Taking a Bite Out of Dental Caries Integrating Cavity Prevention with WIC Nutrition Services Presented by: Susan Moyer, RN, MSN, CNSPH Jefferson County Public Health Community Health Services December, 2009
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JCPH Cavity Free at Three presentation
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Taking a Bite Out of Dental
CariesIntegrating Cavity Prevention
with WIC Nutrition ServicesPresented by: Susan Moyer, RN, MSN, CNSPH
Jefferson County Public Health Community Health Services
December, 2009
Presentation Goals
• Outline the statewide Cavity Free
at Three (CF3) grant and clinical
model
• Show how Jefferson County
Public Health (JCPH) designed
its service delivery model
• Three-year statewide effort to prevent oral disease in young children
• Engages multiple disciplines in prevention and early detection
• Teaches a new clinical model to screen, educate, and apply fluoride varnish in medical and public health settings
Program Catalyst: Cavity Free at Three
What is Cavity Free at Three?
Program Catalyst: Cavity Free at Three
Why?
• Dental caries is the most common chronic childhood disease
• 80% of the disease is in 20% of the population
• Dental disease causes pain and affects children's ability to eat properly, grow, attend school and learn
Program Catalyst: Cavity Free at Three
Who?
• Technical Assistance Team: leading dentists, physicians and dental hygienists
• Funding Agencies: Caring for Colorado Foundation, The Colorado Health Foundation, The Colorado Trust, Delta Dental of Colorado Foundation, Kaiser Permanente and Rose Community Foundation.
• Implementing Agencies: Caring for Colorado Foundation (first year), then University of Colorado Denver School of Medicine, Department of Family Medicine and the University of Colorado Denver School of Dental Medicine
• Three annual grant cycles occurring between Fall 2008 and 2011
• JCPH Awarded CF3 grant in Fall 2008
Program Catalyst: Cavity Free at Three
When?
• Each grant is valued at $50,000 and includes:– On-site education on the infant oral health
protocol
– Help in developing systems for infant oral care
– Provider and patient information and education
– Provider infant oral care kits for the infant oral care exam
– Evaluation of the implementation of the infant oral care model and
– Funding to help off-set costs of staff working to implement the model
Program Catalyst: Cavity Free at Three
How?
Cavity Free at Three Grantee:
Designing a Service Delivery Model
Public Health Nurses used the nursing process to design the most efficient and effective service delivery model
1. Community Assessment
2. Community Oriented Nursing Diagnosis
3. Program Planning
4. Program Implementation
5. Evaluating the Program
6. Sustaining the Program
Nursing Process Phase 1: Assessment
Identify Communities • Target Population: WIC Program
Pregnant women and children
– Low income
– Multiple barriers to accessing preventive care (time, cost, travel)
– Regularly attend WIC appointments to meet family nutrition needs
Nursing Process Phase 3: Program Design
Evidence-Based Program Design
• Research proven service delivery models
– Texas Head Start uses RDHs to provide preventive oral hygiene services
Nursing Process Phase 3: Program Design
Ideal Service Providers
1. RDH: Registered Dental Hygienist
2. Independent: Owns dental hygiene business
3. Medicaid/CHP+ Providers
Nursing Process Phase 3: Program Design
Provider Non-Fiscal Contract
• Adhere to CF3 clinical model
• Must see all uninsured clients pro bono in exchange for paying no office rent or supply fees
• Bill Medicaid/CHP+ for eligible clients as part of own independent practice
Nursing Process Phase 3: Program Design
Developing a Local Referral Network
• Visit community providers on list generated during community assessment phase
• Inform about CF3 Program
• Ask to include on referral list
• List Includes
– Medicaid/CHP+ providers who also offer discounted services for the uninsured (both pediatric and adult)
Nursing Process Phase 3: Program Design
Case Management Guidelines
• Encourage all clients to establish a dental home
• Recommend that all clients obtain dental insurance when possible
• Refer clients with non-urgent problems to providers on list
• Refer clients with urgent problems to local provider immediately and program coordinator for case management
Nursing Process Phase 5: Evaluation
Measuring Impact
• Oral health screening from completed for every client encounter
• Basic data recorded in electronic medical record
• Case Studies
Nursing Process Phase 5: Evaluation
Ongoing Evaluation
• Periodic meetings with stakeholders
• Monitor and maximize provider incentives
• Capacity building activities as needed
Tracking Screenings
February 55
March 266
April 162
May-July 150-200
August 100 (Vacations)
Screenings to date Over 1,100
Nursing Process Phase 6: Sustaining Benefits
Keys to Sustainability
• Negligible cost to JCPH
• Maximizing Incentives for Service Providers
• Minimizing Costs of Participation for Service Providers
• Minimizing Supply Costs
Conclusion
Linking for Synergy
JCPHCHSStaff
CF3 Service
Providers
JCPHEPSDT
InsuranceProviders
LocalDentalHome
JCPHWICStaff
Target PopulationProgram Coordinator
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