Staff parent rpt - mchoralhealth.orgJessi Metzger, Student Assistant Lisabeth Bauer, Editor ... Appendix B: Interview Instrument, Head Start Parent . Oral Health-Parent/Staff Attitudes

Oral Health for Ohio Head Start Children Parent and Staff Attitudes and Practices

Interview Results

Prepared for: Bureau of Oral Health Services

Ohio Department of Health

Evaluation Services Center University of Cincinnati

May, 2003


Interview Results

Evaluation Services Center Debbie Zorn, Director Mary L. Marx, Project Coordinator With the assistance of: Donna Sheets-Ruiz, Evaluation Associate Deborah Smith, Consultant Karen Ludwig, Technical Support Coordinator Jessi Metzger, Student Assistant Lisabeth Bauer, Editor Acknowledgement UCESC project staff wish to acknowledge interview participants, both health coordinator staff and parents from Ohio Head Start and Early Head Start programs, and Bureau of Oral Health Services staff who collaborated on the design of the project and interpretation of the results.


Interview Results

Table of Contents List of Tables Table 1. Head Start Program Demographics ............................................................................ 2 Table 2. Head Start Staff Demographics .................................................................................. 2 Table 3. Family Demographics................................................................................................. 3 Table 4. Age Child Should Be When He.................................................................................. 3 Table 5. Head Start Staff and Parent Comments about Age Recommended for a Child’s First

Visit to the Dentist ............................................................................................................ 4 Table 6. Difficulty of Finding a Dentist to Care for Children .................................................. 6 Table 7. Reasons It Is More Difficult to Find a Dentist............................................................ 7 Table 8. Most Frequently Mentioned Barriers That Interfere with Children Getting Needed

Dental Care ....................................................................................................................... 8 Table 9. Parents’ Report of Dental Care Payment Source........................................................ 8 Table 10. Parents’ Report of Their Children’s Dental Needs and Access to Care ................... 9 Table 11. Head Start Programs’ Assistance to Parents Related to Signing Up for a Medical

Card................................................................................................................................. 10 Table 12. Head Start Programs’ Assistance to Parents Related to Accessing Dental Care for

Their Children................................................................................................................. 11 Table 13. Types of Assistance Offered in Helping Parents Access Dental Care for Their

Children........................................................................................................................... 12 Table 14. Strategies Used by Head Start Staff to Educate Children about Oral Health ......... 13 Table 15. Strategies Used by Head Start Staff to Educate Parents about Oral Health ........... 14 Table 16. Parents’ Perceptions of Oral Health Education Provided by Head Start ............... 15 Table 17. Head Start Staff Involvement in Prevention Programs Related to Oral Health...... 16 Table 18. Head Start Staff Attitudes Related to Specific Oral Health Issues ......................... 17 Table 19. Additional Strategies Head Start or the Community Could Use to Help Meet

Children’s Oral Health Needs......................................................................................... 18 Table 20. Head Start Staff Final Comments ........................................................................... 19 Appendixes Appendix A: Interview Instrument, Head Start Staff Appendix B: Interview Instrument, Head Start Parent

Oral Health-Parent/Staff Attitudes and Practices 1

Evaluation Services Center, University of Cincinnati


Interview Results

The Evaluation Services Center (ESC) of the University of Cincinnati College of

Education was contracted by the Ohio Department of Health, Bureau of Oral Health Services, to conduct an interview study of Head Start health coordinator staff and Head Start parents. The purpose of the study was to learn about staff and parent attitudes and practices related to dental care for young children in Ohio. This report summarizes results of the interviews. Results will be combined with findings from companion studies to develop a compendium report of promising practices related to improved dental care access and oral health status for Ohio children in Head Start and Early Head Start programs.

Sampling Methodology

A convenience sample of fifteen Head Start programs was assembled from Head Start health coordinator staff who participated in the Approaches That Work interview study. The sample programs were representative of Head Start and Early Head Start programs, geographic setting (i.e., urban, rural, suburban), and geographic locations in the state of Ohio (north, south, east, west, and central). Following interviews for Approaches That Work, health coordinator staff were asked to identify three to five parents who had children in Head Start programs. Parents were given an information sheet and asked to return the form to their child’s teacher indicating their consent for ESC to contact them for a telephone interview. Parents provided the ESC with phone numbers and preferred times for interviews on the information sheet. The ESC used this information to schedule interviews. The first parent from each Head Start program to be reached by phone was included in the study.



Results Table 1. Head Start Program Demographics

Program Characteristics

Programs (n=15)

n % Program Type Head Start 11 73.3 Combined HS/EHS 4 26.7 Setting Rural 8 53.3 Urban 5 33.3 Combination 1 6.7 Suburban 1 6.7

Table 2. Head Start Staff Demographics

Respondent Characteristics

Staff (n=15)

n % Role Health Manager/Coordinator 8 53.3 Health, Nutrition and/or Disabilities Manager/Coordinator 7 46.7 Years in role Less than 1 1 6.7 1 to 5 8 53.3 More than 5 6 40.0



Table 3. Family Demographics

Family Characteristics

Parents (n=15)

n % Age of Child

4 years 12 80.0 5 years 3 20.0 Respondent relationship to child

Mother 14 93.3 Foster Parent 1 6.7

Child has disability* Yes 3 20.0 No 12 80.0

* Two children had speech delays; one child had a heart defect. Table 4. Age Child Should Be for First Visit to the Dentist

Staff (n=15)

Parents (n=15)

Age in Years n % n % 1 or younger 5 33.3 6 40.0 2 7 46.7 3 20.0 3 2 13.3 4 26.7 4-5 1 6.7 1 6.7 Don’t know 1 6.7



Table 5. Head Start Staff and Parent Comments about Age Recommended for a Child’s First Visit to the Dentist Respondent Age Comments Staff (n=11)

1 or younger

• Months (at time they get teeth). At times infants/toddlers need to go. Depends on pediatrician to refer, but some are still in mindset like parents. "They will lose them (baby teeth)."

• One to two. If physician is doing a decent job looking at teeth and teeth are coming in. If physician isn't looking, Mom better be telling them to look at their teeth.

• First tooth [at about] 9-12 months. • When they start walking is ideal. Three to five for Head Start.

2 • Once they have enough teeth to look at. • Two to three years. Kids who will open their mouths. • Two and a half years. • Two and a half to three. My advice is ideally, after eruption of first tooth.

Local dentists push for three to five years. • The sooner the better, by age 1 would be good, at least by age 2 (per

dental advocate we have).

4-5 • Close to kindergarten, because it is very difficult with threes and fours. But if a child is going to sleep with a bottle and decay is present, then earlier.



Table 5. Head Start Staff and Parent Comments about Age Recommended for a Child’s First Visit to the Dentist (Continued) Respondent Age Comments Parent (n=14)

1 or younger

• We have no fluoride and my child's teeth rotted as a baby. She has one cap already, and will get one more tomorrow.

• I feel like if it would be any earlier, it is hard to look in the mouth and children may be scared.

• As a precautionary measure. The children have teeth at this age so it is a good time to start with dental visit. Also want to prevent gum disease.

• A lot of things go wrong during that time-some go to bed with bottle and juice. Preventive tooth decay and parts that moms don't see.

• To introduce child to dentist and dental health care. Fluoride treatments, machinery.

• Because parents don't think teeth are important, but they are.

2 • When they start to get teeth. • Because this is when they are getting off the bottles and pacifiers and they

need to get their teeth cleaned. The dentist can help them with teeth brushing.

• In my opinion, at two, soon they will be getting into good brushing habits and not being scared of going to dentist and getting used to the technique the dentist uses. My older child went older and was afraid and I had go through all the steps of what was going to happen and now she’s not afraid. My younger daughter (HS child) is not afraid to go because of going earlier and knowing what happens.

3 • Because that is when they get more teeth. • Two year olds don’t do well and sit still, but they do need to see a dentist.

Checked as early as possible if they'll sit still, very important. • Three years just because they can start to get acclimated and get used to

it. (My child started going when he was two.) They are more independent going from three to four.

• What my dentist suggests.

4-5 • My child doesn't need cleaning, prevention, to get used to going to dentist.



Table 6. Difficulty of Finding a Dentist to Care for Children

Staff (n=15)

Parents (n=15)

Responses

n % n % It’s more difficult to find a dentist 9 60.0 10 66.7 It’s more difficult to find a doctor 1 6.7 1 6.7 It’s about the same 2 13.3 It’s no trouble finding either a doctor or a dentist 2 13.3 4 26.7 Other* 1 6.7

*Problem for [dental] follow-up, not exam.



Table 7. Reasons It Is More Difficult to Find a Dentist Respondent Themes Comments Staff* (n=10)

Dentists don’t accept Medicaid

• Dentists are not willing to provide services to children with medical cards. It’s not lucrative.

• We have a lack of dentists to provide care to families with Medicaid or at a reduce rate to families with no insurance

• Pool of dentists accepting Medicaid is very small

Problems with Medicaid

• Poor reimbursement • No show rate • Pre-approval process

No dentists in area • Don’t have a focus on dentistry and not a high number of

dentists in NE Ohio • We did a survey and should have [a certain number] of

dentists and only have half that, and half are ready to retire

• Dentists just not available in the area for pediatrics

Dentists not willing to serve young children

• Especially for EHS because most family practice dentists don’t want children that young

• Dentists don’t know what to do with uncooperative children/ children yelling

Dentists not willing to

provide follow-up treatment

• Problem with follow-up • Have to go to Columbus Children’s and OSU for follow-up

Parent (n=10)

Dentists don’t accept Medicaid/ Medical Cards

• More pediatricians accept medical cards than dentists

• No pediatric dentists available

No dentists in area • Wanted a family dentist for whole family

Dentist not accepting

new patients • Doctors are always accepting new patients. Dentists

seem overwhelmed, more doctors than dentists.

*Respondents may have offered comments in more than one category.



Table 8. Most Frequently Mentioned Barriers That Interfere with Children Getting Needed Dental Care Barriers* Staff

(n=15) Parents (n=15)

n % Rank n % RankLong waiting time to get appointments

10 66.7 1 5 33.3 4

Parent problems getting to the appointment (e.g., transportation, childcare, getting off of work)

10 66.7 1 6 40.0 2

Parent didn’t think the child’s problem was serious enough

9 60.0 3

Dentists aren’t available or don’t accept medical cards

9 60.0 3 9 60.0 1

Cost of dental care (e.g., parent had no insurance or couldn’t afford it)

5 33.3 5 6 40.0 2

Parent didn’t feel welcomed in the dental office or clinic

1 6.7 6

Child is afraid of the dentist

2 13.3 5

Other**

2 13.3 n/a 2 13.3 n/a

*Respondents were asked to select three barriers. **Other reasons, staff: dental office hours; education, Appalachian culture, other priorities. Other reasons, parents: child is too young according to dentist; medical disability. Table 9. Parents’ Report of Dental Care Payment Source

Parents (n=15)

Payment Source n % Medical Card/Medicaid 7 46.7 Private Insurance 5 33.3 Family Pays/No Insurance 3 20.0



Table 10. Parents’ Report of Their Children’s Dental Needs and Access to Care

Question

Parents (n=15)

n % Child has visited a dentist

Yes 13 86.7 No * 2 13.3 Child had a toothache in the past 12 months Yes 6 40.0 No 9 60.0 Child was unable to get dental care in the past 12 months Yes 5 33.3 No 10 66.7 Children who

visited a dentist (n=13)

n % Provider Type

Family dentist ** 5 38.5 Child’s dentist/pediatric dentist 7 53.8

Hospital emergency room 1 7.7 Reason for child’s last visit Cleaning/check up 8 53.5 Restorative work (e.g., caps, fillings) 3 20.0 Dental Screening 2 13.3 Consultation 1 6.7 Timing of child’s last visit Within the past 6 months 9 69.2 6 months to 1 year 4 30.8

* One child could not get care due to his/her disability **Three of five children see the same dentist as their family members



Table 11. Head Start Programs’ Assistance to Parents Related to Signing Up for a Medical Card

Question Staff (n=15)

n % Do you help parents sign up for a medical card, if needed?

Yes 15 100 Theme Sample Comments: If yes, please describe how: (n=15) Target parents at enrollment

• Parents identified at enrollment or if status change • Provide parents application packets at enrollment

Facilitate the process • Staff trained to initiate process of obtaining a medical card • Help parents complete applications • Follow up with parents to complete application process

Parents

(n=15) n % Did your Head Start/Early Head Start program help you get the medical card?

Yes 1 6.7 No, it’ wasn’t needed (e.g., already had one) 14 93.3



Table 12. Head Start Programs’ Assistance to Parents Related to Accessing Dental Care for Their Children


n % Are there other ways in which you help parents access dental care for their children?

Yes 15 100 Parents

(n=15) n % Did your Head Start/Early Head Start program help you to get dental care for your child?

Yes 6 40.0 No, already had dental care or knew who to go to 9 60.0



Table 13. Types of Assistance Offered in Helping Parents Access Dental Care for Their Children Respondent Theme Comments Staff (n=15)

Arrange special clinics/partner with providers

• Dentist with portable full set up who goes to our sites • Refer to dental clinic that gets them in if they say its for a HS

check • Dentists R Us from Detroit • Special screening day: a dentist that received a grant for

supplies, training and equipment brings other dentists to assist and in-Kind they do our screenings in two days

• We serve migrant families, we line them up with the dates the migrant centers have their health screen, mobile unit

• Dentist comes in to see children, has OR time at hospital and squeezes in the children and time to wait is reduced

• Past parent a dentist that partners with us

Take child to dental provider with parent permission

• Family signed off so that family advocate to take child to dentist

• Get permission to get exams at dental clinic

Facilitate the whole process/ locate dentist/ make appointment/ provide transportation/ child care

• We do all of that and prepare the child and parent for what to expect

• We let parents know upfront what they need and we work with them as needed, let them know we are available and we provide help timely, whatever it is

• Provide child care • We have children go in saying exam is for HS and they get in

Locate providers/ provide provider lists

• Provide a community resource document, lists providers with sliding scales service

• Hand guide that lists dentists phone numbers and addresses with free (or low cost), Medicaid accepted

• List of dentists that take Medicaid • Master lists of dentists that accept medical card

Cover costs if no other source

• We pay as long as funds are available • If a parent can’t pay, I pay for some of the cost though

arrangements with the dental office, percent varies by case (federal slots only, state slots must be TANF monies)

• If child doesn’t qualify for Healthy Start, we will pay Parent (n=6)

Locate providers/ provide provider lists

• HS gave me a pediatric dentist to call that would accept Medicaid

• Helped by providing a list of possible dentists • Referred me to Children’s Hospital

Facilitate with

appointment and transportation

• HS made the appointment and transported us to the appointment



Table 14. Strategies Used by Head Start Staff to Educate Children about Oral Health Themes Comments Daily dental care tooth with instruction in the classroom

• Tooth brushing/swishing is part of daily routine • Tooth brushing skills taught • Do classroom activities about how to brush and why it’s important

Curriculum activities in the classroom

• Curriculum throughout the year on dental health and safety with songs and games

• Teachers promote dental health in their lessons periodically • [Our program requires that ] dental health is taught once a month • Nurses do center visits and check if dental health is included in the

curriculum • Colgate Bright Smiles and Bright Futures curriculum

Stuffed dolls with teeth are in the classroom, teachers educate children with dolls, books, art (color cavity on paper and then kids brush off)

• We have books, games, videos, puppets, Mr. Happy Tooth, Mr. Tooth Decay

• Some teachers have a health center in the classroom with tooth puzzle

• Use videos, e.g., Dudley Goes to the Dentist

Speakers/visitors in the classroom discuss dental health

• Specialists visit classroom and do activities and give brushes • Dental students come in and present and show videos • Dental students do a student’s experience – dental education

Focus on dental health in February for Dental Health Month

• Focus one week in February, kids make teeth, etc. in class • We have a strong focus in February • During February there is a special presentation in the classroom

(n=15)



Table 15. Strategies Used by Head Start Staff to Educate Parents about Oral Health Themes Comments Distribution of educational materials

• General newsletter has health issues, sometimes these are for oral health

• Newsletters in the fall on oral health • Flyer on the importance of baby teeth

Distribution of materials for dental hygiene

• Distribute tooth paste/ brushes • Parent bag (brush, paste, info) • Summer packet- toothbrush, tooth paste, brush for adult and child if

siblings if I can, floss, disclosure tablet and other things- mirror, timer • Bright Smiles bright Futures parent packets (brush, paste, sticker-

brush young teeth, chart, brushing flyer, important to brush and how to brush, also get books, cassettes for the classroom

• Pact activities with parents, parents get disclosing tablets and instructions of tooth brushing

Education presentations by dental professionals and Head Start staff

• Dental health is on monthly parent agenda, usually November we do an educational program

• At least one parent club we talk about oral health • Nutritional workshops • Parent training for two nights, invite dental hygienist to talk about

proper brushing/importance of dental care Nurse talks about brushing, working dental care into the evening schedule at home

Borrowing library • Parents can access same resources teachers can to use with their children (books, games, videos)

Other • Work individually with parents as needed • Weekly live broadcast collaborative with high school; topics include

oral health; dentist as presenter in February

(n=15)



Table 16. Parents’ Perceptions of Oral Health Education Provided by Head Start

*Two of these parents said, “No,” but then they went on to say what Head Start did provide; recoded as “Yes.”

Question Parents (n=15)

n % Have you learned anything from Head Start about how to take care of your child’s teeth?

Yes* 11 73.3 No 4 26.7 Theme Sample Comments If yes, what did you learn? (n=11)

Daily dental care

• To make sure child brushes each time she eats. To rinse mouth before bed to get plaque off before sleeping

• Brushing with my child so he knows how. • What to look for in his mouth, teach him how to brush.

Written materials and information sent home with child

• Information sent home is really good. Calendar on how and when to brush teeth.

• We do keep parents informed; send things home. Healthy eating habits • Tell what healthy eating habits are.

• Healthy eating habits. They send home nutritional activities 3 times a month.



Table 17. Head Start Staff Involvement in Prevention Programs Related to Oral Health

* (n=3)


n % Is your program involved in any prevention programs related to oral health?

Yes 3 20.0 No 12 80.0 Theme Comments* If yes, please describe? Follow-up on water source/well water (e.g., test water, inform parents, provide fluoride)

• We test the well water if no city water and tell parents results; we tell them to ask dentists about getting supplements and use fluoride paste

• In the past we tested well water and did fluoride treatments; now we use paste in the classroom that is fluoridated

• We don’t have fluoridated water; we provide them with fluoridated tablets.



Table 18. Head Start Staff Attitudes Related to Specific Oral Health Issues

Staff

(n=15)

Statement

Strongly Agree

n (%)

Somewhat Agree

n (%)

Somewhat Disagree

n (%)

Strongly Disagree

n (%)

Teachers in our program are strongly committed to tooth-brushing in the classroom.

6 (40.0)

7 (46.7)

2 (13.3)

My program is able to meet the oral health needs of the children we serve.

3 (20.0)

6 (60.0)

4 (26.7)

2 (13.3)

It is difficult to find dentists to provide basic dental services, such as examination and cleaning, to children in our program.

5 (33.3)

2 (13.3)

2 (13.3)

6 (60.0)

It is difficult to find dentists to provide complex dental services, such as filling cavities, extracting teeth, to children in our program.

9 (60.0)

1 (6.7)

2 (13.3)

3 (20.0)

Parents do not tend to value oral health care for their children.

7 (46.7)

3 (20.0)

5 (33.3)

Given all the responsibilities my role entails, I find it hard to make dental care needs for children a priority.

1 (6.7)

3 (20.0)

2 (13.3)

9 (60.0)



Table 19. Additional Strategies Head Start or the Community Could Use to Help Meet Children’s Oral Health Needs

*Respondents may have offered comments in more than one category.

Respondent Theme Comments Staff (n=15)

Partner in broader community effort

• Take advantage of community initiatives happening on a larger scale that impact oral health systems

• Be part of planning processes • Get a dental clinic, a collaborative community venture • Write a grant

Find more dentists • We’d like to have our own dentist • Dentist that could go in house • Get more dentists but that’s not up to us

Increase scope of

services for hygienists • At the state level allow dental hygienist to do screening;

they could give parent a tangible statement child needs follow-up

Educate the dental

community

• Educate the dental community

Increase staff oral health education

• Maybe we should first educate all HS staff

Increase parent education and advocacy

• Explain the importance of oral health care at a young age • Have parents ask pediatricians about oral health • Help parents know the signs of oral problems • Promote parent support and follow-up • Promote importance to parent of signing permission slips

when dentist is coming on site • Get parents to make it a priority. We just need a

commitment from them and their time in order to allow them to use our resources to get dental care

• Educate on city access to reduce fear going to Children’s Hospital

Obtain educational

materials on oral health

• I need good literature in parent friendly language to understand importance of baby teeth, good foods, brushing. Literature should use bullets and pictures

• Current materials available are outdated

Adapt classroom facilities for oral health

• Facilities are not set up ideally for tooth care, install mirrors lower where children can see, etc.

Oral health case

management for every child

• Oral care case management, getting dental care for each child, one contact with families

• Our program could use more staff dedicated to oral health and medical health issues in order to reduce case load to recommended [number]



Table 19. Additional Strategies Head Start or the Community Could Use to Help Meet Children’s Oral Health Needs (Continued)

Table 20. Head Start Staff Final Comments Theme Responses Share survey results • I want to hear survey results and “promising practices” from other

programs

Sustaining current efforts • I serve on community improvement committee related to oral health. Multiple planning projects (e.g., maps of need for supply; case management). How can we sustain what we do?

(n=2)

Respondent Theme Sample Comments Parent (n=14)

Nothing (e.g., already doing a good job)

• Head Start is really good. They do everything. Nothing else that they can do.

• Nothing. They are pretty much on top of dental care. • Already provide toothbrushes, they are doing a good job. • Nothing…at the present. In the past when they had on site

dental visits, it was helpful to get the dental sheet filled out on site and convenient for people who [couldn’t] make visits to the office.

• Not much to do. The nurse sends home information. We are very happy with what they are doing.

• Nothing I can think of. Great to do weekly activities about dental care with children in the classroom.

Increase parent

education • Provide more dental information to parents or classes for

parents on dental health. • Let me know what they do at school for dental care.

Increase on-site

services • A dental hygienist could come to the school or they could

set up a field trip to the health department so the children could get their teeth cleaned. Hard for parents to get them to a dentist.

Availability of dentists

taking Medicaid

• More dentists to take medical cards.



Appendixes



Appendix A: Interview Instrument, Head Start Staff



Respondent ID ____________ Introduction and consent: The Ohio Department of Health has contracted with us—the Evaluation Services Center at University of Cincinnati—to conduct this interview. The purpose of the interview is to find out about your perceptions of children’s oral health care needs and how those needs are met. There should be no risks involved in participating; we hope the study will benefit children who attend Head Start and Early Head Start programs in the future, by improving their access to dental care. Your participation in the interview is voluntary. You can decline participation or end the interview at any time. Your responses will be confidential, and seen only by staff at our center. Responses will be reported in aggregate. No individual responses will be identified. Questions about the study can be directed to Mary Marx (513-556-3750) or Debbie Zorn (513-556-3818). The duration of the interview depends on your responses, but we estimate the interview will take about 15 minutes. May I have your consent, now, to participate in this interview?

[ ] Yes (Respondent agrees to participate.) [ ] No (Respondent declines to participate.) Interviewer signature: ________________________________ Date: __________________ Staff respondent name: __________________________________ HS/EHS program name: ______________________________



Respondent ID ____________

Program name: _______________________________ Date: ______________ [ ] Head Start [ ] Early Head Start [ ] Combined HS/EHS 1) What is your title or position?

2) How long have you been in this role?

3) What kind of setting is your program in?

[ ] Urban [ ] Rural [ ] Suburban

4) Now we will talk about dental care for children. How old do you think a child should be when he or she goes to the dentist for the first time? (If the respondent answers with a phrase (e.g., “when they are developmentally ready;” “when they get their first permanent tooth”), record the comment, but probe for a number.) _____ year(s)

5) We want to know whether you think it is more difficult to find dentists or doctors to provide care to children in your program. Please select one of the following answers:

It’s more difficult to find a dentist (If selected, go to 5a) It’s more difficult to find a doctor It’s about the same It’s no trouble finding either a doctor or a dentist Other (please describe) ________________________________________

___________________________________________________________

a. Could you describe why you think it is this way?



6) Now I’m going to read a list of barriers that sometimes interfere with children getting the

dental care they need. Please select three that you consider to be the major barriers. I can read the list again, if needed. Top Three

Barriers

a. Parent didn’t think the child’s problem was serious enough

b. Parent problems getting to the appointment (e.g., transportation, childcare, getting off of work)

c. Cost of dental care (e.g., parent had no insurance or couldn’t afford it)

d. Dentists aren’t available or don’t accept medical cards

e. Long waiting time to get appointments

f. Child is afraid of the dentist

g. Parent didn’t feel welcomed in the dental office or clinic

h. Other reason (please describe) 7) Do you help parents sign up for a medical card (i.e., for Medicaid), if needed?

Yes No If YES, a) Please describe how you help parents apply for a medical card.

(Probe: give them a phone number; help them fill out the application; drive them to the appointment)

8) Are there other ways in which you help parents access dental care for their children?

Yes No If YES, a) Please describe how you help them access dental care for their children

(Probes: -locate dentist/clinic -make appointments -provide transportation/child care -tell child or parent what to expect -help parent advocate for child’s dental care needs)



9) What does your program do to educate children about oral health?

(Probes: cleaning/brushing, nutrition) (NOTE: Carry over any relevant information from the “Approaches That Work” interview so that we are not asking respondents the same question twice)

10) What does your program do to educate parents about oral health for children?

(Probes: cleaning/brushing, nutrition, dental visits (first visit/frequency of visits) (NOTE: Carry over any relevant information from the “Approaches That Work” interview.)

11) Is your program involved in any prevention programs related to oral health?

(Probe: fluoride varnish, fluoride supplements, fluoride mouth rinse) (NOTE: Carry over any relevant information from the “Approaches That Work” interview.)



12) Next, I’ll ask you to rate your agreement with some statements about oral health issues.

You’ll be rating each statement using this 4-point scale: 4 = Strongly Agree 3 = Somewhat Agree 2 = Somewhat Disagree, and 1 = Strongly Disagree Here are the statements.

Strongly Agree

Somewhat Agree

Somewhat Disagree

Strongly Disagree

N/A or No

opinion (4) (3) (2) (1) N/Aa. Teachers in our program are strongly

committed to tooth-brushing in the classroom

b. My program is able to meet the oral health needs of the children we serve

c. It is difficult to find dentists to provide basic dental services, such as examination and cleaning, to children in our program

d. It is difficult to find dentists to provide complex dental services, such as filling cavities, extracting teeth, to children in our program

e. Parents do not tend to value oral health care for their children

f. Given all the responsibilities my role entails, I find it hard to make dental care needs for children a priority

13) Here’s the last question. What else could your program do to help meet the oral health needs

of children you serve?

THANK YOU VERY MUCH!



Appendix B: Interview Instrument, Head Start Parent



Introduction and consent: The Ohio Department of Health has contracted with us—the Evaluation Services Center at University of Cincinnati—to conduct this interview. The purpose of the interview is to find out about dental care for your child. There should be no risks involved in participating; we hope the study will benefit children who attend Head Start and Early Head Start in the future, by improving their access to dental care. Your participation is voluntary. It will not affect your child’s services if you decide not to participate, or if you want to end the interview before it is over. Your answers will be confidential, and seen only by staff at our center. Responses will be grouped for the report. No individual responses will be identified. If you have questions about the study, you can call Mary Marx (513-556-3750) or Debbie Zorn (513-556-3818). The interview will probably take about 20 minutes, but it depends on the length your responses. May I have your consent, now, to participate in this interview?

[ ] Yes [ ] No (If “No,” thank the respondent for their time.) Interviewer signature: ________________________________ Date: __________________ Parent respondent name: __________________________________ HS/EHS program name: ______________________________



Program name: ____________________________ [ ] Head Start [ ] Early Head Start 14) I’ll begin by asking you about your child who is enrolled in Head Start (Early Head Start).

What is the date of birth of your child? (If respondent has more than one child enrolled in HS/EHS, record the birth date of the child who has been enrolled the longest. Tell the respondent the interview will focus on that child.) ____ / ____ / ____ (month / day / year)

15) What is your relationship to the child? (Probes: Mother, father, grandparent, legal guardian)

16) Does your child have a disability?

Yes No If YES, a) Could you please describe the disability?

17) How old do you think a child should be when he or she goes to the dentist for the first time? ____ year(s) (If the respondent answers with a phrase (e.g., “when they get their permanent teeth”), record the comment, but probe for a number.) a) Could you say more about why a child should go to the dentist for the first time at that

age?



18) Has your child ever been to a dentist? By this we mean any kind of dental professional, such as an orthodontist, an oral surgeon, or a dental hygienist. Yes No

If No,

a) During the past 12 months, has your child had a toothache? Yes No Don’t know/don’t remember

b) During the past 12 months, was there a time when your child needed dental care, but you were unable to get that care? Yes No

Go to Question 6.

If YES c) Where do you usually take your child to the dentist?

(If multiple dentists are used, which one would they go to for exam and cleaning?)

Family dentist/private dentist….If YES, Is this the dentist you and your family go to? Yes No

Child’s dentist (pediatric dentist)

Dental clinic……………….…..If YES, Which one? ___________________________

Hospital emergency room/ER

d) What was the reason for your child’s last visit to the dentist? (Probe: Check-up? Cleaning? Filling? Toothache? Tooth pulled? Caps on teeth? Injury?)

e) When did the last visit to the dentist occur? Within the past 6 months Between 6 months and 1 year More than 1 year

f) During the past 12 months, has your child had a toothache? (Use carryover information—ask only if needed) Yes No Don’t know/don’t remember

g) During the past 12 months, was there a time when your child needed dental care, but you were unable to get that care? (Use carryover information—ask only if needed) Yes No



19) I’m going to tell you some reasons that might keep parents from taking their child to the dentist. Which three could be the biggest problems for you?

Check Three

Reasons

a. Problems getting to the dental office/clinic (e.g. transportation, childcare, getting off work)

b. Costs are too high c. Can’t find a dentist OR dentists don’t accept medical cards d. It takes to long to get an appointment e. My child’s teeth weren’t bad enough to go to the dentist f. My child is afraid to go to the dentist g. I don’t feel welcomed in the office/clinic h. Other reason (please describe)

20) Has it been more difficult to find a dentist or a medical doctor (e.g. Pediatrician) to care for

your child? more difficult to find a dentist (If Yes, ) more difficult to find a doctor it’s about the same no trouble finding a doctor or a dentist other (please describe)

a) Why do you say it’s more difficult to find a dentist?

21) Have you learned anything from Head Start about how to take care of your child’s teeth?

(e.g., how to clean or brush, healthy foods to eat, how often to take child to the dentist) Yes No

a) (If Yes), What did you learn about taking care of teeth from Head Start?



22) How is your child’s dental care paid for? Medical card (Medicaid/Medicaid HMO) If , Go to Question 9a

Private Insurance

Family pays/No insurance

Other, please describe __________________________________

a) Did your Head Start (Early Head Start) program help you get the medical card? Yes No If NO,

i) You said they didn’t help you. Could you please say why? (Probes: You didn’t need one, you were not eligible)

If YES,

ii) What did the program do to help you? (Probes: Gave you a number to call; told you how to sign up; went with you to sign up)

23) Did your Head Start (Early Head Start) program help you to get dental care for your child?

Yes No

If NO, a) Did you want help but didn’t get it? Yes No

If YES,

b) How did the program help you? (Probes: helped find a dentist, make appointments, provided transportation, provided childcare, went with us to the dentist, prepared us for what to expect)

24) What else could Head Start do to help you meet your child’s dental health needs?

THANK YOU!!

Documents

Staff parent rpt - mchoralhealth.orgJessi Metzger, Student Assistant Lisabeth Bauer, Editor ... Appendix B: Interview Instrument, Head Start Parent . Oral Health-Parent/Staff Attitudes