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Margaret Drozdowski, DMD, Dental Director
Margaret Flinter, APRN, VP/Clinical Director
Model For Successful Model For Successful Implementation Implementation
Of A Mobile Dental Of A Mobile Dental Program Program
To Increase Dental Access To Increase Dental Access For School Aged For School Aged
ChildrenChildren
Who We AreWho We Are
Largest FQHC community health center in CT
1972: dentistry was CHC’s first clinical services
CHC has grown to 9 primary care centers across
CT,
rural to urban; large to small
• New Britain, Meriden, Middletown, Clinton, New
London, Groton and Norwalk
4 school-based health centers, elementary to
high
school
Who We AreWho We Are
Who We AreWho We Are
Medical, dental,
mental health,
HIV, OB and
domestic violence
services
180,000 visits FY 2005 - 40,000 dental visits
Who We AreWho We Are
We are collaborators,
organizers, and innovators
As an FQHC, we have a
particular set of mandates and responsibilities
The scope of our project has to be able to expand to the scope of the needs of our target communities and
service areas
Dental Disease In Dental Disease In ChildrenChildren
Dental disease in children is the most common preventable infectious disease
Fewer than 1 in 5 medicaid covered children have an annual dental preventative visit
Situation In ConnecticutSituation In Connecticut
Over 400,000 total medicaid recipients
1 in 4 kids in CT on medicaid
2/3 receive no dental care
Only 26% preventative care and 14% treatment
Statewide 30-50% of elementary school kids have untreated decay
Provider CrunchProvider Crunch Few safety net dentists
Less than 15% of private dentists participate
Shrinking dental workforce
Statewide oral health conference
• need for increased access
• need for additional services
Action TakenAction Taken
Connecticut Health Foundation
•oral health major focus
•major funder to build collaboration and
increase care delivery
•statewide involvement
Universal Goals
•Double utilization
•Self sustainable systems within 5 yrs
Potential SolutionsPotential Solutions
Increased # of participating private providers
Increased # of safety net providers/clinics
Expand into non traditional service delivery site• School based• HeadStart
School Based Dental School Based Dental ServicesServicesAt one time, the norm rather than the new
Proven effective
Provide access
Crumbles barriers, allow for early identification of decay, preventative treatment, and education
Resurrecting A “New Resurrecting A “New Old” ModelOld” ModelCHC in partnership
Portable equipment utilized
• cost efficient with significantly less start up costs
• more versatile due to portability
• Schools love it!!!
Non-clinical staff focused on developing relationship with school staff and parents
Delivery Models: CHC New Delivery Models: CHC New BritainBritain New Britain’s Start Smiling Program
Established in 2002
CHF grant to CHC as fiduciary agent
3 primary mechanisms:
1) community outreach and dental health education
2) delivery of preventive dental services
3) referral to treatment resources for children requiring restorative, emergent, and specialty care
Delivery Models: CHC New Delivery Models: CHC New BritainBritain February 2005 CHC added a dental unit at
New Britain High School: Connecticut’s largest public high school with almost 3,000 students
Addition of dental component into an already existing SBHC
161 children were seen for preventative visits
Step By StepStep By Step
Global support
Seed money
Lease hold improvement
Equipment
Hygienist
License and approvals
ChallengesChallenges
Mid year start date•promotion and marketing
•consent forms and medical histories
Class time interruptionTracking Follow up and completion of treatmentChair time not optimized Access ≠ delivery especially in
adolescent group
Success In New BritainSuccess In New Britain
161 kids treated in 6mos by part time hygienist
FinancialsFinancialsInitial investment
• $26,000 equipment• $4,000 space improvements
On-going expenses• “rent” space provided in-kind by the school• staff: hygienist and care coordinator• supplies
Profit/Loss: reimbursement and “utilization”• fixed medicaid rate• sliding fee scale rate for uninsured• unused chair time
Expansion In NB Expansion In NB Elementary SchoolsElementary SchoolsLocal hygiene student program data collection
•58% HUSKY kids with untreated decay
•63% uninsured kids with untreated decay
School board strongly supports a dental program
Pilot at the “neediest” school
Delivery Models – Delivery Models – Southeast CTSoutheast CTSoutheast CT Smiles program
•Local Health district
•Connecticut Health Foundation
•CHC is one of two participating FQHC’s
Age group of focus for this project is the elementary and middle school population
Mobile dental equipment first piloted
Delivery Models – Delivery Models – Southeast CTSoutheast CT CHC subcontract with Health District to
provide service
In school year 2004-2005, CHC joined mobile team
17% of enrolled elementary students were seen by the CHC’s mobile hygiene team
Unique Difference In CHC Unique Difference In CHC New LondonNew London
No pre-existing school based
health center
Identify location with school
Advance coordination of appointments
2nd trip coordination for sealants
MORE COMPLEX COORDINATION NEEDED
Success In New LondonSuccess In New London
279 kids seen by mobile team
56% 61%
30%
0%
10%
20%
30%
40%
50%
60%
70%
UntreatedDecay
NeededSealants
CompletedTreatment
Delivery Models –HeadStart Delivery Models –HeadStart in Norwalkin NorwalkEarly detection and prevention is key
Over 170 children screened
•48% had dental decay
•18% of the children had decay in more than 3 areas
Far away from Healthy People 2010 goal
Community rallied together to affect change
2 mobile dental clinics in the works
Collaboration Leads To Collaboration Leads To SuccessSuccess
Innovation and plan
Key members
•community leader support
•safety net sites and providers
•private parishioners
•community agencies
Board of Education support
“If there’s a will there’s a way”
$$$ = Sustainability
Next Steps…Next Steps…
Start as early as possible Increase participating centers Maximize utilization
Key PointsKey Points
Collaboration
Sustainability
Access ≠ care
Success is
possible
Contact InformationContact Information
Margaret Drozdowski, DMDCommunity Health Center of New BritainOne Washington SquareNew Britain, CT 06051 ph: 860.224.3642 x5167 email drozdom@chc1.com
Margaret Flinter, APRNCommunity Health Center, Inc.635 Main StreetMiddletown, CT 06457 ph: 860.347.6971 x3622 email flintem@chc1.com
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