oral health collaboration in humboldt co perspectives from a rural county l.
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Oral Health Collaboration in Humboldt Co. Perspectives from a rural county. Laura McEwen, MS, RD. Agenda. Story of oral health in a Public Health model Guidelines for State and Territorial Oral Health Programs by ASTDD, 2005 Assessment Policy Development – Develop a plan

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  • Story of oral health in a Public Health model
  • Guidelines for State and Territorial Oral Health Programs by ASTDD, 2005
    • Assessment
    • Policy Development – Develop a plan
    • Assurance – Do what you planned
  • Foundation of Collaboration

Size of Rhode Island

Population: 128,000

Humboldt County - Lost Coast

Rural and Isolated

45% of the county population live away from main services in small, unincorporated communities of 3,000 or less

Six hours by car to San Francisco, Sacramento or Portland

High Poverty Rates

Overall 18%, but 24% of children 0-17 years old live in poverty

High Drug, Alcohol, & Tobacco Use

County has high methamphetamine use and manufacturing, highest binge drinking rate in the state, and ranks among the worst in the state for drug-related deaths

Non-profits make up 12% of economy - 5th largest employer
  • Eureka and Arcata voted best small towns in America for artists
  • Beautiful environment
learning from the community 1999 2000
Learning from the Community1999-2000
  • Local foundation receives small two-year grant to address children’s health issues
    • Anemia and dental disease
    • Public Health and Foundation as partner
  • Caesar Chavez Community Service Award
    • Dental disease in children and youth
    • California Conservation Corps as partner
bringing the partners together 2000
Bringing the Partners Together2000
  • Early Idealism
  • Roundtable included Head Start, Public Health, Private Practice Dentists, Dental Clinics, School Nurses, retired doctors and local Foundations
  • We think we have a children’s dental crisis
  • Didn’t have a clue as to what everyone did
  • It was always someone else’s problem
assessment data as catalyst for change 2000 2001
AssessmentData as Catalyst for Change2000-2001
  • Start simple
  • One pediatric practice did oral health screenings on all children for one month
    • about 1500 children screened
  • 11% overall had at least one untreated carie
    • 4% of private insurance
    • 20% of those on Medi-Cal or CHDP
assessment data as catalyst for change 2000 20019
AssessmentData as Catalyst for Change2000-2001
  • Dental van did oral health assessments on all 57 children in a low-income rural isolated community
  • 91% needed further treatment
  • 85% have untreated caries
  • Average of 5 teeth affected per child
assessment data as catalyst for change 2000 200110
AssessmentData as Catalyst for Change2000-2001
  • Oral Health in America – A Report of the Surgeon General
  • Oral health is essential to overall health
  • Put the mouth back in the body
policy development developing a plan
Policy DevelopmentDeveloping a plan
  • Local Foundation said, “We will fund a facilitator for the dental partners to develop a a strategic plan”.
  • Creation of Task Force
    • Ten members – broad based
  • Foundation involvement implied future funding based on strategic plan
policy development developing a plan12
Policy DevelopmentDeveloping a plan
  • Very contentious
  • Dentists, Public Health, Non-profits, and Foundations had never worked together
  • Broke into two ideological groups
    • Pay private practice DDS to treat Medi-Cal children
    • Build the infrastructure of preventive services
policy development developing a plan13
Framework for Action rather than strategic plan

Mosaic approach where everyone can move ahead


Target children age 0-12 years old

Framework for Action





Case Management



Policy DevelopmentDeveloping a plan

Policy DevelopmentDeveloping a plan

Humboldt County Children’s Oral Health Report included the Needs Assessment and Framework for Action

Produced in July 2001

Printed as full report and as executive summary

Glossy print job



Phase I


  • Raising awareness about the children’s dental crisis
    • Newspapers
    • Radio
    • Television
    • Community Groups
    • First 5 Humboldt
    • Foundations, Non-profits
assurance phase ii 2002 2005
AssurancePhase II2002-2005
  • Circle of Smiles Partnership – 2002 - 2005
    • Access to Care
      • New 11-operatory dental clinic, expanded mobile dental services, coordinator for hospital-based services
    • Preventive Education
      • CCC mimicked CDDPP for 2 years, Quack & Wabbit Puppeteers, Mobile dental van from Santa Clara
    • Collaboration
      • Oral Health Coordinator at Public Health, annual sealant clinics, develop the Dental Advisory Committee
assurance phase ii 2002 200517
AssurancePhase II2002-2005
  • The California Endowment awarded the Circle of Smiles Partnership almost $1 million over three years in August 2002
assurance phase ii 2002 200518
AssurancePhase II2002-2005
  • Great successes with COS
    • CCC joined CDDPP – 5,000 children
    • Sealant Clinic – 250 children annually at no cost using volunteer dental professionals
    • Dental Advisory Group became a very engaged well-networked collaborative
      • In the final analysis this was the legacy of COS
assurance phase ii 2002 200519
AssurancePhase II2002-2005
  • Extensive collaboration led to halo activities
    • AAP Oral Health Preceptorship Award
    • Grants for Saturday dental clinics for Head Start and Foster Care children
    • Red Carded program provides case management for the ADA Class III & IV children identified in sealant clinic screening
    • WIC is strong partner in oral health education
    • Small grant to Paso a Paso to provide longer credit terms to undocumented families who want care at private practice dentists
assurance phase ii 2002 200520
AssurancePhase II2002-2005

Other Halo Activities

  • Dental Angel Fund
  • Another hospital-based dental program
  • CCC TOOTH gets large AmeriCorps grant with 14 more FTEs
  • First Smiles Training for medical and dental professionals
assurance phase ii 2002 200521
AssurancePhase II2002-2005

Sealants & Smiles at College of the Redwoods

President of CR

HBMWD Fluoridation


CDDPP at Elementary Schools

Superintendent of Instruction

Eureka Rotary supports Sealants & Smiles

assurance phase iii 2005 2010
AssurancePhase III2005-2010
  • In 2005 a move was started to remove the fluoride from Arcata’s water
  • It has been fluoridated for over 40 years
  • Very coordinated response from medical, dental, and health advocates
  • Election in Nov ‘06
assurance phase iii 2005 201023
AssurancePhase III2005-2010
  • What next?
  • Early Smiles, Forever Smiles (Pending 2007-2010)
    • Establish the Well Child Dental Visit for children 0-5 years old on Medi-Cal at medical and dental clinics
    • Expand the CCC TOOTH program to address targeted needs
    • Establish a promatora program to address oral health and diabetes awareness with Latino families
    • Continue case management of Red Carded program
    • Sociospatial evaluation
assurance phase iii 2005 201024
AssurancePhase III2005-2010

Well Child Dental Visit

  • Based on the six-steps from the First Smiles Dental Initiative
    • Anticipatory guidance, knee-to-knee position, toothbrush prophy, oral health assessment, fluoride varnish, and counseling
  • Goal: 70% of all children 0-5 years old on Medi-Cal have three WCDV per year by 2010
  • Sociospatial evaluation of Head Start dental data over time
assurance phase iii 2005 201025
CCC TOOTH Expansion


Special Education Classes

Parent outreach

Two outlying high-need communities

Service Project to develop a corps of volunteers

AssurancePhase III2005-2010
assurance phase iii 2005 201026
AssurancePhase III2005-2010

Promatora Program

Identify and train Latina women of the community to use the natural social networks to raise awareness about oral health and diabetes

assurance phase iii 2005 201027
AssurancePhase III2005-2010

Red Carded Program

  • About 9% of all children screened for sealants are ADA Class III or IV
    • Data of 3,000 screened
  • About 70 students/year
  • Provide intensive case management for families
  • St Joseph Family Resource Centers
assurance phase iii 2005 201028
Sociospatial Evaluation

Incorporates environmental and social factors

GIS Maps

Percent 0-5 year olds living in poverty by geographic indicator

Our Evaluation

Head Start dental severity data mapped by a sensitive geographic indicator over time

Location and number of WCDV

AssurancePhase III2005-2010
in summary
In Summary
  • Creative solutions based on a strong foundation of collaboration using a classic public health model

Lmcewen@co.humboldt.ca.us 707-476-4980