cavity free @ 3 citymatch presentation

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

September, 2010

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?

• $10,000 awarded

• On-site education/training on the infant oral health protocol

• Infant oral care kits for the oral care exam

• Provider and patient information and education tools

• Evaluation of the implementation of the infant oral care model and

• Technical assistance

– Each grant is valued at $50,000

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 form 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

• Began screenings February of 2009– 1,521 screenings completed as of

June 30, 2010

– 87.5% High Caries Risk assessment

• Additional Screenings

– 500 with Head Start

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

Healthcare Access

Contact Information

Susan Moyer RN MSN CNSPH

Public Health Nurse Supervisor

Jefferson County Public Health

Lakewood, Colorado

• skmoyer@jeffco.us

• 303-239-7045

• http://jeffco.us/health/

• http://www.cavityfreeatthree.org/