Reaching the Healthy People 2010 Objectives for Rural Children:

Facilitators and Barriers for Reaching Healthy People 2010 Goals.

Elaine Jurkowski, MSW, PhD1

Sandra Nagel Beebe, RDH, PhD2

Charla J. Lautar, RDH, PhD2

School of Social Work1

Department of Health Care Professions2

Southern Illinois University Carbondale2

Problem

In rural, southern Illinois, despite the perception that oral health services are available through public services, low income or Medicaid children still DO NOT access services.

Healthy People 2010

Healthy People 2010 outlines a series of benchmarks for children and their oral health status. Included in these benchmarks are the following:

21-1. Reduce the proportion of children and adolescents who have dental caries experience in their primary or permanent teeth.

Healthy People 2010 (cont.)

21-2a & b. Reduce the proportion of young children and adolescents with untreated dental decay in their primary teeth.

21-8. Increase the proportion of children who have received dental sealants on their molar teeth.

- 21.10 Increase the proportion of children and older adults who use the oral health system each year.

Healthy People 2010 (cont.)

21-12. Increase the proportion of low-income children and adolescents who received any preventive dental service during the past year.

Limited Access

Miles for Smiles School-based Sealant Program Medicaid Dental Clinic (limited hours) FQHC No dentist accepts Medicaid patients Counties without a dentist Specialists are within an hour or more No method for referrals (i.e., Head Start)

Perceived needs for care

Oral health education Services and resources for people that do not

have access Education for parents and providers working in

care facilities Transportation Reduced materials in Spanish Target parental attitudes

Methods for investigation

Chart review from FQHC, University Teaching and Medicaid clinics targeting children >18 years of age.

100% sample from the University Teaching Clinic

100% sample from the Medicaid Clinic 20% sample from the Federally Qualified

Health Center.

Methods

Chart reviews for patients seen in 1998 and 2002 from FQHC clinic and University Teaching Clinic (UTC).

Sample was as follows: N=88 UTC; N=166 Heartland; 100% sample –

2002. N= 144 UTC; 100% sample; N= 205 FQHC; 20%

sample – 1998.

Methods (continued)

Variables collected included zip code, age, race, payer source, reason for exam, brush/floss frequency, year of first visit, number of decayed, missing & filled teeth, and number of existing sealants.

Findings

Year patients were first seen…

3.41.11.1

11.43.4

78.4

100

0

20

40

60

80

100

UTC Medicaid

199419951999200020012002

Age breakdown of patients seen(1998 vs 2002)

0

10

20

30

40

50

FQHC98 Medicaid02 UTC98 UTC02

<3 3-6 yrs. 7-11 yrs. 12-15 yrs. 16-18 yrs.

Racial breakdown of patients seen(1998 vs 2002)

0

20

40

60

80

100

White PacificIslander

Asian

FQHC98 Medicaid02 UTC98 UTC02

Reasons for visit(1998 vs 2002)

020406080

100

Prevention ExamEmergency

Consultation

FQHC98 Medicaid02 UTC98 UTC02

Percent of kids with no sealants by age group (1998 vs 2002)

0

20

40

60

80

100

<3 3-6 yrs. 7-11 yrs. 12-15 yrs. 16-18 yrs.

FQHC98 Medicaid02 UTC98 UTC02

Percent of kids with sealants by age group (1998 vs 2002)

0

20

40

60

80

100

<3 3-6 yrs. 7-11 yrs. 12-15 yrs. 16-18 yrs.

FQHC98 Medicaid02 UTC98 UTC02

Findings (cont.)

There is a significant difference in the age of children seen in 1998 UTC (Mean=12.43 years) as compared to 2002 UTC (Mean =9.7 years) t=2.92, df=61.65, p=.005.

There is a significant difference between the number of caries in the primary teeth with more seen in 1998 (t=4.375, df=170.983, p=.000)

Findings (cont.)

Findings reflect the disparities of the Surgeon General’s report and other data/literature.

There was a significant difference in the number of filled teeth for primary and permanent dentitions, with higher mean values in 1998 (t=4.568. df=168.919, p=.000; t=2.436, df=168.354, p=.016).

Conclusions

The majority of patients seen in public clinics in 2002 were new referrals, which suggests either follow-up does not exist, or intervention efforts at recruitment were successful.

Although a sealant program exists, it is likely that the patients who were utilizing the sealant program are not the same children seen in the public clinics.

Although resources may exist, there is some work needed to direct services to reach those most in need of services.

Conclusions (cont.)

The nature of the public clinics does not promote long term relationships with clients who may be low income or under insured. This has an impact on the efficacy of targeted intervention efforts, and requires address.

Discussion

Are outreach efforts with Head Start and WIC really working? How can we better serve or address the needs of those who have problems?

The data found suggest that those who are utilizing public resources for oral health care are not seeking care consistently or returning to the clinics for follow up.

What are the barriers that exist?

Transportation and realities of living conditions for community based rural children and their families.

Lack of follow-up from pilot projects or demonstration projects to improve access to services.

Medicaid and health insurance are not readily accepted by dentists in rural communities.

What facilitators can be used by providers to reach the uninsured?

Teach the importance of oral health care to school health personnel and school social workers in an effort to translate information to the target population.

Integrate patient education to children and their parents in waiting rooms of clinics.

Follow-up is necessary within the public clinics to insure that patients return for care and services.

What facilitators can be used by providers to reach the uninsured?

Implement a referral system so that when case managers within either the school or DCFS systems detect a problem, they have resources available for referral.

Integrate the role of oral health and oral health assessment into the role of total health assessments through screening or “trigger” questions.

What are some specific steps that can be undertaken to eliminate barriers?

Continue to integrate dental hygiene students with WIC program case managers, Head Start, and oral health school curriculum for education and intervention.

Work with providers to identify strategies and respectable practices which will encourage follow through with target group.

Strengthen and expand indigent care options with current providers.

What are some specific steps that can be undertaken to eliminate barriers?

Develop health promotion messages which can be integrated through brief motivational counseling methods.

Continue to foster volunteer dentists’ participation.

Advocate for a shift in Medicaid policy which requires provider numbers on all claims versus dental provider (i.e., Medicaid clinic vs. actual dentist)

Contact information:

Charla J. Lautar, RDH, PhD cjlautar@siu.edu Interim Chair, Dept. of Health Care

Professions, SIUC M/C 6615 College of Applied Sciences and Arts Southern Illinois University Carbondale (618) 453-7211

Contact information (cont.)

Elaine T. Jurkowski, MSW, PhD etjurkow@siu.edu Director, Center on Gero-Enrichment for

Social Work Education, SIUC M/C 4329, Quigley 4 School of Social Work Southern Illinois University Carbondale (618) 453-1200

Contact information

Sandra N. Beebe, RDH, PhD M/C 6615 Dental Hygiene Program College of Applied Sciences and Arts Southern Illinois University Carbondale (618) 453-7202

Special thanks to….

Preetesh Mahendra, Doctoral Student, (SIUC) for his help with chart reviews and data collection.

Notes…..