Princeton, N.J.—The Robert Wood Johnson Foundation (RWJF) today released a series of oral health reports revealing that a key to improving the nation’s oral health may rest with innovative programs that already exist. Researchers commissioned by the Foundation examined 25 programs that addressed barriers to preventive oral health services with solutions in non-traditional, community, and mobile settings. The reports culminate a two-year collaborative effort led by a team from RWJF and consultant ICF International. The team examined programs that address socioeconomic, cultural, and geographic barriers to care; provide care in schools, Head Start sites, and senior centers; and offer preventive oral health care for infants and toddlers.
David Krol, MD, MPH, FAAP, the RWJF senior program officer who led the team, said the report points to solutions that are applicable to other oral health programs. “We know that oral health is the nation’s hidden health challenge. But there is potential for success. These reports identify programs and approaches that we should embrace as guideposts.”
Socioeconomic, Cultural, and Geographic Barriers to Preventive Oral Health Care
Each report is a synthesis analyzing programs that address the same barriers to care. Nine of the 25 programs studied work to bridge socioeconomic, cultural, and geographic barriers. All nine worked to increase the number of children from low-income families who get preventive oral health care, and to encourage families and communities to prioritize oral health. The reports surfaced major barriers confronting children covered by Medicaid. The numbers of pediatric oral health providers who accept Medicaid are far outstripped by the size of the population that needs to be served.
In response to barriers to care, the nine programs offered the following successful strategies:
- Implement cost-effective strategies to expand services;
- Provide training and technical assistance to increase competence in delivering oral health education and care for children;
- Develop creative service delivery models that address transportation and cultural barriers.
All nine programs worked to increase delivery of Medicaid services, in particular:
- Two created incentives for providers to see more Medicaid-eligible clients, and seven established new clinics and mobile units, some staffed by hygienists.
- Eight programs identified Medicaid-eligible children through Head Start and social service agencies.
- Eight targeted communities with a history of poor access to dental care, including communities of color—especially Black, American Indian, and immigrant populations.
Five provided or arranged transportation to obtain care, and nearly all used strategies such as staff training and child-friendly, culturally welcoming clinics and materials to engage patients, families, and communities in preventive oral health behavior.
Preventive Oral Health Care for Infants and Young Children in Women, Infants, and Children (WIC), Early Head Start, and primary care settings
The assessment team examined seven programs providing preventive oral health care to infants and young children in Women, Infants, and Children (WIC), Early Head Start, and primary care settings.
Four of the programs prioritized integrating oral health into primary care settings, and four pushed integration of oral health within WIC and Early Head Start. Most of the programs created an expanded role in community settings for workforce providers from primary care, public health, and childhood development professionals to play an essential role in access to preventive oral health care.
Dental Professionals in Non-Dental Settings
Of the oral health programs studied, nine are seeking to increase access to preventive oral health care in non-dental settings such as senior centers, schools, and Head Start sites. Each program works to expand the dental workforce through training new types of providers. All support an expanded role for dental hygienists. This includes registered dental hygienists in alternative practice (RDHAP) and expanded-practice dental hygienists (EPDH) who are licensed or certified to provide care in public health or non-dental sites without on-site supervision from a dentist.
Most of the programs are also engaged in strategies to increase cost-effectiveness, and are providing training and technical assistance to deliver oral health care and education to children. Offering oral health care services in residential and community venues such as senior centers, schools, and Head Start makes care available to more patients and increases the level of trust and engagement.
Systematic Screening and Assessment of Workforce Innovations in the Provision of Preventive Oral Health Services
RWJF commissioned ICF International to conduct the study. The programs studied were drawn from a list of 99 oral health programs nominated by local, state, and national organizations. The project team winnowed this list to 80, and prepared summary program descriptions. In June 2012, the Foundation convened a panel of 19 experts in dentistry, oral health, prevention services, oral health workforce innovations, and evaluation. The panel selected 25 programs for an evaluability assessment (EA) that was segmented into three phases: review of program background and documentation, development of a logic model to outline program goals and activities, and a 2.5 day site visit.
Krol says the next step will be to conduct more extensive research on select programs. “The strategies with the greatest potential for rigorous evaluation may emerge as best practices to create more access to preventive oral health care.”
The following programs were included in the evaluation:
Access to Baby and Child Dentistry Montana (Bozeman, MT)
All About Children Pediatric Partners (Reading, PA)
Baby Dental Clinic (Columbus, OH)
Bright Smiles for Babies (Richmond, VA)
Capitol Dental Care Head Start Outreach (Salem, OR)
Children’s Dental Services (Minneapolis, MN)
Community Dental Health Coordinator Program (Chicago, IL)
Community Health Center Inc. Mobile Dental Program (Middletown, CT)
Early Childhood Caries, United Healthcare (Santa Ana, CA)
Future Smiles (Las Vegas, NV)
Group Health’s Delivery of Oral Health Initiative (Seattle, WA)
I-Smile Dental Home Initiative (Des Moines, IA)
Medical Management of Caries (Redmond, OR)
Miles of Smiles (Olathe, KS)
Oral Health Across the Commonwealth (Boston, MA)
Program to Improve Community Oral Health (St. Paul, MN)
Sarrell Dental Program (Anniston, AL)
Sheboygan Schools Seal Students’ Smiles (Sheboygan, WI)
Smiles for Life—Senior Center Dental Access Program (Bellingham, WA)
UK North Fork Valley Community Dental Outreach Program (Hazard, KY)
Virtual Dental Home (San Francisco, CA)
WIC Dental Days Program (Sonoma, CA)
WIC Outreach Oral Health Program (Redmond, OR)
WIC Smiles 4 U (Tampa, FL)