Promoting Oral Health for South Florida A Community Dialogue October 15 th , 2007

1. Policy Considerations in Oral HealthMary E. Foley, RDH MPHDean, Forsyth School of Dental HygieneMassachusetts College of Pharmacy and Health Sciences Promoting Oral Health for South Florida A Community Dialogue October 15th, 2007

2. What is Policy?

3. According to Webster… • a definite course of action selected from among alternatives and in light of given conditions to guide and determinepresent and future decisions; • a high-level overall plan embracing the general goals and acceptable procedures especially of a governmental body

4. Many Kinds of Policies • Professional • Programmatic • State • Federal • Public

5. Professional Policies

6. Examples of Professional Policies • American Academy of Pediatric Dentistry • Dental Home • American Dental Association • Fluoride Varnish • Association of State and Territorial Dental Directors • Fluoridation • American Academy of Pediatrics • First Dental Visit • Pros and Cons • Authoritative sources provide same and sometimes different viewpoints

7. Executive Branch President Legislative Branches House of Representatives Senate Federal PoliciesPublic Policies • Policies created by the Legislature • Enact Bills to protect public, promote health and prevent disease • Approved/Vetoed by the President • Example: SCHIP

8. Federal PoliciesProgrammatic

9. US Department of Health and Human Services

10. Executive Branch Florida Governor, Charlie Crist Legislative Branch Florida House of Representatives The Florida Senate State Policies

11. Process of Policy Development State or Federal Government Agencies • Policy that leads to Programmatic Development • Policies that Support Programs • Medicaid

12. Process of Policy Development • Federal legislation that creates programs: “Authorization” • Authorization is not enough • Dollars need to be “Appropriated” to support the legislation or the program • Examples: SCHIP, Head Start

13. Examples of Programmatic Policies • Federal Level • Head Start • SCHIP • State Level • Community Water Fluoridation • State Oral Health Authority • Rules and Regulations that support dental care services, i.e. pregnant women; school-based dental sealant programs, CSHCN

14. Examples of Public Policies • Agency: CDC • Develops national policies • Influence State Health Departments • Immunizations and School Entry • Vision, Hearing and Oral Health Screenings • Community water Fluoridation • Agency: CMS • Programs: Medicaid and SCHIP • Provides rules and regulations to support programs • Provides Federal dollars to support programs

15. US Department of Health and Human Services

16. How the Public can Impact Policy • Educate policy makers on ways to increase the capacity and effectiveness of state oral health programs • Utilize an organized approach • Message bearers (leadership, coalition, partners) • 4 evidentiary inputs (burden document, state plan, surveillance findings, results of evaluation) • Promote support for outcome goals CDC/CDHP

17. Conceptual Framework www.cdhp.org

18. Identify Opportunities for Policy Change • Environmental Assessment • Assess state systems, social mores, political conditions, and policy directions • Systemic approach: • Private dental care delivery system • Safety net dental care delivery system • Dental/dental hygiene education system • School system • Water system • Political system • Legislative system www.cdhp.org

19. Consider Socio-Political Agenda • Identify and align with political agenda • Economy • Employment • Individual income levels • Demography - particularly of vulnerable populations • Immigrants • Migrants • Minorities • Age-related distribution • Special populations: frail elderly, adult handicapped, institutionalized • Geography/Rurality • Epidemiology of oral diseases and competing diseases (e.g. obesity, cardiovascular health, diabetes) • Political philosophy www.cdhp.org

20. Inform Legislature • Raise awareness of issues/problems to legislators • Stakeholders can use anecdotal evidence, advocacy/activism, event or press coverage, or data. • Data - burden document, epidemiologic studies • “Hooks and Drivers" www.cdhp.org

21. Coalition Building • Coalitions: Powerful Advocacy Groups that Moves Agenda Forward • Inform Legislators • Engage • Carry messages forward • Identify legislative champions • Add volume to the voice • Say things that program directors cannot say • Provide different perspectives • Demonstrate to policymakers that issues have been well thought-out and understood by many stakeholders www.CDHP.org

22. Result • Through preparation, strategy, and collaboration… • Generate champions… • Shape the debate… • Push for legislation that promotes oral health and disease prevention… • The outcome … • Policy enactment www.cdhp.org

23. Legislative Support for anOral Health Authority • 17 report a statutory mandate for an office/division/bureau/program of oral health • Arizona • Arkansas • California • Florida • Hawaii • Illinois • Indiana • Maryland • Mississippi • Missouri • Nebraska • Nevada • North Carolina • Oklahoma • Pennsylvania • Rhode Island • Texas ASTDD 2003 Survey; www.astdd.org; www.cdhp.org

24. Legislative Support for Community Water Fluoridation • 12 states report a statutory mandate for state-wide community water fluoridation • California • Connecticut • Delaware • Georgia • Illinois • Kentucky • Louisiana • Minnesota • Nebraska • Nevada • Ohio • South Dakota ASTDD 2003 Survey

25. State Policies to Improve Early Childhood Oral Health • State Infrastructure: AZ • Medicaid EPSDT: TN • Medicaid Perinatal Benefit: MA • Fluoridation: IL • Sealants: OH • Infant Oral Health: WA • Fluoride Varnish: NC

26. Policy & Program Opportunities Based on the “New View” Adapted from SG Workshop and AMCHP in “Opening the Mouth” at http://ccnmtl.columbia.edu/draft/soup/openMouth/pt02.html

27. Opportunities for Policymakers from SG Workshop 1. Early & Timely Intervention A.Link oral health policies & programs to other early childhood efforts including: • High risk infant toddler programs • Visiting nurse, promotores, and care coordination programs • Nutrition programs/ WIC/ Head Start/ Early Head Start • CSHCN programs • Primary care pediatrics • Day care accreditation and regulation B. Adopt AAP and AAPD recommendations • Age one dental visit, particularly for high risk children • Establish a “dental home” along with a “medical home” for all

28. Opportunities for Policymakers from SG Workshop 2. Assure competencies: Prepare the health care workforce • Promote a common core curriculum on oral health for • OBs, pediatricians, family docs • nurse practitioners, nutritionists • dentists, hygienists • public health practitioners • Require core competencies in oral health promotion in • accreditation standards • guidelines • performance measures for state supported health professional education.

29. 3. Go public Partner with private sector organizations Initiate a public awareness campaign Promote state-level oral health coalitions Develop and publicize “disease burden documents” Develop a state oral health plan Champion oral health with visits, legislation, programs, press, proclamations, speeches, influence Opportunities for Policymakers from SG Workshop

30. Opportunities for Policymakers from SG Workshop 4. Fix public programs • Infrastructure: ensure empowered, stable, well-staffed office of oral health • Financing: retain comprehensive dental benefits in Medicaid & SCHIP; adopt & promote age 1 standard • Prevention: maximize state fluoridation &promote sale of fluoridate bottled water; expand sealant programs • Safety net: expand dental care for pregnant women and young children in health centers, coordinate with WIC/ Head Start… • Health professional education: include early oral health education and experience • Special Needs Programs: integrate oral health

31. Opportunities for Policymakers from SG Workshop 5. Maximize use of science • Surveillance: Conduct regular epidemiologic reviews • Maximize prevention: Develop & promote risk screening, oral anticipatory guidance, and primary prevention in infants • Target at-risk young children in Medicaid/SCHIP: provider education/ incentives and age-defined enhancements • Conduct pilot trialsof “medical management” for efficacy, effectiveness, and cost-effectiveness • Engage AHECsin provider education on early caries prevention and management • Establish fluoride varnish programs with a variety of providers • Link programs: caries & obesity share common risks

32. Resources • American Academy of Pediatric Dentistry • American Academy of Pediatrics • American Dental Association • Association of Clinicians for the Underserved • Association of State and Territorial Dental Directors • Association of State and Territorial Health Officials • CDC Division of Oral Health • Children’s Dental Health Project • HRSA Maternal and Child Health Bureau • MCHB Oral Health Policy Center, MCHB Oral Health Resource Center • NIH/NIDCR Oral Health Disparities Program CAN-DO and CREEDD • Children’s Dental Health Project

33. Contact Information Mary E. Foley, RDH, MPH Dean of Forsyth School of Dental Hygiene Associate Professor of Dental Hygiene Massachusetts College of Pharmacy and Health Sciences 179 Longwood Avenue Boston, Massachusetts 02115 t: 617-735.1049 f: 617-732.2225 mobile: 857-488-9046 Mary.foley@mcphs.edu