Policy Considerations in Oral Health Mary E. Foley, RDH MPH Dean, Forsyth School of Dental Hygiene...

Policy Considerations Policy Considerations in Oral Healthin Oral Health

Mary E. Foley, RDH MPHMary E. Foley, RDH MPHDean, Forsyth School of Dental HygieneDean, Forsyth School of Dental Hygiene

Massachusetts College of Pharmacy and Health SciencesMassachusetts College of Pharmacy and Health Sciences

Promoting Oral Health for South FloridaPromoting Oral Health for South Florida A Community DialogueA Community Dialogue

October 15October 15thth, 2007, 2007

What is Policy?What is Policy?

According to Webster…According to Webster…

a definite a definite course of actioncourse of action selected from selected from among alternatives and in light of given among alternatives and in light of given conditions to conditions to guide and determineguide and determine present present and future decisions;and future decisions;

a high-level overall plan embracing the a high-level overall plan embracing the general goals and acceptable procedures general goals and acceptable procedures especially of a governmental body especially of a governmental body

Many Kinds of PoliciesMany Kinds of Policies

ProfessionalProfessional ProgrammaticProgrammatic StateState FederalFederal PublicPublic

Professional PoliciesProfessional Policies

Examples of Professional PoliciesExamples of Professional Policies

American Academy of Pediatric DentistryAmerican Academy of Pediatric Dentistry Dental HomeDental Home

American Dental AssociationAmerican Dental Association Fluoride VarnishFluoride Varnish

Association of State and Territorial Dental DirectorsAssociation of State and Territorial Dental Directors FluoridationFluoridation

American Academy of PediatricsAmerican Academy of Pediatrics First Dental VisitFirst Dental Visit

Pros and ConsPros and Cons Authoritative sources provide same and sometimes Authoritative sources provide same and sometimes different different

viewpointsviewpoints

Federal PoliciesFederal PoliciesPublic PoliciesPublic Policies

Executive Branch• President

Legislative Branches House of

Representatives

Senate

Policies created by the LegislaturePolicies created by the LegislatureEnact Bills to protect public, promote health and prevent diseaseEnact Bills to protect public, promote health and prevent diseaseApproved/Vetoed by the PresidentApproved/Vetoed by the PresidentExample: SCHIPExample: SCHIP

Federal PoliciesFederal PoliciesProgrammaticProgrammatic

US Department of Health and Human Services

State PoliciesState Policies

Executive BranchExecutive Branch Florida Governor, Florida Governor,

Charlie CristCharlie Crist

Legislative BranchLegislative Branch Florida House of Florida House of

Representatives Representatives The Florida SenateThe Florida Senate

Process of Policy Development Process of Policy Development State or Federal Government AgenciesState or Federal Government Agencies

Policy that leads to Programmatic Policy that leads to Programmatic DevelopmentDevelopment

Policies that Support ProgramsPolicies that Support Programs MedicaidMedicaid

Process of Policy DevelopmentProcess of Policy Development

Federal legislation that creates programs: Federal legislation that creates programs: “Authorization”“Authorization”

Authorization is not enoughAuthorization is not enough Dollars need to be “Appropriated” to Dollars need to be “Appropriated” to

support the legislation or the programsupport the legislation or the program Examples: SCHIP, Head StartExamples: SCHIP, Head Start

Examples of Programmatic PoliciesExamples of Programmatic Policies

Federal LevelFederal Level Head StartHead Start SCHIPSCHIP

State LevelState Level Community Water FluoridationCommunity Water Fluoridation State Oral Health AuthorityState Oral Health Authority Rules and Regulations that support dental care Rules and Regulations that support dental care

services, i.e. pregnant women; school-based dental services, i.e. pregnant women; school-based dental sealant programs, CSHCNsealant programs, CSHCN

Examples of Public PoliciesExamples of Public Policies

Agency: CDCAgency: CDC Develops national policiesDevelops national policies Influence State Health DepartmentsInfluence State Health Departments

• Immunizations and School EntryImmunizations and School Entry• Vision, Hearing and Oral Health ScreeningsVision, Hearing and Oral Health Screenings

Community water FluoridationCommunity water Fluoridation

Agency: CMSAgency: CMS Programs: Medicaid and SCHIPPrograms: Medicaid and SCHIP

• Provides rules and regulations to support programsProvides rules and regulations to support programs• Provides Federal dollars to support programsProvides Federal dollars to support programs

US Department of Health and Human Services

How the Public can Impact Policy How the Public can Impact Policy

Educate policy makers on ways to increase the Educate policy makers on ways to increase the capacity and effectiveness of state oral health capacity and effectiveness of state oral health programsprograms

Utilize an organized approach Utilize an organized approach Message bearersMessage bearers (leadership, coalition, (leadership, coalition,

partners)partners) 4 4 evidentiary inputsevidentiary inputs (burden document, state (burden document, state

plan, surveillance findings, results of evaluation) plan, surveillance findings, results of evaluation) Promote support for Promote support for outcome goalsoutcome goals

CDC/CDHP

Conceptual FrameworkConceptual Framework

www.cdhp.org

Identify Opportunities for Policy Identify Opportunities for Policy ChangeChange

Environmental AssessmentEnvironmental Assessment Assess state systems, social mores, political Assess state systems, social mores, political

conditions, and policy directionsconditions, and policy directions Systemic approach:Systemic approach:

Private dental care delivery system Private dental care delivery system Safety net dental care delivery system Safety net dental care delivery system Dental/dental hygiene education system Dental/dental hygiene education system School system School system Water system Water system Political system Political system Legislative system Legislative system

www.cdhp.org

Consider Socio-Political AgendaConsider Socio-Political Agenda Identify and align with political agendaIdentify and align with political agenda

Economy Economy Employment Employment Individual income levels Individual income levels Demography - particularly of vulnerable populations Demography - particularly of vulnerable populations Immigrants Immigrants Migrants Migrants Minorities Minorities Age-related distribution Age-related distribution Special populations: frail elderly, adult handicapped, institutionalized Special populations: frail elderly, adult handicapped, institutionalized Geography/Rurality Geography/Rurality Epidemiology of oral diseases and competing diseases (e.g. obesity, Epidemiology of oral diseases and competing diseases (e.g. obesity,

cardiovascular health, diabetes) cardiovascular health, diabetes) Political philosophy Political philosophy

www.cdhp.org

Inform LegislatureInform Legislature

Raise awareness of issues/problems to Raise awareness of issues/problems to legislatorslegislators

Stakeholders can use anecdotal evidence, Stakeholders can use anecdotal evidence, advocacy/activism, event or press coverage, advocacy/activism, event or press coverage, or data. or data. Data - burden document, epidemiologic studiesData - burden document, epidemiologic studies ““Hooks and Drivers"Hooks and Drivers"

www.cdhp.org

Coalition BuildingCoalition Building Coalitions: Powerful Advocacy Groups that Coalitions: Powerful Advocacy Groups that

Moves Agenda ForwardMoves Agenda Forward Inform LegislatorsInform Legislators EngageEngage Carry messages forwardCarry messages forward Identify legislative championsIdentify legislative champions Add volume to the voice Add volume to the voice Say things that program directors cannot say Say things that program directors cannot say Provide different perspectives Provide different perspectives Demonstrate to policymakers that issues have been Demonstrate to policymakers that issues have been

well thought-out and understood by many well thought-out and understood by many stakeholders stakeholders

www.CDHP.org

ResultResult

Through preparation, strategy, and Through preparation, strategy, and collaboration…collaboration…

Generate champions…Generate champions… Shape the debate…Shape the debate… Push for legislation that promotes oral Push for legislation that promotes oral

health and disease prevention…health and disease prevention… The outcome …The outcome … Policy enactmentPolicy enactment

www.cdhp.org

Legislative Support for anLegislative Support for anOral Health AuthorityOral Health Authority

17 report a statutory mandate for an 17 report a statutory mandate for an office/division/bureau/program of oral healthoffice/division/bureau/program of oral health

ASTDD 2003 Survey; www.astdd.org; www.cdhp.org

•Arizona Arizona •Arkansas Arkansas •California California •Florida Florida •Hawaii Hawaii •Illinois Illinois •Indiana Indiana •Maryland Maryland

•Mississippi Mississippi •Missouri Missouri •Nebraska Nebraska •Nevada Nevada •North Carolina North Carolina •Oklahoma Oklahoma •Pennsylvania Pennsylvania •Rhode Island Rhode Island •Texas Texas

Legislative Support for Community Legislative Support for Community Water FluoridationWater Fluoridation

12 states report a statutory mandate for 12 states report a statutory mandate for state-wide community water fluoridationstate-wide community water fluoridation

ASTDD 2003 Survey

•California•Connecticut •Delaware •Georgia •Illinois •Kentucky

•Louisiana •Minnesota •Nebraska •Nevada •Ohio •South Dakota

State Policies to Improve Early State Policies to Improve Early Childhood Oral Health Childhood Oral Health

1.1. State Infrastructure: AZState Infrastructure: AZ

2.2. Medicaid EPSDT: TNMedicaid EPSDT: TN

3.3. Medicaid Perinatal Benefit: MAMedicaid Perinatal Benefit: MA

4.4. Fluoridation: ILFluoridation: IL

5.5. Sealants: OHSealants: OH

6.6. Infant Oral Health: WAInfant Oral Health: WA

7.7. Fluoride Varnish: NCFluoride Varnish: NC

Policy & Program Opportunities Policy & Program Opportunities Based on the “New View”Based on the “New View”

Adapted from SG Workshop and AMCHP in “Opening the Mouth” at http://ccnmtl.columbia.edu/draft/soup/openMouth/pt02.html

Opportunities for Policymakers Opportunities for Policymakers from SG Workshopfrom SG Workshop

1. 1. Early & Timely InterventionEarly & Timely Intervention

A.A. Link oral health policies & programs to other early childhood Link oral health policies & programs to other early childhood efforts including:efforts including:

High risk infant toddler programsHigh risk infant toddler programs Visiting nurse, Visiting nurse, promotores, promotores, and care coordination programsand care coordination programs Nutrition programs/ WIC/ Head Start/ Early Head StartNutrition programs/ WIC/ Head Start/ Early Head Start CSHCN programsCSHCN programs Primary care pediatricsPrimary care pediatrics Day care accreditation and regulationDay care accreditation and regulation

B. Adopt AAP and AAPD recommendationsB. Adopt AAP and AAPD recommendations Age one dental visit, particularly for high risk childrenAge one dental visit, particularly for high risk children Establish a “dental home” along with a “medical home” for allEstablish a “dental home” along with a “medical home” for all


2. Assure competencies: Prepare the health care workforce2. Assure competencies: Prepare the health care workforce

– Promote a common Promote a common core curriculumcore curriculum on oral health for on oral health for OBs, pediatricians, family docs OBs, pediatricians, family docs nurse practitioners, nutritionistsnurse practitioners, nutritionists dentists, hygienists dentists, hygienists public health practitionerspublic health practitioners

– Require Require core competenciescore competencies in oral health promotion in in oral health promotion in accreditation standards accreditation standards guidelines guidelines performance measures performance measures

for state supported health professional education.for state supported health professional education.


3. Go public3. Go public Partner with private sector Partner with private sector

organizationsorganizations Initiate a public awareness Initiate a public awareness

campaigncampaign Promote state-level oral Promote state-level oral

health coalitionshealth coalitions Develop and publicize Develop and publicize

“disease burden documents”“disease burden documents” Develop a state oral health Develop a state oral health

planplan Champion oral health with Champion oral health with

visits, legislation, programs, visits, legislation, programs, press, proclamations, press, proclamations, speeches, influencespeeches, influence


4. Fix public programs4. Fix public programs InfrastructureInfrastructure: : ensure empowered, stable, well-staffed office of oral ensure empowered, stable, well-staffed office of oral

healthhealth FinancingFinancing: : retain comprehensive dental benefits in Medicaid & retain comprehensive dental benefits in Medicaid &

SCHIP; adopt & promote age 1 standardSCHIP; adopt & promote age 1 standard PreventionPrevention: : maximize state fluoridation &promote sale of fluoridate maximize state fluoridation &promote sale of fluoridate

bottled water; expand sealant programsbottled water; expand sealant programs Safety netSafety net: : expand dental care for pregnant women and young expand dental care for pregnant women and young

children in health centers, coordinate with WIC/ Head Start…children in health centers, coordinate with WIC/ Head Start… Health professional educationHealth professional education: : include early oral health education include early oral health education

and experienceand experience Special NeedsSpecial Needs Programs: Programs: integrate oral healthintegrate oral health


5. Maximize use of science5. Maximize use of science SurveillanceSurveillance: : Conduct regular epidemiologic reviewsConduct regular epidemiologic reviews Maximize preventionMaximize prevention: : Develop & promote risk screening, oral Develop & promote risk screening, oral

anticipatory guidance, and primary prevention in infantsanticipatory guidance, and primary prevention in infants Target at-risk young childrenTarget at-risk young children in Medicaid/SCHIP: in Medicaid/SCHIP: provider provider

education/ incentives and age-defined enhancements education/ incentives and age-defined enhancements Conduct pilot trialsConduct pilot trials of “medical management” for efficacy, of “medical management” for efficacy,

effectiveness, and cost-effectivenesseffectiveness, and cost-effectiveness Engage AHECsEngage AHECs in provider education on early caries prevention in provider education on early caries prevention

and managementand management Establish fluoride varnish programs Establish fluoride varnish programs with a variety of providerswith a variety of providers Link programs:Link programs: caries & obesity share common risks caries & obesity share common risks

ResourcesResources

American Academy of Pediatric Dentistry American Academy of Pediatric Dentistry American Academy of PediatricsAmerican Academy of Pediatrics American Dental AssociationAmerican Dental Association Association of Clinicians for the UnderservedAssociation of Clinicians for the Underserved Association of State and Territorial Dental DirectorsAssociation of State and Territorial Dental Directors Association of State and Territorial Health OfficialsAssociation of State and Territorial Health Officials CDC Division of Oral HealthCDC Division of Oral Health Children’s Dental Health ProjectChildren’s Dental Health Project HRSA Maternal and Child Health BureauHRSA Maternal and Child Health Bureau MCHB Oral Health Policy Center, MCHB Oral Health Resource MCHB Oral Health Policy Center, MCHB Oral Health Resource

CenterCenter NIH/NIDCR Oral Health Disparities Program CAN-DO and CREEDDNIH/NIDCR Oral Health Disparities Program CAN-DO and CREEDD Children’s Dental Health ProjectChildren’s Dental Health Project

Contact InformationContact Information

Mary E. Foley, RDH, MPHMary E. Foley, RDH, MPHDean of Forsyth School of Dental HygieneDean of Forsyth School of Dental Hygiene

Associate Professor of Dental HygieneAssociate Professor of Dental Hygiene

Massachusetts College of Pharmacy and Health SciencesMassachusetts College of Pharmacy and Health Sciences

179 Longwood Avenue179 Longwood Avenue

Boston, Massachusetts 02115Boston, Massachusetts 02115

t:t: 617-735.1049 617-735.1049 f:f: 617-732.2225 617-732.2225

mobile: mobile: 857-488-9046857-488-9046

[email protected]@mcphs.edu

Policy Considerations in Oral Health Mary E. Foley, RDH MPH Dean, Forsyth School of Dental Hygiene...

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