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ATTACHMENT A
CALIFORNIA STATE UNIVERSITY LOS ANGELES
PROJECT: DENTAL TRANSFORMATION INITIATIVE (DTI) LOCAL DENTAL
PILOT PROGRAM (LDPP)
SECTION 1 LEAD ENTITY AND PARTICIPATING ENTITIES
Overview
The Rongxiang Xu College of Health and Human Services (RXHHS) of
California State University, Los Angeles (Cal State L.A.) in
collaboration with the Herman Ostrow School of Dentistry of the
University of Southern California (USC) is pleased to submit this
application for an LDPP Domain 4 project. The proposed pilot
program for the Los Angeles Basin builds on Cal State L.A.s
philosophical commitment to community service, engagement and the
public good, the College of Health and Human Services
interdisciplinary (human and social service) expertise, and the
Herman Ostrow School of Dentistry of USCs long history of serving
underserved communities. The proposed program seeks to implement an
interprofessional whole child and whole community approach to
increase the proportion of children and young adults (0-20) who
receive preventive dental services, establish positive oral health
habits in families, increase continuity of dental care, and provide
other health and social services to support these goals. The whole
child and whole community approach aligns with best practices in
the delivery of health and human services that acknowledge that
social, educational, psychological and cultural contexts inform
help seeking behaviors and capacities to sustain health promotion
behaviors. This orientation is enriched by a service delivery
stance that recognizes that families and communities present with
multiple strengths that provide the foundation for positive
collaborations with care-giving and healthy delivery systems. This
LDPP integrates state of the art practice in dental care with a
theoretical orientation that is fundamentally respectful and
collaborative in the design and delivery of all interventions.
The Lead Organization for this application is Cal State L.A.s
Rongxiang Xu College of Health and Human Services (RXHHS), which
will be responsible for coordinating the LDPP and will serve as the
single point of contact for the Department of Health Care Services
(DHCS) and the Centers for Medicare and Medicaid Services (CMS).
RXHHS will leverage its strong disciplinary programs in Child and
Family Studies, Communication Disorders, Public Health, Nutritional
Science, and Nursing; our strong connection with the networks of
community based child and family serving organizations; and our
diverse and talented student body to succeed in these efforts.
Demographic Description of Cal State L.A. and RXHHS
Cal State L.A. is situated in a rich and unique environment that
is home to the largest Latino community in the nation and at the
doorway to one of the largest Asian and Asian American communities
in the nation. The University service area includes
African-American communities, as well as the second largest urban
American Indian and Alaskan Native population in the nation. Cal
State L.A. is a federally designated Hispanic Serving Institution
(HSI), an Asian American and Native Pacific Islander Serving
Institution (AANAPISI), and Minority Serving Institution.
Fifty-seven percent of students at Cal State L.A. identify as
Hispanic/Latino, 15% as Asian American, 9% as White, and 4% as
African American. Eighty-two percent of students who attend Cal
State L.A. are first-generation college students. Most of our
students are local to the communities surrounding Cal State L.A.,
with 86% coming from Los Angeles County or other Los Angeles metro
areas. According to data from 2016, 6,334 undergraduate and
graduate students are enrolled in RXHHS, making it the largest
college on campus. In our college, 62.2% of students identify as
Hispanic/Latino, 16.7% as Asian American, 7.9% as White, 4.1% as
African American, 1.8% as two or more races, and 0.06% as American
Indian and Alaskan Native. Within the college, 76% of students are
female. The students who will participate in training
activities
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reflect the demographics of the communities adjacent to the
university and articulate strong motivations to work within their
home communities.
RXHHS Academic Programs
RXHHS faculty have demonstrated excellence in teaching,
scholarship, and service to the community. RXHHS is composed of
seven units; five academic units will participate in the efforts
outlined in this proposal. These include the Department of Child
and Family Studies, Department of Communication Disorders,
Department of Public Health, School of Kinesiology and Nutritional
Science, and the School of Nursing. Child and Family Studies
maintains robust educational pipeline partnerships with local
community colleges and with disciplinary and professional
organizations, such as a regional partnership with Child Life
Specialists and networks of early childhood education providers and
professionals. The Department of Communication Disorders maintains
a Speech and Language Clinic, which serves primarily children and
addresses articulation, phonology, language, cognitive, voice,
fluency, and hearing disorders, as well as three Child Language
Labs. Their Speech and Language Pathology MA program places
students in schools and hospitals across LA County. The Department
of Public Health maintains contracts with over 60 Los Angeles area
organizations at which students undertake internships and gain
valuable work experience. The department also runs an annual health
policy conference and will be opening a new graduate program in
Urban Community Health in Fall 2017. Kinesiology and Nutritional
Science have generated over $12 million in grants over the last
eight years. This school houses the Coordinated Dietetics Program,
which is one of only three of its kind in California and the only
one offered at a public institution. It is accredited by the
Accreditation Council for Education in Nutrition and Dietetics. The
School of Nursing is ranked #23 in the top 50 nursing schools in
the Western United States and in the top 100 in the U.S. according
to the US Nursing Schools Almanac.
In addition to providing high-quality disciplinary training,
each of the involved disciplinary units have extensive fieldwork
and internship training programs in place, which leverage and
expand the universitys extensive connections with community
partners. Additionally, RXHHS units have partnered with government
and educational entities to produce several community health and
professional development training projects. Examples include a
project to provide professional development training and social
work field education services to the County of Los Angeles,
Department of Children & Family Services and a CaPROMISE grant
to improve the provision and coordination of services and supports
for child SSI recipients and their families.
Administrative Leadership Team
The Program Director, Dr. Rita Ledesma, has been a lifelong
resident of the communities surrounding Cal State L.A. and has
developed strong and lasting relationships with several community
organizations serving underserved or at-risk populations due to
low-income, substance abuse, involvement in dependency court, and
people with developmental disabilities. These organizations include
El Nido Family Centers, United American Indian Involvement, Inc.,
East LA Community College, and the USC University Center for
Excellence in Developmental Disabilities at Childrens Hospital Los
Angeles. She brings over 30 years of experience as a social work
practitioner-scholar, working within the American Indian and Latino
communities in Los Angeles County. In particular, Dr. Ledesma has a
strong record of engagement with American Indian and Latino child
and family serving organizations and leadership in policy and
advocacy groups. Dr. Ledesma is a Licensed Clinical Social Worker
(CA) and an enrolled member of the Oglala Lakota Tribe, Pine Ridge
Reservation.
Dr. Ledesma currently serves as RXHHS Associate Dean of
Diversity and Student Engagement. Prior to this, she
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served as Department Chair of Child and Family Studies, during
which time she developed the departments successful peer mentorship
program, Pathways to Graduation, which received competitive funding
from the University. Before her tenure in Child and Family Studies,
Dr. Ledesma was part of the School of Social Work, where she was
instrumental in the development of the Master of Social Work
Program and served as first director of field education. Throughout
her career, she has been instrumental in developing several
community-campus interventions. For example, with the Pat Brown
Institute at Cal State L.A., she developed the Health Policy
Outreach Center, which received support from the California
Endowment and the Wellness Foundation and established partnerships
with 60 health and social service agencies in East/Northeast Los
Angeles and West San Gabriel Valley. She served as Co-Principal
Investigator on an STEM intervention project, Pueblo Science, which
was funded by the National Science Foundation. Pueblo Science was
housed in the East Los Angeles community and involved a partnership
with several local agencies. Dr. Ledesma was Co-Principal
Investigator on an educational pipeline initiative pilot program
that was funded by the Kellogg Foundation. She also directed the
Partnership for Academic Learning and Success (PALS) Peer-Mentoring
Program for several years. Dr. Ledesma received a Social Work
Leadership Award to conduct research in the urban American Indian
Alaska Native community from the Soros Foundation, Open Society
Institute, Partnership on Death in America. In her role as
Associate Dean, Dr. Ledesma has the opportunity to promote and lead
College wide initiatives that support health equity, student
engagement, and collaborations/partnerships that contribute to the
greater good of the region.
The Associate Director for Cal State L.A. for this project, Dr.
Ashley Munger, contributes a wide variety of research, clinical,
and teaching skills to address the exigencies of community-based
and programmatic research. These include training and experience
with curriculum and program development, program evaluation, and
experience working within diverse communities. Previously, Dr.
Munger was involved in basic and community intervention research
through a statewide collaboration between the School of Public
Health at the University of Maryland, College Park and the
University of Maryland Extension Food Supplement Nutrition
Education Program. Furthermore, Dr. Munger trained and practiced as
a couple and family therapist, developing clinical skills in
systems-thinking, relationship building, problem-solving, and group
facilitation. These skills will enable her to effectively
communicate and coordinate program components. Additionally, she
has considerable training in university teaching, including areas
such as general best practices, diversity and inclusion in the
classroom, scholarship of teaching and learning, service learning,
and online course design, which will be leveraged to ensure
high-impact learning and experiences for student interns.
Associate Director, Roseann Mulligan, D.D.S., M.S., is the
Associate Dean of Community Health Programs and Hospital Affairs
for the Herman Ostrow School of Dentistry of USC, Chair of the
Division of Dental Public Health & Pediatric Dentistry, and
Charles M. Goldstein Professor of Community Dentistry. She is a
recent recipient (2016) of the American Assoc. for Dental Research,
Jack Hein Public Service Award. Additionally, Dr. Mulligan received
the Harold Berk award (2014) from the Academy of Dentistry for
Persons with Disabilities. She brings expertise in providing dental
services to a wide array of special populations that are frequently
underserved and a whole-family approach to the LDPP, including,
general dentistry and dentistry for special populations which
includes individuals with intellectual and physical disabilities
and those with complex medical conditions. Dr. Mulligan serves as
the Principal Investigator of USCs Childrens Health and Maintenance
Program (CHAMP), a five-year oral health prevention, education, and
dental home project serving children 0-5 years of age funded
through First 5 LA. Dr. Mulligan will be the lead for the USC Team
in this collaboration.
Description of the Program and Efforts Undertaken by Lead
Entity
Childrens oral health is connected to a wide variety of outcomes
throughout a childs lifespan. Poor oral health is associated with
school absence and poor academic performance, reduced growth and
poor quality of
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life (American Academy of Pediatric Dentistry, 2014).
Unfortunately, for families with many needs competing for time and
financial resources, oral health may be difficult to prioritize.
Even among families who are eligible for dental health services
through Medi-Cal, the utilization rate for Denti-Cal
fee-for-service ranges from an average of 27% for children 0-3 to
52% for children 6-18. (Barzaga, 2015). Additionally, multilevel
factors including environmental and social determinants have been
shown to influence oral health. For example, family-level factors
(e.g., social support; parents beliefs, behaviors, and health; and
family culture) and community-level factors (e.g., physical and
social environments and availability of resources) indirectly
impact childrens oral health (Fisher-Owens et al., 2007).
Unfortunately, very few existing programs have sought to consider
the whole child or whole family and address these contextual
factors that influence oral health.
This project integrates the expertise and experience of two
major universities, in partnership with a broad range of child and
family serving organizations, to connect families to dental homes
and to promote dental health in vulnerable populations. Program
activities will intervene with conditions that undermine oral
health status by adopting a multidisciplinary service delivery
approach that is attentive to culture, responsive to the social
ecology and focused on strengths and capacity. The USC team brings
a strong record of success in advancing the dental health of
children and youth that is complemented by the Cal State L.A. teams
record of success in advancing the whole child and whole family
approach. Each team elevates the achievements of the other by
endorsing a shared value for integrated service delivery systems,
while specializing in distinct scopes of practice. The USC team
will assume primary responsibility for dental health screening
activities, and the Cal State L.A. team will implement educational
and intervention strategies to support oral health, as both
entities focus on continuity of care, interdisciplinary training of
students, agency staff and community members. We expect that
emerging professionals, who participate in field and practicum
training experiences, will adopt an approach to practice that is
more complex and useful to the communities where they will
practice. We anticipate that these activities will stimulate
interest in the field of oral health and career opportunities
related to oral health amongst program participants.
The project seeks to promote oral health by addressing the
complexity of issues associated with lack of access to dental care
among children aged 0 to 20 who are Medi-Cal eligible in the LA
Basin through the following Specific Aims:
Aim 1: Increase access to dental health care for underserved
populations by 1) deploying mobile care teams to the community to
provide oral health screenings and 2) connecting children and their
families to local dental homes for continuity of care using an
interdisciplinary approach
Aim 2: Identify contextual barriers to childrens oral health by
1) assessing families existing resources, capacities and challenges
concerning oral health; 2) developing and implementing protocols to
assess families values, attitudes, knowledge, and behaviors related
to oral health and 3) integrating this knowledge in the design and
delivery of program interventions
Aim 3: Increase access to dental health care for children/youth
in the urban American Indian Alaska Native urban community by 1)
complementing the goals of Aim 1 through specialized outreach and
recruitment strategies; 2) hiring designated staff to strengthen
these efforts and 3) integrating best practice knowledge from
Indian Health Service protocols
Aim 4: Utilize findings from the assessment referenced in Aim 2
by 1) developing Individualized Oral Health Care Plans, 2) creating
education materials on various topics of relevance to the
population that are congruent with the cultural and developmental
contexts of the audience, 3) delivering educational content to
target audiences utilizing an interdisciplinary team approach, 4)
delivering oral health
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educational materials individually and to community groups, and
5) utilizing mobile technology to engage families to practice what
they have learned about oral health
Aim 5: Increase the involvement of professionals in related
fields (child development, education, and general health care) in
raising awareness among their clients of the importance of
preventative and regular maintenance of oral health care in
children, youth and young adults by 1) developing strategies to
educate practitioners about the importance of oral health and its
link to general health and wellbeing and 2) educating healthcare
providers (pediatricians, OB/GYNs, primary care physicians, nurses,
nutritionists, etc.) to deliver and incorporate oral health care
into primary care
Aim 6: Disseminate findings from this project to appropriate
consumer, professional, and legislative audiences
The above Aims will be met through the collaborative efforts of
the Cal State L.A. Rongxiang Xu College of Health and Human
Services (RXHHS) and The Herman Ostrow School of Dentistry of USC
using the following methods. Each entity has a scope of
responsibility and accompanying administrative support that is
integrated in the design and delivery of comprehensive
multidisciplinary interventions that address oral health using the
lens of the whole child, whole family and whole community. The
RXHHS-USC partnership will develop and implement an
interdisciplinary approach to oral health promotion and dental
disease prevention that is strengths based and culturally focused.
This approach will include the production of culturally attuned and
developmentally sensitive protocols for investigating the factors
that influence oral health outside of the scope of dental care. The
knowledge gleaned from this process will inform the development of
interdisciplinary dental health promotion intervention and
materials which will encourage families to engage in small,
specific behavior changes concerning dental health care and other
factors that influence oral health, such as cultural beliefs,
demographic considerations, parenting behaviors, nutrition and
access to dental care system.
RXHHS will recruit, train, and supervise undergraduate student
interns from multiple disciplines who will serve as members of
Bridge Teams. (See Section 3.) These interns will participate in an
interdisciplinary training program that extends across the academic
year. During this time, interns will be sent out to participating
entities in the community in order to gather information and
implement oral health promotion educational interventions; to
assess the conditions that undermine capacities to maintain and
sustain dental health; and to implement interventions (under the
supervision of the RXHHS discipline faculty) that mitigate these
conditions. Following completion of the internship program, interns
will be hired as student assistants in order to ensure continuity
of training, intervention activities, and evaluation of efforts.
RXHHS will employ promotoras (oral health educators) who will work
closely with Bridge Teams and support the community based oral
health activities.
The Herman Ostrow School of Dentistry will provide dental
faculty (dentists, hygienists) who will supervise dental students
who will be deployed to the community as part of the Bridge Team to
provide oral health screenings. USC will also utilize its School of
Social Work interns for Bridge Team participation. Intra-oral
digital cameras will be used as an oral health education tool to
improve oral health knowledge, promote awareness of the need for
care and reduce childrens dental fear and anxiety. When needed,
geo-mapping technology will be used to locate appropriate dental
homes for children and their families at community partner clinics.
Through the Herman Ostrow School of Dentistrys current large-scale
dental health service project, CHAMP, a large network of dental
homes to which families can be referred has already been
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established. Additionally, in collaboration with RXHHS, USC will
provide training for dental and non-dental professionals to improve
their knowledge and skills in all aspects of pediatric and prenatal
oral health care and to develop dental health promotion
materials.
To complement the efforts of the Bridge Teams, a mobile
application will be developed. Mobile applications have been
successful in promoting positive health behaviors (Philips, 2003).
The application developed for this program will be modeled on
successful efforts undertaken for tobacco cessation programs and
other public health initiatives (Pike, 2015). Use of this
application will help to continue the programs relationships with
each family by reinforcing education provided on site; providing
small, specific behavioral nudges for families to engage in
activities that promote oral health; and permitting the program to
collect ongoing data concerning each family's connection to dental
homes and continuing oral health. All data collection will comply
with relevant privacy laws and regulations.
Lead Entity Decision Making Process These efforts above will
require coordinating multiple participating and subcontracting
entities in order to ensure program success. As the lead entity,
Cal State L.A. and its personnel will serve as point of contact and
provide appropriate reports to DHCS and the Centers for Medicare
and Medicaid Services (CMS).
Within Cal State L.A., the Dean of the Xu College of Health and
Human Services (RXHHS) is the direct supervisor of the proposed
Program Director (Rita Ledesma), who also serves as the Associate
Dean for Diversity and Student Engagement in the College. The
College is housed in the Universitys Division of Academic Affairs.
Academic Affairs, one of the largest units within the University,
is under the leadership of the Provost and Vice President for
Academic Affairs, Dr. Lynn Mahoney. As noted above, the Xu College
of Health and Human Services is home to 7 Departments and Schools
and 4 Institutes. Dr. Ledesma is authorized to serve as lead for
this proposed project and is responsible for ethically and
effectively leading the project. The Program Director is expected
to adhere to the policies and procedures associated with effective
grant management within the University. The Dean and other
University leaders and offices, such as the University Auxiliary
Services, are available to monitor, guide and consult with the
Program Director to ensure the successful achievement of the
proposed project goals. The Program Director must abide by the
administrative procedures that inform management of grants and
contracts on behalf of the University. All managers within the
University complete mandatory trainings offered by the Chancellors
Office to develop knowledge about and awareness of the policies
that govern supervision of employees, Title IX provisions, sexual
harassment issues, and the responsibilities of supervisors. The
College fiscal management office will work with the University
Auxiliary Services to support program operations. Dr. Ledesma and
the projects Associate Directors, Ashley Munger from Cal State L.A.
and Dr. Mulligan from USC, are committed to standards of ethical
behavior, best practices and confidentiality requirements
associated with each discipline.
RXHHS will also coordinate all project components and facilitate
communication among all entities. Mechanisms for continuing
communication and monitoring are built into the project, and
include the development of a Leadership Team, a Program Operations
Committee, an Interprofessional Development and Coordination
Committee, and an Advisory Board. Meetings held by the Committees
and Advisory Board will be documented via meeting minutes that will
be distributed to the Leadership Team and available for review to
others upon request. RXHHS will be responsible for directing and
coordinating these efforts. (See Section 1.4)
Final decisions will be made by the Program Director after
receiving input and guidance from the Associate Directors and the
various Committees.
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1.1 Lead Entity and Contact Person
Type of Entity CSU campus Contact Person Alma P. Sahagun Title
Executive Director Telephone (323) 343-5366 Email Address
[email protected] Mailing Address Cal State L.A.
University Auxiliary Services, Inc.
5151 State University Drive, GE 314 Los Angeles, CA
90032-4226
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mailto:[email protected]
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1.2 Participating Entities
Organization Name and Address
Description of Organization
Contact Name, Title, Telephone and Email
Role in LDPP
Herman Ostrow At 119 years old, the Roseann Mulligan
Subcontractor School of Herman Ostrow School of Charles M.
Goldstein Professor A. Provides outreach Dentistry of Dentistry of
USC has Community Dentistry, Associate community services:
University of educated thousands of the Dean, Community Health
caries risk assessment, Southern worlds most talented and Programs
and Hospital Affairs, oral health screenings California trusted
dental
professionals. The School is an international leader in dental
and craniofacial research and a pioneer in serving populations who
lack access to dental care. A cornerstone of dental care experience
for School students is community engagement. As of 2016, the School
has 21 dental service sites. Working in FQHCs, at the Union Rescue
Mission dental clinic, through urban outreach efforts and mobile
dental vans, the School serves underserved areas throughout the
state. It provided care to 79,000 patients in 2015 - and the number
continually rises. Service in action not only in theory. Developing
culturally diverse dental professionals in the hugely
multi-cultural L.A. area is a necessity that the School takes
seriously. It is a benchmark of ethnic, racial and academic
diversity. The class of 2020
Chair Division of Dental Public Health & Pediatric Dentistry
1149 S. Hill St, Suite H550 Los Angeles, CA 90015 (213) 740-1084
[email protected]
and education to children, oral health education for caregivers,
dental home referrals; B. Provides direct patient care at
University Clinics serving as Dental Home; C. Enhances and delivers
professional and interprofessional education to health
professionals focusing on the inclusion and integration of oral
health as an important part of overall health.
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is an example of diversity in action, with 188 dental students
and 40 dental hygiene students representing 34 different majors, 7
ethnicities and 17 nations.
Childrens The USC University Center Barbara Yoshioka Wheeler,
PhD. Subcontractor Hospital Los for Excellence in Associate
Professor of Clinical A leader in the field of Angeles
Developmental Disabilities, Pediatrics Keck School of developmental
USC University based at Childrens Medicine of University of
disabilities within the Center for Hospital Los Angeles and
Southern California western U.S. Will Excellence in affiliated with
the USC Associate Director, USC consult on Developmental Keck
School of Medicine, University Center for Excellence
interdisciplinary training, Disabilities is a nationally recognized
in Developmental Disabilities education and technical (UCEDD)
leader in developing and Childrens Hospital Los Angeles assistance.
Will also
implementing quality 4650 Sunset Blvd. serve as an advocate in
services for infants, Los Angeles, CA 90027 the public arena to
children, youth and adults Wheeler, Barbara strengthen systems and
with, or at risk for, [email protected] services for
individuals behavioral, developmental, and families impacted by
physical, and/or special special developmental, health care needs
and their behavioral and/or health families. care needs. - serves
5,000 children/ yr.
El Nido Family Founded in 1925, El Nido Liz Herrera, LCSW
Community Agency Centers Family Centers mission is Executive
Director Provides access to client
to empower families in 10200 Sepulveda Blvd. populations in
program low-income communities Suite 350 sites who will receive of
Los Angeles County to Mission Hills, CA 91345 LDPP interventions:
break the cycle of poverty, (818)830-3646 preventive dental care,
child abuse, violence, health promotion academic failure, and teen
activities, assessment pregnancy through and response to the
non-outstanding educational, dental issues that youth development,
health intersect capacities to and therapeutic services. access and
sustain El Nido provides behaviors/practices that community based
social support dental health services in some of the and engagement
with most underserved dental home. communities in Los Angeles
County including: Pacoima and surrounding communities, South Los
Angeles, Compton, and the
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Antelope Valley. Last year, 10,298 individuals were served by El
Nido Family Centers; 80% of whom live at or below the poverty line;
the agency is the largest provider in the state of services to
adolescent mothers and fathers. - serves 10,278 persons/yr.
Kaiser Doing well in school can Kaiser Permanente Educational
Community Agency Permanente send a student on a lifelong Outreach
Program Provides access to client Educational trajectory for
success. The 4141 Maine Ave populations in program Opportunity
Educational Outreach Baldwin Park, CA 91706 sites who will receive
Program Program (EOP) provides
education and support services in the San Gabriel Valley section
of Los Angeles County. The focus of EOP is to provide programs and
activities that improve school performance, promote family
communication, teach skills that are needed to meet various life
tasks and alleviate stress, create opportunities for the
development of leadership skills for both youth and their parents
so that they can address issues that have an impact on their
community, and increase awareness of professional opportunities in
the health field for young people. In 2015, EOP provided services
to 1,428 participants with 928 participants under the age of 20.
Program growth anticipated for FY 16-17.
Ruth Padilla - King, LCSW (626) 814-6400
LDPP interventions: preventive dental care, health promotion
activities, assessment and response to the non-dental issues that
intersect capacities to access and sustain behaviors/practices that
support dental health and engagement with dental home.
East Los Angeles College
East Los Angeles College empowers students to achieve their
educational
Julie Benavides, Vice President of Special Services/Special
Programs
Community Agency Provides access to client populations in
program
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goals, to expand their East Los Angeles College sites who will
receive individual potential, and to 1301 Avenida Cesar Chavez LDPP
interventions: successfully pursue their Monterey Park, CA 91754
preventive dental care, aspirations for a better 323-265-8650
health promotion future for themselves, their activities,
assessment community and the world. and response to the non-ELAC
has been serving the dental issues that Monterey Park community
intersect capacities to since 1945. More than access and sustain
40,000 students are behaviors/practices that enrolled every
semester support dental health and offer career- and and engagement
with transfer-oriented courses dental home; specialized and
programs that range outreach to students who from Administration of
are under age 20 and to Justice and Nursing to students who are
Chicana/o Studies and parents. Chemistry. Over 23,000 students were
enrolled at ELAC in 201516, which includes and approximately 25%
are younger than 20 years old. The non-traditional student
population includes many students who are also parents.
California State Cal State L.A. is a Ron Vogel, Dean Community
Agency University Los university dedicated to Rongxiang Xu College
of Health Provides access to client Angeles engagement, service,
and and Human Services populations in program Division of the
public good. Founded 5151 State University DR sites who will
receive Student Affairs in 1947, the University Los Angeles CA LDPP
interventions:
serves more than 27,000 90032 preventive dental care, students
and 247,000 (323) 343-4600 health promotion distinguished alumni,
who [email protected] activities, assessment are as diverse as
the city we and response to the non-serve. Located in the heart
dental issues that of Los Angeles, Cal State intersect capacities
to L.A. has long been access and sustain recognized as an engine of
behaviors/practices that economic and social support dental health
mobility. Led by an award- and engagement with winning faculty, the
dental home; specialized University offers nationally outreach to
students recognized programs in under age 20 and science, the arts,
business,
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criminal justice, children of student engineering, nursing,
parents. education and the humanities. The Cal State L.A. student
population includes 7,000 students who are under the age of 20 and
includes many students who are parents.
Clnica Clnica Msr. Oscar A. Sandra Rossato, Executive Dental
Home Monseor Oscar Romero is a 501 (c)(3) Director Will provide
direct A. Romero nonprofit Federally 123 S. Alvarado Street patient
care, serving as a
Qualified Health Center Los Angeles, CA 90057 dental home on
this (FQHC) with three clinic (213) 989-7700 project. sites located
in the Pico- [email protected] Union and Boyle Heights
neighborhoods of Los Angeles. They provide comprehensive medical
services, dental care, and health education to low-income men,
women and children of all ages living in Los Angeles County. Health
care is a human right and Clnica Romero works to ensure access to
it for all people regardless of their ability to pay.
Childrens The Children's Dental John Blake, DDS Dental Home
Dental Health Health Clinic is a 501(c)(3) Exec. Dir./Dental Dir.
Will provide direct Clinic non-profit organization 455 E. Columbia
St. #32 patient care, serving as a
serving c hildren and young Long B each, CA 90806 dental home on
this adults, ages 0-21, in the (562) 933-3141 project. Greater Long
Beach and [email protected] South Bay areas who are economically
disadvantaged or have issues in access to care. They are dedicated
to providing quality basic and specialty dental treatment, as well
as preventive services. - serves 10,000 children/yr.
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Public Health The PHFE WIC Program is Kiran Saluja, MPH, RD
Community Agency Foundation WIC the largest local WIC Executive
Director Provides access to client (PHFE) agency in the country,
PHFE WIC Program populations in program
serving a pproximately 4% 12781 Schabarum Ave. sites who will
receive of the nations total and Irwindale, CA 91706 LDPP
interventions: 23% of Californias total (626) 856-6650 ext. 202
preventive dental care, WIC participants. 250,000 [email protected]
health promotion clients are served monthly activities,
assessment
at 62 sites. Eighty-four and response to the non-percent of the
clients dental issues that served by PHFE WIC are intersect
capacities to Latino, 6% are African- access and sustain American,
3% are behaviors/practices that Caucasian, 6% are Asian support
dental health and 1% are American and engagement with Indian and
Alaskan Native. dental home. WIC serves pregnant, breastfeeding,
and postpartum women, infants and children under the age of five
who are low to moderate income (up to 185% of the federal poverty
level) and at nutrition risk. WIC gives vulnerable population the
best possible start by providing nutrition education and healthy
foods during c ritical stages of development so children achieve
optimal nutritional status. PHFE is the nations premier catalyst
for advancing program and support services to optimize population
health. The 9 sites involved in project serve 48,384
persons/yr.
USC School of Founded in 1970 as a Theda Douglas Community
Agency Early Childhood teaching school for future Assoc. Vice
President Provides access to client Education early-childhood USC
Government Partnerships populations in program (USC SECE)
professionals, the USC and Programs sites who will receive
School for Early Childhood (213) 821-2746 LDPP interventions:
Education (USC SECE) [email protected] preventive dental care,
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has served more than 4,700 health promotion neighborhood
children activities, assessment from 4,200 families. By and
response to the non-providing comprehensive, dental issues that
high-quality early intersect capacities to childhood education
access and sustain services to children and behaviors/practices
that their families in South Los support dental health Angeles and
cultivating and engagement with parental involvement, USC dental
home. - SECE seeks to create positive change in the community now
and in the future. - serves 500 children/yr
Para Los Nios Founded on Skid Row in Martine Singer, CEO
Community Agency 1980, Para Los Nios is a 500 Lucas Ave Provides
access to client nonprofit social services Los Angeles, CA 90017
populations in program and education organization (213) 413-1466
sites who will receive dedicated to the success of
[email protected] LDPP interventions: L.A.s neediest
children preventive dental care, and families. With six early
health promotion education centers and three activities, assessment
charter schools serving and response to the non-some 2,000
low-income dental issues that children (ages 6 months to intersect
capacities to 14 years), Para Los Nios access and sustain places
education at the c ore behaviors/practices that of its mission to
break the support dental health cycle of poverty. The and
engagement with organization provides a dental home. comprehensive
social services model that incorporates: high-quality education,
family support & mental health services, parent engagement and
community building opportunities. - serves 7,500 children/yr
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Boys & Girls The mission of the Los Calvin Lyons, CEO
Community Agency Club of Metro Angeles Boys & Girls Club 800 S.
Figueroa Provides access to client Los Angeles is to inspire and
enable all Los Angeles, CA. 90017 populations in program Consortium
youth, especially those who (323) 221-9111 sites who will
receive
need us most, to realize LDPP interventions: their full
potential as preventive dental care, productive and responsible
health promotion members of the activities, assessment community.
This growing and response to the non-consortium of clubs dental
issues that currently serves 1500 intersect capacities to members
and their families access and sustain within Los Angeles County
behaviors/practices that with the expectation that it support
dental health will grow to include 11 and engagement with clubs.
dental home. - serves 1,500 children/yr.
To Help For more than four Clifford Shiepe Dental Home and
Everyone decades, T.H.E. (To Help Pres. & CEO Community Agency
Health & Everyone) Health and 3834 Western Ave. Provides access
to client Wellness Wellness Centers has been Los Angeles, CA. 90062
populations in program Centers improving the wellbeing of
[email protected] sites who will receive
in-need, underserved (323) 730-1920 LDPP interventions:
communities in Los preventive dental care, Angeles by providing
health promotion access to high-quality activities, assessment
healthcare and dental care and response to the non-and for all,
regardless of dental issues that ability to pay, while being
intersect capacities to mindful of the diverse access and sustain
cultural, social and behaviors/practices that economic factors that
make support dental health up the foundation of the and engagement
with community. dental home.
Montebello Montebello Unified is the Susanna Contreras Smith
Community Agency Unified School third-largest school district
Superintendent Provides access to client District in Los Angeles
County. In 123 S Montebello Blvd populations in program
the school year just begun, Montebello, CA 90640 sites who will
receive it welcomed 53,000 LDPP interventions: students to the
appropriate preventive dental care, educational level of health
promotion schooling from transitional activities, assessment
kindergarten to adult and response to the non-school, with 87%
receiving dental issues that
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free & reduced lunch intersect capacities to support. 96% of
the district access and sustain students are Hispanic or
behaviors/practices that Latino Partnering with support dental
health Family Healthcare Center and engagement with of Los Angeles
to provide dental home. family health care at Bell Gardens High
School is a new and growing initiative. - serves 53,000
students/yr. (87% receive free or reduced lunch)
Family In California, parent-to- Yvette Baptiste, PhD Community
Agency Resource parent support is offered Executive Director
Provides access to client Network of LA through a network of 47
1000 S. Fremont Ave. populations in program County Family Resource
Centers Suite 6050, Unit 65 sites who will receive
(FRCs). These centers have Alhambra, CA 91803 LDPP
interventions: a common mission of (626) 300-9171 preventive dental
care, providing services to health promotion
families of children age activities, assessment birth 3.
However, many and response to the non-centers have expanded dental
issues that their mandate beyond the intersect capacities to 0-3
population and serve access and sustain families of children of all
behaviors/practices that ages and special needs. support dental
health FRCs are directed and/or and engagement with staffed by
parents of dental home. children with special needs. FRCs strive to
reflect the diversity of their community and can accommodate
cultural and language needs through bilingual/ bi-cultural paid and
unpaid staff. In LA County, there are 10 FRCs which can serve as a
gateway to eligible populations for this grant. - serves 50,000
persons/yr
Fiesta Fiesta Educativa was Irene Martinez, MSW Community Agency
Educativa, Inc. founded in California in Executive Director
Provides access to client
1978 to inform and assist 2310 Pasadena Ave. populations in
program Latino families in Suite 213 sites who will receive
obtaining services and in Los Angeles, CA 90031 LDPP
interventions:
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caring for their children (323) 221-6696 preventive dental care,
with special needs. Fiesta [email protected] health
promotion Educativa was formed by activities, assessment
family members and and response to the non- professionals who
dental issues that recognized the need to intersect capacities to
provide assistance and access and sustain advocacy to these
Spanish- behaviors/practices that speaking families. FEI support
dental health provides the following and engagement with services:
(1) Assist dental home; specialized families gain knowledge,
outreach to access key resources and children/youth who have
understand their developmental fundamental rights; (2)
disabilities. Influence the advancement and rehabilitative
potential of Latinos with special developmental needs; (3) Increase
the consciousness of professionals about the unique cultural
characteristics and needs of Latino children and their families;
(4) Expand and develop culturally sensitive programs and services.
In Los Angeles County, approximately 2000 clients were served in
2015 with 50% of the clients below the age of 20 years old
Fuerza This community-based Ana Trujillo, Exec. Director
Community Agency (Familias parent organization has 1340 E. McWood
St. Provides recruitment Unidas En been in existence for 30 West
Covina, CA 91790 sites for initial encounter Respuesta al years and
is dedicated to [email protected] with targeted Sindrome de serving
the Latino, (626) 277-6316 population. Assist the down y otras
Spanish-speaking families project in identifying Alteraciones) with
children with eligible families and
disabilities that due to their disseminating cultural,
socio-economic information on project and language barriers are
services in the
underserved. Of the 500+ community; specialized families in
Fuerza, outreach to approximately 120 families children/youth who
have have children with
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disabilities 0-20 who are developmental Medicaid eligible.
disabilities. - serves 120 families/yr
United Established in 1974, the Jerimy Billy, MBA Community
Agency American United American Indian Chief Executive Officer
Provides access to client Indian Involvement, Inc. (UAII) is 1125
West 6th Street, Suite 103 populations in program Involvement, a
501(c)3 private, non- Los Angeles, CA sites who will receive Inc.
profit organization offering (213) 202-3977 LDPP interventions:
a wide array of health and preventive dental care, human
services to health promotion American Indians/Alaskan activities,
assessment Native (AIAN) living and response to the non-throughout
Los Angeles dental issues that County. UAII has grown intersect
capacities to from a small community- access and sustain based
organization behaviors/practices that providing social services to
support dental health AIAN living in the Skid and engagement with
Row area within the City dental home; will assist of Los Angeles,
to a with specialized multidisciplinary outreach to urban
comprehensive service American Indian Alaska center meeting the
multiple native families in the needs of AIAN region.
countywide.
UAII operates under Federal guidelines established by the
Department of Health and Human Services Indian Health Service when
determining eligibility for program services.
- serves 761 persons/yr (145 children)
Centro de Nios Centro de Nios y Padres Maria Andrade Moberg
Community Agency y Padres (Center for Young Director Provides
recruitment
Children and their Centro de Nios y Padres sites for initial
encounter Families) has proudly 5151 State University Drive with
targeted served Los Angeles and Los Angeles, California 90032
population. Assist the neighboring communities Ph. 323-343-4420
project in identifying with a staff dedicated to Fax: 323-343-6115
eligible families and providing families the disseminating skills
and knowledge to information on project
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support their children in services in the their continuing
education. community; specialized Early Intervention outreach to
Specialists (Lead Teachers) children/youth who have and certified
and trained developmental assistant staff offers special
disabilities. skills, to young children and their families,
including the ability and experience to work with infants and
toddlers who are identified with the following types of
disabilities:
autism spectrum disorder (ASD)
low incidence disabilities (visual impairments, physical
disabilities, deaf and hard of hearing)
medically fragile severe multiple
disabilities developmental
delays at risk for delays
- serves 60 families per month; in FY15-16, 114 unduplicated
children received services
Visionary The Visionary Youth Robert Hernandez, MSW Community
Agency Youth Center, Center seeks to service Director Provides
access to client Hollywood vulnerable youths, in the 5030 Santa
Monica Blvd. populations in program Community East Hollywood Los
Angeles CA 90029 sites who will receive Housing Community, who are
at 323 454-6221 LDPP interventions: Corporation risk for variety of
preventive dental care,
adolescent social issues health promotion stemming from
violence- activities, assessment
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and response to the non- dental issues that intersect capacities
to
access and sustain behaviors/practices that
support dental health and engagement with dental home.
related trauma. The mission is to uplift youth from the negative
impacts of trauma and violence exposure by establishing a holistic
youth center focused in creating generation change, fostering
resiliency, and empowering youth to build thriving communities.
- serves 50 clients and interacts with 400 residents under the
age of 20
Dental Homes The primary role of all Dental Home participating
entities is to treat the oral needs of project participants
identified during oral health screenings at participating Community
Agency outreach sites. Bridge Team members, Benefits Enrollment
Specialists and Social Work Interns will work closely with the
Dental Home participants in scheduling appointments and exchanging
information on patient progress.
Expectations of Dental Home partners include: Adherence to the
goals of the project; Treatment of all project participants
referred to dental clinic in a timely manner; Provision of patient
specific treatment data for each project participant on a
quarterly basis; Maintenance of all necessary patient care and
reporting documentation; Allowance of time for staff training
regarding the project, data management and
reporting, as well as periodic updates; Allowance of posting of
project promotional and educational materials; Participation of
dental staff in dental continuing education events; Provision of
feedback to project leadership, regarding project processes,
successes, and
opportunities for improvement, through participation in the
projects Advisory Board.
Community Agencies The Community Agency participating entities
are the outreach sites where the initial contact with families in
the target population will occur. These community agencies are well
established and trusted resources within each locale and represent
the points of contact with the families to be served by the
project. Bridge Teams will visit these sites to recruit families
into the program and provide services to the families on site at
the agency.
Expectations of Community Agency outreach sites include:
Adherence to the goals of the project; Provision of inside space
for Bridge Teams to meet/recruit potential project
participants;
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Program Director Associate Directors (LT)
Project Operations Committee (POC)
Interprofessional Development and
Coordination Committee (IDCC)
Informatics and Data Management Center
(IDMC)
Office of Community Resources Navigation
(OCRN) Advisory Board
(AB) 3 Bridge Teams
(BT)
Community Organizations Denti-Cal and Medicaid Managed Dental
Plans 1 Mini Bridge Team
(BT) Dental Homes
Allowance of time for staff training regarding the project, the
importance of oral health and periodic project updates;
Posting of project promotional and educational materials;
Provision of feedback regarding to project leadership, regarding
project processes,
successes, and opportunities for improvement, through
participation on the Advisory Board.
1.3 Letters of Participation Letters of participation from the
organizations listed above are attached in Exhibit A.
1.4 Collaboration Plan: To facilitate regular communication and
prevent silos, the project will be managed through the structure of
6 separate but interrelated entities: the Leadership Team (LT), the
Program Operations Committee (POC), the Interprofessional
Development and Coordination Committee (IDCC), the Informatics and
Data Management Center (IDMC), the Office of Community Resources
Navigation (OCRN), and the Advisory Board (AB).
Figure 1: Project Administrative Structure
The IDCC, OCRN, and the IDMC report to the POC. Cal State L.A.
leads the POC and coordinates the ABs efforts. The PIs provide the
required and definitive administrative supervision and scientific
expertise to
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conduct this community dental public health pilot project
properly and efficiently. Each entitys roles in data collection and
analysis, communication, and sustainability is described below.
1) Leadership Team: This Leadership Team includes the Program
Director and Associate Directors and will meet weekly, prior to the
Program Operations Committee, and will set the agenda for the POC.
This group is responsible for the overall success and direction of
this collaborative project. Weaving together robust
interdisciplinary efforts from two local universities, this project
has the potential to improve the welfare of many vulnerable Los
Angeles residents. Ultimate decision-making authority rests with
the Program Director from the Lead Entity (Dr. Ledesma of Cal State
L.A.).
2) Program Operations Committee: The Program Operations
Committee (POC) is comprised of the Program Director and Associate
Directors, as well as key faculty from both Cal State L.A. and USC
with expertise in oral health, public health, child development,
social work, nursing, nutrition, epidemiology, biostatistics and
bioinformatics. The committee will meet weekly and oversee the
project through completion. Three meetings per month with take
place via teleconferencing, and one meeting will occur in-person.
For the first 6 months of the project timeline, the POC will be in
charge of developing the project protocols and setting up the
needed operational infrastructure. After this period, the POC will
continue to meet weekly to monitor implementation, identify and
address challenges, and modify the project protocols as needed to
ensure that the project is efficiently and effectively achieving
the state pilots goals. POC will be in charge of analyzing progress
reports based on the established goals and relevant data (See
Section 4.1). The POC will identify areas of weakness, adjust the
project protocols and implement additional trainings as needed.
Data output to inform POC decisions will be produced by the
IDMC.
The Committee will also explore opportunities for
sustainability. Both Universities have strong experience in
applying for federal, state and local government grants and have
raised millions of dollars to sustain their profiles of community
health projects (Health Policy Institute & American Dental
Association, 2015). The Directors believe that the proposed
projects Bridge Teams (described in section 3.1) have the potential
to tap into the reimbursement money of Denti-Cal/Medi-Cal working
as s an extension of dental home partners, and/or as a dental plans
partner. The Leadership Team also considers the possibility of
developing further partnerships with Local Government Agencies
through this pilot and securing their funding with matching federal
funds for the future. This mechanism, known as MAA (Medi-Cal
Administrative Activities), is currently being pursued by USC as a
part of its CHAMP program by partnering with Los Angeles
County.
3) The Interprofessional Development and Coordination Committee
(IDCC): The IDCC will be led by expert faculty in professional and
interprofessional education from Cal State L.A. and USC. The IDCC
will: Develop appropriate instruments (curriculum, student
rotations and internships, students/interns
evaluation) for all students and interns involved in this
project from both universities; Develop several multi-level and
multi-disciplinary educational track programs that provide
progressive, year-long, continuing education courses for dental
professionals and professional education for non-dental healthcare
professionals using didactic lecturing and hands-on workshops;
topics include childrens oral health and its impact on development
throughout developmental periods, including prenatal, infancy,
adolescence and early adulthood and will consider both dental and
non-dental factors influencing oral health;
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Evaluate existing education materials that promote oral health
and construct new materials that are attentive to the linguistic,
cultural and literacy profiles of the target populations.
In the first 6 months of the project timeline, the IDCC will
develop training materials, an implementation strategy, and an
evaluation plan. Thereafter, the IDCC, in consultation with our
Assessment Coordinator, will routinely evaluate the quality of
curriculum and training materials, interprofessional education,
professional and community presentations, printable brochures and
posters, and the website (and its traffic). IDCC will conduct this
evaluation through informal processes (such as reflective writing
assignments that are routinely submitted by students participating
in the Bridge Teams), or formal feedback questionnaires
administered by IDCC to the target audiences or participants. IDCC
will use these tools to improve the quality of these different
products in order to achieve the desired impact. To accomplish
these goals, the IDCC will meet weekly (in person or by
teleconference). The committee will be responsible for ensuring the
availability of the educational programming and materials beyond
the life of the project. Thus, these activities will promote
sustainability as community partners will have continuing access to
the referral services and educational programs/materials developed
as a result of these endeavors.
The weekly meeting strategy is modeled after the highly
successful USC CHAMP Program for both the POC and the IDCC. The
weekly meetings (actual or virtual) allow for much faster
decision-making and implementation of corrective actions.
4) The Informatics and Data Management Center (IDMC): IDMC will
manage, analyze and summarize all collected data. IDMC will be
staffed by experts in bioinformatics
and biostatistics who are capable of providing technical
assistance, advanced data management and statistical analyses, and
recommendations related to the improving data quality. IDMC will
monitor individual, team, and entity performance and compare
performance to benchmarks set by POC in the project protocol. In
cases of poor performance or deviation from protocols, POC will
take appropriate actions, such as additional protocol training,
communication or team building exercises, or even a recommendation
to the Project Director for termination if needed. IDMC will
support the submission of progress reports to DHCS in intervals
agreed upon.
The project will use an innovative communication platform
(described in Section 3.2) that will facilitate communication among
the project stakeholders by enabling sharing of data, reports and
resources at different levels while complying with best practices
for maintaining patient confidentiality. This platform will be
maintained by USC after the end of the grant to provide project
community stakeholders with the resulting learning experiences and
needed resources to develop other relevant or advanced
projects.
5) The Advisory Board (AB): The Advisory Board (AB) will meet
bi-monthly with the primary purpose of soliciting feedback directly
from the communities being served. The AB will serve as a point of
contact for coordination and support of participating entities.
This board will include selected representatives from the Lead
Entity, the projects POC and IDCC Committees, but will consist
primarily of members from the projects participating Community
Agencies, participating Dental Homes, and individual community
representatives (such as parents and foster parents, legal
guardians, teachers and social workers) who will be invited to join
the Boards regular meetings. At these bi-monthly meetings, the AB
will identify and discuss the project advancements and challenges,
develop appropriate strategies to advance the project and overcome
obstacles, identify potential service gaps, ensure proper
communication among all leading and participating entities, review
quality control and progress reports, and ensure that the
activities conducted and the materials developed are culturally
appropriate.
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During the meetings, members will be provided adequate
opportunities to voice their concerns, as well as brainstorm and
develop recommendations that align the project goals with the goals
of all participating entities, share resources, and explore
opportunities for cooperation, expansion, and pursuing
sustainability projects. The AB will have the ultimate power to
make the decision about partnership termination whenever
performance falls below the expected. All decisions and
recommendations of the AB will be brought to the POC for discussion
and implementation if appropriate.
Cal State L.A. will ensure in these monthly reviews that all
participating entities are informed and compliant with the State's
requirements for this pilot project. Participating entities that
are not represented at the advisory board meetings will be sent
bi-monthly memos, updating them on the states requirements for the
project, the progress of the project, and the activities of the
Advisory Board. Dr. Munger will serve as point of contact for all
participating entities, with help from support staff.
6) The Office of Community Resources Navigation (OCRN): OCRN is
an office established by USC and staffed by social work interns and
the Community Services Navigator through the USC CHAMP Project.
OCRN will tap into its already established broad network of
community stakeholders in Los Angeles County. These staff members
are trained to navigate local social and medical systems, provide
families with appropriate and culturally competent resources in a
timely manner, and support families in their utilization of these
resources. OCRN will utilize a Task Management System and Call
Center developed by the IDMC (described in Section 3.2). OCRN will
collect data concerning relevant metrics, described in Section 4.1,
which will be entered into the projects data management system.
Minimization of silos can be facilitated by this administrative
structure that promotes information sharing through regular
meetings and additionally utilizing the methods below:
Orientation and training sessions to address professional and
academic silos focusing on the need to share information and
provide constructive feedback between the various parts of the
project;
Regularly scheduled peer-to-peer Bridge Team member
problem-solving sessions. These teams will meet to discuss
programmatic and individual client needs at the conclusion of each
site visit day;
A single, centralized client-centered data management system,
developed and managed by the Informatics and Data Management
Center, which will allow the various professions (nursing, dental,
social work, etc.) and team members to document client
interactions, etc. and to review these interactions with the other
professions;
Specific, pre-set client benchmarks/goals applicable across all
disciplines.
Sustainability The infrastructure of the pilot is necessary to
launch the project. However, not all components of the pilot will
need to be sustained following the end of the pilot. After the
pilot is established and operations are running, a part of the
executive level as well as staff needed for the
reporting/analytical purposes may be able to be reduced. The extent
of any potential clinical interventions provided by the Bridge
Teams as well as the clinical operations of Dental Home partners
will depend on actual and projected financial returns and will be
thoroughly analyzed throughout the projects duration so that
efficient and productive strategies to continue providing these
services will continue after the pilot is completed.
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At the same time, the pilot places strong emphasis on activities
in the served communities that, once initiated and bought-into by
the families and staff at Community Agencies, can continue on their
own. These activities include the train-the-trainer approach to
oral health education for the major community stakeholders,
integration of oral health topics in the non-dental curriculums of
Cal State L.A. programs, development of reusable informational
materials and ongoing mobile app usage. In addition, collaboration
of the two major Universities on this project will open new
opportunities for educational/research/services grants, fundraising
activities and other local and federal funding. Lastly, families
who integrate good oral health knowledge and practices will pass
those to the next generation.
SECTION 2: GENERAL INFORMATION AND TARGET POPULATION
Target Population Determination and Number to be Served
In 2011 USC completed a needs assessment of underserved children
in L.A. County. As a result of this study, we determined that the
highest oral health care needs were in the inner city SPAs where
high density minority populations are located. These findings and
the experience of Cal State L.A. and USC in their outreach efforts
in the local communities informed us in choosing to focus on the
geographic areas that make-up SPAs 3, 4, 6 and 8. Cal State L.A.
and USC are located in these SPAs and have firsthand experience in
recognizing and working to address the needs of their neighbors.
Other participating entities (Community Agency outreach sites and
Dental Home partners) were chosen based on current partnerships
with Cal State L.A. and USC, and their established presence in the
areas to be served and the populations which they currently
serve.
We chose the number of children to be served (32,400) based upon
our analysis of the available funding and our experience with the
USC CHAMP project in providing similar services to underserved
children. Reaching this number of children and their families may
seem ambitious; however, by building upon the strategies that our
CHAMP teams have honed in reaching nearly 50,000, age 0 to 5 year
old children, we feel it is achievable and will make a significant
impact on the entire family, including siblings. The 0-20 year old
participant focus allows us to build upon and expand the personal
contacts we have with individuals and families, offering expanded
services/resources.
2.1 Geographic Area and Target Population Needs
Community Needs and Project Significance
The focus of this project is Service Planning Areas (SPAs)
3,4,6,8 which represent some of the poorest areas of Los Angeles
County. Persons, who are Latino, African American, Asian Pacific
Islander and immigrants, represent very large sectors of these
communities. American Indian and Alaska Native children and
families reside in these communities as well. Dental caries (or
cavities) is the most common childhood illness in the nation,
accompanied by challenging societal economic and social burdens
(Little Hoover Commission, 2016). The psychosocial effects of poor
oral health impact childrens health, social wellbeing, academic
performance and quality of life (American Academy of Pediatric
Dentistry, 2014). In California, 55% of children ages six to eight
years have untreated tooth decay, more than twice the national
average for this age group (California Healthcare Foundation,
2009). In 2007, the Center for Oral Health (then known as the
Dental Health Foundation) estimated the prevalence of untreated
dental caries among kindergarten and 3rd
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grade students in Californias elementary public schools to be at
28%.
Based on the data presented in Figure 2 below, this project
focuses its effort on areas of greatest economic hardship in Los
Angeles County. This County core also represents what has been
referred to as the dental desert of Los Angeles, with the lowest
percentage of dental services in comparison to the population need
in LA County. This inter university, interprofessional project
brings critical wellness resources to the most vulnerable segment
of our county. The provision of these resources will be enhanced by
a programmatic orientation that highlights and embraces the
strengths, cultural inheritances and capacities of the target
communities while building partnerships for health and
well-being.
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Figure 2: Economic Hardship Index by City/Community and SPA, Los
Angeles County
(County of Los Angeles Department of Public Health, 2015)
The Project Design and Comprehensive Plan Cal State L.A. and USC
have incorporated the theoretical models of Whole School, Whole
Community, Whole Child (WSCC) and the Accountability Health
Community Model (AHC) (described further in Section 3.1) to guide
this pilot project with the goal of creating a comprehensive and
innovative program that promotes oral health among children 0-20
years of age in Los Angeles County. This pilot project is designed
to yield favorable outcomes related to DTI Domains 1-3. We have
learned that multiple factors and social hazards affect a familys
capacity to engage with oral health care services. Therefore, we
have designed the project
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using interdisciplinary bridge teams to help families overcome
barriers that prevent them from participating in care. The Bridge
Teams provide oral health screenings, oral health and nutritional
education, behavioral and child development education, and resource
navigation for family needs such as food, shelter, safety
counseling and resources.
The following concepts are incorporated in this project:
Core Concepts: 1. Recognize and address oral health disparities.
2. Establish dental homes as soon as the first tooth erupts. 3.
Develop Interprofessional Education (IPE) and Collaborative
Practice (CP). 4. Emphasize oral health as an essential part of
overall wellness. 5. Promote oral health using multi-dimensional
approach.
1. Recognize and Address Oral Health Disparities Disparities in
oral health continue to persist in the United States with alarming
rates of dental caries among vulnerable children (Dye et al.,
2015). According to CDC, persons who are non-Hispanic Black,
Hispanic, and American Indian and Alaskan Native generally have the
poorest oral health among the racial and ethnic groups in the
United States. The greatest racial and ethnic disparity among
children aged 24 years and aged 68 years is seen among children who
are Mexican American and non-Hispanic Black (Childrens Oral Health,
2016). Nationally, the percentage of children and adolescents aged
5 to 19 years with untreated tooth decay is twice as high for those
from low-income households (25%) compared with children from
higher-income households (11%) (Disparities in Oral Health,
2016).
The most recent study that examined the caries status of
vulnerable children in Los Angeles County was conducted by the USC
team in 2011 (Mulligan et al., 2011). This study focused on a
random selection of WIC centers and Head Start programs and a
proportional-to-size, clustered by age group, a random sample of
elementary and high schools (schools were included in the sampling
frame if at least 50% of the enrolled students were from a minority
racial or ethnic group and at least 62% of the enrolled children of
the school were eligible for the free and reduced meals programs).
As a result of the oral exams performed, the estimated prevalence
of untreated dental caries specifically among three groups of
unprivileged children in Los Angeles County (ages 25, 68 and 1416)
was estimated to be 73%, with 44% having frank cavities and 29%
having white lesions, which are the precursors of cavities
(Mulligan et al., 2011). This data is much higher than the national
average for children. For example in 2011-2012, 10% of children
aged 2-5 and 20% of children aged 6-8 years old in the US had
untreated tooth decay (CDC, 2016b). Access to dental care is
limited for the majority of the beneficiaries of the Denti-Cal,
Californias Medicaid dental program for the vulnerable (Little
Hoover Commission, 2016). Half of Californian children (over 4.5
million children) are eligible for Denti-Cal, but only half of
those children see a dentist annually (Little Hoover Commission,
2016). Thus it is not surprising that the uninsured and MediCal
beneficiaries represented in 2007 nearly twothirds of all hospital
emergency visits for dental reasons (California Healthcare
Foundation, 2009), and that 9% of Los Angeles children seeking
needed dental care at a medical office or hospital emergency room
due to lack of access to dental care (Mulligan et al., 2011).
Certain populations within the overall group of vulnerable
children in LA County are of special interest in this project,
specifically American Indian and Alaskan Native (AIAN) and children
and youth with developmental and intellectual disabilities. The
AIAN population suffers from the poorest oral health of any
population in the
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United States, with staggering rates of untreated tooth decay
among children, and untreated tooth decay and periodontal diseases
among adults. Pre-school -aged AIAN children have four times more
untreated tooth decay than white children (43% vs. 11%) (The Pew
Charitable Trusts, 2015). In Los Angeles County, only 0.2 % of the
AIAN population seeks dental care in public health clinics
(Cabezas, 2016).
It is relevant to mention to that AIAN population is young and
growing at rate that is almost two times as fast as the total U.S.
population (Norris, Vines, & Hoeffel, 2012). California has the
largest share of the AIAN population and Los Angeles metropolitan
region has the second largest AIAN population in the nation
(Norris, Vines, & Hoeffel, 2012); still there is no a specific
geographic home for the community. Ledesma (2007) reports that AIAN
children and families experience similar vulnerabilities as other
poor children and families in the region, but that the AIAN
experience is invisible outside of their community in comparison to
the high visibility of other racial and ethnic groups in the
region. Further, the dispersed AIAN services across the region
render these services challenging and inaccessible. Members of the
community are often disconnected from reservation-based health,
educational, social and cultural support systems. The Annie E.
Casey Foundation (2008) notes that urban AIAN children and families
experience a host of social, economic, educational and health
vulnerabilities that compromise life opportunities and undermine
health status. A health status brief (US Department of Health and
Human Services Office of Minority Health, 2016) reports on specific
challenges for urban AIAN community members and notes that this
group has less access to hospitals, Indian Health Service
providers, and tribal health programs. These conditions exacerbate
the vulnerability status of children and families and fuel the risk
factors that result in dental caries and dental disease across the
lifespan.
Developmental disabilities (DD) are defined as a group of
conditions due to an impairment in physical, learning, language, or
behavior areas. Developmental disabilities, which typically start
during childhood and last throughout the lifespan, may impact
day-to-day functioning (Facts About Developmental Disabilities,
2015). Approximately 15% of children aged 3 to 17 in the U.S. has
one or more developmental disabilities, which include conditions
such as Attention-Deficit/Hyperactivity Disorder (ADHD), Autism
Spectrum Disorder (ASD), cerebral palsy, hearing loss, intellectual
disability, vision impairment, and other developmental delays
(Boyle, 2011). Children with developmental disabilities may face
particular physical, psychological, behavioral, or economic
barriers to oral health, such as difficulty with transportation to
dental clinics because of physical, economic, or behavioral
reasons; a prioritization of other medical exigencies over oral
health; behavioral issues that complicate office visits and
treatment; fear and anxiety about visiting the dentist; etc.
(Slack-Smith, 2010; Lehl, 2013). The caregivers of children and
youth who have developmental disabilities may experience additional
challenges in accessing and sustaining dental care. These
challenges may include surmounting language barriers and
establishing relationships with dental providers, who are attuned
to their specific needs and concerns.
Children with developmental disabilities are identified by the
American Academy of Pediatric Dentistry (AAPD) as a group with
Special Health Care Needs (SHCN) (2012). In the 2011 Institute of
Medicine Report, Improving Access to Oral Health Care for
Vulnerable and Underserved Populations, people with SHCN were
identified as having poorer oral health than the general population
(Institute of Medicine & National Research Council, 2011).
Low-income children with SHCN may be particularly at risk of not
receiving preventive services. Many with SHCN rely on government
funded health care to meet their medical and dental needs; however,
research indicates that children with SHCN who are enrolled in
Medicaid are less likely to receive needed preventive dental care
than children with SHCN who were not enrolled in Medicaid (Kenney,
2009). This could be due in part to factors outside of access to
care. For example, for children with SHCN, family poverty was found
to be associated with greater caregiver burden, defined as the time
and financial
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demands associated with caring for a child with disability that
constrain the parental social role, (McManus, et al., 2011) and
less preventative dental use (Chi et al., 2014).
This LDPP directs program activities to vulnerable children and
their families who reside in Los Angeles Countys dental desert, in
particular American Indians and Alaska Natives and children with
developmental and intellectual disabilities. This focus is enriched
by a perspective that incorporates attention to cultural and social
variables that intersect help-seeking and health sustaining
behaviors and that are respectful of family/community strengths and
capacities.
The proposed project is unique in its capacity to address the
issues that are summarized, because this partnership of two major
universities leverages experience, wisdom and resources in an
integrated program design. This capacity is strengthened by a
commitment to deliver culturally attuned services and dental health
promotion activities in the second largest AIAN urban community and
to build university-community partnerships with a historically
underserved population. The LDPP intends to integrate recommended
best practices from Indian Health Service as well as build on the
wealth of practice wisdom of AIAN practitioners in the urban
community. There is also the opportunity to disseminate best
practices to other AIAN urban communities via the knowledge gleaned
from this partnership.
This LDPP seeks and integrates the knowledge of faculty and
providers, who are experts in this field and who can strengthen
outreach and intervention strategies. Project Associate Director,
Dr. Mulligan, and participating entity, Childrens Hospital Los
Angeles, have extensive expertise concerning the delivery of health
care for children with disabilities, assets that will be leveraged
in the proposed project.
2. Establish Dental Homes for children by the time the first
tooth erupts Leading health and oral health organizations,
including the American Academy of Pediatrics (AAP), American
Academy of Pediatric Dentistry (AAPD), American Dental Association
(ADA), California Dental Association (CDA), and American
Association of Dental Public Health Dentistry (AAPD), recommend a
first dental visit by age 1 (Agency for Healthcare Research and
Policy, 2015). Research has shown early intervention leads to
better oral health and lower cost for families and society
(Casamassimo, 2009). While few very young children (1.5%) are seen
by the dentist at the recommended age of 1 for a dental check-up,
the majority (89%) of young children are seen by pediatricians and
primary care providers for well-baby visits (Health Professions
Network Nursing and Midwifery, 2010). Physicians and nurses can act
as a first line of defense against this most common childhood
disease and help link those children to proper dental homes, if
they are provided with the right information and training.
Additionally, enhancing the clinical skills of dental professionals
through continuing education will enable them to be willing and
ready to provide dental services for very young children and
improve access to care for this population.
We are proposing a community-based oral health promotion program
that combines health education by inter-disciplinary teams that
incorporate cultural and contextual understandings into their
interactions with beneficiaries. This model has been more effective
than alternative methods that solely focus on interventions, such
as those that aim to promote access to fluoride, improve children's
diets or provide oral health education alone, which have shown only
limited impact according to a recent systematic review (de Silva,
2016).
3. Develop Interprofessional Education (IPE) and Collaborative
Practices (CP) IPE & CP have been proposed and advocated by the
World Health Organization (WHO), as well as other
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national and international health organizations, for improving
team-based patient care and enhancing population health. According
to the WHO, Interprofessional Education (IPE) is defined as when
two or more professions learn about and with each other to enable
effective collaboration and improve health outcomes. Collaborative
Practice occurs when multiple health workers from different
professional backgrounds provide comprehensive services by working
with patients, families, and communities to deliver the highest
quality of care across settings. IPE is essential to the
development of CP (Health Professions Network Nursing and
Midwifery, 2010). Therefore, our focus in this proposal is
expanding the knowledge and activities of other non-dental
disciplines in improving oral health practices at the community
level (e.g., teaching nurses and other health professionals to
apply fluoride varnish, encourage drinking fluoridated tap water,
and provide anticipatory guidance health checks), the family level
(e.g., changing parental feeding practices and establishing family
routines that promote oral health), and the individual level (e.g.,
empowering teenagers through helping them develop plans to overcome
barriers to well-being and self-care). The development of
interdisciplinary training curricula that draws on the expertise
and scholarship of RXHHS and USC faculty will enhance these
efforts. In particular, faculty knowledge and scholarship about the
role of the cultural inheritance and the contexts that shape
developmental processes for children, youth, family and communities
will enrich pedagogy and curriculum.
In order to measure the success of interprofessional education
(IPE), we will assess how IPE impacts the client experience
(vertical integration), and how IPE improves interprofessional
collaborative efforts (horizontal integration). IPE can affect a
range of outcomes, such as learners attitudes toward one anothers
professions, collaborative behavior, and overall quality of client
care (Reeves, 2008). Evidence proves that on the whole, IPE is
well-received and helps participants to develop knowledge and
skills for collaborative working, including an understanding of
roles and responsibilities (Thistlethwaite, 2012).
4. Emphasize that Oral health is an essential part of overall
wellness Oral and general health are intertwined. Poor oral health
makes it difficult to eat, speak, and be employed. For children,
poor oral health can make it difficult to learn due to pain,
discomfort, or social stigma. Accordingly, oral health affects
individuals selfesteem, psychological and social wellbeing, income
level, interpersonal relations, and quality of life (U.S.
Department of Health and Human Services, 2000). Additionally, just
this month (Sept. 2016) the World Dental Federation (DFI) launched
a new definition of the term oral health, designating oral health
as an integral part of general health and well-being (Burger,
2016). According to this definition, oral health is:
Multi-faceted and includes the ability to speak, smile, smell,
taste, touch, chew, swallow and convey a range of emotions through
facial expressions with confidence and without pain, discomfort and
disease of the craniofacial complex;
A fundamental component of health and physical and mental
wellbeing, which exists along a
continuum and is influenced by the values and attitudes of
individuals and communities;
Reflective of the physiological, social and psychological
attributes that are essential to quality of life and are influenced
by the individuals changing experiences, perceptions, expectations
and ability to adapt to circumstances.
This definition emphasizes that oral health does not occur in
isolation, but is embedded in the wider framework of overall health
and well-being. Our project is an integrative and collaborative
approach in line with the new definition of oral health by FDI,
designed to improve oral health and related quality of life among
children and youth.
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5. Promote oral health using a multidimensional approach
Children and their families are nested within broader contexts that
may promote or hinder their oral health; oral health and dental
care are inextricably linked to a variety of societal, community,
family interpersonal, and individual factors (Patrick et al., 2006;
Fisher-Owens et al., 2007). For example, family-level factors (such
as social support; parents beliefs, behaviors, and health; and
family culture) and community-level factors (such as the physical
and social environments and the availability of resources)
indirectly impact childrens oral health (Fisher-Owens et al.,
2007). A 2011 report from the Institute of Medicine, currently
known as the Academy of Medicine, entitled, Advancing Oral Health
in America, made multiple recommendations known as the New Oral
Health Initiative (Institute of Medicine, 2011). Recommendations of
particular interest to this project include:
Improving oral health literacy and cultural competence;
Enhancing the role of non--dental healthcare professionals;
Promoting collaborations among private and public stakeholders.
Therefore, an interdisciplinary, multilevel approach is needed
to truly address oral health. Such an approach will be utilized in
this project. The approach is based on the Whole School, Whole
Community, Whole Child (WSCC) model (described further in Section
3)developed by the Centers for Disease Control. WSCC has 10
components: (1) Health Education; (2) Nutrition Environment and
Services; (3) Employee Wellness; (4) Social and Emotional School
Climate; (5) Physical Environment; (6) Health Services; (7)
Counseling, Psychological and Social Services; (8) Community
Involvement; (9) Family Engagement; and (10) Physical Education and
Physical Activity. By addressing the multiple needs of vulnerable
children and their families based on this model, reductions in
contextual barriers and see improvement in engagement, adherence
and compliance in oral health and overall health should be
seen.
Target Population: Our target population is Medicaid eligible,
vulnerable children 0-20 years old residing in the County of Los
Angeles Service Planning Areas (SPAs 3, 4, 6, 8). These SPAs
represent the highest poverty levels in the County and the County
has the highest poverty rate in the state as shown in Figure 2
above.
26% of Los Angeles County children (about 526,500) live below
the po