GOAL – ELIMINATE ORAL HEALTH DISPARITIES 1 Promoting Oral Health for South Florida A Community Dialogue Jungle Island, Miami Florida October 15, 2007 Harry

GOAL – ELIMINATE ORAL HEALTH DISPARITIES1

Promoting Oral Health for South Promoting Oral Health for South FloridaFlorida A Community Dialogue A Community Dialogue

Jungle Island, Miami Florida

October 15, 2007

Harry W. Davis, DDS, MPH

Dental Director

Florida Department of Health

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Florida’s State Oral Health Florida’s State Oral Health Improvement PlanImprovement Plan

Facilitating Collaborative Partnerships Working Towards

Common Goals

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OutlineOutline

History/BackgroundComponentsRecommendations and StrategiesActivities

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HistoryHistory

1997 - A Dental Summit was held by the Department of Health and the Agency for Health Care Administration. This began dialog

Resulting In

1998 – The creation of the Statewide Dental Coordinating Council, which began increased integration and strategic planning efforts with expanded participation by stakeholder organizations in oral health

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History History

•2001 - National Governors Association Oral Health Policy Academy participation highlighted the importance of oral health and of community coalition development to combat oral health disparities

•2003 - Federal Grant was awarded to facilitate development of an Oral Health Improvement Plan for Disadvantaged Floridians

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Advisory Committee(Development Team)

Core Members of the Statewide Dental Coordinating Council and the National Governors Association Oral Health Policy Team

Additional Members as broad based as possible representing Public and Private Organizations as Possible

Communication through: An Extensive E-mail Distribution List and Face to Face Meetings

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Email Distribution List

Florida Dental Association

Florida Dental Hygiene Association

Florida Dental Assistants Association

Florida Academy of Pediatric Dentistry

Florida Medical Association

UF College of Dentistry

Nova SE College of Dental Medicine

Florida Board of Dentistry

Florida Assoc. of Comm. Health Centers

Florida Healthy Kids

Florida Head Start Collaboration Office

Florida Developmental Disabilities Council

Sunrise Community, Inc

Florida Institute of Family Involvement

Florida Baptist Convention

USF School of Public Health

Sunshine State Dental Association

Suncoast Community Health Center

Community Voices Miami

ACORN Clinic

Suwannee River AHEC

Florida Health Care Association

AHCA Medicaid Program

Developmental Disabilities Agency

Department of Elder Affairs

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The E-mail Distribution List Also Included the Following from the Florida Department of Health

Adult and Community Health

Child Nutrition

Children’s Medical Services

Chronic Disease

Public Health Dental Program

Disease Control - HIV/AIDS

Family and Community Health

Family Health Services

Maternal and Child Health

School Health

Minority Affairs

Volunteer Program

Alachua We Care

WIC Program

Broward CHD

Duval CHD

Flagler CHD

Jefferson/Madison CHDs

Palm Beach CHD

The distribution list is kept updated with organizations who wish to participate in implementation activities and collaborative partnerships

Currently over 100 organizations

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ComponentsComponents

Background information on oral health issues

Recommendations with strategiesAction plan with objectivesWebsite: Oralhealthflorida.com

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Oralhealthflordia.com website The Starting Point for Finding Oral Health Information in Florida

A comprehensive source for:

• SOHIP Overview, History and News

• SOHIP Documents and Reports

• Background Information

• Fact Sheets (under development)

• Current SOHIP Initiatives

• Workgroups and Community Coalitions

• Oral Health Profiles for Each County and the State

• Partner and Other Oral Health Resource Links

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STATE ORAL HEALTH IMPROVEMENT PLAN

Recommendations

1. Improve access to community and school-based preventive programs for all ages

2. Improve access to community and school-based education programs for children and adults

3. Increase public and governmental awareness of oral health issues

4. Improve state and county-based oral health data collection and research

5. Improve access to care by assuring a highly trained, diverse, appropriately allocated dental workforce

6. Improve access to care by assuring adequate statewide, publicly focused infrastructure and support programs

7. Improve the integration of oral health prevention and education into general health

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Activities

• Advisory committee and workgroup meetings

• Conference Calls

• Email Communications

• Statewide forums

• Local coalition development

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CONDUCT STATE FORUMS TO DEVELOP SPECIFIC POPULATION STRATEGIES

o Head Start 6/2005

o Early Childhood Caries 7/2006

o Seniors 6/2007

o Children with Special Needs 8/2007

Future Forums

o Minority Health

o Migrant Workers and Refugees

o HIV/AIDS

o Women

Statewide Forums

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• Statewide Workgroups Open for ParticipationStatewide Workgroups Open for Participation

o Early Childhood Caries Preventiono Migrant Oral Healtho Oral Health for the Elderlyo Special Needso Independent Non-profit Coalition

Future Workgroupso HIV/AIDSo Teledentistryo Womeno Minoritieso Integration of Oral Health into Medical Professional

Education o Periodicity Schedules for Medicaid Patientso Incentives to Provide Dental Care through Publicly

Funded Programs

Current Workgroups

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Local Coalition Development

Uses state plan as foundation to develop Uses state plan as foundation to develop local strategies and partnershipslocal strategies and partnerships

Coalitions in various stages of development

Alachua Miami Dade

Baker/St. Johns Okeechobee

Dixie/Gilchrist Osceola

Gadsden Polk

Indian River Santa Rosa

Martin Wakulla

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New Federal GrantNew Federal Grant

To continue and enhance activities over next four years

Increase statewide forums

Increase workgroups

Increase local coalition development

Enhance website


State State InitiativesInitiatives• County Health Department ProgramsCounty Health Department Programs

– Onsite treatment programsOnsite treatment programs– Mobile unitsMobile units– Community dental projectsCommunity dental projects– Early childhood caries preventionEarly childhood caries prevention– TeledentistryTeledentistry– Oral health integration into general healthOral health integration into general health

• Fluoridation

• Governor’s Office Policy Initiatives


County Health Department County Health Department ProgramsPrograms Onsite treatment programs Onsite treatment programs (R6S2)(R6S2)

– 44 CHDs 81 Clinics - Reaching over 44 CHDs 81 Clinics - Reaching over 130,000 persons yearly130,000 persons yearly

– Doubled capacity over last 6-7 yearsDoubled capacity over last 6-7 years– Provide care to over 20% of Medicaid Provide care to over 20% of Medicaid

recipients – Up to 80% in smaller recipients – Up to 80% in smaller countiescounties

– 3 new programs under development3 new programs under development– Expansion of existing programsExpansion of existing programs


County Health Department County Health Department ProgramsPrograms Mobile Units Mobile Units (R6S2)(R6S2)

– Most effective way to provide school-Most effective way to provide school-

based preventive servicesbased preventive services– Currently 8 programs – 1 under Currently 8 programs – 1 under

development development – 3 started within last several months3 started within last several months


County Health Department County Health Department ProgramsPrograms Community Dental ProjectsCommunity Dental Projects

– Based on local needs - flexibleBased on local needs - flexible– Basic configuration – Coordinator and expenses Basic configuration – Coordinator and expenses – Currently 6 projects – 6 under developmentCurrently 6 projects – 6 under development– Activities includeActivities include

School-based preventive and educational School-based preventive and educational (R1S2/3; (R1S2/3; R2S3)R2S3)

Fluoridation promotion Fluoridation promotion (R1S1)(R1S1) Contractual providers for uninsured Contractual providers for uninsured (R5S1)(R5S1) Referral and follow up Referral and follow up (R6S3)(R6S3) Coalition development/partnerships Coalition development/partnerships (R3S4)(R3S4) Surveys Surveys (R4S1)(R4S1)


County Health Department County Health Department ProgramsPrograms Early Childhood Caries PreventionEarly Childhood Caries Prevention

(R3S4;R7)(R3S4;R7)

– Utilize medical staff during routine child visits Utilize medical staff during routine child visits – Protocol and trainingProtocol and training– Activities for ages 0 to 4 includeActivities for ages 0 to 4 include

Risk assessmentRisk assessment Anticipatory guidanceAnticipatory guidance Preventive services (fluoride varnish)Preventive services (fluoride varnish) Referral to establish dental homeReferral to establish dental home


County Health Department County Health Department ProgramsPrograms Teledentistry Pilot ProjectsTeledentistry Pilot Projects (R6S10)(R6S10)

– Supervise dental hygienist at remote Supervise dental hygienist at remote site site

– Fixed site to fixed site (Nassau CHD)Fixed site to fixed site (Nassau CHD) Recently startedRecently started

– Fixed site to mobile site (Wakulla CHD)Fixed site to mobile site (Wakulla CHD) Under developmentUnder development


County Health Department County Health Department ProgramsPrograms Oral health integration into general Oral health integration into general

healthhealth

(R7S1)(R7S1)– Guidelines under development for Guidelines under development for

specific programsspecific programs– Systemic disease relationshipsSystemic disease relationships


Fluoridation Fluoridation (R1S1)(R1S1)

Foundation of dental public healthFoundation of dental public health Most cost effective prevention of Most cost effective prevention of

dental cariesdental caries 2005 – Exceeded Healthy People 2005 – Exceeded Healthy People

2010 objective of 75%2010 objective of 75% Currently at 78%Currently at 78% Last several years Florida has had Last several years Florida has had

largest increase in persons served by largest increase in persons served by fluoridating systemsfluoridating systems


Governor’s Office Policy Governor’s Office Policy InitiativesInitiatives Workforce issues related to public Workforce issues related to public

health practice health practice (R5S4)(R5S4)

– Licensure for dentistsLicensure for dentists

– Supervision levels for dental hygienistsSupervision levels for dental hygienists


Questions/CommentsQuestions/Comments

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Recommendation 1. Improve access to community and school-based prevention programs for all ages.

Strategies:

1. Increase access to fluoridation.

2. Advocate for improved diet and nutrition in schools in at least one area of the state.

3. Expand school-based and school-linked dental sealant programs.

4. Expand school-based fluoride mouthrinse programs.

5. Develop school-based fluoride varnish programs

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Recommendation 2. Improve access to community and school-based education programs

Strategies:

1. Enlist support from and train school health providers and educators on oral health issues.

2. Provide appropriate grade-level oral health education curricula in both public and private schools.

3. Provide community-based oral health education presentations throughout communities.

4. Advocate for increased funding for community and school-based oral health education programs.

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Recommendation 3. Increase public and governmental awareness of oral health issues

Strategies:

1. Educate lawmakers and policymakers about the importance of oral health.

2. Educate the public about the importance of oral health and the connection between oral health and general health

3. Educate non-dental health care providers on the importance of oral health.

4. Conduct work groups, forums, or summits to develop strategies, objectives, and action steps for specific disadvantaged population groups including those with specific health care needs.

5. Utilize internet resources for oral health information and education.

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Recommendation 4. Improve state and county-based oral health surveillance and research

Strategies:

1. Develop an outcome/disease-based surveillance system and develop and maintain state and county-specific profiles.

2. Develop a systematic, annual analysis of the Medicaid and KidCare programs

3. Advocate for a statewide oral health research agenda.

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Recommendation 5. Improve access to care by assuring a highly trained, diverse, appropriately allocated dental workforce

Strategies:

1. Assure that an adequate number of appropriate dental care provider types exist and increase the diversity of dental care providers.

2. Expand professional training opportunities regarding care for special needs populations.

3. Expand volunteer incentives.

4. Consider reforms to better utilize the existing dental workforce to achieve improved access to care.

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Recommendation 6. Improve access to care by assuring adequate statewide, publicly focused infrastructure and support programs

Strategies:

1. Promote improvement of the Medicaid program.

2. Expand community-based safety-net fixed clinics and mobile units.

3. Promote school oral health screenings at periodic intervals with appropriate referrals.

4. Improve the dental services through the State Children’s Health Insurance Program (SCHIP).

5. Expand number of dental care providers/practitioners and centers with expertise in caring for disadvantaged and special needs populations.

6. Promote continuity of care through targeted case management and patient education.

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Recommendation 7. Improve the integration of oral health prevention and education into general health

Strategies:

1. Develop protocols to integrate oral health into all appropriate DOH programs.

2. Utilize existing community networks to identify and educate patients with systemic diseases that relate to oral health.

3. Advocate for oral health screenings to become a routine part of medical examinations.

4. Advocate for increased oral health training for medical professionals.