A COPC health intervention for kids in the Mary s Center community

1. A COPC health intervention for kids in the Mary’s Center community Cheryl Focht, MD and Heather Cerar, RN Special Thanks to Duane Foster, Maria Gomez, Fitzhugh Mullan, Ben Gitterman, and the entire staff at Mary’s Center

5. Community Characterization

6. Community Health Status Secondary Data Sources US Census- 1990 and 1997 Estimates District of Columbia Office of Planning District of Columbia Office of Maternal and Child Health District of Columbia Department of Health State Center for Health Statistics Council of Latino Agencies Mary’s Center for Maternal and Child Care Children’s National Medical Center DC Department of Tuberculosis Control

8. Vital Health Statistics Infant Mortality Rates per 1000 live births Infant Mortality Rate for DC is 14.4 Infant Mortality Rate for Latinos is incalculable due to such low numbers Prenatal Care 50% of DC Latinas did not receive prenatal care during their first trimester

10. Teen Pregnancy The percentage of births to teenagers (13-19years) out of the total number of births * 1993 data

11. Health Statistics HIV/AIDS In the District of Columbia, Latinos made up 4% of the new AIDS cases reported in 1998 (they comprise 8% of the total population) Sexually Transmitted Diseases: In DC, rates among all teens are up 26% from 1996-1997

12. Hospital Admissions to Children’s Hospital in DC Latinos Pneumonia Bronchiolitis Dehydration Perinatal Infection Urinary Tract Infection (Latino children made up 10% of admissions) African Americans Asthma Chemotherapy Pneumonia Bronchiolitis

13. Immunization Rates Percentage of 2-year olds up to date on required immunizations (1996 data) Mary’s Center 96% DC 65%

14. Oral Health In a 1995 dental screening in our community, 45% of children ages two to five years were found to have dental caries. 1999 CSNAP Survey at Mary’s Center (Children’s Sentinel Nutrition Assessment Program) 90% of Latino children did not have regular dental visits 29% did not practice recommended dental hygiene

15. Nutritional Status At Mary’s Center... In 1995, 5% of children ages six months to five years were diagnosed as failure to thrive In 1998, over 20% of children ages one to eight were diagnosed as obese

16. Health Insurance Coverage at Mary’s Center(1996 data)

17. Qualitative Data Sources Key Informants Pharmacist Pediatrician Teen Program Director Day Care Center Director Social Worker Radio Show Host Community Educator Clinic Receptionist Focus Groups Even Start Program Educators Community Agency Staff Community Parents Mary’s Center Staff

18. Community Comments Definition of health: “If the child eats, smiles and plays he’s healthy.” Who is your community: “I like the centers of help, because…they make you feel like you are not alone.” Strengths of the community: “strength of the people, commitment to family” Barriers in receiving health care: “…ser Hispano (todo esto) es un problema” and “No poder communicarle con el doctor lo que tiene el nino” Common problems in health care: “Providers need to adapt their care based on the health care needs of the community”

19. Identified Health Care Problems of Children in Our Community Decreased access to well child care Poor parental understanding of normal development Parental perception for use of medication Lack of available services for diagnosis and treatment of learning & behavioral problems Lack of knowledge about community services Teenage pregnancy Nutritional Problems/Obesity Tuberculosis HIV/AIDS Asthma Anemia Elevated lead levels Suicide and Depression School Dropouts Dental caries/poor oral health

20. Prioritization

21. Step 1: Community Team Participants: members and directors of community agencies, a parent in the community, and two members of the Mary’s center staff. Activities: presentation of characterization data, discussion of community issues, individual ranking of top five health issues. Outcome: AIDS/HIV Nutritional Problems Lack of available services for diagnosis and treatment of learning and behavioral disorders Lack of parental education Poor oral health/caries

22. Step 2: Clinic Staff Participants: all staff members of Mary’s Center Activities: presentation of characterization data, scoring of five health problems selected by community prioritization team Criteria used: Magnitude Community concern Efficacy of an intervention Resources needed Sustainability of an intervention

23. Detailed Assessment

25. Dental Caries - Literature Search Early childhood caries (ECC) is defined as one or more carious lesions involving maxillary anterior teeth in a child under three years. Prevalence: US overall 5% Developing countries 20% US inner city immigrants and Native Americans 50%

27. High Risk Behaviors Mother’s dental hygiene Passive child rearing/overindulgent parents Inappropriate feeding practices: Frequent bottle use “At will” breast or bottle feeding Nighttime bottle use (sugar pools around teeth) Prolonged bottle use after normal weaning Inadequate dental hygiene (brushing, fluoride toothpaste, regular dental visits)

29. Environmental Risk Factors Race/Ethnicity Culture Socioeconomic status Stress Health care delivery and access

30. Discussions with Dental Caries Experts Three nationally renowned dental caries researchers A pedodontist working with the Federal government to reduce dental caries Director of pediatric dentistry at Children’s Hospital in DC Local pedodontist, caries researcher and community advocate for Latino children Local dentists Several national dental organizations

31. Primary Data Collection

32. Intervention Planning

33. What is being done?

34. What needs to be done? Recognize the problem as a major public health issue Prevention. Prevention. Prevention. With a focus on the prenatal period and the first year of life. Encourage involvement of primary care providers and train dental providers to work effectively with children. Train all health care providers about the current guidelines for oral hygiene Provide access to preventative dental services for all children.

35. The Intervention

36. Program Objectives Increase the knowledge of parents about cleaning infants mouths and brushing children’s teeth. Increase the number of parents of children under age 1 who clean their child’s teeth. Increase the number of parents who know that tap water is a source of fluoride. Increase the number of children drinking tap water. Decrease the number of children drinking from the bottle past one year of age. Increase the number of parents who know which beverages and foods most commonly cause cavities. Increase the number of children who have had their first dental visit before the age of 2 years. Increase access to preventative dental care.

37. Educational Activities 1. Initial training with Mary’s Center Staff 2. Preventive dental program integrated into existing prenatal classes. 3. Integration of oral health on the well child forms used at each visit.

38. “Hands-On” Activities Posters in each exam room. (foods to avoid, proper snacks, bottle use, dental hygiene) Picture brochures to hand out at the 6 month visit regarding proper dental hygiene. Local dentist to come in during playgroup to talk to parents about routine dental care. Referral source of local dentists. Bottle exchange Handing out toothbrushes and toothpaste Radio campaign

39. Program Evaluation

41. Evaluation Oral Health Knowledge and Behavior Survey re-administered to parents 2 years after program implementation. Documentation of prevalence of early childhood caries among target population after 3-5 years of program.

42. Future Directions Oral Health at Mary’s Center Collaborations with neighborhood dental offices and dental departments at local hospitals to increase the safety net of dental providers within the community. Dissemination of program to other community clinics. Grant funding to maintain oral health supplies within the clinic. Focusing on parental oral health. Future projects – reassessment and reprioritization of a health care issue to target.