NOHN Resource Booklet by Southern Plains Tribal Health Board

RESOURCE GUIDE Published January 2022

CONTENTS Pathways for Peer-to-Peer Collaborations ��1- 2 Wisdom of the Three Sisters ��3 Who We Are ��3 - 4 Federally Funded Health-Care Delivery System ��5 Factors That Impact Oral Health Outcomes ��6 Oral Health Surveillance ��7 - 8 Dental Clinic Listings �� 9 - 12 National Resources �� 13 - 14 Area Resources �� 15 - 16 State Resources �� 17 - 18 Helpful Links �� 19 - 22 Steering Committee �� 23 - 26 Acknowledgements �� 28

NOHN RESOURCE GUIDE

PATHWAYS FOR

COLLABO

CORE G

Actively participates in discussi various projects and overall direct works closely with SPTHB in p

OCCASIONAL

ACTIVE

OCCASIONAL

ACTIVE

OCCASIONAL

Interact with NOH members themse provide a service products and resou NOHN, or sponsor

Attends NOHN meetings occasionally, limited contribution, uses information and resources available through NOHN and shares with colleagues and other networks

SPONSORS

R PEER-TO-PEER

ORATIONS

GROUP

ion, makes decisions regarding tion of NOHN, facilitates meetings, providing leadership for NOHN

OCCASIONAL

ACTIVE

OCCASIONAL

ACTIVE Attends NOHN meetings regularly, participates occasionally in discussion and in NOHN projects that are of interest, provides feedback

HN without being elves, receive or e, gain access to urces produced by r NOHN activities

OCCASIONAL

SUPPORT

NOHN RESOURCE GUIDE

WISDOM OF THE

THREE SISTERS Alone, a bean is just a vine, squash an oversize leaf. Only when standing together with corn does a whole emerge which transcends the individual. The gifts of each are more fully expressed when they are nurtured together rather than alone. In ripe ears and swelling fruit, they counsel us that all gifts are multiplied in relationship. This is how the world keeps going.

- Robin Wall Kimmerer (Citizen Potawatomi) from Braiding Sweetgrass

Who we are The Native Oral Health Network (NOHN) established in 2017 by partners from the Southern Plains Tribal Health Board (SPTHB) and the Absentee Shawnee Tribe in Oklahoma, is a program administered through the SPTHB. The NOHN consists of members from tribes, tribal organizations, state departments, professional organizations, academic institutions, and other groups across several states that connect to improve oral health in tribal communities. With momentum and capacity building since 2017, NOHN now consists of over 120 members, who bring over 31 unique areas of expertise. NOHN has collaboratively developed resources and facilitated partnerships that have strengthened efforts to improve the oral health of American Indians and Alaska Natives (AI/ANs).

What we do • Provide opportunities for networking, stakeholder collaboration, and professional development • Provide resources to support AI/AN oral health efforts • Provide education and tools for oral health advocacy • Provide technical assistance (training, data collection, etc.)

How we do it

• R&R with NOHN • Quarterly calls with updates on NOHN activities and member spotlights • NOHN core team meetings 3

• Quarterly workgroup calls guiding NOHN activities • Frequent outreach and interaction with members and stakeholders to offer and provide technical assistance (data collection, data analysis, educational materials, grant writing, document editing, etc.) • Monthly newsletter • Regular communication to members about partner events, NOHN activities, and up-to-date resources • Listening sessions and interviews on key topics and priorities • Resource development (tool kits, live/ on-demand webinars, fact sheets, data briefs, etc.)

Why we do it • To improve oral health outcomes and quality of life for AI/AN peoples • To reduce inequities among AI/ANs that lead to lack of access to dental care and poor oral and overall health • To support each other as peers with the goal of increasing productivity and efficiency to affect positive change • To align and enhance our work in providing AI/AN communities the keys to good oral health

Benefits of being a member • Networking opportunities • Help drive strategy and innovation • Faster problem solving • Access to new resources • Cross-pollinate ideas • Leverage resources with collaborations and partnerships • Professional development

Peer-to-peer collaborations and support are with SPTHB serving as the main facilitator. Membership and the extent of engagement are fluid and adjust based on topic, knowledge, interest, and availability. Engagement with NOHN activities can be categorized in the following areas: Core member: Actively participates in discussion, makes decisions regarding various projects and overall direction of NOHN, facilitates meetings, works closely with SPTHB in providing leadership for NOHN Active member: Attends NOHN meetings regularly, participates occasionally in discussion and NOHN projects that are of interest, provides feedback Occasional member: Attends NOHN meetings occasionally, limited contribution, uses information and resources available through NOHN and shares with colleagues and other networks Sponsor/Support: Interacts with NOHN without being members themselves, to receive or provide a service or to gain access to products and resources produced by NOHN or to sponsor NOHN activities

Your voice shapes NOHN

Consistent and frequent feedback is vital to the value NOHN creates. Ideas and comments on the work NOHN is doing, or should be doing, is what allows us to serve our members and their communities in a meaningful way. This is the most important aspect of being a NOHN member. For more information on how to get involved, contact Julie Seward at jseward@spthb.org.

NOHN RESOURCE GUIDE

FEDERALLY FUNDED HEALTH-CARE DELIVERY SYSTEM 6.9 million AI/ANs 573 tribes 326 reservations 546 statistical areas

2.6 million AI/ANs Served by Indian Health Service System (IHS)

Urban Programs

Tribal Programs

• 70% of AI/ANs live in urban areas • 41 nonprofit organizations provide services at 59 sites • Most are also federally qualified health centers (FQHC) Federal IHS Programs

• 22 hospitals • 429 clinics/centers/stations - Self-determination contracts - Self-governance compacts • Services provided set by tribes

• 24 hospitals • 93 clinics/centers/stations • Services provided are set by IHS and often limited to basic dental services

Source: https://www.ihs.gov/newsroom/factsheets/ihsprofile/ 5

FACTORS THAT IMPACT ORAL HEALTH OUTCOMES

Intervention Strategies

Workforce, Infrastructure & Policy

E.g., Community water fluoridation, interprofessional collaborations

E.g., Oral health in health improvement policies, sufficient funding to support oral health improvement

Risk Factors

Access to Care

E.g., Food deserts, social inequities

E.g., Alternative workforce models, teledentistry

ORAL HEALTH SURVEILLANCE

Oral Health Surveillance Monitoring oral health is essential for...

Oral conditions to monitor

Setting achievable objectives

Tooth decay (dental caries)

Planning and implementing oral

Gum disease (periodontitis)

health programs

Oral and throat (oropharyngeal)

Evaluating oral health programs

cancer

Gaining support and funding for

Infrastructure and access to

oral health programs

care

Indian Health Service (IHS) Division of Oral Health Surveillance Plan Every five years, the IHS Division of Oral Health will conduct small surveys (potentially with trained and calibrated examiners) that provide only national aggregate results for each age group. Every 10 years, the IHS Division of Oral Health will conduct large sample surveys (with only trained examiners) that provide IHS national and area specific results. Since the inception of this oral health surveillance plan in 2010, there are eight surveys conducted. Each survey used the Basic Screening Survey instrument (https://www.astdd.org/basicscreening-survey-tool/) as the tool to conduct community-based, clinic-based, and schoolbased surveys. The surveillance plan is subject to change based on the IHS Division of Oral Health. All of the IHS surveillance reports are public facing on the IHS Dental Portal at www. ihs.gov/doh.

TIMELINE OF ORAL HEALTH SURVEYS Oral Health Survey of AI/AN Adults 35 Years and Over

Oral Health Survey of 1-5 year-old-AI/AN Preschool Children

Oral Health Survey of Oral Health Survey of 6-9 year-old-AI/AN 13-15 year-old-AI/AN Children Youth

Fall - Spring

2021- 2022

2022- 2023

2023- 2024

2024- 2025

COUNCIL OF STATE AND TERRITORIAL EPIDEMIOLOGISTS (CSTE) Oral Health Status Preschool, Kindergarten, & 3rd Grade

CORE ELEMENTS OF AN ORAL HEALTH SURVEILLANCE SYSTEM

Permanent Tooth Loss for Adults Incidence of & Mortality From Oral and Pharyngeal Cancer Annual Dental Visit for Medicaid/CHIP Children

Oral Health Outcomes

CORE INDICATORS

Annual Dental Visit for Children 1-17 Years old

Access to Care Intervention Strategies

Annual Dental Visit for Adults & Adults with Diabetes

Workforce, Infrastructure, Policy

Community Water Fluoridation

Number of Dentists and Community-Based Oral Health Programs

Oral Health Survey of AI/AN Adults 35 Years and Over

Oral Health Survey of 1-5 year-old-AI/AN Preschool Children

Oral Health Survey of 6-9 year-old-AI/AN Children

Oral Health Survey of 13-15 year-old-AI/AN Youth

Fall - Spring

2026- 2027

2027- 2028

2028- 2029

2029- 2030

DENTAL CLINIC LISTINGS TRIBES, TRIBAL ORGANIZATIONS, AND URBAN INDIAN ORGANIZATIONS WITH DENTAL FACILITIES

OKLAHOMA CITY AREA CLINICS A-MO HEALTH CENTER 900 N Owen Walter Blvd Salina, OK 74365 (918) 434 - 8500 ABSENTEE SHAWNEE 15951 Little Axe Dr Norman, OK 73026 (405) 447- 0300 ANADARKO INDIAN HEALTH CENTER 201 E Parker McKenzie Dr Anadarko, OK 73005 (405) 247 - 7900 ARDMORE HEALTH CLINIC 2510 Chickasaw Blvd Ardmore, OK 73401 (580) 226 - 8181 CHICKASAW NATION MEDICAL CENTER 1921 Stonecipher Blvd Ada, OK 74820 (580) 436 - 3980 CITIZEN POTAWATOMI HEALTH CLINIC - EAST CLINIC 2307 S. Gordon Cooper Dr Shawnee, OK 74801 (405) 273 - 5236 COOWEESCOOWEE HEALTH CENTER

395200 W 2900 Rd Ochelata, OK 74051 (918) 535 - 6000

CHOCTAW NATION HEALTH CARE CENTER 1 Choctaw Way Talihina, OK 74571 (918) 567 - 7000 CLAREMORE INDIAN HOSPITAL 101 S Moore Ave Claremore, OK 74017 (918) 342 - 6658 CLINTON INDIAN HEALTH CENTER 10321 N 2274 Rd Clinton, OK 73061 (580) 331 - 3300 DURANT REGIONAL MEDICAL CLINIC 1801 Chukka Hina Dr. Durant, OK 74701 (580) 920 - 2100 EUFAULA INDIAN HEALTH CENTER 500 Eunice Burns Rd Eufaula, OK 74432 (918) 689 - 2547 HUGO HEALTH CLINIC 410 North M St Hugo, OK 74743 (580) 326 - 7561 IDABEL HEALTH CLINIC 902 E Lincoln Rd Idabel, OK 74745 (580) 286 - 2600

INDIAN HEALTH CARE RESOURCE CENTER OF TULSA

OKLAHOMA CITY INDIAN CLINIC

550 S Peoria Ave Tulsa, OK 74120 (918) 588 - 1900

4913 W Reno Oklahoma City, OK 73127 (405) 948 - 4900

KOWETA INDIAN HEALTH CENTER

OKMULGEE INDIAN HEALTH CLINIC

31870 E Highway 51 Koweta, OK 74429 (918) 279 - 3200

1313 E 20th St Okmulgee, OK 74447 (918) 591 - 5700

KANZA HEALTH CLINIC

PAWNEE HEALTH CENTER

3151 E River Rd Newkirk, OK 74647 (580) 362 - 1039

1201 Heritage Cir Pawnee, OK 74058 (918) 762 - 2517

KICKAPOO TRIBAL HEALTH CENTER

POTEAU HEALTH CLINIC

105365 N Highway 102 McLoud, OK 74851 (405) 964 - 2081

109 Kerr Ave Poteau, OK 74953 (918) 649 - 1100 PERKINS FAMILY CLINIC

LAWTON INDIAN HOSPITAL 1515 Lawrie Tatum Rd Lawton, OK 73507 (580) 354 - 5000

509 E OK-33 Perkins, OK 74059 (405) 547 - 2473

MCALESTER HEALTH CLINIC

1438 Hardcastle Blvd. Purcell, OK 73080 (405) 527 - 4700

1127 S George Nigh Expressway McAlester, OK 74501 (918) 423 - 8440 NORTHWEST TRIBAL HEATH SYSTEM 7600 S Highway 69A Miami, OK 74354 (918) 332 - 4316 OKEMAH INDIAN HEALTH CENTER 1800 E. Coplin St Okemah, OK 74859

PURCELL HEALTH CLINIC

REDBIRD SMITH HEALTH CENTER 301 S JT Stites Blvd Sallisaw, OK 74955 (918) 744 -1400 SAM HIDER HEALTH CENTER 859 E Melton Dr Jay, OK 74346 (918) 253 - 1700

(918) 623 - 1424 10

DENTAL CLINIC LISTINGS

TRIBES, TRIBAL ORGANIZATIONS, AND URBAN INDIAN ORGANIZATIONS WITH DENTAL FACILITIES

SAPULPA INDIAN HEALTH CENTER 1125 E Cleveland Sapulpa, OK 74066 (918) 224 - 9310

715 Grandview Pawhuska, OK 74056 (918) 287 - 9300

STIGLER HEALTH CLINIC

WATONGA INDIAN HEALTH CENTER

2204 E Main St Stigler, OK 74462 (918) 967 - 9200

1307 S Clarence Nash Blvd Watonga, OK 73772 (580) 623 - 4991

THREE RIVERS HEALTH CENTER

WEWOKA INDIAN HEALTH CENTER

1001 S 41st St Muskogee, OK 74403 (918) 781 - 6500

36640 Barking Water Rd Wewoka, OK 74884 (405) 257 - 6282

TISHOMINGO HEALTH CLINIC

WHITE EAGLE HEALTH CENTER

817 E 6th St Tishomingo, OK 73460 (580) 371 - 2361 VINITA HEALTH CENTER

WAH-ZHA-ZHI HEALTH CENTER

20 White Eagle Dr Ponca City, OK 74601 (580) 762 - 8104

27371 S 4410 Rd Vinita, OK 74301 (918) 256 - 4800

KANSAS AREA CLINICS

W.P. MANKILLER HEALTH CLINIC

HASKELL INDIAN HEALTH CENTER

471688 OK-51 Stilwell, OK 74960 (918) 696 - 8800

2415 Massachusetts St Lawrence, KS 66046 (785) 843 - 3750

W.W. HASTINGS HOSPITAL

HUNTER HEALTH CLINIC

100 S Bliss Ave Tahlequah, OK 74464 (918) 458 - 3150

527 N Grove Wichita, KS 67214 (316) 262 - 2415

KICKAPOO NATION HEALTH CENTER 1117 Goldfinch Rd Horton, KS 66439 (785) 486 - 2154 PRAIRIE BAND POTAWATOMI HEALTH CENTER 11400 158th Rd Mayetta, KS 66509 (785) 966 - 8290

TEXAS AREA CLINICS KICKAPOO TRADITIONAL TRIBE OF TEXAS 2212 Rosita Valley Rd Eagle Pass, TX 78852 (830) 773 - 2105 URBAN INTER-TRIBAL CENTER OF TEXAS - CLINIC 1261 Record Crossing Rd Dallas, TX 75235 (214) 941 - 1050

MID-DEL COMMUNITY CLINIC 4748 S Bryant Ave Oklahoma City, OK 73135 (405) 672 - 0488 NEIGHBORHOOD SERVICES ORGANIZATION DENTAL CLINIC 431 SW 11th St Oklahoma City, OK 73122 (405) 236 - 0413

DELTA DENTAL FOUNDATION OF OKLAHOMA: RESOURCE FOR DENTAL CARE https://sites.deltadentalok.org/site_docs/ DDOK_FND_ResourceGuide_LR.pdf

DELTA DENTAL HELPLINE 405-607-4747 The Dental Navigators help patients find dental care resources they need and can afford.

OTHER LOW-COST/FREE CLINICS IN OKLAHOMA *Source: Health Alliance for the Uninsured

CHRIST COMMUNITY CLINIC 101 SW 25th St Oklahoma City, OK 73106 (405) 601 - 4948 HEALING HANDS HEALTH CARE SERVICES 411 NW 11th St Oklahoma City, OK 73103 (405) 272 - 0476

NATIONAL RESOURCES

AREA DENTAL SUPPORT CENTERS The purpose of the IHS Dental Preventative and Clinical Support Centers program is to combine IHS and tribal resources and infrastructure to address broad challenges and opportunities associated with preventative and clinical dental programs.

Dental Support Center

Dental Support Center Director

Alaska Area Dental Support Center

Dr. Sarah Shoffstall-Cone

sshoffstallcone@anthc.org

Albuquerque Area Dental Support Center

Aliandra Maes, RDH, BS

amaes@nappr.org

California Dental Support Center

Consuelo Gambino

cgambino@crihb.org

Great Plains Area Office

Dr. Flauryse Baguidy

flauryse.baguidy@ihs.gov

Montana/Wyoming Tribal Dental Support Center

Dr. Joe Park

joseph.park@srmt-nsn.gov

Nashville Area Dental Support Center

Frank Licht, RDH

flicht@usetinc.org

Oklahoma Area Dental Support Center

LCDR Keasha Myrick

keasha.myrick@ihs.gov

Southwest Dental Support Center

CDR Nadine Brown

nadine.brown@ihs.gov

Northwest Tribal Dental Support Center

Ticey Mason

tmason@npaihb.org

NATIONAL DATA SOURCES Data Sources

Information Available

Medicaid: Form-416 (more current data may be available from your state Medicaid agency)

Preventive dental service for children age 1-20 years enrolled in Medicaid or CHIP Medicaid expansion

https://www.medicaid.gov/medicaid/ benefits/epsdt/index.html

Any dental service for children age 1-20 years enrolled in Medicaid or CHIP Medicaid expansion Dental sealant uses among children aged 6-9 and 10-14 years enrolled in Medicaid or CHIP Medicaid expansion

Centers for Disease Control and Prevention- Youth Risk Behavior Surveillance System

Dental visit among adolescents in grades 9-12

https://nccd.cdc.gov/youthonline/App/ Centers for Disease Control and Prevention- Behavioral Risk Factor Surveillance System https://www.cdc.gov/brfss/ brfssprevalence/ National Cancer Institute-State Cancer Profiles https://statecancerprofiles.cancer.gov/ deathrates/ https://statecancerprofiles.cancer.gov/ incidencerates/ Water Fluoridation Reporting System https://www.cdc.gov/fluoridation/ statistics/ Association of State and Territorial Dental Directors https://www.astdd.org/docs/synopsessummary-report-2019.pdf https://www.astdd.org/docs/datasurveillance-reference-guide.docx

Dental visit for adults over the age of 18 All teeth lost among adults age 65 and older

Mortality from invasive cancer of the oral cavity or pharynx Incidence of invasive cancer of the oral cavity or pharynx

Population serviced by community water fluoridation

State-based oral health surveillance system ASTDD State Surveillance Data Reference Guide 14

AREA RESOURCES

OKLAHOMA CITY AREA Oral Health Quality in Medicaid and CHIP

Oklahoma Oral Health Report Card 2020 State Score:

Oklahoma <21 years

9/2021

Overview: Child Healthcare Quality

When compared to the nation’s performance on 13 key oral health indicators, Oklahoma scores a D. The Oklahoma Oral Health Coalition is a collaboration of organizations and individuals committed to impacting the oral health of Oklahomans. We created this report card to illustrate the gravity of the oral health problem in our state. Working together, we can improve these grades and the oral wellness of Oklahomans.

Year

Any Service (% children)

(% children)

Topical Fluoride ≥ 2/year (% children)

Caries-Related ED Visits Per 100,000 Member Months

2018

51.2%

46.9%

3.4%

20.2%

18.9

2017

50.3%

46.0%

3.7%

19.7%

22.3

2016

N/R

3.0%

N/R

21.0

52.1%

47.2%

3.7%

21.2%

National Sample, 2018*

INDICATOR

GRADE

16% of ages 1-2 received a preventive dental care visit 49% of ages 3-5 received a preventive dental care visit

49% of ages 1-20 received a preventive dental care visit

10% of ages 6-14 received dental sealants on permanent molars

49.6%

Urban

46.9%

Total

72% of ages 1-17 received one or more dental visits last year

66% of third graders have caries experience (treated or untreated tooth decay)

25% of third graders have dental sealants on permanent molars

ADULTS 58% of ages 18-64 visited the dentist in the last year

43% of ages 65+ have lost six or more teeth due to tooth decay or gum disease

21% of ages 65+ have lost all of their natural teeth due to tooth decay or gum disease

35% of pregnant women had their teeth cleaned during pregnancy

70% of Oklahomans have access to fluoridated water (natural or adjusted)

40% of needs were met in Dental Health Provider Shortage Areas

1-2 yrs 4.0% 3-5 yrs 6-7 yrs 8-9 yrs 10-11 yrs 12-14 yrs 15-18 yrs

42.5%

Rural

CHILDREN: GENERAL POPULATION 5

10%

20%

30%

40%

25.9% 27.1% 26.8% 25.2% 17.8% 20.2%

10%

20%

30%

% Children

1 in 4 children 6-14 years had at least 2 topical fluoride applications.

43% of children living in rural areas had an oral evaluation.

18.6%

6.3%

19-20 yrs Total

50%

% Children

Children aged 19-20 years had more than 4 times as many ED visits as the program average.

A REVIEW OF THE CURRENT DATA 2020-2021

Caries-Related ED Visits by Age and Geography, 2018 100

75 50

GENERAL POPULATION

Topical Fluoride at Least 2/Year by Age, 2018

Oral Evaluation by Geography, 2018

26.8

*Based on analysis of 29 states; N/R: Not Reportable, insufficient data. See DQA Oral Health Quality Reports for more info.

CHILDREN: ENROLLED IN MEDICAID 1

Caries Risk Oral Evaluation Documentation (% children)

ORAL HEALTH AMONG INDIAN HEALTH SERVICE OKLAHOMA CITY AREA POPULATION

1 <1yr

7 1-2 yrs

25 16

3-5 yrs

6-7 yrs

8-9 yrs

32 13

10-11 12-14 15-18 19-20 yrs yrs yrs yrs Visits/100,000 MM

Rural

Urban

Total

Julie Seward, RDH, MEd, Southern Plains Tribal Health Board Amanda J. Llaneza, MPH, Department of Biostatistics & Epidemiology The University of Oklahoma Health Sciences Center Alexandrea Holt, Southern Plains Tribal Health Board

Source: Analysis of Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files (TAF) [CY 2016, Release 2; CY 2017 & CY 2018, Release 1], Centers for Medicare & Medicaid Services. Analyses conducted by Key Analytics and Consulting. Contact dqa@ada.org for questions or additional data. 2021 American Dental Association on behalf of the Dental Quality Alliance (DQA)© All rights reserved.

For a PDF containing sources and details, go to oohc.org

Development and Underwriting by

Oklahoma Oral Health Report Card 2020

Oral Health Quality in Medicaid & CHIP Oklahoma<21 years

BEMIDJI AREA

IHS Oklahoma City Area Oral Health Report

PORTLAND AREA

ORAL HEALTH REPORT

BEMIDJI AREA AMERICAN INDIAN/ALASKA NATIVE (AI/AN) REPORT ON ORAL HEALTH DATA & SURVEILLANCE SYSTEMS

GREAT LAKES INTER-TRIBAL EPIDEMIOLOGY CENTER (GLITEC)

FEDERAL, STATE, AND TRIBAL ORAL HEALTH DATA COLLABORATIVE REPORT 2019

Bemidji Oral Health Report

E-Learing Course-Optimize Dental Teams with Dental Therapists

WEBINARS ON OKLAHOMA ORAL HEALTH OKLAHOMA ORAL HEALTH COALITION WEBINAR SERIES The Oklahoma Oral Health Coalition hosted the 2020-2021 webinar series “Raising the Grade on Oral Health in Oklahoma” to highlight and discuss the various aspects of the Oklahoma Oral Health Report Card. Each webinar features a panel of experts and discussions on specific populations or subjects. The recordings of these webinars are available at oohc.org. Rural Dental Health Professional Shortage Areas and Teledentistry Special Populations: Seniors, Veterans, Individuals with Disabilities Children and Pregnant Women Working-Aged Adults Dental Professional Workforce

NOHN DENTAL THERAPY WEBINAR SERIES An introduction to the dental health aide therapy (DHAT) provider model. Subject matter experts discuss what the DHAT provider model is, how dental therapy has been implemented, what dental therapy looks like in practice, and dental therapy’s impact on Native communities across the country. The recordings of these webinars are available at www.spthb.org/programs/our-grants/native-oral-health-network/ Dental Therapy: The Basics Highlights dental therapy outreach and advocacy activities happening throughout Choctaw Nation in Oklahoma, in addition to other activities to improve access to oral health care. This webinar also highlights a certified dental health aide therapist (DHAT) serving the Port Gamble S’Klallam Tribe in Washington State. Tribal Innovations for Improving Access to Oral Health Care An expert panel provides reflections on past advocacy efforts and how to build on those experiences in Oklahoma. This webinar takes a deeper dive into dental team dynamics when a dental therapist is part of that team. Further Considerations for Dental Therapy in Oklahoma

STATE RESOURCES

HEAD START GRANTEES

HARPER

WOODS

KAY

GRANT

ALFALFA

OSAGE WOODWARD

PAWNEE

TULSA

BLAINE

KINGFISHER

CREEK

LOGAN

CANADIAN

WAGONER

OKFUSKEE

CLEVELAND CADDO

POTT

GRADY

KIOWA

McCLAIN

SEQUOYAH

PITTSBURG

PUSHMATAHA

MURRAY

COTTON

ATOKA

JOHNSTON

CARTER JEFFERSON

MARSHALL

LOVE

-2 T F

Pontotoc

Comanche

Murray Carter

Johnston

Muskogee

Bryan

Adair

Sequoyah

Into

Pittsburg

Atoka

Stephens

Caddo Nation Child Development Program (HS) Central Tribes of the Shawnee Area (HS/EHS) Cherokee Nation (HS/EHS) Cheyenne-Arapaho (HS) Chickasaw Nation (HS) Choctaw Nation of Oklahoma (HS) Iowa Tribe of Oklahoma (EHS) Kickapoo (HS) Kiowa Tribe (HS) Muscogee (Creek) Nation (HS) Osage Nation (HS) Otoe-Missouria (HS) Ponca Tribe (HS) Seminole Nation Early Childhood Services (HS/EHS) CDI Serving Tecumseh (EHS)

Wagoner

Hughes

ttaw

ela

Grady

Kiowa

ato mie

Caddo

Tulsa

Okfuskee

Seminole

h kla

Okmulgee

Canadian

Washita

Lincoln

Beckham

Mayes

Payne Logan

Craig

Rogers

Roger Mills Custer

Kingfisher Blaine

McCURTAIN

CHOCTAW

BRYAN

Noble

Dewey

LeFLORE

LATIMER

COAL

STEPHENS TILLMAN

HASKELL HUGHES

PONTOTOC

GARVIN

COMANCHE

JACKSON

SEMINOLE

GREER

WASHITA

ev Cl

CHEROKEE

McINTOSH BECKHAM

Osage

DELAWARE

OKMULGEE MUSKOGEE

OKLAHOMA

Kay

MAYES

ADAIR

LINCOLN

CUSTER

OTTAWA

CRAIG

ROGERS

PAYNE

DEWEY

ROGER MILLS

NOBLE

GARFIELD

MAJOR

ELLIS

HARMON

Big Five Community Services HS CAA of OKC HS & Sunbeam EHS Community Action Devel. Corp. (CADC) HS CADC HS & Southwest OK CAG HS/EHS CAPTC HS/EHS, CARD HS/EHS, NACT HS & Educare EHS CDI Head Start Serving Northeast Oklahoma HS/EHS Community Action Resource & Development HS/EHS Crossroads Youth & Family Services (CYFS) HS/EHS CYFS EHS & Wewoka Public Schools Co-op HS Delta Community Action Foundation HS/EHS INCA Community Services HS KI BOIS Community Action Foundation HS Little Dixie Community Action Agency HS/EHS Muskogee County HS/EHS - Green Country Behv. Health Srvs. Opportunities, Inc. HS/EHS Southwest Oklahoma Community Action Group HS/EHS Twin Rivers HS United Community Action Program HS/EHS Washita Valley Community Action Council HS/EHS Wewoka Public Schools Co-op HS

NOWATA

Delaware

BEAVER

Cherokee

TEXAS

Nowata

CIMARRON

WASHINGTON

Head Start Grantees in Oklahoma

Haskell Latimer LeFlore

Pushmataha

Choctaw

McCurtain

MAP OF PROGRAMS

KAY

NOWATA OSAGE

NOBLE

MAYES

ROGERS PAYNE

DEWEY BLAINE ROGER MILLS

TULSA

KINGFISHER

CREEK

LOGAN

CUSTER CANADIAN

OKLAHOMA

WAGONER

DELAWARE

CHEROKEE ADAIR

LINCOLN

OKMULGEE MUSKOGEE OKFUSKEE

SEQUOYAH McINTOSH

BECKHAM

WASHITA

CLEVELAND CADDO

POTT

GRADY

KIOWA

SEMINOLE

CDI EHS (also Cleveland & Oklahoma Counties) Caddo Nation HS / Kiowa Tribe (Caddo County) HS Central Tribes of Shawnee Area HS (also Pottawatomie Cnty) Cherokee Nation HS/EHS Cheyenne-Arapaho HS Chickasaw Nation HS Choctaw Nation of Oklahoma HS Iowa Tribe of Oklahoma EHS (also Logan County) Kickapoo HS (also Pottawatomie and Lincoln Counties) Kiowa HS (also Caddo County) Muscogee (Creek) Nation HS Osage Nation HS Otoe-Missouria HS (also Ponca Tribe HS) Seminole Nation HS/EHS

HASKELL HUGHES

PITTSBURG

LATIMER

LeFLORE

PONTOTOC

COMANCHE

COAL PUSHMATAHA

MURRAY CARTER

JOHNSTON

ATOKA

BRYAN

CHOCTAW

McCURTAIN

OKLAHOMA HEAD START PROGRAMS Head Start helps families find preventative care with the Early & Periodic Screening, Diagnostic, and Treatment (EPSDT) schedule. EPSDT is a comprehensive, preventative care guide developed by the Oklahoma Health Care Authority. For dental care information on American Indian children enrolled in Head Start and Early Head Start, please contact: Paula A. Brown Director, Head Start State Collaboration Office Oklahoma Association of Community Action Agencies 605 Centennial Boulevard Edmond, OK 73013 P: 405-949-1495 F: 405-747-6681 headstart@okacaa.org

HELPFUL LINKS

RURAL HEALTH INFORMATION HUB

American Indian/Alaska Native populations. https://www.health.state.ok.us/stats/index. shtml

The Rural Health Information Hub, formerly the Rural Assistance Center, is funded by the Federal Office of Rural Health Policy to be a national clearinghouse on rural health issues. Supports health-care and population health in rural communities. https://www.ruralhealthinfo.org/

OKLAHOMA HEALTHCARE AUTHORITY

CDC WONDER CDC Wonder is a queryable web system that includes data for AIDS Public Use, births, cancer statistics, environment, mortality, online tuberculosis information system, population data (from Census), sexually transmitted disease morbidity, and vaccine adverse event reporting. https://wonder.cdc.gov/

NATIONAL INSTITUTE ON MINORITY HEALTH AND HEALTH DISPARITIES The National Institute on Minority Health and Health Disparities (NIMHD) is one of the 27 Institutes and Centers of the National Institutes of Health (NIH), the nation’s premiere medical research agency. NIMHD’s work touches the lives of millions of Americans burdened by disparities in health status and health-care delivery, including racial and ethnic minority groups, rural populations, populations with low socioeconomic status, and other population groups. https://hdpulse.nimhd.nih.gov

OK2SHARE Oklahoma Statistics on Health Available for Everyone is a queryable web system that includes vital statistics, health surveys, hospital and ambulatory surgery centers, and registries. This system is also linked with IHS data on 19

The Oklahoma Health Care Authority (OHCA) administers two health programs for the state. The first is SoonerCare, Oklahoma’s Medicaid program. SoonerCare works to improve the health of qualified Oklahomans by ensuring that medically necessary benefits and services are available. Qualifying Oklahomans include certain low-income children, seniors, the disabled, those being treated for breast or cervical cancer and those seeking family planning services. The second program OHCA operates is Insure Oklahoma, which helps qualifying adults and small business employees in obtain health-care coverage for themselves and their families. OHCA helps individuals find a provider, releases Dental Fast Facts quarterly, and releases SoonerCare demographics and breakdowns for American Indians/Alaska Natives monthly. https//www.okhca.org/

INDIAN HEALTH SERVICE DENTAL PORTAL The purpose of the Dental Portal is to have one place where staff who work in Indian health-care can locate essential resources to support the operation of effective clinical and community dental programs. https://www.ihs.gov/doh/ Indian Health Service Dental Directory https://www.ihs.gov/dentaldir/

ORAL HEALTH PROGRESS AND EQUITY NETWORK (OPEN) The Oral Health Progress & Equity Network (OPEN) brings change agents together to make sure that every person has the keys to fully access good oral health. OPEN is taking on the United States oral health challenges so that everyone has an equal chance to thrive. There are close to 2,000 members

from every state in the country engaged in this equity work. http://www.oralhealth.network/

NATIONAL MATERNAL AND CHILD ORAL HEALTH RESOURCE CENTER A national center serving the maternaland child-health community with highquality oral health technical assistance, training, and resources. https://www.mchoralhealth.org/index. php

HEAD START EARLY CHILDHOOD LEARNING AND KNOWLEDGE CENTER Resources available to promote healthy mouths for our youngest. Learn about proper toothbrushing, other preventative measures, and how to find a dentist. https://eclkc.ohs.acf.hhs.gov/oral-health

STRONG TEETH, STRONG KID - NATIVE AMERICAN CONNECTIONS Native American Connections, along with various oral health partners, launched the Strong Teeth, Strong Kid campaign November 1, coinciding with Native American Heritage Month. The Strong Teeth, Strong Kid campaign is an American Indian-led statewide effort to raise awareness of the importance of dental milestones for American Indian children age 0 to 5 year. https://strongteethstrongkid.org/

U.S. SURGEON GENERAL’S REPORT ON ORAL HEALTH Publication of this first Surgeon General’s Report (July 2000) on Oral Health marks a milestone in the history

of oral health in the United States. The report elaborates on the meaning of oral health and explains why oral health is essential to general health and well-being. https://www.nidcr.nih.gov/research/datastatistics/surgeon-general

U.S. SURGEON GENERAL’S REPORT ON ORAL HEALTH The purpose of this report will be to document progress in oral health the publication in 2000 of the first Surgeon General’s Report on oral health. The new report will also describe key issues that currently affect oral health, identify challenges and opportunities that have emerged since publication of the first report, articulate a vision for the future, and call upon all U.S. citizens to take action. https://www.nidcr.nih.gov/newsevents/2020-surgeon-generals-reportoral-health

OKLAHOMA STATE DEPARTMENT OF HEALTH DENTAL HEALTH SERVICE Dental Director, Dr. Jana Winfree Ph: (405) 271-5502 | Fax: (405) 271-5434 https://www.ok.gov/health/Family_ Health/Dental_Health_Service/index.html

EARLY CHILDHOOD CARIES COLLABORATIVE The Indian Health Service (IHS) Early Childhood Caries (ECC) Collaborative is a multi-faceted program designed to enhance knowledge about early childhood caries (also known as childhood tooth decay) prevention and early intervention among not only dental providers but also all health-care providers and the community. The collaborative provides the entire health-care team with the tools to begin a successful ECC program. Increasing access to oral health 20

HELPFUL LINKS care and evidence-based prevention is a collaborative effort that must include the oral health care team, medical providers, community health representatives, Head Start staff, and Women, Infant, and Children (WIC) program staff. The collaborative also provides the framework to dental providers for ECC early intervention, focusing on “caries stabilization.” https://www.ihs.gov/medicalprograms/ doh/index.cfm?fuseaction=ecc.display

POLICY STATEMENT ON ORAL HEALTH DISPARITIES AMONG INDIGENOUS CHILDREN A policy statement from the American Academy of Pediatrics (AAP) regarding the oral health disparities affecting Native American and Canadian Indigenous children. This statement addresses the high rates of dental caries and other oral health diseases Indigenous children, and the consequences of those high rates of disease. The AAP notes dental workforce shortages contribute to these disparities and advocates for dental therapy to increase access to care and to support the dental workforce. https://publications.aap.org/ pediatrics/article-abstract/147/6/ e2021051481/180261/Early-ChildhoodCaries-in-Indigenous-Communities?redire ctedFrom=fulltext

POLICY EQUITY TOOLCOMMUNTIY CATALYST The Oral Health Policy Equity Tool by Community Catalyst helps stakeholders analyze policies and center oral health in the principles of equity and community engagement. This interactive tool offers six sections of guided questions and discussion prompts to inform policy agenda setting, targeted questions focused on how a policy will affect various populations and marginalized groups, links to additional policy analysis tools with suggestions on where to integrate them with this tool, and a follow-up survey through which users can share feedback, 21

experiences, and suggestions for future updates to the tool. https://www.communitycatalyst.org/ initiatives-and-issues/initiatives/dentalaccess-project/oral-health-policy-equitytool

NATIONAL PARTNERSHIP FOR DENTAL THERAPY Co-chaired by Community Catalyst, the National Indian Health Board and the National Coalition of Dentists for Health Equity, the goal of the National Partnership for Dental Therapy is to elevate the visibility and broad, multisector support for dental therapy as an evidence-based way to improve access to oral health. The Partnership’s focus is improving access to much needed dental care in communities where the needs are the greatest. Support for dental therapy spans the political and geographic spectrum and over 100 groups have signed on to the NPDT to show their support for these innovative, communityfocused providers. For more information and resources please visit https://www.dentaltherapy.org/

IHS ORAL HEALTH STATUS OF AMERICAN INDIANS & ALASKA NATIVES https://www.ihs.gov/doh/documents/ surveillance/Infographic%20 encompassing%20surveys%20from%20 2016-2020.pdf

ORAL HEALTH POLICY AND IMPROVEMENT STRATEGIES IN OKLAHOMA This policy brief describes the oral health status of Oklahomans, challenges to oral health-care access, solutions to challenges in accessing health-care policy implementations on federal, state, and Tribal levels, and strategies to improve oral health care for American Indians/ Alaska Native in Oklahoma. https://issuu.com/spthb/docs/nohnpolicy-brief

MEDICAID ADULT DENTAL BENEFITS: IMPROVING ACCESS FOR TRIBAL POPULATIONS This policy brief is a collaborative effort of Community Catalyst, The National Indian Health Board, The Southern Plains Tribal Health Board, and Native American Connections. It outlines how dental benefits for adults on Medicaid can improve the oral health status of American Indians/Alaska Natives, how Medicaid and tribal health systems are connected, and recommendations for Congress on how to help improve the oral health of tribal populations. Medicaid Adult Dental Benefits

the 2011-2020 oral health surveillance surveys and a detailed timeline for the 2022-2030 surveillance plan. https://www.ihs.gov/doh/documents/ surveillance/IHS%20Oral%20Health%20 Surveillance%20Plan%202022-2030.pdf

NATIONAL INDIAN HEALTH BOARD (NIHB): TRIBAL ORAL HEALTH INITIATIVE The NIHB’s Tribal Oral Health Initiative is a growing body of work that includes a tool kit, research, tribal leader and tribal health-care administrator trainings, and eventually, the Tribal Oral Health Agenda. https://www.nihb.org/oralhealthinitiative/

ORAL HEALTH KANSAS Oral Health Kansas is dedicated to promoting the importance of lifelong dental health by shaping policy and educating the public so Kansans know that all mouths matter. Oral Health Kansas has played a major role in the efforts to raise the profile of oral health as a policy area and public health need in Kansas. oralhealthkansas.org

IHS DIVISION OF ORAL HEALTH ORAL HEALTH SURVEILLANCE PLAN 20112020 REVISION #2: 20222030 This is the current oral health surveillance plan from the IHS Division of Oral Health. This document contains key findings from

2021 NOHN STEERING COMMITTEE Gifty Crabbe, MPH Epidemiologist GCrabbe@glitc.org The Great Lakes Inter-Tribal Epidemiology Center (GLITEC) is a program of the Great Lakes Inter-Tribal Council, Inc. GLITEC serves the 34 tribes, four urban programs, and three service units of the Bemidji Indian Health Service Area (Bemidji Area), which includes Michigan, Minnesota, Wisconsin, and Chicago. GLITEC has been serving communities in the Bemidji Area since 1996. To learn more about program activities at GLITEC, please visit www.glitc.org/ epicenter You can also submit a request for assistance online at www.glitc.org/programs/ assist Aliandra Maes, RDH BS Director, Albuquerque Area Dental Support Center amaes@nappr.org The Albuquerque Area Dental Support Center’s role is to provide guidance, training, and enhancement to all of the IHS/Tribal/Urban dental programs within the Albuquerque Area as defined by the Indian Health Service. This Area includes New Mexico, southern Colorado, and El Paso, Texas. The AADSC serves 20 dental programs at 22 sites with approximately 180 related oral health personnel and administrators. The AADSC is housed within a tribal organization, Native American Professional Parent Resources, Inc. (NAPPR) whose mission is to empower, educate, and provide supportive services to build healthy Native American children and families www.nappr.org/dental Miranda Davis, DDS, MPH Native Dental Therapy Initiative Director mdavis@npaihb.org The mission of the Native Dental Therapy Initiative is to connect tribal communities with innovative approaches to address AI/AN oral health disparities, to remove barriers impeding the creation of efficient, high quality, modern dental teams and to provide opportunities for AI/AN people to become oral health providers. There is a tremendous opportunity to increase access to oral health care and improve oral health outcomes by training and employing Dental Health Aide Therapists (DHATs). DHATs are highly-trained primary oral health care providers. Part of a dentist-led team, they have a narrow scope of practice, focusing on routine and preventive services. They are recruited from their communities and go back to serve their communities. Tribes deserve the reliable, culturally relevant care that DHATs offer. The Native Dental Therapy Initiative is working to ensure this solution is available to all Tribes in the Portland Area. 23

www.npaihb.org/ndti/

Ticey Mason, MA Director, Northwest Tribal Dental Support Center tmason@npaihb.org The overall goals of the Northwest Tribal Dental Support Center (NTDSC) are to provide training, quality improvement, and technical assistance to the 39 IHS/Tribal dental programs in the Portland Area, and to ensure that the services of the NTDSC result in measurable improvement in the oral health status of the AI/AN people served in the Portland Area. The objectives are to continue oral health assessment, ensure quality of care, implement clinical and community-based prevention programs and provide continuing dental education. Furthermore, NTDSC works closely with IHS and other dental support centers towards meeting national objectives. The objectives of NTDSC are supported through ongoing communication with local dental programs via site visits, email groups, telephone consultation, and an annual Area-wide dental meeting. www.npaihb.org/ntdsc/

STEERING COMMITTEE Monica McKee, BSDH, MPH Director of Patient Services Monica.m@okcic.com Central Oklahoma American Indian Health Council, Inc. dba Oklahoma City Indian Clinic (OKCIC) is a 501(c)(3) nonprofit corporation that strives to increase access to quality health care and wellness services and produce positive health care outcomes for urban American Indians living in central Oklahoma. OKCIC is a contractor of the Indian Health Service to provide culturally sensitive health and wellness services from talented and devoted providers. From pediatric and prenatal care to family medicine, OKCIC services not only included basic medical care, but also dental, optometry, behavioral health services, fitness, nutrition and other family programs. www.okcic.com LaTonya Shelton-Miller, DDS Dental Director Jamie Rowell, RDH Lead Dental Hygienist jrowell@astribe.com The Absentee Shawnee Tribal Health System (ASTHS) serves the healthcare needs of Native Americans, SoonerCare members, American Indian Veterans, and insured Absentee Shawnee Tribe employees with a wide range of services for all ages. The ASTHS provides a culturally-sensitive, quality health care system for American Indians and Alaska Natives, which leads to health promotion and disease prevention through a multi-disciplinary team using holistic and evidence-based practices that address all health issues and educational needs while protecting individual confidentiality. Learn more about ASTHS, their services, and values at www.asthealth.org

Keasha Myrick, RDH, DHSc Director, Oklahoma City Area Dental Support Center Keasha.myrick@ihs.gov The Oklahoma Area Dental Support Center (OCADSC) provides preventive and clinical support, training and technical consultation to all dental programs in the Indian Health Service Oklahoma City Area, which includes 38 federally recognized Tribes in Oklahoma, 4 Tribes in Kansas, 1 Tribe in Texas, and 4 Urban Health Centers. The primary areas of focus for the OCADSC includes: • Address broad challenges and opportunities associated with IHS preventive and clinical dental programs • Provide support, guidance, training, and enhancement of I/T/U dental programs • Ensure that the dental support program services result in measurable improvements in the oral health status among the Native American population www.ihs.gov/doh

STEERING COMMITTEE

ACKNOWLEDGEMENTS The Southern Plains Tribal Health Board and the Native Oral Health Network (NOHN) staff would like to thank the following NOHN steering committee members for their time, expertise, and dedication to supporting tribes and tribal organizations improve oral health in their communities through the development and review of this guide. Aliandra Maes, RDH Director, Albuquerque Area Dental Support Center Native American Professional Parent Resources, Inc amaes@nappr.org Keasha Myrick, RDH, DHSc Director, Oklahoma City Area Dental Support Center Indian Health Service keasha.myrick@ihs.gov

This resource guide was prepared by the Southern Plains Tribal Health Board/Oklahoma Area Tribal Epidemiology Center. The Native Oral Health Network is a program of Southern Plains Tribal Health Board and is funded by the Center of Chronic Disease Prevention and Health Promotion within the Centers for Disease Control and Prevention under the grant “Building Public Health Infrastructure in Tribal Communities to Accelerate Disease Prevention and Health Promotion in Indian Country” in addition to the Oklahoma Shared Clinical and Translational Resources Program. 28

Julie Seward, RDH, MEd jseward@spthb.org | 405-339-7225 Alexandria Holt, MPH, CPH aholt@spthb.org | 405-965-3589 9705 N Broadway Ext, Ste 200 | Oklahoma City, OK 73114