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Improving the Oral Health of School-Aged Children: Promising Approaches for Linking Them With Dental Homes Washington, DC May 11-12, 2006

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Improving the Oral Health of School-Aged Children: Promising Approaches for Linking Them With Dental Homes Washington, DC May 11-12, 2006. Cincinnati Health Department/ Greater Cincinnati Oral Health Council School-Linked Clinic and Mobile Dental Van Lawrence F. Hill, DDS, MPH

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Improving the Oral Health of School-Aged Children: Promising Approaches for Linking Them With Dental HomesWashington, DCMay 11-12, 2006

Cincinnati Health Department/

Greater Cincinnati Oral Health Council

School-Linked Clinic and Mobile Dental Van

Lawrence F. Hill, DDS, MPH

Cincinnati Health Department, Dental Director

Nancy L. Carter, RDH, MPH

Cincinnati Health Department, Assistant Dental Director

history pre 2004
HistoryPre 2004

Pre 1982 - Inner-City

  • School-linked/based hybrid clinics
    • Excellent in school-based
    • Not good in linked
  • 11 clinics – all antiquated
  • Neighborhood health centers monopolized by adult emergencies and adult care

1982 – All school clinics closed

sealant program results 1984 2000
Sealant Program Results1984 - 2000
  • 31-47% of participants needed treatment
  • 78% of those received no care after one year
referral failures
Referral Failures
  • Dental Assistant phone calls
  • Lists to school nurses
  • Letters to parents
  • Intensive case management
2004 give kids a smile day
2004“Give Kids A Smile Day”
  • Linked one school with one 6-chair CHD clinic and two mobile vans
  • 40 dentist volunteers
give kids a smile day organization
“Give Kids A Smile Day” Organization
  • Four Fridays in February
  • Consents to all kids
  • Screened all with consents
  • Organized by number of decayed teeth per classroom
  • ~ 300 kids and $80,000 gross
subsequent years
Subsequent Years
  • Dental Society dropped out (now have their own volunteer clinic)
  • We now move dentists and assistants from other clinics to supplement the Crest Smile Shoppe instead of volunteers
  • We have paid transportation
  • Coordinated effort of the project coordinator, school-based health center, and the dental clinic.
numbers for 2005
Numbers for 2005
  • Number of days = 21 (5 hour days)
  • Number of users = 425; encounters = 578
  • Gross production = $216,118
  • Cost = $57,625 (salary + fringe + supplies + transportation)

Assumption:

    • 2/3 Medicaid ($140,000)
    • Medicaid pays about ½ of fees ($70,000)
    • Thus, break even (only for costs shown)
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+

Utilized current facility and staff

-

Doesn’t increase community capacity, but may increase individual provider production

lessons learned school linked program
Lessons Learned School-Linked Program

Requires:

  • Intense organization
  • Reliable transportation
  • Cooperation of school staff (health center nurses) to coordinate consents/getting kids on buses, etc.
  • Resources of multiple providers at one place at one time
lessons learned school linked program11
Lessons LearnedSchool-Linked Program

Requires:

  • Can be done with volunteers or paid staff (volunteer staff takes additional planning and coordination and is less reliable!)
  • Can provide continuous care for children in participating schools
  • Impractical to do with a solo private practitioner because of cost of coordinator and transportation
  • Only works for schools that are in close proximity to safety net clinic
alternative model mobile van
Alternative Model: Mobile Van
  • High level of frustration in community over access to care for kids
  • Oral Health Regional Assessment and Planning Project (RAPP) – community request
  • School nurses and Head Start staff asked for a mobile van
slide13
2004
  • Initiated Mobile Van Program
  • Two chairs (1 Dentist, 2 Assistants, 1 Driver/Receptionist/Manager)
  • Dentrix, direct digital radiography
funders
Funders
  • My godfather at the Ohio Department of Health
  • Anthem Foundation of Ohio
  • Mayerson Foundation
  • United Way

Mark

capital costs
Capital Costs
  • Van $315,000
  • Dental Equipment 80,000
  • Digital/Electronics 80,000

TOTAL $475,000

school based clinic
School-Based Clinic
  • Construction
    • $100/sq. ft. x 400 $ 40,000
  • Equipment$ 80,000
  • Electronics?

TOTAL $120,000

targeting
Targeting
  • Blanket school with consent forms
  • Sealant kids
  • Kids who come to school nurse
  • Nurse screenings
van operations 2005
Van Operations2005
  • 1,230 school children (users)
    • 497 (40%) – diagnostic/preventive only
    • 733 (60%) – diagnostic/preventive/treatment
  • 713 Head Start children (users)
    • 492 (69%) – diagnostic/preventive only
    • 221 (31%) – diagnostic/preventive/treatment
school children
School Children
  • Enrolled: 3,060 (6 schools)
  • Children participating: 1,230 (40%)
  • Much higher participation in early grades
  • Function of school principal and nurse
lessons learned about vans
Lessons Learned About Vans
  • Needs one strong dental staff person to provide liaison with schools
  • Need a cooperative, designated school person to coordinate from inside (i.e. school nurse, office personnel, etc.)
  • Need linkages to pediatric specialists and to a private practice, safety net program, or dental school to provide back-up when van is not available
lessons learned about vans21
Lessons Learned About Vans
  • Need sound plan for provision of care and generation of revenue on days schools aren’t available
  • Need more vans
    • 16/62 schools in 2.5 years with only 40% participation
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