ORAL HEALTH AMERICA

Strengthening School-based Dental Sealant

Programs through Partnerships, Policy

Development and Innovation

September 23, 2014

/Oral Health America @Smile4Health

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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.

OUR MISSION

OHA PRIORITIESOur 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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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

Shared responsibility

for health

Performance is measured

Payment for outcomes and

health

Transparency and clear

information

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