Best practices for state local oral health programs
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Best Practices for State & Local Oral Health Programs. ASTDD Best Practices Project March 2010. Introduction to Best Practices. Optimal oral health across the lifespan…. Need for Best Practices. Oral Health in America: A Report of the Surgeon General. National Call To Action

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Best Practices for State & Local Oral Health Programs

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Best Practices forState & Local Oral Health Programs

ASTDD Best Practices Project

March 2010

Introduction to Best Practices

Optimal oral health across the lifespan…

Need for Best Practices

Oral Health in America:

A Report of the

Surgeon General

National Call To Action

To Promote Oral Health 

A Public-Private Partnership

Under the leadership of The Office of

the Surgeon General

Building Infrastructure

and Capacity in

State and Territorial

Oral Health Programs

Prepared by: ASTDD

Need for Best Practices

To improve oral health and

general health status

To improve systems of care

Developing Best Practices

What will be

your program’s purpose

for developing best practices?

Association of State & TerritorialState Dental Directors (ASTDD)Best Practices Project

ASTDD Best Practices ProjectPurpose

Build more effective state, territorial and community oral health programs.

For: Expand Infrastructure & Capacity

Respond to National Call to Action

Advance Healthy People 2010

ASTDD Best Practices ProjectGoal

Promote the development of best practices by state, territorial and community oral health programs to enhance the oral health of Americans and reduce disparities.

Uses ofBest Practice Information

  • Use as building blocks

  • Share ideas & lessons learned

  • Raise awareness of oral health

  • Promote collaborations

  • Update guidelines

End-Users ofBest Practice Information

Dental Directors

Government Officials & Staff

Public Health Programs



Professional & Advocacy Organizations




Best Practices forState & Local Oral Health Programs

Using Best Practice Concepts

Optimal oral health across the lifespan…

Best Practice Concepts

1. A best practice is a methodology

that, through experience and

research, has proven to reliably

lead to a desired result.

2. Using best practices is a commitment

to using all the knowledge and technology

at one's disposal to ensure success.

Best Practice Concepts

3. Best practices do not have one template or form for everyone to follow.

4. “Best practice” does not commit

people or organizations to one

inflexible, unchanging practice.

Best Practice Concepts

5. Best practices is a philosophical

approach based around continuous

learning & continual improvement.

6. Learning & transfer of best practices

is an interactive, ongoing & dynamic

process that cannot rest on a static

body of knowledge.

Best Practices forState & Local Oral Health Programs

Best Practice Criteria

Optimal oral health across the lifespan…

“Best Practice”

“Best” from whose perspective

and using what criteria?

Obtain Input from End-Usersfor Best Practice Criteria

  • Build consensus through selection & ranking of BP criteria

    - Early buy-in

  • Collect additional information to guide selection of BP criteria

    - Types of BP information end-users need

    - Public health strategies in use

    - Self-reported successful practices

Association of State & TerritorialState Dental Directors (ASTDD)Best Practices ProjectSetting Best Practice Criteria

ASTDD Best Practices ProjectInput from States

State surveys:

  • Developed list of BP criteria

  • Ranked BP criteria

  • Identified categories of Best Practices information states wanted

  • Obtained listing of states’ reported top strategies and successful practices

ASTDD Best Practices ProjectBest Practice Criteria

  • Impact / Effectiveness

  • Efficiency / Cost Effectiveness

  • Demonstrated Sustainability

  • Collaboration / Integration

  • Objectives / Rationale

ASTDD Best Practices ProjectBest Practice Criteria

  • Impact / Effectiveness

    Provided benefits to the oral health care and well-being

    of certain populations or communities

  • Efficiency / Cost Effectiveness

    Showed costs and expenses are appropriate to benefits


  • Demonstrated Sustainability

    Demonstrated sustainable benefits and/or

    demonstrated that the practice been sustainable within

    populations/communities and/or in states/territories

ASTDD Best Practices ProjectBest Practice Criteria

  • Collaboration / Integration

    Built effective partnerships/collaborations among

    various organizations and integrated oral health with

    other health projects and issues

  • Objectives / Rationale

    Addressed HP 2010 objectives, met the National Call

    to Action to Promote Oral Health, and/or built basic

    infrastructure and capacity for oral health programs

ASTDD Best Practices Project“Best Practice” Definition

“Best Practice” is a service, function or process that has been fine-tuned, improved and implemented to produce superior results

that demonstrate impact/effectiveness, efficiency, sustainability, and collaboration/integration, with appropriate objectives/rationale.

Best Practices forState & Local Oral Health Programs

Best Practices

Applying the Science

Optimal oral health across the lifespan…

Best PracticeTranslate Research into Practice

■ Research evidence supporting the effectiveness & cost-effectiveness of a dental public health strategy

■ State of the science to design and implement programs and services

Why evidence?

■Constant or diminishing resources require that public health programs focus on effective and efficient practices

■“Evidence-based” approaches incorporate the best available scientific information into decision-making*

*Based on Sackett et al., BMJ 1996

Systematic Reviews

■Preferred method for identifying available knowledge; determining what is “best”; and summarizing it in a useful manner*

■Rule-based process reduces bias and error in reviewing and summarizing findings

Bader J et al., J Am Dent Assoc 2004;

Mulrow C et al., American College of Physicians 1998

Process in Analyzing aBest Practice Approach

■Describe the public health strategy

■Evaluate the evidence for effectiveness and cost effectiveness of the strategy

■Set initial review standards for Best Practice criteria

■Learn from state/community practices that show successful implementation methods

In the Absence ofResearch Evidence

■ Realize that the intervention may or may not be effective

■ Review available information

(e.g., related policies and position statements; theoretical rationale; consensus of expert opinion; descriptive data)

■ Identify and implement evaluative measures

■ Consider any unintended harms that could result from the intervention

ASTDD Best Practices ProjectUse of Evidence-Based Information

BP Project uses evidence-based information:

■In analyzing a Best Practice Approach

■In promoting its use for program development, implementation, and evaluation

■In sharing state of the science information on the ASTDD Website

Best Practice ApproachEvaluation of Evidence


Approaches ............................……..........… Approaches

Strength of Evidence

Research + Research +++

Expert Opinion +Expert Opinion +++

Field Lessons + Field Lessons +++

Theoretical Rationale+++ Theoretical Rationale+++

A Best Practice Approach Report

Research Evidence

Summary of Research Evidence

Best Practices forState & Local Oral Health Programs

Best Practices

Field Lessons & Support Network

Optimal oral health across the lifespan…

Successful PracticesProject’s Database

  • 48 states and 2 territories provided submissions

  • 230+ successful practices described

  • An expanding collection

Successful Practice DescriptionContent

  • History

  • Justification

  • Inputs, Activities, Outputs & Outcomes

  • Budget Estimates

  • Lessons Learned/Plans for Improvement

  • Available Information Resources

  • Best Practice Criteria

  • Contact Persons for Inquiries

Successful Practice Descriptions

Nevada’s State Oral Health Plan

Ongoing and DynamicDevelopment of Best Practices


Best Practices

Science & Art

of Successful


Supportive Environment




Best Practices


Best Practices

Project’s Developing Role:Building a Supportive Environment

  • A support network

  • Partners’ support

  • Building of evidence

  • State of the science

  • Capacity building tools

  • Program & policy evaluation

Best Practices forState & Local Oral Health Programs

Using Best Practice to

Build Infrastructure & Capacity

Optimal oral health across the lifespan…

Build Infrastructure & Capacity

  • 1999 ASTDD Project

  • State dental directors from 43 states participated

  • 10 essential elements identified

Surveillance System


State Plan




Linkages / Partnerships

Population-based interventions

Community capacity

Health systems interventions

Leveraging resources

Build Infrastructure & Capacity Essential Elements

Best Practice Approach Reports

1. State Oral Health Surveillance System

2. State Oral Health Coalitions

3. State Oral Health Plans

4. Mandate for a State Oral Health Program

5. Community Water Fluoridation

6. School Sealant Programs

7. School Fluoride Programs

8. Workforce Development

9. Oral Health of Individuals with SHCN

Best Practice Approach Reports(continued)

10. Improving Children’s Oral Health

through Coordinated School Health

Programs (released March 2010)

11. Prevention and Control of

Early Childhood Tooth Decay

(released March 2010)

Building Infrastructure1999 to 2007 Comparison

  • State oral health surveillance systems

    8 to 30 states

  • State oral health coalitions

    20 to 41 states

  • State oral health plans

    7 to 23 (33) states; 5 in development

Best Practices

ASTDD Best Practices Project

The Journey Continues

Optimal oral health across the lifespan…

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