Final Report Format - mchoralhealth.org · 1.1.Determine the source of each child’s drinking water. 1.1. Survey families to determine if their children drink city water, non-fluoridated

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Final Report Format

Follow-Up Activities to EHS/HS State/Territorial Oral Health Forums

State/Territory: NevadaPerson Submitting Report: Nicole King, NvHSA CoordinatorPhone: 775-544-7343E-mail: [email protected]

Activities originally proposed and how they relate to action plan (copy or summarize fromproposal with any revisions submitted after acceptance):

The Nevada Head Start Association, in conjunction with Nevada’s Head Start granteesand the Nevada State Health Division, propose to hold three regional oral health strategicplanning sessions to address the oral health issues facing the state. An oral health strategicplanning session will be held in the southern, rural and northern regions of the state. ChristineForsch, the State Health Division’s Oral Health Program Manager, will provide the content andexpertise during the planning sessions, as well as assist with the overall planning of the sessions.Ms. Forsch will also assist in identifying and contacting key community stakeholders and dentalcare providers to attend the planning sessions. Head Start grantees will assist in identifyingparticipants, help with creating the agenda for the session held in their particular region, and willbe key participants in the planning sessions. NvHSA Coordinator, Nicole King, will serve asproject manager implementing and overseeing all aspects of the project. Specifically, Ms. Kingwill be responsible for the planning, coordination, facilitation, meeting review and follow-up,drafting final strategic plan for each region, and writing the final report.

Activities accomplished: include process used, participants, partners, and significantdates/timelines:In conjunction with the Nevada State Health Division Oral Health Program, NvHSA coordinatedthree regional oral health strategic planning sessions. Initial planning was done via conferencecall with the HS grantees from each region, Ms. Forsch and Nicole King. The initial planningestablished the time, date, location, planning session agenda and the key stakeholders (bothcommunity and HS employees) to be invited. (List of session attendees is attached). Invitationswere created by Ms. Forsch and sent from the NvHSA office. The Las Vegas regional oralhealth planning session was held on Friday, February 4, 2004; the Northeastern Nevada sessionwas held on Friday, January 28, 2005 and the Northern Nevada session was held on Friday,February 25, 2005.

Ms. Forsch, in collaboration with Dr. Reg Louie, prepared in advance a draft Action Plandetailing a set of proposed goals, objectives and strategies. These draft Action Plans weredistributed to the HS grantees prior to the session for their review and approval. The draftAction Plan was used to guide the sessions and served as a means of determining currentresources as well as areas where further assistance was needed.

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Immediate outcomes (attach any reports or other documents/materials):The immediate outcomes achieved are the detailed Action Plans developed for each region.These documents are attached. The Action Plans have been adopted by the regional dentalcoalitions (i.e. Southern Oral Health Coalition, the Tooth Fairy Council and the Coalition forUnderserved Populations). Coalition members are the “right” people to help execute the ActionPlans as they have access to resources and are able to assist HS grantees in achieving their oralhealth goals.

A notable outcome is the relationship that has been established between the Southern Oral HealthCoalition and the EOB Head Start health staff. Since the planning session, the Southern OralHealth Coalition has created a Head Start subcommittee which meets monthly and guides theexecution of the Action Plan. This coalition, in collaboration with Ms. Forsch, is in the processof developing in English and Spanish a Power Point presentation on the importance of fluoride.This presentation will be used to educate HS start staff and will be distributed to the otherregions upon completion. They are also in the process of developing the oral health SingleOverriding Communication Objectives which will be distributed to the other regions as well.And they are developing a Risk Assessment tool to identify the level tooth decay for each child.The tool is designed to be used by any HS staff, regardless of their experience with oral healthissues.

Additional follow-up activities planned:NvHSA plans to add an oral health update to our quarterly meeting agendas. Each region will beasked to discuss ways in which their Action Plans are being implemented and to identify anyresources needed. It is expected that the regional dental coalitions will assist with the on-goingprocess of executing the Action Plans.

Need for additional resources to accomplish other follow-up activities (please be specific):Funding for State Oral Health Program Manager to travel to dental coalition meetings to providetechnical assistance and to monitor the implementation of the Action Plans.

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Budget Explanation

How ASTDD Funds WereUsed

Other Funds Expended,Include Source

In-Kind Support,Include Source

Commercial Air $342.00Copies $142.50Postage $40.00Per Diem $35.00Conference Calls $26.19Coordinator Fees $1914.00

NvHSAMeeting Refreshments $471.91Meeting Supplies $149.10

State Oral HealthProgram OfficeTravel and Per Diem forManagerManager’s SalarySupplies

E-mail by July 1, 2005 to Kathy Geurink at [email protected],

cc: [email protected] and [email protected]

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Economic Opportunity Board of Clark County (EOB) Head StartOral Health Forum Invitees

Norma Abi-KaramNevada Department of Child and FamilyServices

Bernard Addo-Quaye, MD

Seth Adjovu, MD

Keith W. AllredNevada Department of Education

Bob AndersonExecutive DirectorSouthern Nevada DentalSociety

Maury Astley, CAEExecutive DirectorNevada Dental Association

Jackie Y. BrantleyOffice of the Governor

Sue Brooks, APN, RNC.O.W.

Tikva Butler, APN, RN

Gabriel CarpoPhysicians Health Net

Jann CarsonMiles for Smiles/Nevada Health Centers

Clentine ColemanCatholic Charities of Southern Nevada

Robert Cooley, DDSDirectorUNSOM Pediatric Dental ResidencyProgram

Mary CoonCovering Kids Program

Jeanne CosgroveSunrise Hospital-Safe Kids

Patricia Craddock, DDSChair, Access to Care CommitteeNevada Dental Association

Paula CrawfordNevada Early Intervention Services

Tyree Davis, DDSMiles for Smiles/Nevada Health Centers

Martin DoyneDoyne Medical Center

Maureen Fanning, RNClark County Health District

Chris Forsch, RDH, BSOral Health Program ManagerNevada State Health Division

Rose GastonEOB Community Action Partnership

Stephanie GilbertTry-Angles Program

Mary Grant

Terryann GunnSunrise HospitalCenter for Healthy Family, Safe Kids

Vivian HansenNevada Rural Health Centers, Inc.

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Mildred HarrisonEOB Community Action Partnership

Sherry Henniger, RNClark County Health District

Nicole Horn, RDHPresidentSouthern Nevada Dental Hygienists'Association

Karin HummelNevada HAND

Sally Jost, RNClark County School District, SpecialServices

Nicole KingExecutive DirectorNevada Head Start Association

Richard Kohlmeyer, DDSPresident, Southern Nevada DentalSociety

Constance KosudaBrainstomers, Inc.

Arann Lea, RDHNevada Health Centers

Reg Louie, DDS, MPHRegional Head Start Oral HealthConsultant

Rosy LozoyaBig Brothers, Big Sisters of Nevada

Millie McClain, PHDUniversity of Nevada, Las VegasSchool of Dental Medicine

Dawn McClellan, DDSChildren's Dental Care International

Denyse McGuinn, RN, APN

Susan Meachan, PhDUNLV Department of Nursing

Judith MillerChild Find Project

Dexter Morris, OD

Judy MoseleyClark County School DistrictSpeech and Lanuage Services

Celeste OchalCandlelighters of Childhood Cancer

Jodi OliveriAudiologist-Siegle Diagnostic Center

Stephanie VesnikNevada P.E.P.

Sharon Peterson, RDHNevada State Board of DentalExaminers

Theresa Raglin, RDHDirector, CCSN Dental HygieneProgram

Raymond Rawson, DDSCommunity College of Southern Nevada

Lorinda RobertsTry-Angles Program

Dixie Rogers1 DAY Program CoordinatorSouthern Nevada Dental Society

Janice RogersEOB Community Action Partnership

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Michael Sanders, DMD, EdMDirector of Patient Care ServicesUniversity of Nevada, Las Vegas Schoolof Dental Medicine

Lilliam ShellNevada Health Centers

Jill Sibert-MelanconChildhood Development

Kelly SimonsonHealth Plan of Nevada

Mary Alyce SmithAccess One Grant Writing

Virginia Smith, RNClark County School District, SpecialServices

Cheryl Sonneberg, PhdEOB Health Service Division

Mary Ellen StevensDivision of Child and Family Services

Mary TwittyEOB Community Action Partnership

Janice Vandenbergen, RNSunrise HospitalCenter for Healthy Family, Safe Kids

Pamela Van PekUniversity of Nevada, Las VegasCooperative Extension

Daniel VogesEOB CCAD

Geri Wallace-AndrewsDirector, Special Projects

Leisa WhitmanPBS KLVX Ready to Learn

Cozetta WilliamsNevada P.E.P.

Jean Wolff, RDH, MSEdPresidentNevada Dental Hygienists' Association

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EOB Head Start Action Plan

FluoridationGoal Statement #1: To ensure all children enrolled in EOB Head Start/Early Head Start are receiving appropriate pre-eruptivefluoride.

Outcome/Measurement:The percent of children enrolled in EOB Head Start/Early Head Start who drink optimally fluoridated wateror who are ingesting fluoride supplements appropriately.

Objective Strategies or actions tomeet the objective

Evaluation criteria Agencies/organizations

involved

Timeframe

1.1.Determine thesource of each child’sdrinking water.

1.1. Survey families to determine iftheir children drink city water, non-fluoridated bottled water or fluoridatedbottled water.

1.1.Data on the source ofeach childs drinking water isobtained on a regular,systematic basis.

1.1. EOB HS 1.1.Annually

1.2.Educate parentsabout the benefits ofdrinking fluoridatedwater.

1.2. Educate the Policy Council, HealthAdvisory Committee, staff, and parentson the benefits of drinking fluoridatedwater through in-service training,brochures, and one on one education.

1.2. a. Can all members ofthe Policy Council, HealthAdvisory Council and EOBHead Start staff explain thebenfits of drinkingflouridated water? Are allparents provided informationon the benefits of drinkingfluoridated water? Has the %of children drinking citywater or fluoridated bottledwater increased?

1.2. EOB HS, StateOral Health Program,Community Coalitionfor Oral Health.

I.2.a. Inservice-annually.1.2.b.Ongoing.1.1.2.c.Evaluateannually.

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Fluoride VarnishGoal Statement #2: All children enrolled in EOB Head Start/Early Head Start will receive post-eruptive fluoride treatments asindicated by a risk assessment performed by a medical or dental professional.

Outcome/Measurement: The percent of children enrolled in EOB Head Start/Early Head Start who receive appropriate post eruptivefluoride treatments.


Evaluationcriteria

Agencies/organizations

involved

Timeframe

2.1. Determine cariesrisk status of childrenenrolled in EOB HeadStart.

2.1.a. Develop a risk assessment tool.

2.1.b. Implement the tool to determinethe risk status of children enrolled inEOB Head Start.

2.1.a. Has a riskassessment tool beendeveloped?

2.1.b. Is caries riskstatus for each childestablished within 90days of enrollment?

2.1.a. CommunityCoalition for OralHealth , EOB HS

2.1.b. EOB HS, dentalproviders.

2.1.a. 06/05

2.1.b.Within 90days ofenrollment.

2.2. Develop a systemfor delivering post-eruptive flouridetreatments (fluoridevarnish) on an on-going, systematicbasis.

2.2. a. Identify partners who canprovide fluoride varnish treatments on aregular, ongoing basis.

2.2. b. Establish a formal MOU withagency/organization that will providefluoride varnish treatments.

2.2.c. Implement quarterly fluoridevarnish program.

2.2.a. Have potentialpartners beenidentified?

2.2.b. Have formalMOUs beenestablished?

2.2.c. Has a quarterlyfluoride varnishprogam beenimplemented?

2.2.a. EOB HS,Community Coalitionfor Oral Health.

2.2.b. EOB HS andidentified agencies.

2.2.c. Identifiedagencies.

2.2. a. 05/05

2.2.b. 08/05

2.2.c. 09/05

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Oral Health EducationGoal Statement #3: All children enrolled in EOB Head Start/Early Head Start will demonstrate appropriate oral hygiene and consumea diet that promotes oral health.

Outcome/Measurement: The percent of families with children enrolled in EOB Head Start/Early Head Start who have participated inage appropriate, culturally sensitive, evidence-based oral health education.


Evaluationcriteria


involved

Timeframe to

3.1. The PolicyCouncil, HealthAdvisory Committee,staff , parents andchildren understandthe importance of oralhealth

3.1.a. Develop Single OverridingCommunication Objectives (SOCOs)regarding oral health.

3.1.b. Communicate the SOCOs to allmembers of the Policy Council, HealthAdvisory Committee, and staff.

3.1.c. Integrate the SOCOs in all EOBHead start communications(newsletters, flyers, artwork displayedin centers, menus etc.)

3.1.d. Provide oral health education toparents and children on an ongoing andsystematic basis through health fairs,parents education events, one on onecounseling, “adopt a center” programs.

3.1.a. Have SOCOsbeen developed?

3.1.b. Do all membersof the Policy Council,Health AdvisoryCommittee and staffknow the SOCOs?

3.1.c. How often havethe SOCOs beenintegrated into EOBHead Startcommunications?

3.1.d. Is oral healtheducation provided onan ongoing andsystematic basis?

3.1.a. EOB HS, HealthAdvisory Committee,State Oral HealthProgram, CommunityCoalition for OralHealth.

3.1.b. EOB HS, HealthAdvisory Committee,State Oral HealthProgram, CommunityCoalition for OralHealth.

3.1.c. EOB HS.

3.1.d. CommunityCoalition for OralHealth, State OralHealth Program, EOBHS, Nevada DentalAssociation, SouthernNevada Dental Society,UNLV School ofDental Medicine,Pediatric DentalResidency Program,CCSN Dental Hygiene

3.1.a. 06/05

3.1.b. 09/05

3.1.c. Ongoing.

3.1.d. Healthfair, parenteducationevents –annually. Oneon onecounseling –ongoing.

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Evaluationcriteria


involved

Timeframe to

counseling, “adopt a center” programs. HS, Nevada DentalAssociation, SouthernNevada Dental Society,UNLV School ofDental Medicine,Pediatric DentalResidency Program,CCSN Dental HygieneProgram.

annually. Oneon onecounseling –ongoing.

3.2. Children, parentsand staff demonstratebehaviors thatpromote good oralhealth.

3.2.a. Educate parents on the role theyplay in keeping their children’s teethhealthy (transfer of bacteria frommother to child, the need to brushchildren’s teeth for them at least once aday until the child is able to removeplaque effectively by themselves, theeffect of diet on oral health).

3.2. b. Implement activities to motivateparents to improve the oral health oftheir children (disclosing solution ortablets, healthy snack suggestions,brushing charts, recognition of thecenters where a high percentage ofparents have assisted their child withbrushing at least once a day).

3.2.a. How are parentsbeing educated aboutthe role they play intheir child’s oralhealth?

3.2.b. What activitiesto motivate parentshave beenimplemented?

3.a. CommunityCoalition for OralHealth, State OralHealth Program, EOBHS, Nevada DentalAssociation, SouthernNevada Dental Society,UNLV School ofDental Medicine,Pediatric DentalResidency Program,CCSN Dental HygieneProgram.

3.2.b. EOB HS,Community Coalitionfor Oral Health.

3.1. Annually

3.2.b. at leastone activitywill beimplementedquarterly.

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Dental ExaminationsGoal Statement #4: All children enrolled in EOB Head Start/Early Head Start will have a dental examination by a licensed dentistwithin 90 days of enrollment (HS) or by age one or within 6 months of the eruption of the first tooth (EHS).

Outcome/Measurement: The percent of children enrolled in Head Start/Early Head Start who have a dental examination within 90days of enrollment or by age one or within 6 months of the eruption of the first tooth.


Evaluationcriteria


involved

Timeframe

4.1. Establish policy/procedure forMedicaid eligiblechildren to have anexamination throughthe UNLV School ofDental Medicine.

4.1.a. Enter into a formal MOU with thedental school.

4.1.b. Establish written policy/procedure for children to get anappointment at the school or at acommunity clinic (three to four monthsbefore school starts, make arrangementsto reserve a block of time for EOB HSchildren to be examined.)

4.1.a. Has a formalMOU been established?

4.1.b. Have writtenpolicies/proceduresbeen established?

4.1.a. EOB HS, UNLVSchool of DentalMedicine (MichaelSanders).

4.1.b. EOB HS, UNLVSchool of DentalMedicine (MichaelSanders).

4.1.a. 06/05

4.1.b. 09/05

4.2. Establishpolicy/procedure foruninsured children tohave an examinationthrough the 1DAYprogram.

4.2.a. Enter into a formal MOU with the1 DAY program.

4.2.b. Establish written policyprocedure for children to get anappointment through 1DAY (three tofour months before school starts, makearrangements to reserve a block of timefor EOB HS children to be examined.)



4.2.a. EOB HS, 1 DAY(Dixie Rogers).

4.2.b. EOB HS, 1DAY(Dixie Rogers)

4.2.a. 06/05

4.2.b. 09/05

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Emergency Dental TreatmentGoal Statement #5: All children enrolled in EOB Head Start/Early Head Start needing emergency treatment due to the presence ofpain or swelling are treated to relieve the pain or swelling within 24 hours of EOB staff becoming aware of the problem.Outcome/Measurement: The percent of children enrolled in EOB Head Start/Early Head Start who receive emergency treatmentwithin 24 hours of EOB staff becoming aware of the problem.

Objective Strategies or Actions tomeet the objective

EvaluationCriteria


involved

Timeframe

5.1. Establish policy/procedure for childrenwho are having adental emergencywho are Medicaideligible or uninsuredto be treated throughthe UNLV School ofDental Medicine.


5.1.b. Establish written policy/procedure to follow for children to getan appointment at the school or at acommunity clinic.



5.1.a. EOB Head Start,UNLV School ofDental Medicine(Michael Sanders).

5.1.b. EOB Head Start,UNLV School ofDental Medicine(Michael Sanders).

5.1.a. 06/05

5.1.b. 09/05

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Routine Dental TreatmentGoal Statement #6: All children enrolled in EOB Head Start/Early Head Start will have all of their routine dental treatment needs metwithin 90 days of the end of the program year.Outcome/Measurement: The percent of children enrolled in EOB Head Start/Early Head Start will have all of their routine dentaltreatment needs met within 90 days of the end of the program year.


EvaluationCriteria


involved

Timeframe

6.1. Empower parentsto take responsibilityfor their children’shealth.

6.1.a. Develop SOCOs and implement amarketing plan that ties into theeducation identified in Goal #3.

6.1.b. Develop a program to educate HSteachers, children and families aboutappropriate dental office behavior andprotocol that ties into Goal #3. (Modelthe program after programs in otherstates such as Oregon and SouthCarolina).

6.1.a. Has a SOCO anda marketing plan beendeveloped andimplemented?

6.1.b. Has aneducational programbeen developed?

Have no show ratesdecreased?

6.1.a. Policy Council,Health AdvisoryCommittee, HS staff,Community Coalitionfor Oral Health.

6.1.b. Policy Council,Health AdvisoryCommittee, HS staff,Community Coalitionfor Oral Health.

6.1.a. 09/05

6.1.b. 09/05

6.2. Develop a systemto improve thetransfer of clientinformation betweenEOB HS andproviders, clinics, andagencies (address,phone, insuranceinformation, treatmentneeds, etc.)

6.2.a. Identify information needed byproviders in order for them to serveclients most efficiently and effectively.

6.2.b. Develop a tool to collect theinformation.

6.2.c. Implement the tool so thatproviders have all the information theyneed to provide services efficently andeffectively.

6.2.a. Have providersbeen contacted to findout what informationthey need and want?

6.2.b. Has a tool tocollect the informationbeen developed?6.2.c. Is the tool beingimplemented?

Have no show ratesdecreased?

6.2.a. EOB Head Start,Community Coalitionfor Oral Health.

6.2.b. EOB Head Start,Community Coalitionfor Oral Health.6.2.c. EOB HS

6.2.a. 05/05

6.2.b. 07/05

6.2.c.09/05

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EvaluationCriteria


involved

Timeframe

decreased?6.3. Identify specificissues, reasons andthe frequency withwhich HS parentsloose dentalinsurance.

6.3.a. Develop a tool to survey parentsabout insurance issues.

6.3.b. Implement the tool.

6.3.c. Evaluate the data from the survey.

6.3.d. Utilize the information to assistEOB HD families with insurance issues.

6.3.a. has a tool beendeveloped?

6.3.b. Has the tool beenimplemented?

6.3.c. Has the data beenevaluated?

6.3.d. Has theinformation been usedto assist EOB HDfamilies with insuranceissues?

6.3.a. EOB HS.

6.3.b. EOB HS.

6.3.c. EOB HS.

6.3.d. EOB HS.

6.3.a. 06/05

6.3.b. 09/05

6.3.c. 12/05

6.3.d. Ongoing.

6.4. Expand the poolof providers who willsee HS and EHSchildren.

6.4.a. Advocate for Medicaid policychanges that will reduce challenges toobtaining care (establish presumptiveeligibility and eliminate barriers toprovider participation.)

6.4.b. Outreach to providers andeducate them about the HS populationby inviting them to Head Startconferences, meetings and presenting attheir meetings and conferences.

6.4.a. Does EOB HSknow what policychanges could be madeto improve providerparticipation? DoesEOB HS advocate forpolicy changes toimprove providerparticipation? Havepolicy changesoccurred? Has the poolof providers who willsee EOB HS childrenexpanded?

6.4.b. Has EOB invitedproviders to meetingsand conferences? HasEOB HS presented atmeetings andconferences ofproviders? Has thepool of providersexpanded?

6.4.a. EOB HS,Community Coalitionfor Oral Health.

6.4.b. HS Staff,Community Coalitionfor Oral Health.

6.4.a. Ongoing

6.4.b. Ongoing

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EvaluationCriteria


involved

Timeframe

educate them about the HS populationby inviting them to Head Startconferences, meetings and presenting attheir meetings and conferences.

providers to meetingsand conferences? HasEOB HS presented atmeetings andconferences ofproviders? Has thepool of providersexpanded?

Community Coalitionfor Oral Health.

6.5. Establish policy/procedure forMedicaid eligiblechildren to receiveroutine treatmentthrough the UNLVSchool of DentalMedicine.


6.5.b. Establish written policy/procedure for children to getappointments at the school or at acommunity clinic (three to four monthsbefore school starts, make arrangementsto reserve a block of time fortreatmentof EOB HS children.)



6.5.a. School of DentalMedicine (MichaelSanders).

6.5.b. EOB HS, UNLVSchool of DentalMedicine (MichaelSanders).

6.5.a. 06/05

6.5.b. 09/05

6.6. Establishpolicy/procedure foruninsured children toreceive treatmentthrough the 1DAYprogram.


6.6.b. Establish written policyprocedure for children to getappointments through 1DAY (three tofour months before school starts, makearrangements to reserve a block of timefor treatment of EOB HS children.)





6.6.a. 06/05

6.6.b. 09/05

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Hospital or Surgery Center Based Dental TreatmentGoal Statement #7: All children enrolled in EOB Head Start who need hospital or surgery center based dental treatment will betreated within 90 days of the end of the program year.Outcome/Measurement: The percent of children enrolled in EOB Head Start who need hospital or surgery center based dentaltreatment who are treated within 90 days of the end of the program year.


Evaluationcriteria


involved

Timeframe

7.1. Establish policy/procedure for childrenwho needhospital/surgerycenter based dentalcare who areMedicaid eligible oruninsured to betreated through thePediatric DentalResidency Program

7.1.a. Enter into a formal MOU with thePediatric Dental Residency Program.

7.1.b. Establish written policy/procedure to follow for children to getan appointment at the Pediatric DentalResidency Program.



7.1. a. HS Staff,Pediatric DentalResidency Program(Dr. Robert Cooley)

7.1.b. HS Staff,Pediatric DentalResidency Program(Dr. Robert Cooley)

5.1.a. 06/05

5.1.b. 09/05

7.2. Establishpolicy/procedure foruninsured childrenwho needhospital/surgerycenter based dentalcare through the1DAY program.


7.2.b. Establish written policyprocedure for children to get anappointment through the 1DAYprogram.





7.2.a. 06/05

7.2.b. 09/05

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Elko / Ely (NE) Head Start Oral Health Summit Attendees

Joan AndersonDirectorHead Start of Northeastern Nevada

Cindi BlissProgram CoordinatorREM Nevada

Stephanie ChristensenChair, Policy CouncilHead Start of Northeastern Nevada

Karen CooleyFamily Resource Center

Mary ElridgeDirectorLittle People’s Head Start

Dayle Everts, RNHead Start of Northeastern Nevada

Chris Forsch, RDH, BSOral Health Program ManagerNevada State Health Division

Gloria GrantFamily Services CoordinatorLittle People’s Head Start

Kent Henderson, DDSPresidentNortheastern Nevada Dental Society

Tim Hill, DDSMiles for Smiles, Elko

Nicole KingCoordinatorNevada Head Start Association

Madelien Kalleres, RNLittle People’s Head Start

Arann Lea, RDHNevada Health Centers

Matthew Liperarelli, ODChairman, Health Advisory Committee,Head Start of Northeastern Nevada

Carrie Powers, APNPublic Health Nurse

Georgiana Smith, RNDirector of Nursing, Great Basin College

Maria ToldeoChair, Executive BoardHead Start of Northeastern Nevada

Cheri WardRegional Operations DirectorMiles for Smiles, Elko

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NE Action Plan

FluoridationGoal Statement #1: To ensure all children enrolled in Little People’s or Northeastern Nevada’s Head Start//Early Head Start arereceiving appropriate pre-eruptive fluoride.

Outcome/Measurement:The percent of children enrolled in Little People’s and Northeastern Nevada Head Start/Early Head Startwho drink optimally fluoridated water or who are ingesting fluoride supplements appropriately.

Objective Strategies or actions to meet theobjective


involved

Time frame

1.1. Evaluate fluorideintake for each child.

1.1. Add specific oral health questionsto the Intake form regarding the type ofwater the child drinks non-fluoridatedbottled water, fluoridated bottled water,city water, water from a private well)and if fluoride supplements are beingtaken.

1.1 Does the intakeform ask about drinkingwater and fluoridesupplementation?

1.1. HS administrativeand health staff.

1.1. 06/05

1.2. Provide fluoridesupplementation asappropriate.

1.2. Floride supplements are given dailyas appropriate.

1.2. Are childrendrinking fluoridatedwater or ingestingfluoride supplementsappropriately?

1.2. HS staff,prescribing physicianor dentist.

1.2. Daily.

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Fluoride VarnishGoal Statement #2 All children enrolled in Little People’s or Northeastern Nevada’s Head Start/Early Head Start will receive post-eruptive fluoride treatments as indicated by a risk assessment performed by a medical or dental professional.

Outcome/Measurement: The percent of children enrolled in Little People’s or Northeastern Nevada’s Head Start/Early Head Startwho receive appropriate post eruptive fluoride treatments.



involved

Time frame

2.1. Determine cariesrisk status of childrenenrolled in LittlePeople’s HeadStart/Early Head Startand NortheasternNevada Head Start.


2.1.b. Implement the tool to determinethe risk status of children enrolled inLittle People’s Head Start/Early HeadStart and Northeastern Nevada HeadStart..



2.1.a. HS staff, ToothFairy Council. 4/1/05The Oral HealthProgram will sharewhat is developed bythe CommunityCoaklition for OralHealth Head StartCommittee with NENV HS, LP HS andthe Tooth FairyCouncil.

2.1.b. HS staff, dentalproviders, medicalproviders.

2.1.a. 06/05



2.2. a. Identify partners who canprovide fluoride varnish treatments on aregular, ongoing basis. 4/1/05 NE NVHS has identified the FamilyResource Center as a partner.

2.2. b. Establish a formal MOU withagency/organization that will providefluoride varnish treatments.



2.2.a. HS staff, FamilyResource Center,Public Health Nurse,Miles for Smiles.

2.2.b. HS staff andidentified agencies.

2.2. a. 05/05

2.2.b. 07/05

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involved

Time frame

fluoride varnish treatments.

2.2.c. Provide fluoride varnish trainingto staff/partners as needed.

2.2.d. Implement quarterly fluoridevarnish program.

established?

2.2.c. Has neededtraining been provided?

2.2.d. Has a quarterlyfluoride varnishprogam beenimplemented?

2.2.c. State Oral HealthProgram.

2.2.d. Identifiedagencies.

2.2.c. 08/05

2.2.d. 09/05

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Oral Health EducationGoal Statement 3: All children enrolled in Little People’s or Northeastern Nevada’s Head Start/Early Head Start will demonstrateappropriate oral hygiene and consume a diet that promotes oral health.

Outcome/Measurement: The percent of families with children enrolled in Little People’s or Northeastern Nevada’s Head Start/EarlyHead Start who have participated in age appropriate, culturally sensitive, evidence-based oral health education.



involved

Time frame

3.1. Develop oralhealth classes,trainings, and forumsto educate parents,teachers, and childrenabout appropriate oralhygiene and diet

3.1.a. Educate parents on the role theyplay in keeping their children’s teethhealthy (transfer of bacteria frommother to child, the need to brushchildren’s teeth for them at least once aday until the child is able to removeplaque effectively by themselves, theeffect of diet on oral health). 4/1/05 NENV HS plans to conduct a largeannual meeting with parents andchildren. They will also providetargeted one-on-one education to highrisk chikdren as needed.

3.1. b. Implement activities to motivateparents to improve the oral health oftheir children (disclosing solution ortablets, parent information sheet withplaque status of child recorded, healthysnack suggestions, brushing charts,coloring books and toothbrushes.

3.1.a. How are parentsbeing educated aboutthe role they play intheir child’s oralhealth?

3.1.b. What activitiesto motivate parentshave beenimplemented?

3.1. a. HS health staffHS Policy CouncilHS Health AdvisoryCouncil, Oral HealthProgram, Tooth FairyCouncil.

3.1.b. HS health staffHS Policy CouncilHS Health AdvisoryCouncil, Oral HealthProgram, Tooth FairyCouncil.

3.1. a. Annually

3.1.b. At leastone activitywill beimplementedquarterly.

22

Dental ExaminationsGoal Statement #4: All children enrolled in Little People’s and Northeastern Nevada’s Head Start/Early Head Start will have a dentalexamination by a licensed dentist within 90 days of enrollment.

Outcome/Measurement: The percent of children enrolled in Little People’s and Northeastern Nevada’s Head Start/Early Head Startwho have a dental examination within 90 days of enrollment.


Evaluationcriteria


involved

Timeframe

4.1. Establish policyand procedure forchildren to have anexamination throughthe Miles for Smilesprogram or from aprivate practitioner.

4.1.a. Enter into a formal MOU with theMiles for Smiles program or the privatepactioner.

4.1.b. Establish written policy/procedure for children to get anappointment with the Miles for Smilesprogram or the private pactioner. (three to four months before schoolstarts, make arrangements to reserve ablock of time for HS children to beexamined.) 4/1/05 Writtenpolicy/procedure is already in place.



4.1.a. HS staff, Milesfor Smiles, privatepractioners.

4.1.b. HS staff, Milesfor Smiles, privatepractioners.

4.1.a. 06/05

4.1.b. 09/05

23

Emergency Dental TreatmentGoal Statement #5: All children enrolled in Little People’s and Northeastern Nevada’s Head Start/Early Head Start needingemergency treatment due to the presence of pain or swelling are treated to relieve the pain or swelling within 24 hours of staffbecoming aware of the problem.Outcome/Measurement: The percent of children enrolled in Little People’s and Northeastern Nevada’s Head Start/Early Head Startwho receive emergency treatment within 24 hours of staff becoming aware of the problem.


EvaluationCriteria


involved

Timeframe

5.1. Establish policy/procedure for childrenwho are having adental emergencywho are Medicaideligible or uninsuredto be treated throughthe Miles for Smilesprogram (LP HS,NENV HS) or by Dr.Bartley (LP HS) -White Pine Countywill pay up to $200per child for childrenliving in White PineCounty.

5.1.a. Enter into a formal MOU with theMiles for Smiles Program (LP HS,NENV HS) and Dr. Bartley (LP HS).

5.1.b. Establish written policy/procedure to follow for children to getan appointment with Miles for SmilesProgram (LP HS, NENV HS) and Dr.Bartley (LP HS).



5.1.a. LP HS, NENVHS, Miles for Smiles,Dr. Bartley.

5.1.b. LP HS, NENVHS, Miles for Smiles,Dr. Bartley.

5.1.a. 06/05

5.1.b. 09/05

24

Routine Dental TreatmentGoal Statement #6: All children enrolled in Little People’s and Northeastern Nevada’s Head Start/Early Head Start will have all oftheir routine dental treatment needs met within 80 days of the end of the program year.Outcome/Measurement: The percent of children enrolled in Little People’s and Northeastern Nevada’s Head Start/Early Head Startwho have all of their routine dental treatment needs met within 90 days of the end of the program year.


EvaluationCriteria


involved

Timeframe

6.1. Establish policy/procedure forMedicaid anduninured childreneligible children toreceive routinetreatment at theoffices of Dr. Bartley(LP HS) or throughthe Miles for Smilesprogram (NENV HS,LP HS).

6.1.a. Enter into a formal MOU with Dr.Bartley (LP HS) and the Miles forSmiles program (NE NV HS)

6.1.b. Establish written policy/procedure for children to getappointments with Dr. Bartley (LP HS),and the Miles for Smiles program (LPHS, NENV HS) (three to four monthsbefore school starts, make arrangementsto reserve a block of time for treatmentof HS children.)



6.1.a. LP HS, NENVHS, Miles for Smiles,Dr. Bartley.

6.1.b. LP HS, NENVHS, Miles for Smiles,Dr. Bartley.

6.1.a. 06/05

6.1.b. 09/05

25

Hospital or Surgery Center Based Dental TreatmentGoal Statement #7: All children enrolled in Little People’s and Northeastern Nevada’s Head Start/Early Head Start who needhospital or surgery center based dental treatment will be treated within 90 days of the end of the program year.Outcome/Measurement: The percent of children enrolled in Little People’s and Northeastern Nevada’s Head Start/Early Head Startwho need hospital or surgery center based dental treatment that are treated within 90 days of the end of the program year.


Evaluationcriteria


involved

Timeframe

7.1. Establish policy/procedure for childrenwho needhospital/surgerycenter based dentalcare who areMedicaid eligible tobe treated by Dr.Bartley (LP HS) orDr. Johansen in SaltLake City (NENVHS.)

7.1.a. Enter into a formal MOU with Dr.Bartley (LP HS) and Dr. Johansen(NENV HS).

7.1.b. Establish written policy/procedure to follow for children to getan appointment with Dr. Bartley (LPHS) and Dr. Johansen (NENV HS)..



7.1. a. HS Staff, Dr.Bartley (LP HS) andDr. Johansen (NENVHS).

7.1.b. HS Staff, Dr.Bartley (LP HS) andDr. Johansen (NENVHS).

5.1.a. 06/05

5.1.b. 09/05

7.2. Obtain theservices of a pediatricdentist who will cometo Elko.

7.2.a.. Investigate options to staff thesurgery center and/or hospita onSaturday.

7.2.b. Investigate oprions to haveresidents with the Pediatric DentalResidency Program do rotations inElko.

7.2.a. Has the hospitalbeen contacted todiscuss options? Is thesurgey center staffed onSaturdays/

7.2.b. Have optionsbeen discussed with thePediatric DentalResidency Program?Are Pediatric residentsdoing rotations in Elko?

7.2.a. HS staff, ElkoTooth Fairy Council,hospital administration.

7.2.b. HS staff, ElkoTooth Fairy Council,Pediatric DentalResidency Program.

7.2.a. 06/05

7.2.b. 06/05

26


Evaluationcriteria


involved

Timeframe

7.3. Establish a freestanding clinic totreatMedicaid/uninsuredchildren who cannotbe treated on theMiles for Smilesmobile clinic.

7.3. Advocate for funding to buildand staff the clinic.

7.3 Has the clinicbeen opened and is itproviding care toMedicaid anduninsured children? s

7.3. Northeastern NVAHEC, Miles forSmiles, Tooth FairyCouncil.

7.3. 08/05

7.4. Improvetransportationservices forMedicaid children.

7.4.a. Provide the State Oral HealthProgram with data related tochallenges encountered.

7.4.b. Enter into an MOU with theVeterans Administration to transportchildren needing care in urbansettings. 4/1/05 NE NV HS willinvestigate how LP HS had madetheir arrangements.

7.4.a. Has the databeen provided to theOral Health Program?Has the Oral HealthProgram contactedthe Division ofHealth CareFinancing and Policyand Logisticare?Have transportationservices improved?

7.4.b. Has an MOUbeen established?

7.4.a. HS,Oral Health Program,Division of HealthCare Financing andPolicy, Logisticare.

7.4.b. HS, VeteransAdministration.

7.4.a. 06/05

7.4.b. 09/05

27

UNR/CSA Head Start/Early Head StartOral Health Forum Attendees

Marlena BoothClinic ManagerHealthy Smiles Family Dentistry

Chris Forsch RDH, BSOral Health Program ManagerNevada State Health Division

Jane HogueCoordinatorUNR Early Head Start

Mike Johnson MS, LADCManagerSaint Mary's Outreach Programs

Nicole KingExecutive DirectorNevada Head Start Association

Michelle Kling RN, MSDivision DirectorWashoe County District Health Department

Renee LandaFamily Services SpecialistCSA Head Start

Reg Louie DDS, MPHRegional Head Start Oral Health Consultant

Thomas Maynor IIDeputy DirectorWashoe Tribal Health Center

Dr. Debra MarkoffHAWC

Sherri RiceDirectorCSA Head Start

Mike Rodolico Ed.D., MPH,Executive DirectorHealth Access Washoe County CommunityHealth Center

Kathy StanfieldHealth & Nutrition Services AssistantUNR Early Head Start

Rebecca ZatarainHealth Services ManagerCSA Head Start

28

UNR/CSA Head Start/Early Head StartAction Plan

FluoridationGoal Statement #1: To ensure all children enrolled in UNR, CSA, and Washoe Tribal Head Start/Early Head Start are receivingappropriate pre-eruptive fluoride.

Outcome/Measurement:The percent of children enrolled in UNR, CSA, and Washoe Tribal Head Start/Early Head Start who drinkoptimally fluoridated water or who are ingesting fluoride supplements appropriately.


Evaluationcriteria


involved

Timeframe

1.1. Evaluate fluorideintake for each child.

1.1. Add specific oral health questionsto the Intake form regarding the type ofwater the child drinks; (non-fluoridatedbottled water, fluoridated bottled water,city water, water from a private well)and if fluoride supplements are beingtaken (Oral Health Program plans topurchase a device for testing wells andcould assist agencies with well testing).

1.1. Does the intakeform ask about drinkingwater and fluoridesupplementation?

1.1. HS 1.1. 06/05

1.2. Provide fluoridesupplementation asappropriate.

1.2. Floride supplements are given dailyas appropriate. Connect with EOB HSto find out about their source for freevitamins; obtain and distributevitamins

1.2. Are childrendrinking fluoridatedwater or ingestingfluoride supplementsappropriately?

1.2. HS, prescribingphysician or dentist.

1.2. Daily

1.3. Develop aneducational programfor parents andphysicians regardingfluoride.

1.3. Educate the Policy Council, HealthAdvisory Committee, staff, parents andproviders about the benefits of fluoridethrough in-service training, brochures,and one on one education (utilize thebrochure developed by the Oral HealthProgram, inform providers about thefluoride supplementation poster).

1.3. Can all members ofthe Policy Council,Health AdvisoryCouncil and Head Startstaff explain the benfitsof flouride? Are allparents providedinformation on thebenefits of fluoride?

1.3. HS. CUSP, OralHealth Programs

I.3. In service-annually.

.

29


Evaluationcriteria


involved

Timeframe

brochure developed by the Oral HealthProgram, inform providers about thefluoride supplementation poster).

of flouride? Are allparents providedinformation on thebenefits of fluoride?

30

Fluoride VarnishGoal Statement #2: All children enrolled in UNR, CSA, and Washoe Tribal Head Start/Early Head Start will receive post-eruptivefluoride treatments as indicated by a risk assessment performed by a medical or dental professional.

Outcome/Measurement: The percent of children enrolled in UNR, CSA, and Washoe Tribal Head Start/Early Head Start who receiveappropriate post eruptive fluoride treatments.


Evaluationcriteria


involved

Timeframe

2.1. Determine cariesrisk status of childrenenrolled in UNR,CSA, Washoe TribalHead Start/EarlyHead Start.


2.1.b. Implement the tool to determinethe risk status of children enrolled inUNR, CSA, Washoe Tribal HeadStart/Early Head Start Start..



2.1.a.. Head Start staff,Oral Health Program,CUSP.

2.1.b. HS staff, dentalproviders, medicalproviders.

2.1.a. 06/05



2.2. a. Identify partners who canprovide fluoride varnish treatments on aregular, ongoing basis.

2.2. b. Establish formal MOUs withagencies//organizations that willprovide fluoride varnish treatments.

2.2.c. Provide training as needed.



2.2.c. Has neededtraining been provided?

2.2.a. HAWC,WCDHD,Saint Mary’s, TMCCDental HygieneProgram, Orvis Schoolof Nursing, TribalHealth Clinic,HS Staff.

2.2.b. HS staff andidentified agencies.

2.2.c. State Oral HealthProgram.

2.2. a. 05/05

2.2.b. 07/05

2.2.c. 08/05

31


Evaluationcriteria


involved

Timeframe

2.2.d. Implement quarterly fluoridevarnish program.

2.2.d. Has a quarterlyfluoride varnishprogam beenimplemented?

2.2.d. Identifiedagencies.

2.2.d. 09/05

32

Oral Health EducationGoal Statement #3: All children enrolled in UNR, CSA, and Washoe Tribal Head Start/Early Head Start will demonstrate appropriateoral hygiene and consume a diet that promotes oral health.

Outcome/Measurement: The percent of families with children enrolled in UNR, CSA, and Washoe Tribal Head Start/Early HeadStart who have participated in age appropriate, culturally sensitive, evidence-based oral health education.


Evaluationcriteria


involved

Timeframe

3.1. The PolicyCouncil, HealthAdvisory Committee,staff, parents andchildren understandthe importance of oralhealth

3.1.a. Provide oral health education tothe Policy Council, Health AdvisoryCommittee, staff, parents and childrenon an ongoing and systematic basis byimplementing health fairs, parentseducation events, one on onecounseling, and “adopt a center”programs. Focus on educating parentsto brush their children’s teeth at leastone time per day, educating parents onhow to talk to their children about oralhealth, educating parents on how tonavigate the system (health literacy,educating parents about bacterialransmission from mother to child.(research the Cavity Free Kids healthcurriculum)

3.1.b. Recruit a dentist/hygienist to beon Health Advisory Board.

3.1.a.Do all membersof the Policy Council,Health AdvisoryCommittee and staffunderstand theimportance of oralhealth? Is oral healtheducation beenprovided on an ongoingand systematic basis?

3.1.b Has a hygienistor dentists beenrecruited to serve onthe Health AdvisoryBoard?

3.1.a. HS, HealthAdvisory Committee,State Oral HealthProgram, CUSP.

3.1.b.. HS, CUSP.

3.1.a. 06/05

3.1.b. 06/05

3.2. Children, parentsand staff demonstratebehaviors thatpromote good oralhealth.

3.2.a. Implement activities to motivateparents to improve the oral health oftheir children (disclosing solution ortablets, healthy snack suggestions,brushing charts, recognition of thecenters where a high percentage ofparents have assisted their child withbrushing at least once a day).

3.2.a. What activities tomotivate parents havebeen implemented?

3.2.a. HS, CUSP, OralHealth Progam.

3.2.a. At leastone activitywill beimplementedquarterly.

33


Evaluationcriteria


involved

Timeframe

and staff demonstratebehaviors thatpromote good oralhealth.

parents to improve the oral health oftheir children (disclosing solution ortablets, healthy snack suggestions,brushing charts, recognition of thecenters where a high percentage ofparents have assisted their child withbrushing at least once a day).

3.2.b.Develop program specific goals toincrease percentage of pregnant womenwho have a dental exam

motivate parents havebeen implemented?

3.2.b. Have programspecific goals beendeveloped andimplemented?

Health Progam.

3.2.b. HS, CUSP, OralHealth Program.

one activitywill beimplementedquarterly.

3.2.b. 06/05

34

Dental ExaminationsGoal Statement #4: All children enrolled in UNR, CSA, and Washoe Tribal Head Start/Early Head Start will have a dentalexamination by a licensed dentist within six months of the eruption of the first tooth, their first birthday or within 90 days ofenrollment.

Outcome/Measurement: The percent of children enrolled in UNR, CSA, and Washoe Tribal Head Start/Early Head Start who have adental examination six months after the eruption of the first tooth, their first birthday, or within 90 days of enrollment.


Evaluationcriteria


involved

Timeframe

4.1. Identify partnerswho can provideexaminations forchildren enrolled inUNR, CSA, andWashoe Tribal HeadStart/Early Head Starton a regular andsystematic basis.

4.1. Contact potential partners todiscuss options.

4.1. Have potentialpartners beenidentified?

4.1. HS, HAWC, SaintMary’s, NorthernNevada Dental HealthProgram, Tribal HealthCenters

4.1. 04/05

4.2. Establish policyand procedure forchildren to have anexamination throughthe identified partnersor from a privatepractitioer.

4.2.a. Enter into a formal MOU with theidentified partners or the privatepactioner.

4.2.b. Establish written policy/procedure for children to get anappointment with the identified partnersor the private pactioner.(three to four months before schoolstarts, make arrangements to reserve ablock of time for HS children to beexamined.)



4.2.a. HS staff,identified partners,private practioners.

4.2.b. HS staff,identified partners,private practioners.

4.2.a. 06/05

4.2.b. 09/05

35

Emergency Dental TreatmentGoal Statement #5: All children enrolled in UNR, CSA, and Washoe Tribal Head Start/Early Head Start needing emergencytreatment due to the presence of pain or swelling are treated to relieve the pain or swelling within 24 hours of staff becoming aware ofthe problem.Outcome/Measurement: The percent of children enrolled in UNR, CSA, and Washoe Tribal Head Start/Early Head Start who receiveemergency treatment within 24 hours of staff becoming aware of the problem.


EvaluationCriteria


involved

Timeframe

5.1. Identify partnerswho can provideexaminations forchildren enrolled inUNR, CSA, andWashoe Tribal HeadStart/Early Head Starton a regular andsystematic basis.



5.1. HS, HAWC, SaintMary’s, NorthernNevada Dental HealthProgram, Tribal HealthCenter.

5.1. 04/05

5.1. Establish policy/procedure for childrenwho are having adental emergencywho are Medicaideligible or uninsuredto be treated throughHAWC, Saint Mary’s,Northern NevadaDental HealthProgram, TribalHealth Center.

5.1.a. Enter into a formal MOU with theidentified partners.

5.1.b. Establish written policy/procedure to follow for children to getan appointment with the identifiedpartners.



5.1.a. HS, HAWC,Saint Mary’s, NorthernNevada Dental HealthProgram, Tribal HealthCenter.

5.1.b. HS, HAWC,Saint Mary’s, NorthernNevada Dental HealthProgram, Tribal HealthCenter.

5.1.a. 06/05

5.1.b. 09/05

36

Routine Dental TreatmentGoal Statement #6: All children enrolled in UNR, CSA, and Washoe Tribal Head Start will have all of their routine dental treatmentneeds met by the end of the program year.Outcome/Measurement: The percent of children enrolled in UNR, CSA, and Washoe Tribal Head Start/Early Head Start who haveall of their routine dental treatment needs met by the end of the program year.


EvaluationCriteria


involved

Timeframe

6.1. Identify partnerswho can provideroutine dentaltreatment for childrenenrolled in UNR,CSA, and WashoeTribal HeadStart/Early Head Starton a regular andsystematic basis.




6.1. 04/05

6.2. Establish policy/procedure for childrenenrolled in UNR,CSA, and WashoeTribal HeadStart/Early Head Startto receive routinetreatment fromidentified partners.

6.2.a. Enter into a formal MOU withidentified partners

6.1.b. Establish written policy andprocedure for children to getappointments with identified partners (3to 4 months before school starts, makearrangements to reserve a block of timefor treatment of HS children.)



6.2.a. HS, identifiedpartners.

6.1.b.HS, identifiedpartners.

6.2.a. 06/05

6.1.b. 09/05

37

Hospital or Surgery Center Based Dental TreatmentGoal Statement #7: All children enrolled in UNR, CSA, and Washoe Tribal Head Start who need hospital or surgery center baseddental treatment will be treated by the end of the program year.Outcome/Measurement: The percent of children enrolled in UNR, CSA, and Washoe Tribal Head Start who need hospital or surgerycenter based dental treatment that are treated by the end of the program year.


Evaluationcriteria


involved

Timeframe

7.1. Identify partnerswho can provideroutine dentaltreatment for childrenenrolled in UNR,CSA, and WashoeTribal HeadStart/Early Head Starton a regular andsystematic basis.




7.1. 04/05

7.2. Establish policy/procedure forMedicaid anduninured childreneligible children toreceive routinetreatment at theofficesidentifiedpartners.

7.2.a. Enter into a formal MOU withidentified partners

7.1.b. Establish written policy/procedure for children to getappointments with identified partners (3to 4 months before school starts, makearrangements to reserve a block of timefor treatment of HS children.)



7.2.a. HS, identifiedpartners.

7.1.b.HS, identifiedpartners.

7.2.a. 06/05

7.1.b. 09/05

Documents

Final Report Format - mchoralhealth.org · 1.1.Determine the source of each child’s drinking water. 1.1. Survey families to determine if their children drink city water, non-fluoridated