M A R G A R E T D R O Z D O W S K I M A U L E , D M D , D E N T A L D I R E C T O R

L O R I C L A V E T T E , R D H , M O B I L E D E N T A L H Y G I E N I S T M A N A G E R

J A N E H Y L A N , M P H , M C H E S , D I R E C T O R O F S C H O O L B A S E D H E A L T H S E R V I C E S

C A S B H C C O N F E R E N C E

A P R I L 2 6 , 2 0 1 3

School Based Health Services

and our

Mobile Dental Program

Objectives

Provide

a brief overview of CHC School Based Health Services, Dental Services and the development of a mobile dental program

Discuss

the roles and responsibilities of Mobile Team

the challenges of program administration

the growth of the mobile program, rate of treatment plan completion with onsite restorative, and future plans

achievements and lessons learned

The Beginning~

School Based Health Services

Mission:

To Promote and enhance the physical and mental health of children and youth,

Particularly in the uninsured and underinsured populations and

To assure their access to comprehensive primary and preventive healthcare.

Our Process~We ALWAYS are:

Invited into a school by a community

Provided only when parents enroll their children and give written consent for care

Partners with school nurses, coaches, counselors, and classroom teachers

Accountable to Board of Education and/or school administration and their staff

Qualified health providers

Dependent on a community’s request: multidisciplinary team, pair or individual

Where the Kids Are:

CHC’s School Based Health Services:

Reaches over 10,000 students annually

7827 mobile dental

3200 medical

1464 behavioral health

Provides care in over 170 locations across the state

Single service delivery

Multi-service delivery

Comprehensive service delivery

Where we are in CT

In-School Services Provided

Medical Care Diagnosis and

treatment Physical Exams Chronic Disease

management Immunizations Rx Health Education Referral Lab

Behavioral Health Crisis

Intervention Individual

Counseling Group Counseling Family

Counseling Referral

Oral Health Screenings Exams Cleanings X-Rays Sealants Referrals Oral Health

Education

Outcomes

Academic

Improves health status

Reduces absenteeism

Decreases discipline referrals

Increases parental involvement

Improves readiness to learn

Increases the link between the school and the family

Self

Increases understanding of health issues

Increases positive health and safety behaviors

Increases the ability to communicate about and advocate for their personal health care needs

Community

Reduces emergency room use

Attributes to a reduction in Medicaid expenditures

Assists families with insurance eligibility and navigation of system

Our Vision: Since 1972, Community Health Center, Inc. has been building a world-

class primary health care system committed to caring for underserved and uninsured populations and focused on improving health outcomes, as well as building healthy communities.

Innovations

• Integrated primary care disciplines • Fully integrated EHR • Patient portal and HIE • Extensive school-based care system • “Wherever You Are” Health Care • Centering Pregnancy model • Residency training for nurse practitioners • New residency training for psychologists

Community Health Center, Inc.

10

Three Foundational Pillars Clinical Excellence Research & Development Training the Next Generation

CHC Dental Program

• 7 Fixed Locations (48 operatories, 18 DMD’s, 10 mobile RDH, 9 Fixed RDH, support staff)

• 82,000 annual visits

• Comprehensive general dentistry

– Preventative

– Restorative

– Prosthetic

• Pediatric and Adult Medicaid Participation

• Sliding fee scale for uninsured

• Integrated Health Record

• Digital Radiography

How Mobile Dental Began

In 2002 - 2003 the NBOHC and SECOHC received 5 year funding from CHF

In 2004 - In school dental program with support from SECOHC opens in-

school dental program in Norwich

Feb 2005 - 2006: NBHS opens for hygiene, and pilots in 4 NB elementary

schools.

In 2007- 2008 - Begin restorative care in NBHS, expands to middle schools

and enters more town

Presently – Providing services in over 170 school and community sites

statewide., continued exapnsion

External Components of Mobile Program

Initial School Board and Community Stakeholder Contacts

Coordination with Superintendent, Principals, Teachers, and School Nurses

Community Outreach by the Program Coordinator: Attend Open Houses, Health Fairs, PTO Meetings

Willing participants: Schools, Private doctors, FQHC, Hospitals, WIC/ Head Start

Locate seed money: Charitable association, Federal Expansion grants

Memorandum of Agreement

Financial Start up

Initial start up cost $37,500

Equipment is approximately $23,000

Instrument purchase $1,400

Consumable supplies $ 5,600

Maintenance consumables $1,500

Digital radiography $6,000

Mobile Dental Model

Establish connection

s to schools

Prevention , Radiographs and

Oral Health Education for

everyone

Identify patients who need sealants

and place them Children with no evidence of

decay referred for dentist exam

annually

Follow up with parents for

completion of identified disease

Maintain patients within recall system when mobile

team returns in 6 months.

Deliver services directly at mobile

site

Refer for restorative treatment to

established dental home at FQHC

Collaboration with private or outside

providers to complete care

Follow up with parents for

completion of identified

disease

Ideal follow through

~30% children need to see a dentist

Recommend annual dentist t exam

Majority of care can be completed on site

Ability to track progress on complete TX plans

Removes barrier of transportation and decreased N/S

Care coordinator play essential role

Difficulty with contact with patients

Contact information out of date

Transportation and N/S issues

Least ability to track outcomes

Difficulty with tracking show rate and treatment completion

Completing the Loop with Restorative Care: Most Difficult Step

Anywhere from 33-70% of kids seen in school need some type of restorative care

2008 completion of restorative care - the rate at which patients have completed restorative care within 3 months of their hygiene visit - is low: between 14 - 20%

2009 pilot in one school, completed 90% of 30 kids

Pediatric dentist in Enfield 2009, completed 70% of care for 101 kids

General dentist in NL in 2010, completed 56% of care for 300 kids

2012/13 Northern Hartford County: 23 out 65 kids completed (35%) in 11 treatment days so far

Mobile Dental Restorative Care Trends

• Mobile hygiene team places 70% of CHC’s sealants

• Data tracking by each RDH in each school starting in school yr 2010-11

– Identify need for sealants

– Identify reason sealants not warranted

– Track number of sealants placed

– Track reason why could not place sealants

– Track decay in permanent molars

CHC Dashboard:

Placement of appropriate sealants

Deeper look into sealants

No Yes

Total 386 252

0

50

100

150

200

250

300

350

400

450

# o

f P

ati

en

ts

Total Patients Assessed for Sealants

Exisitng Sealants Decayed Restored

# Patients 223 75 57

0

50

100

150

200

250

Patients Sealants Not Needed

A total of 638 patients assessed

Deeper look into sealants

Two month data collection at schools

•638 children seen and assessed

•39% (252) of children required sealants

•58% (223) already had sealants

•15% (57) were restored and 19% (75) were

decayed

•87% of those children who needed sealants received

them within the stay of the hygienist at the mobile site

•13% (32 children) did not receive sealants

•808 sealants needed to be placed

•87% (703) sealants were placed

In 5 yrs…

•reduction in

active decay

(33% to 25%)

•increase in

sealants

(17% to 24%)

Is this working? Tunxis Community College Hygiene Findings

Why CHC Mobile Dental Services are Unique

According to a recent assessment conducted by RWJ Foundation CHC’s Mobile Dental Program is unique because it:

Utilizes promising innovations

Increases the workforce and capacity of dental and non-dental professionals

Provides preventative oral health services in atypical settings

Dental providers are in non-dental settings

Increase awareness of the importance of oral health to overall health and well being

Increase acceptance and adoption of effective and preventative interventions

Reduce disparities in access to effective preventive and dental treatment services

Reaching the Healthy People 2020 goals

with Mobile Dental program

The Nuts and Bolts

of a Mobile Dental Program

State wide Administration/ Management Team

Senior Management Chief Dental Officer

Director of School Based Health Services

Program Management Program Manager

• Oversees daily operations

Dental Hygiene Manager

• Provides training

• Ensures adherence to policies and procedures

• Handles day to day clinical issues

Front Line Staff

Care Coordinator

Establishes a relationship with school staff/contact

Distributes enrollment forms

Coordinates follow up care

Hygienist

Provides services

Communicates to Care Coordinator any follow up care identified

Facilities Team

Successes Challenges

EHR

Digital x-rays

Standardization

Integration of services

Connectivity

Communication

Isolation

Economics

Successes and Challenges

Tracking and Reporting

Areas Served:

Northern Hartford County

New Britain

Norwalk/Stamford

New London

Middletown

Meriden

2545

4800

8021

5406

10812

0

2000

4000

6000

8000

10000

12000

2006/2007 2007/2008 2008/2009 2009/2010 halfyear)

2009/2010 full year)

Services Provided by the Mobile Dental Program in CT

2009-2010 2010-2011 2011-2012

office visits 10,837 11,942 11,149

Patients 7289 7230 6827

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

Mobile Dental visits/patients

office visits

Patients

Statewide Procedure Data

Cleanings and sealant data

948

1169

1838

894

1182

1477

683

373

1246

185

1072

704

0

200

400

600

800

1000

1200

1400

1600

1800

2000Mobile Dental

Child Prophy

Sealants

Future Goals

Provide restorative services at all locations

Complete the cycle of care in 100% of our patients

Expansion into additional communities

Decrease barriers to utilization

Increase number of patients with sealant placement and retention

Questions