New Mexico Results for Oral Health The National Survey of Children with Special Health Care Needs Rohini Singh, MPH candidate Tulane University School.

New Mexico Results for New Mexico Results for Oral HealthOral Health

The National Survey of The National Survey of Children with Special Health Children with Special Health

Care NeedsCare Needs

Rohini Singh, MPH candidate Rohini Singh, MPH candidate Tulane University Tulane University

School of Public Health and Tropical MedicineSchool of Public Health and Tropical MedicineGraduate Student Internship Program ParticipantGraduate Student Internship Program Participant

MCH Bureau/HRSA/DHHSMCH Bureau/HRSA/DHHSAssigned to MCH Epidemiology, NM Dept. of Health Assigned to MCH Epidemiology, NM Dept. of Health

Prevalence of CSHCN inPrevalence of CSHCN in New Mexico New Mexico

88.57

11.43

Not a CSHCN

This is a CSHCN

CSHCN Potentially Eliglible for Medicaid/SCHIP

50.42

15.81

11.08

22.7

0 10 20 30 40 50 60

Below 200%FPL

Below 300%FPL

Below 400%FPL

at or above400% FPL

CSHCN Insurance CoverageCSHCN Insurance Coverage 8.81% [95%CI;5.94-12.85] 8.81% [95%CI;5.94-12.85]

have no insurance coveragehave no insurance coverage 43.45% [95%CI: 38.45-48.59] 43.45% [95%CI: 38.45-48.59]

have Medicaid or SCHIP have Medicaid or SCHIP 4.66% [95%CI: 3.17-6.79] 4.66% [95%CI: 3.17-6.79]

are covered by Title V are covered by Title V 52.41% [95%CI: 47.34-57.44] 52.41% [95%CI: 47.34-57.44]

have private insurancehave private insurance

CSHCN: increased riskCSHCN: increased risk

Some CSHCN are born with oral Some CSHCN are born with oral diseases diseases

Nature of condition may require Nature of condition may require pediatric dentist with knowledge in pediatric dentist with knowledge in caring for such childrencaring for such children

Reliance on family for daily oral Reliance on family for daily oral health carehealth care

CLEFT LIP AND PALATE

Photos courtesy of Operation Smile.

Dental Care and InsuranceDental Care and Insurance 30% [95% CI: 22.94-38.46] of CSHCN without 30% [95% CI: 22.94-38.46] of CSHCN without

private insurance said that they did not need private insurance said that they did not need dental care. dental care.

Over 90%[95%CIs:86.3-94.84,66.49-83.97]of Over 90%[95%CIs:86.3-94.84,66.49-83.97]of CSHCN with private insurance received all the CSHCN with private insurance received all the dental care they needed, compared to 76% of dental care they needed, compared to 76% of those not covered by private insurance. those not covered by private insurance.

86% [95%CIs: 80.82-90.22, 43.29-84.08] of 86% [95%CIs: 80.82-90.22, 43.29-84.08] of those with any insurance received dental care, those with any insurance received dental care, compared to 66% of those without insurance. compared to 66% of those without insurance.

During the past 12 months was there any time when During the past 12 months was there any time when (“S” CHILD(“S” CHILD) needed dental care including check-ups?) needed dental care including check-ups?

No 25%

Yes 74%

DK 1%

Primary care and need for dental carePrimary care and need for dental care

40% of families who claimed the doctor 40% of families who claimed the doctor never spent enough time with their child never spent enough time with their child said they did not need dental care.said they did not need dental care.

Over 60% of families whose provider was Over 60% of families whose provider was never sensitive to their family’s customs never sensitive to their family’s customs and values said they did not need dental and values said they did not need dental care.care.

Photo courtesy of http://dgl.microsoft.com/

Did Did (“S” CHILD”)(“S” CHILD”) receive all the dental care that receive all the dental care that he/she needed?he/she needed?

Yes 85%

No 15%

Receiving dental care is significantly Receiving dental care is significantly associated with:associated with:

Severity of child’s Severity of child’s conditioncondition

# of missed school # of missed school daysdays

Need for physical, Need for physical, occupational, or occupational, or speech therapyspeech therapy

Need for hearing Need for hearing and communication and communication aidsaids

Care coordinationCare coordination Financial problems Financial problems

and need for and need for additional incomeadditional income

The need to stop The need to stop working or cut working or cut down hours to care down hours to care for the childfor the child

Children whose condition is considered severe are less Children whose condition is considered severe are less likely to be receiving dental care.likely to be receiving dental care.

9.141

90.86

21.75

78.25

0

20

40

60

80

100

120

received all needed

dental care

not severe severe Overall, how would you rank the severity of the

child's condition(s) or problem(s)?

No Yes

More about severity of child’s condition and More about severity of child’s condition and receiving dental carereceiving dental care

About half of the children who need About half of the children who need communication aids and devices are not communication aids and devices are not receiving the dental care they need.receiving the dental care they need. [95% [95% CI: 20.31-81.12]CI: 20.31-81.12]

Only three quarters of the children who need Only three quarters of the children who need physical, occupational, or speech therapy are physical, occupational, or speech therapy are receiving all needed dental care, compared to receiving all needed dental care, compared to 90% of those who do not need this therapy. 90% of those who do not need this therapy. [95% CI: 63.97-83.54,83.01-93.05][95% CI: 63.97-83.54,83.01-93.05]

Children are less likely to miss school if they are Children are less likely to miss school if they are receiving dental care.receiving dental care.

12.69

87.31

12.36

87.64

28.1

71.9

0

10

20

30

40

50

60

70

80

90

100

received all needed

dental care

0-4 days 5-10 days 11+ days

During the past 12 months, how many days did your child miss school because

of illness or injury?

Yes

No

Children receiving care coordination are far more Children receiving care coordination are far more likely to be receiving dental care.likely to be receiving dental care.

62.06 37.94

17.27 82.73

0 20 40 60 80 100

receiving dental care

No

Yes

re

ce

ivin

g c

are

co

ord

ina

tio

n

No

Yes

Take-home messagesTake-home messages Low dental IQ: Families of CSHCN need Low dental IQ: Families of CSHCN need

to understand the importance of everyday to understand the importance of everyday dental care and check-upsdental care and check-ups

Dentist shortage: CSHCN, especially Dentist shortage: CSHCN, especially those with severe disabilities, have no those with severe disabilities, have no where to go for dental carewhere to go for dental care

Socioeconomic status: Families having Socioeconomic status: Families having financial difficulties cannot and will not financial difficulties cannot and will not prioritize dental careprioritize dental care

Action and PolicyAction and Policy State-wide social State-wide social

marketing campaign for marketing campaign for dental hygeinedental hygeine

Work with primary care Work with primary care providers to make sure providers to make sure that they are encouraging that they are encouraging oral healthoral health

Have insurance Have insurance companies better companies better advertise dental benefitsadvertise dental benefits

Work with Medicaid to Work with Medicaid to improve reimbursement improve reimbursement rates and reduce rates and reduce paperwork hasslespaperwork hassles

• Recruit more pediatric dentists to New Mexico

Photo courtesy of http://dgl.microsoft.com/

LIMITATIONSLIMITATIONS

under-representation of various minority under-representation of various minority groupsgroups

lack of geographical datalack of geographical data income levels do not match New Mexico income levels do not match New Mexico

income cutoffs for state insuranceincome cutoffs for state insurance self-report biasself-report bias recall biasrecall bias

AcknowledgementsAcknowledgements

Susan Nalder, EdD, MPH, CNMSusan Nalder, EdD, MPH, CNM MCH Epidemiology Program Manager and Internship Advisor MCH Epidemiology Program Manager and Internship Advisor

Ssu Weng, MD, MPH Ssu Weng, MD, MPH Medical Medical Epidemiologist and Advisor for Data AnalysisEpidemiologist and Advisor for Data Analysis

Lynn Christiansen, MSW Lynn Christiansen, MSW Children’s Children’s Medical Services Program Manager/ Mentor: Data to ActionMedical Services Program Manager/ Mentor: Data to Action

Jane Peacock, MS Jane Peacock, MS Family Family

Health Bureau ChiefHealth Bureau Chief Dr. Ray Lyons, DDS, FADPD Dr. Ray Lyons, DDS, FADPD

Chief of Dental Services: Los Lunas Community ProgramChief of Dental Services: Los Lunas Community Program