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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


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History Promising Approaches for Linking Them With Dental HomesPre 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


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Sealant Program Results Promising Approaches for Linking Them With Dental Homes1984 - 2000

  • 31-47% of participants needed treatment

  • 78% of those received no care after one year


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Referral Failures Promising Approaches for Linking Them With Dental Homes

  • Dental Assistant phone calls

  • Lists to school nurses

  • Letters to parents

  • Intensive case management


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2004 Promising Approaches for Linking Them With Dental Homes“Give Kids A Smile Day”

  • Linked one school with one 6-chair CHD clinic and two mobile vans

  • 40 dentist volunteers


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“Give Kids A Smile Day” Organization Promising Approaches for Linking Them With Dental Homes

  • 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


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Subsequent Years Promising Approaches for Linking Them With Dental Homes

  • 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.


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Numbers for 2005 Promising Approaches for Linking Them With Dental Homes

  • 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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+ Promising Approaches for Linking Them With Dental Homes

Utilized current facility and staff

-

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


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Lessons Learned Promising Approaches for Linking Them With Dental HomesSchool-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


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Lessons Learned Promising Approaches for Linking Them With Dental HomesSchool-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


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Alternative Model: Mobile Van Promising Approaches for Linking Them With Dental Homes

  • 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


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2004 Promising Approaches for Linking Them With Dental Homes

  • Initiated Mobile Van Program

  • Two chairs (1 Dentist, 2 Assistants, 1 Driver/Receptionist/Manager)

  • Dentrix, direct digital radiography


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Funders Promising Approaches for Linking Them With Dental Homes

  • My godfather at the Ohio Department of Health

  • Anthem Foundation of Ohio

  • Mayerson Foundation

  • United Way

Mark


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Capital Costs Promising Approaches for Linking Them With Dental Homes

  • Van $315,000

  • Dental Equipment 80,000

  • Digital/Electronics 80,000

    TOTAL $475,000


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School-Based Clinic Promising Approaches for Linking Them With Dental Homes

  • Construction

    • $100/sq. ft. x 400 $ 40,000

  • Equipment$ 80,000

  • Electronics?

    TOTAL $120,000


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Targeting Promising Approaches for Linking Them With Dental Homes

  • Blanket school with consent forms

  • Sealant kids

  • Kids who come to school nurse

  • Nurse screenings


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Van Operations Promising Approaches for Linking Them With Dental Homes2005

  • 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


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School Children Promising Approaches for Linking Them With Dental Homes

  • Enrolled: 3,060 (6 schools)

  • Children participating: 1,230 (40%)

  • Much higher participation in early grades

  • Function of school principal and nurse


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Lessons Learned About Vans Promising Approaches for Linking Them With Dental Homes

  • 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


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Lessons Learned About Vans Promising Approaches for Linking Them With Dental Homes

  • 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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