View
52
Download
0
Category
Tags:
Preview:
DESCRIPTION
Improving the Oral Health of School-Aged Children: Promising Approaches for Linking Them With Dental Homes Washington, DC May 11-12, 2006. Cincinnati Health Department/ Greater Cincinnati Oral Health Council School-Linked Clinic and Mobile Dental Van Lawrence F. Hill, DDS, MPH - PowerPoint PPT Presentation
Citation preview
Improving the Oral Health of School-Aged Improving the Oral Health of School-Aged Children: Promising Approaches for Linking Children: Promising Approaches for Linking
Them With Dental HomesThem With Dental HomesWashington, DCWashington, DCMay 11-12, 2006May 11-12, 2006
Cincinnati Health Department/Cincinnati Health Department/Greater Cincinnati Oral Health CouncilGreater Cincinnati Oral Health Council
School-Linked Clinic and Mobile Dental VanSchool-Linked Clinic and Mobile Dental VanLawrence F. Hill, DDS, MPHLawrence F. Hill, DDS, MPH
Cincinnati Health Department, Dental DirectorCincinnati Health Department, Dental Director
Nancy L. Carter, RDH, MPHNancy L. Carter, RDH, MPHCincinnati Health Department, Assistant Dental DirectorCincinnati Health Department, Assistant Dental Director
HistoryHistoryPre 2004Pre 2004
Pre 1982 - Inner-CityPre 1982 - Inner-City School-linked/based hybrid clinicsSchool-linked/based hybrid clinics
Excellent in school-basedExcellent in school-based Not good in linkedNot good in linked
11 clinics – all antiquated11 clinics – all antiquated Neighborhood health centers monopolized by adult Neighborhood health centers monopolized by adult
emergencies and adult careemergencies and adult care
1982 – All school clinics closed1982 – All school clinics closed
Sealant Program ResultsSealant Program Results1984 - 20001984 - 2000
31-47% of participants needed treatment31-47% of participants needed treatment 78% of those received no care after one year78% of those received no care after one year
Referral FailuresReferral Failures Dental Assistant phone callsDental Assistant phone calls
Lists to school nursesLists to school nurses
Letters to parentsLetters to parents
Intensive case managementIntensive case management
20042004“Give Kids A Smile Day”“Give Kids A Smile Day”
Linked one school with one 6-chair CHD Linked one school with one 6-chair CHD clinic and two mobile vansclinic and two mobile vans
40 dentist volunteers40 dentist volunteers
““Give Kids A Smile Day” Give Kids A Smile Day” OrganizationOrganization
Four Fridays in FebruaryFour Fridays in February Consents to all kidsConsents to all kids Screened all with consentsScreened all with consents Organized by number of decayed teeth per Organized by number of decayed teeth per
classroomclassroom ~ 300 kids and $80,000 gross~ 300 kids and $80,000 gross
Subsequent YearsSubsequent Years Dental Society dropped out (now have their Dental Society dropped out (now have their
own volunteer clinic)own volunteer clinic) We now move dentists and assistants from We now move dentists and assistants from
other clinics to supplement the Crest Smile other clinics to supplement the Crest Smile Shoppe instead of volunteersShoppe instead of volunteers
We have paid transportationWe have paid transportation Coordinated effort of the project coordinator, Coordinated effort of the project coordinator,
school-based health center, and the dental school-based health center, and the dental clinic.clinic.
Numbers for 2005Numbers for 2005 Number of days = 21 (5 hour days)Number of days = 21 (5 hour days) Number of users = 425; encounters = 578Number of users = 425; encounters = 578 Gross production = $216,118Gross production = $216,118 Cost = $57,625 (salary + fringe + supplies + Cost = $57,625 (salary + fringe + supplies +
transportation)transportation)
Assumption:Assumption: 2/3 Medicaid ($140,000)2/3 Medicaid ($140,000) Medicaid pays about ½ of fees ($70,000)Medicaid pays about ½ of fees ($70,000) Thus, break even (only for costs shown)Thus, break even (only for costs shown)
++Utilized current facility and staffUtilized current facility and staff
--Doesn’t increase community capacity, Doesn’t increase community capacity,
but may increase individual provider but may increase individual provider productionproduction
Lessons Learned Lessons Learned School-Linked ProgramSchool-Linked Program
Requires:Requires: Intense organizationIntense organization Reliable transportationReliable transportation Cooperation of school staff (health center Cooperation of school staff (health center
nurses) to coordinate consents/getting kids on nurses) to coordinate consents/getting kids on buses, etc.buses, etc.
Resources of multiple providers at one place at Resources of multiple providers at one place at one timeone time
Lessons LearnedLessons LearnedSchool-Linked ProgramSchool-Linked Program
Requires:Requires: Can be done with volunteers or paid staff Can be done with volunteers or paid staff
(volunteer staff takes additional planning and (volunteer staff takes additional planning and coordination and is less reliable!)coordination and is less reliable!)
Can provide continuous care for children in Can provide continuous care for children in participating schoolsparticipating schools
Impractical to do with a solo private practitioner Impractical to do with a solo private practitioner because of cost of coordinator and transportationbecause of cost of coordinator and transportation
Only works for schools that are in close Only works for schools that are in close proximity to safety net clinicproximity to safety net clinic
Alternative Model: Mobile VanAlternative Model: Mobile Van High level of frustration in community over High level of frustration in community over
access to care for kidsaccess to care for kids Oral Health Regional Assessment and Oral Health Regional Assessment and
Planning Project (RAPP) – community requestPlanning Project (RAPP) – community request School nurses and Head Start staff asked for a School nurses and Head Start staff asked for a
mobile vanmobile van
20042004 Initiated Mobile Van ProgramInitiated Mobile Van Program Two chairs (1 Dentist, 2 Assistants, 1 Two chairs (1 Dentist, 2 Assistants, 1
Driver/Receptionist/Manager)Driver/Receptionist/Manager) Dentrix, direct digital radiographyDentrix, direct digital radiography
FundersFunders My godfather at the Ohio Department of My godfather at the Ohio Department of
HealthHealth Anthem Foundation of OhioAnthem Foundation of Ohio Mayerson FoundationMayerson Foundation United WayUnited Way
Capital CostsCapital Costs
VanVan $315,000$315,000 Dental Equipment Dental Equipment 80,000 80,000 Digital/ElectronicsDigital/Electronics 80,000 80,000
TOTAL TOTAL $475,000$475,000
School-Based ClinicSchool-Based Clinic ConstructionConstruction
$100/sq. ft. x 400$100/sq. ft. x 400 $ 40,000$ 40,000
EquipmentEquipment $ 80,000$ 80,000
Electronics?Electronics?
TOTALTOTAL $120,000$120,000
TargetingTargeting Blanket school with consent formsBlanket school with consent forms Sealant kidsSealant kids Kids who come to school nurseKids who come to school nurse Nurse screeningsNurse screenings
Van OperationsVan Operations20052005
1,230 school children (users)1,230 school children (users) 497 (40%) – diagnostic/preventive only497 (40%) – diagnostic/preventive only 733 (60%) – diagnostic/preventive/treatment733 (60%) – diagnostic/preventive/treatment
713 Head Start children (users)713 Head Start children (users) 492 (69%) – diagnostic/preventive only492 (69%) – diagnostic/preventive only 221 (31%) – diagnostic/preventive/treatment221 (31%) – diagnostic/preventive/treatment
School ChildrenSchool Children Enrolled: 3,060 (6 schools)Enrolled: 3,060 (6 schools) Children participating: 1,230 (40%)Children participating: 1,230 (40%) Much higher participation in early gradesMuch higher participation in early grades Function of school principal and nurseFunction of school principal and nurse
Lessons Learned About VansLessons Learned About Vans Needs one strong dental staff person to Needs one strong dental staff person to
provide liaison with schoolsprovide liaison with schools Need a cooperative, designated school person Need a cooperative, designated school person
to coordinate from inside (i.e. school nurse, to coordinate from inside (i.e. school nurse, office personnel, etc.)office personnel, etc.)
Need linkages to pediatric specialists and to a Need linkages to pediatric specialists and to a private practice, safety net program, or dental private practice, safety net program, or dental school to provide back-up when van is not school to provide back-up when van is not availableavailable
Lessons Learned About VansLessons Learned About Vans Need sound plan for provision of care and Need sound plan for provision of care and
generation of revenue on days schools aren’t generation of revenue on days schools aren’t availableavailable
Need more vansNeed more vans 16/62 schools in 2.5 years with only 40% 16/62 schools in 2.5 years with only 40%
participationparticipation
Recommended