-based • Based on needs of individuals served rather than workplace setting • Portable • Ownership of credentials and record • Specializations • Competency-based (oral health, mental health, dementia, etc.)

1st State-recognized Competency-based specialty under Prepare to Care in area of oral health When this is all in place, everyone will do it the same way. Right now, everyone is doing oral health differently.

Mouth Care Matters Instructors • 37 Dental Hygienists Graduated as Mouth Care Matters’ to date • Instructors—100% were satisfied with training

188 MCM Graduates

• 89% said training increased likelihood they will remain with current employer. • 95% said training increased likelihood they will remain in the field of direct care.

Impact – Direct & Indirect • Significant gain in knowledge.

• 99% can use what they learned.

• 99% satisfied with the training.

• 58 different provider sites had workers participate • 2 unique venues = Job Corps and Central Iowa Works

Impact – Direct & Indirect • Estimated 3500 residents/clients served by 54 provider sites (2 case study sites) • 191 reached via in-services • 8,000 reached (unduplicated/multiple times) with oral health ed via newsletter, websites, etc.

Lessons Learned • Workforce Challenges • Shortages made it difficult for staff to attend two-day classes • Reduced class to one day for second round

• Turnover makes it difficult to conduct meaningful longitudinal research/evaluation based on nursing home resident outcomes • Portability of MCM credential increases likelihood the knowledge and skills will follow workers from place to place • Infrastructure to ensure portability

Lessons Learned • Short-term vs long-term systemic change • Research vs Demonstration • Pre-Post Test Procedures

• Interdisciplinary training • Home and community-based focus • Prevention/Cost savings to system • Iowa heavy nursing home focus

• Cost of Program • Need follow up to reinforce what was learned • Case study sites did receive follow up/interviews/inservices/oral health campaign packets

Next Steps/Opportunities Recap: • Excellent interdisciplinary curriculum • Credential that workers own and are proud of • Dedicated corps of MCM instructors • Success stories • Impact on Iowans served, workforce, and others • Engaged & committed coalition members • Growing interest in direct care credentialing on part of legislators – Future Ready Iowa Initiative

Next Steps/Opportunities Direct care worker oral health education is vital to older Iowans receiving access to optimal oral care.

• Sustainability – Short Term: • Work with I Smile Silver Program in Coordination of Complimentary Programs • Continue to develop and test more consistent best practices/oral health protocols • Provide more Mouth Care Matters classes as funding permits

Next Steps/Opportunities Direct care workforce oral health education is vital to older Iowans receiving access to optimal oral care.

• Sustainability – Long Term: • • • • •

Integrate Prepare to Care into community college structure State infrastructure legislation Align with Governor’s Future Ready Iowa Initiative Telligen CMS Innovations grant Offer MCM as free standing/fee for service class or via scholarships • New federal conditions of participation for nursing homes, home care and other providers with oral care components = higher reimbursement payment

Office of Education and Training • Develop and promote training opportunities for oral health professionals, the direct care workforce, and those providing care for older adults.

• Led by University of Iowa College of Dentistry and Dental Clinics • Lifelong Smiles Coalition endorsed project

Coordination and Outreach Tracy Rodgers, Iowa Department of Public Health

Coordination & Outreach Committee COMMITTEE FOCUS: Strategies to support older Iowans’ access to oral health care and to provide outreach to the public about the importance of oral health for older Iowans COMMITTEE PROJECTS: • Online Outreach – Coordination of social media campaigns and maintenance of website information • I-Smile Silver – Replication of I -Smile program for children, creating a version focused on older Iowans

Why replicate I-Smile?

We’ve made some great strides improving the oral health of Iowa children – through innovative use of workforce and public health programs – and need to think of how to use those best practices with other populations.

Why replicate I-Smile?

I-Smile is a statewide program that began in 2006 I-Smile coordinators (dental hygienists) within 23 public or private non-profit organizations around the state are responsible for: • Working with dentists to accept referrals • Developing community partnerships to increase awareness about oral health • Providing trainings for health care providers – how to do an oral screening & apply fluoride • Providing care coordination to facilitate access to dental care (and more) • Ensuring risk assessments, oral screenings, fluoride varnish and sealant applications are provided to children at public health sites (WIC clinics, Head Start, etc.)

I-Smile: Number of Medicaid-enrolled children, ages 0-12, who receive a dental service – by provider type (2005, 2010, 2016) 140,000

120,000

Dentists 100,000

80,000

I-Smile™/Title V

60,000

Fed Qualified Health Centers* 40,000

20,000

0 2005

2010

2016

What is I-Smile Silver?

Pilot Project in 10 counties Population focus: • Iowans age 60 and older, • Residents of nursing facilities, • Medicaid Elderly Waiver participants, • Home and community-based service participants, • Direct caregivers, families, nursing facility staff, Medicaid Elderly Waiver case managers, and the public Purpose: to develop community-based systems that improve the ability of older Iowans to prevent dental disease, access oral health care, and maintain overall health

What is I-Smile Silver?

Contractors: Three county health departments (service area sizes range from one county to six) Key Workforce: Dental hygienists serving as I-Smile Silver Coordinators in each of the 3 pilot project service areas Current Funding: Private (Delta Dental of Iowa Foundation) and Public (Health Resources and Services Administration) – as well as limited Medicaid reimbursement

I-Smile Silver pilot project - 2017-2018 Pocahontas, Humboldt, Wright Calhoun, Webster, Hamilton

Scott

Des Moines Van Buren

Lee

How does I-Smile Silver work?

I-Smile Silver coordinators are responsible for these project strategies: • Assessing community needs & assets and oral health status of older Iowans • Building local partnerships (AAA, organizations, businesses, dentists, nursing facilities, home health, medical providers) • Developing dental referral systems • Providing care coordination • Training direct caregivers, nurses, and other health care providers

• Promoting oral health • Assuring provision of preventive services in nursing facilities

What do the I-Smile Silver Coordinators do?

Making sure oral health is recognized and becomes part of local systems that help older Iowans

• Participate in community meetings and workgroups - Dentist Recruitment Task Force, Senior Advocacy, Health Alliance, Hospital System’s Senior Services Administration, Long term Care Consortium • Develop relationships with Nursing Facility and Home Health workforce - nurses, speech pathologists, dietitians, occupational therapists, social workers, direct caregivers • Coordinate with the Area Agency on Aging on referrals and staff education • Present program and oral health information to community groups and organizations - Local Boards of Health, Lions Club, Chamber of Commerce, Parish Nurses, Hospital Management, Foster Grandparents

What do the I-Smile Silver Coordinators do?

Making sure the people who provide oral hygiene care for older Iowans understand the importance of oral health and that the dental workforce is comfortable providing care for older Iowans

Provide trainings for nursing facility and home health staff Promote continuing education courses through the University of Iowa College of Dentistry Offer and provide oral health expertise to health care provider training programs (e.g., nursing) at local colleges

What do the I-Smile Silver Coordinators do?

Helping people who are having difficulty understanding a complex dental delivery system

Provide care coordination services to facilitate older Iowans’ access to dental care ✓ Work with dental offices to take referrals or provide onsite care in a nursing facility ✓ Identify payment sources for dental care ✓ Link people with SHIIP coordinators ✓ Link people with Donated Dental Services for dental care (Dental Lifeline Network) ✓ AND link older Iowans to other resources they may need (foot clinics, heating assistance, food banks)

What do the I-Smile Silver Coordinators do?

Participate in community events - Health Fairs, Senior Day at the County Fair, Senior Olympics, Senior Health Expo)

Keeping oral health and I-Smile Silver “in front of people” so they know who to contact when they need help

Promote oral health • Newspaper articles • Newspaper advertisements • Congregate meals displays • Tray covers at local restaurants • Education materials with pharmacy prescriptions • Billboards • Radio shows • Identity badge holders for direct care workers • Bingo daubers

What do the I-Smile Silver Coordinators do? • Provide oral screenings to obtain surveillance data

Understanding the oral health needs and providing preventive care for older Iowans

• Arrange, provide, and oversee provision of screenings, cleanings, and fluoride varnish applications in a limited number of nursing facilities

What makes I-Smile Silver possible?

Relationships Lifelong Smiles Coalition

Delta Dental of Iowa Foundation

Local Public Health

Department of Human Services

Policies Public health supervision of dental hygienists I-Smile program: Improved access to care, care coordination, Medicaid reimbursement for preventive services by hygienists

Lessons learned from I-Smile Silver Successes Increase in community awareness Increase in calls for care coordination assistance Limited collaborations with local dentists Partnerships with Federally Qualified Health Centers Challenges Lack of payment source for dental care (AKA no Medicare dental benefit) More people who need care and cannot afford it compared to dentists willing to accept referrals Reaching homebound and independent living seniors Workforce limitations due to practice act

What have we learned about Older Iowans?

Feel the condition of his/her mouth is fair or poor Needed dental care within the past year, but didn’t get it due to an inability to pay for it Have untreated tooth decay

What are Future Opportunities with I-Smile Silver?

• Use of Silver Diamine Fluoride • Tele-dentistry • Increase focus on oral health connections to medical/hospital costs • Collaboration with Mouth Care Matters • Identify sustainable funding

Contact Information: • Suzanne Heckenlaible, Delta Dental of Iowa Foundation sheckenlaible@deltadentalia.com • Di Findley, Iowa CareGivers di.findley@iowacaregivers.org • Tracy Rodgers, Iowa Department of Public Health Tracy.rodgers@idph.iowa.gov www.lifelongsmilescoalition.com

Question and Answer Session • Questions are welcome! This session may last for 10-15 minutes.

• Write your questions in your control panel on the upper right hand of your screen.

• Submit questions at any time.

CE Credit Available

Contact Information • Suzanne Heckenlaible, Delta Dental of Iowa Foundation • sheckenlaible@deltadentalia.com

• Di Findley, Iowa CareGivers • di.findley@iowacaregivers.org • Tracy Rodgers, Iowa Department of Public Health • Tracy.rodgers@idph.iowa.gov • Eamari Bell • eamari.bell@oralhealthamerica.org