Policy, Systems and Environmental Change Strategy to Increase Access to Pediatric Dental Care

State: KY Type: Promising Practice Year: 2014

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If dental services could be provided to at risk students during their school day barriers such as inability to locate local dentists accepting Medicaid, lack of transportation, difficulty keeping appointments and parent’s inability to miss work for a child’s dental visit could be eliminated. The Oral Health Coalition partnered with the school board to install compatible electrical outlets that would serve as the environmentally friendly power source for the University of Kentucky College of Dentistry Pediatric Mobile Dental Unit (PMDU) during each school visit, saving on diesel costs, environmental emissions and ensuring dependability of equipment for dental services. The PMDU services elementary age children who have Medicaid and/or no form of health/dental insurance across the state. The practice is novel in its approach to ensuring quality dental care for high risk elementary school children by creating true environmental change at the most fundamental level, policy initiation.

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Franklin County Health Department
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Policy, Systems and Environmental Change Strategy to Increase Access to Pediatric Dental Care
Franklin County has a residing population of 49,285. According to the 2010 U.S. Census Bureau, 14% of Franklin County’s residents are living below poverty level. Although this level is less than the state percent of 18.4, it is just slightly below the U.S percent of 14.3. Of greatest concern, is the 19.2% of Franklin County youth who are living below poverty compared to 18.6% in the U.S. These socioeconomic characteristics in our youngest residents have helped play a large role in determining access to care, particularly in the area of oral health services. Unfortunately, much of the oral health data available for Kentucky is dated 2000-2001 where an article in MMWR reported that one-half of Kentucky’s children had decay in their primary teeth and 46.8 percent of children 2- 4 years of age had untreated dental problems; more than twice the national average. In addition, access to care was highlighted in a brief written by Kentucky Youth Advocates in December 2003, findings included the fact that only one-third of eligible children received any dental services through Medicaid and the Kentucky Children’s Health Insurance Program (KCHIP) in 2002. During this same year and in a state with 2,169 licensed dentists, only 871 were Medicaid enrolled dentists billing Medicaid for services. In 2010, Kentucky Youth Advocates published county data in Kentucky Kids Count 2011 County Data Book which did show an increase in the number of Medicaid enrolled children receiving dental services in Franklin County from 36 percent in 2001 to 55 percent in 2010. While improvements are being made, our community has much ground yet to cover in regards to improving its oral health. Franklin County Mobilizing for Action through Planning and Partnerships (MAPP) Coalition established the goal of improving access to quality health care services including mental and oral health services in our community health improvement plan. These were based on results from a quality of life survey conducted in fall 2009. Open-ended responses were categorized as either strengths or weaknesses and a great need for a dental assistance was noted. Therefore, the Franklin County Oral Health Coalition (OHC) was charged with the goal of assuring access to dental care. When considering that over 50% of the students in Franklin County’s public elementary schools qualify for free/reduced meal assistance and Medicaid, the coalition chose to work with this target population and build a strategy that best responded to this health disparity. If dental services could be provided to at risk students during their school day barriers such as inability to locate local dentists accepting Medicaid, lack of transportation, difficulty keeping appointments and parent’s inability to miss work for a child’s dental visit could be eliminated. The Oral Health Coalition partnered with the school board to install compatible electrical outlets that would serve as the environmentally friendly power source for the University of Kentucky College of Dentistry Pediatric Mobile Dental Unit (PMDU) during each school visit, saving on diesel costs, environmental emissions and ensuring dependability of equipment for dental services. The PMDU services elementary age children who have Medicaid and/or no form of health/dental insurance across the state. The practice is novel in its approach to ensuring quality dental care for high risk elementary school children by creating true environmental change at the most fundamental level, policy initiation. The OHC spent approximately $7400 of grant funds to place compatible outdoor electrical outlets at each elementary school providing power for the PMDU. This practice was cost effective on two fronts, first saving the PMDU diesel fuel costs by allowing the van to run on power provided at each site for 8 hours. Alone this ensured the reliability of the services and increased the number of children seen per school. Second, the return on investment was tremendous if compared to the potential cost of purchasing and mobile dental unit, equipment and then staffing. The goals of the policy, systems and environmental (PSE) change strategy was to increase the number of schools with compatible electrical outlets from 0-7 by 2011, increase the number of schools creating oral health policies from 1-7 by 2011 and increasing the number of students within the target population receiving dental care during school hours from 40 in 2011 to 200 in 2013. At the close of the 2013 school year all of the goals for the practice were achieved as a result of the local partnership compromised of dentists, health department staff, school board, family resource center directors and University of Kentucky Dental School.
Franklin County has a residing population of 49,285. According to the 2010 U.S. Census Bureau, 14% of Franklin County’s residents are living below poverty level. Although this level is less than the state percent of 18.4, it is just slightly below the U.S percent of 14.3. Of greatest concern, is the 19.2% of Franklin County youth who are living below poverty compared to 18.6% in the U.S. These socioeconomic characteristics in our youngest residents have helped play a large role in determining access to care, particularly in the area of oral health services. Unfortunately, much of the oral health data available for Kentucky is dated 2000-2001 where an article in MMWR reported that one-half of Kentucky’s children had decay in their primary teeth and 46.8 percent of children 2- 4 years of age had untreated dental problems; more than twice the national average. In addition, access to care was highlighted in a brief written by Kentucky Youth Advocates in December 2003, findings included the fact that only one-third of eligible children received any dental services through Medicaid and the Kentucky Children’s Health Insurance Program (KCHIP) in 2002. During this same year and in a state with 2,169 licensed dentists, only 871 were Medicaid enrolled dentists billing Medicaid for services. In 2010, Kentucky Youth Advocates published county data in Kentucky Kids Count 2011 County Data Book which did show an increase in the number of Medicaid enrolled children receiving dental services in Franklin County from 36 percent in 2001 to 55 percent in 2010, after the installation of the compatible electrical outlets. While improvements are being made, our community has much ground yet to cover in regards to improving its oral health. Franklin County Mobilizing for Action through Planning and Partnerships (MAPP) Coalition established the goal of improving access to quality health care services including mental and oral health services in our community health improvement plan. These were based on results from a quality of life survey conducted in fall 2009. Open-ended responses were categorized as either strengths or weaknesses and a great need for a dental assistance was noted. Therefore, the Franklin County Oral Health Coalition (OHC) was charged with the goal of assuring access to dental care. When considering that over 50% of the 7100 students in Franklin County’s public elementary schools qualify for free/reduced meal assistance and Medicaid, the coalition chose to work with this target population and build a strategy that best responded to this health disparity. If dental services could be provided to at risk students during their school day barriers such as inability to locate local dentists accepting Medicaid, lack of transportation, difficulty keeping appointments and parent’s inability to miss work for a child’s dental visit could be eliminated. The Oral Health Coalition worked alongside the school board to install compatible electrical outlets that would serve as the environmentally friendly power source for the University of Kentucky College of Dentistry Pediatric Mobile Dental Unit (PMDU) during each school visit, saving on diesel costs, environmental emissions and ensuring dependability of equipment for dental services. The PMDU services elementary age children who have Medicaid and/or no form of health/dental insurance across the state. The practice is truly novel in its approach to ensuring quality dental care for high risk elementary school children by creating environmental change at the most fundamental level, policy initiation. The coalition, funded by a grant from the Kentucky Department for Public Health, spent approximately $7400 to place compatible outdoor electrical outlets at each elementary school providing power for the PMDU. This outlet saves money by allowing the van to run on power provided at each site rather than diesel fuel for 8 hours. It ensures the reliability of the services and increases the number of children being seen per school. Oral health programs have been initiated previously within the community of Frankfort and Franklin County including dental varnishing and sealants. However, given funding cuts at the state health department level and staff attrition, the program-based services were dissolved. The PSE change strategy to increase access to pediatric dental treatment was an innovative approach as it is a policy approach to improving access and delivery of dental care to a target population. An Internet search and review of NACCHO’s Model Practice Database and consultation with other public health professionals revealed similar approaches to access to dental care. However the PSE change strategy is novel in its approach to ensuring quality dental care for high risk elementary school children by creating true environmental change at the most fundamental level. Installing specialized outdoor outlets allowed the mobile van to draw power for the van’s dental unit directly from the school’s electrical system rather than the van’s generators thereby creating a cost savings overhead for the mobile unit and preventing delays in care due to the necessary refueling of the generator. It was noted by the practitioners, that this service has enhanced their ability to provide efficient and dependable care without the fear of interruption due to downed generators or pauses in service due to failure of systems. This change led the PMDU program director to request the coalition’s assistance in replicating this strategy in other areas where these same services are made available to indigent children. The review of the literature showed examples where the health departments were burdened with the financial cost of dental equipment, mobile vans and the salaries of dental professionals rather than establishing a partnership and preventing the duplication of services. Other examples that included partnerships addressed the issue of access to dental care through a program approach rather than a more sustainable environmental change strategy. The following references were used in developing the practice: a. Kentucky Kids Count 2011 County Data Book (from KY Youth Advocates) b. Access to care, especially evidenced-based clinical and community preventive services reduces death, disability (National Prevention Council, 2011) and health inequities and improves quality of life (U.S. Department of Health and Human Services (DHHS), 2011), morbidity and mortality (KDPH, 2005). Forces of Change Survey/Quality of Life Survey/other – used during MAPP process to define objectives and goals. (http://www.fchd.org/MAPP.aspx) c. Kentucky Smiles: A Lifetime of Oral Health. Statewide Oral Health Strategic Plan. The Commonwealth of Kentucky: 2006. d. The Community Guide: Preventing Dental Caries: School-Based or Linked Sealant Delivery Programs.
1)Goals: a. 1. Increase from 0 to 7 the number of elementary schools that have electrical outlets compatible with the UK PediatriccMobile Dental Unit. Performance measures: The program output measured was the number of total public elementary schools in Franklin County containing compatible electrical outlets at initial evaluation compared to the number of schools containing compatible electrical outlets following the intervention. Data: The Franklin County Board of Education maintenance department collected the primary data for the outcome objective. Each public elementary school was first evaluated based on the current existence of the compatible electrical outlet. The second piece of data collected was based on each site’s ability to hold the additional voltage required to run the mobile dental unit. The results showed that none of the 7 elementary schools surveyed contained the compatible electrical outlets, but all 7 could hold the additional voltage requirements. The presence of a master electrician within maintenance provided the expertise necessary to evaluate the schools electrical capabilities. Evaluation results: The Franklin County Health Department witnessed the benefit of community collaboration and the value that can bring to a project. In these times of economic uncertainty, reaching out and investing in partnerships can prove instrumental in goal achievement. By working closely with the Franklin County Board of Education and oral health coalition, the data was obtained by a professional at no cost. Feedback: The master electrician with the Franklin County Board of Education provided a report containing the collected data with results from each site to the oral health coalition chair. The oral health coalition members received the report and the primary data provided the baseline for practice as 0 elementary schools currently containing compatible electrical outlets. The coalition acted immediately on the data and initiated the process of placing the compatible electrical outlets in all 7 public elementary schools, completing achieving the outcome objective. b. 2. Increase the number of elementary schools contracting with UK Mobile Pediatric Dental Unit from 0 to 1 in 2011 and 4 in 2013. Performance measures: As of fall 2011, all 7 county elementary schools in Frankfort, KY have received electrical outlets that are compatible with the UK Pediatric Mobile Dental Unit due to the collaborative effort of the “Bridging the Gap” partnership. In order to ensure the appropriate use of the plug installment, the oral health coalition is currently focusing their efforts on the development of a toolkit that will provide steps necessary for Family Resource Center directors to procure the UK PMDU service. A step by step guide was made available initially to the remaining 6 elementary school resource center directors in the capital city for program replication. The Oral Health Coalition has recorded the number of contracts with new elementary schools participating in the program and compares the figures to fiscal year 2011 data to monitor improvement. Data: The primary data that has been collected for this objective are the number of contracts between the UK PMDU and the Franklin County Board of Education. Evaluation Results: As of fall 2012, all 7 county elementary schools are coordinating school-based dental services with UK PMDU. The outcome objective has been successfully met and exceeded. b (cont)Feedback: All Franklin County MAPP, Board of Health and Board of Education members have been informed of progress throughout the process of installing the electrical outlets. MAPP has widely distributed its community health improvement plan, which includes this objective. The coalition anticipates sharing the achieved outcome objective with the oral health coalition in fall 2012. c. 3. Increase the number of eligible children examined and treated by UK Pediatric Mobile Dental Unit in Franklin County from 40 in 2011 to 100 in 2013. Program outputs used to evaluate practice: At the completion of each school year, the UK PMDU provides the family resource center director with a report tabulating the number of children examined and treated, as well as the number of services provided. The pilot year and school serves as the oral health coalition’s baseline data. Data: Pilot: 40 children were screened and treated. 323 dental procedures were performed at a Medicaid billable value of $13,404.00. Year 2 statistics which reflected integration of services at all 7 county elementary schools resulted in 193 children were screened and treated, 1,527 dental procedures were performed at a Medicaid billable value of $66,090.40. Evaluation Results: Given the brief timeline of March 10, 2011 – May 9, 2011, the coalition felt the program exhibited success at the pilot location. At the completion of services in year 2, expectations were exceeded. Feedback: The ultimate outcome is to improve health in Franklin County and there is no greater proof that change, regardless of how small, can make huge impacts than when you are able to witness the benefits of such collaborative community-wide efforts first hand and see lives impacted. During a scheduled visit from the UK PMDU a child was seen for routine screening. While reviewing the child’s reported dental history, it was discovered that numerous visits to the previous dental home were recorded for unidentified dental pain, which the child to date, continues to battle. Upon initial screening, the dental staff determined that the child had an advanced form of periodontal disease that most often is seen in adults. The child was referred to a specialist for management of the disease. A few short weeks after the mobile unit’s visit, a letter arrived from the child’s parent stating the sincere appreciation toward the school and visiting practitioners. The mother stated, “For the first time my child isn’t complaining of pain when he eats. Thank you for all you have done.” What are the specific tasks taken that achieve each goal and objective of the practice? Objective 1: Obtaining approval from the Franklin County Board of Education to place compatible outlets at each of the 7 elementary schools was the first step towards our goal. A written request was sent to the assistant county school superintendent briefly introducing our proposal and requesting permission to move forward. As a result, the school board offered to evaluate the voltage capabilities at all 7 sites using their maintenance crew. After all schools were approved for placement the school board did provide staff from their maintenance department that worked alongside the contracting electricians and director of the UK PMDU to place the outlets. Objective 2: In order to replicate the services provided by the UK PMDU at all county elementary schools, the Pilot School Family Resource Center Director made contact with each of the center directors personally and shared a packet of information which included: UK PMDU Director contact information, parental newsletter describing the oral health program, screening guidelines, permission forms and proposed schedule flow at visit days. In addition, the director made efforts to attend the first dental visit at each elementary school. Objective 3: The role of the Family Resource Center Directors was paramount in this objective. They are solely responsible for screening the high risk elementary students and then following up with parents to link the on-site services to the eligible children. They begin by sending information and permission forms home to parents via the children. They then assume the task of following back up with those children to acquire permission slips, Once the list of students is created by the center directors, contact is made by email to the UK PMDU director and the students placed on a schedule at the next available site visit. Another key role in the program success is the provision of dental services provided by UK PMDU. The bus arrives promptly at 8:30 am and departs after the last student is seen at the close of the school day. Due to the innovative placement of the compatible electrical outlet sponsored by the oral health coalition, the scheduled number of children are screened and treated and the equipment and power source is dependable and cost effective. What was the time frame for carrying out these tasks? The ability of the Franklin County Oral Health Coalition to expedite the placement of the compatible electrical outlets was remarkable. Since their establishment and funding attainment in September 2010 and completion of outlet placement in Fall 2011, the UK PMDU was able to begin scheduling visits at all county elementary schools in Franklin County beginning with the calendar school year 2011-2012. Please provide a succinct outline of some basic steps taken in implementing your practice. The Franklin County Health Department applied for the grant presented state-wide from the Health Resources and Services Administration Targeted State Maternal Child Health Oral Health Services Systems (TOHSS) program in the amount of $10,000.00. At a quarterly MAPP meeting a community assessment was performed to evaluate the need for a local oral health coalition. Need was established and in September 2010 the charter meeting for the Franklin Co. Oral Health Coalition was held at the Franklin Co. Public Health Center. The coalition is made up of a variety of partners; 4 local private practice dentists, local health department personnel, public school family resource center directors and director of indigent care clinic. As part of the MAPP CHIP the new oral health coalition devised strategies to address the strategic issue of access to dental care. The first goal addressed by the oral health coalition was to research available entities that could provide dental services on site to a highly vulnerable group, children with the Medical Card or uninsured. Contact was made by the Family Resource Center Director at CLE to the UK Pediatric Mobile Dental Unit and a contract was generated with the Franklin Co. Board of Education to allow dental services to be provided on site for eligible students. The Family Resource Center was pivotal in connecting the children with the provided service in that she was able to identify those that qualify for screening by the mobile unit based on their free and reduced lunch status. Contact was made to each family by the resource center director and children were then scheduled for appointments dependent on parent/guardian permission. In order to assist the mobile unit in providing efficient dental treatment and savings on overhead cost (fuel) the oral health coalition sought approval from the Franklin Co. Board of Education to place compatible electrical outlets in all 7 county elementary schools. Who were the primary stakeholders in the practice? Franklin County High Risk Elementary School Students are the ultimate stakeholders of this practice as they will benefit from improved oral health. MAPP and the Franklin County Oral Health Coalition, which includes local dentists and Family Resource Center Directors, were instrumental stakeholders establishing the goals and objectives fro this practice. As policy makers, the Franklin County Board of Education were also stakeholders of this practice along with the UK PMDU. What is the LHD’s role in this practice? The Franklin County Health Department (FCHD) identified a Health Educator to apply for the Kentucky Department for Public Health grant that would initially fund this practice. After receiving allocations, FCHD served as fiscal agent and grant manager for the $10,000.00 awarded to improve access to oral health care in Franklin County. FCHD also filled the role of coordinating agency for the dental initiative. Some of their fulfilled roles include, procuring oral health coalition members, facilitation of oral health coalition meetings, obtaining permission from the Franklin County School Board to initiate placement of the compatible outlet, liaison between Franklin County School Board maintenance department, electrical supply distributors and electricians, grant writing, fiscal agent and program marketing. FCHD reached out to additional key partners who were missing from MAPP and proceeded to charter an oral health coalition as part of the MAPP Public Health System. Meetings are hosted at the health department’s public health center and facilitated by FCHD. This group, though very new in its origin, have addressed the need to improve access to quality dental care head on. The first strategy outlined by MAPP and fulfilled by the coalition was the placement of the compatible electrical outlets which came to completion in fall 2011. What is the role of stakeholders/partners in the planning and implementation of the practice? The role of untraditional community partners has made this collaboration a success. The primary stakeholders were, first and foremost, underserved children requiring dental services, MAPP Oral Health Subcommittee (Franklin County Oral Health Coalition), University of Kentucky (UK) College of Dentistry Mobile Pediatric Unit, Family Resource Center Directors in Elementary Schools, Kentucky Department for Public Health, Franklin County School Board and the Franklin County Health Department. Each partner played a pivotal role in bringing about the policy, systems and environmental change. MAPP partners conducted an assessment of the community which identified the need for improved access to dental care and initiated the policy, systems and environmental change strategy approach. The UK PMDU supplied dental professionals, supplies for service and treatment to high risk elementary school children. The Family Resource Center Director was crucial in connecting the children to the available service. The initial contact with UK was generated by the director. In addition, parental forms were sent home from this office to eligible children and appointments were made with the unit based on those slips returned. The Franklin County School Board provided permission for the oral health coalition to proceed with their outlet placement program. To assist with the coalition’s efforts, the school board allowed correspondence with the master electrician in the maintenance department to provide expertise necessary regarding the voltage needs at each school. Placement of the plugs was recommended after evaluation of best placement to accommodate the van’s size and least disruptive location for school traffic. The Kentucky Department for Public Health acted as the grant funder . What does the health department do to foster collaboration with community stakeholders? In efforts to further foster the collaboration with the program’s primary stakeholders the health department as the facilitator for MAPP, continues to host coalition meetings. During these quarterly visits each entity represented is allotted time for program and policy updates to keep all members abreast of activities occurring to strengthen and enhance achievement of outlined strategic issues. By keeping all partners informed of these celebratory milestones and progress attained, those activities yet to be completed are highlighted and continued help can be solicited. FCHD along with MAPP and OHC members continue to reach out to additional partners as is the case for this practice where we are now working with our independent school system. In addition, many staff persons from LHD attend various meetings and serve on additional committees to ensure that services are not duplicated within the community but instead strengthened. For example, the health department is represented at each Community Early Childhood Council Meeting. This committee is tasked with supporting and strengthening the community by providing information to families, promoting quality in all early childhood programs, and offering quality training to early childhood stakeholders in collaboration with other agencies within the community. As areas for improvement are identified by this council, the health department which staffs a credentialed trainer builds training classes for local child care providers based on these needs. The key take home lesson observed from the above partnership is the importance of fostering the collaboration. Allowing each party to bring their expertise and ideas to the table provides ownership, creativity and buy-in that oftentimes can be smothered in large groups with previously established agendas. Our organization looked at the identified strategic issue, the available resources and research underway in the area of access to dental care then constructed a unique method at addressing an age old problem. Within every program barriers are bound to exist; however, the partnership looks at these obstacles as challenges and potential projects. For example, a barrier to the delivery of care for the mobile unit has typically been the weather. If the van is scheduled to visit a particular elementary school and rain or snow is forecasted oftentimes due to the parking of the unit on grass, the day is cancelled. The coalition has been working to address this barrier by using grant money to place a groundcover on the school property that will enable the van to keep scheduled visits and protect the van and grass; yet another environmental change. A breakdown of the overall cost of implementation, including start-up and in-kind costs and funding services? Start-Up Costs: Electrician fee to establish voltage capabilities at all 7 elementary schools: In-kind donation of expertise and time from the Franklin County Board of Education Maintenance Department. Compatible outlet, hardware and ground cover necessary to allow parking of mobile dental unit: approximately $2600.00 for all 7 elementary schools. Fees covered by Franklin County Oral Health Coalition grant. Electrician Fee to place outlet: Local electrician fee, discounted due to collaboration with Franklin County Board of Education, $4800.00. Fees covered by Franklin County Oral Health Coalition grant. Time spent notifying parents and caregivers of eligible children within the elementary schools : In-kind time donation by family resource center directors. Health department management of oral health grant: In-kind personnel donation and budgeting of remaining funds. Health department facilitation of Oral Health Coalition: In-kind personnel donation Implementation Cost: Delivery of preventive dental services and treatment provided at 7 county elementary schools: UK PMDU bills Medicaid eligible students for services rendered. Managing flow of children to the PMDU throughout the school day: In-kind donation by Family Resource Center Director.
Outcome Objectives: 1. Increase from 0 to 7 the number of elementary schools that have electrical outlets compatible with the UK PediatriccMobile Dental Unit. Performance measures: The program output measured was the number of total public elementary schools in Franklin County containing compatible electrical outlets at initial evaluation compared to the number of schools containing compatible electrical outlets following the intervention. Data: The Franklin County Board of Education maintenance department collected the primary data for the outcome objective. Each public elementary school was first evaluated based on the current existence of the compatible electrical outlet. The second piece of data collected was based on each site’s ability to hold the additional voltage required to run the mobile dental unit. The results showed that none of the 7 elementary schools surveyed contained the compatible electrical outlets, but all 7 could hold the additional voltage requirements. The presence of a master electrician within maintenance provided the expertise necessary to evaluate the schools electrical capabilities. Evaluation results: The Franklin County Health Department witnessed the benefit of community collaboration and the value that can bring to a project. In these times of economic uncertainty, reaching out and investing in partnerships can prove instrumental in goal achievement. By working closely with the Franklin County Board of Education and oral health coalition, the data was obtained by a professional at no cost. Feedback: The master electrician with the Franklin County Board of Education provided a report containing the collected data with results from each site to the oral health coalition chair. The oral health coalition members received the report and the primary data provided the baseline for practice as 0 elementary schools currently containing compatible electrical outlets. The coalition acted immediately on the data and initiated the process of placing the compatible electrical outlets in all 7 public elementary schools, completing achieving the outcome objective. 2. Increase the number of elementary schools contracting with UK Mobile Pediatric Dental Unit from 0 to 1 in 2011 and 4 in 2013. Performance measures: As of fall 2011, all 7 county elementary schools in Frankfort, KY have received electrical outlets that are compatible with the UK Pediatric Mobile Dental Unit due to the collaborative effort of the “Bridging the Gap” partnership. In order to ensure the appropriate use of the plug installment, the oral health coalition is currently focusing their efforts on the development of a toolkit that will provide steps necessary for Family Resource Center directors to procure the UK PMDU service. A step by step guide was made available initially to the remaining 6 elementary school resource center directors in the capital city for program replication. The Oral Health Coalition has recorded the number of contracts with new elementary schools participating in the program and compares the figures to fiscal year 2011 data to monitor improvement. Data: The primary data that has been collected for this objective are the number of contracts between the UK PMDU and the Franklin County Board of Education. Evaluation Results: As of fall 2012, all 7 county elementary schools are coordinating school-based dental services with UK PMDU. The outcome objective has been successfully met and exceeded. Feedback: All Franklin County MAPP, Board of Health and Board of Education members have been informed of progress throughout the process of installing the electrical outlets. MAPP has widely distributed its community health improvement plan, which includes this objective. The coalition anticipates sharing the achieved outcome objective with the oral health coalition in fall 2012. 3. Increase the number of eligible children examined and treated by UK Pediatric Mobile Dental Unit in Franklin County from 40 in 2011 to 100 in 2013. Program outputs used to evaluate practice: At the completion of each school year, the UK PMDU provides the family resource center director with a report tabulating the number of children examined and treated, as well as the number of services provided. The pilot year and school serves as the oral health coalition’s baseline data. Data: Pilot: 40 children were screened and treated. 323 dental procedures were performed at a Medicaid billable value of $13,404.00. Year 2 statistics which reflected integration of services at all 7 county elementary schools resulted in 193 children were screened and treated, 1,527 dental procedures were performed at a Medicaid billable value of $66,090.40. Evaluation Results: Given the brief timeline of March 10, 2011 – May 9, 2011, the coalition felt the program exhibited success at the pilot location. At the completion of services in year 2, expectations were exceeded. Feedback: The ultimate outcome is to improve health in Franklin County and there is no greater proof that change, regardless of how small, can make huge impacts than when you are able to witness the benefits of such collaborative community-wide efforts first hand and see lives impacted. During a scheduled visit from the UK PMDU a child was seen for routine screening. While reviewing the child’s reported dental history, it was discovered that numerous visits to the previous dental home were recorded for unidentified dental pain, which the child to date, continues to battle. Upon initial screening, the dental staff determined that the child had an advanced form of periodontal disease that most often is seen in adults. The child was referred to a specialist for management of the disease. A few short weeks after the mobile unit’s visit, a letter arrived from the child’s parent stating the sincere appreciation toward the school and visiting practitioners. The mother stated, “For the first time my child isn’t complaining of pain when he eats. Thank you for all you have done.”
The key take home lesson observed from the partnership is the importance of fostering the collaboration. Allowing each party to bring their expertise and ideas to the table provides ownership, creativity and buy-in that oftentimes can be smothered in large groups with previously established agendas. Our organization looked at the identified strategic issue, the available resources and research underway in the area of access to dental care then constructed a unique method at addressing an age old problem. Within every program barriers are bound to exist; however, the partnership looks at these obstacles as challenges and potential projects. For example, a barrier to the delivery of care for the mobile unit has typically been the weather. If the van is scheduled to visit a particular elementary school and rain or snow is forecasted oftentimes due to the parking of the unit on grass, the day is cancelled. The coalition has been working to address this barrier by using grant money to place a groundcover on the school property that will enable the van to keep scheduled visits and protect the van and grass; yet another environmental change. Although a cost benefit analysis wasn't performed the practice is more cost effective and provides more extensive services than those that have been offered within the community in prior years. Due to the policy systems and environmental change initiated by the placement of the compatible electrical outlet, the UK PMDU has been successfully connected to all 7 county elementary schools. As the county-wide free and reduced lunch figures for elementary schools remain above 50% the Franklin County School system continues to qualify for the UK PMDU outreach. The second year contract with the Franklin County Board of Education is off to a bright start as all elementary schools have once again began making arrangements for their underserved students to receive dental services at school. In September 2012, the Franklin County Board of Education invited the Franklin Count Oral Health Coalition to attend their monthly board meeting and provide an update on the oral health collaborative project to date. The board was impressed with the number of services and the children treated in the short time period. Had it not been for the start-up money from the TOHSS program it would have been financially infeasible to provide mobile services on such a large scale. However, the continued commitment of the UK PMDU, the Franklin County Board of Education and MAPP Oral Health Subcommittee are committed to assist in sustaining the efforts initiated two short years ago. In these challenging economic times many local health departments themselves cannot sustain dental staff, equipment and additional personnel to ensure this level of service. This environmental and systems level change allows local health departments to ensure access to quality dental care through innovative partnerships with existing mobile units. This change eliminates the need for local health departments to create financially risky or infeasible programs and to focus on changes that will lead to sustainable improvements in oral health. Now more than ever this type of systems change is invaluable; Medicaid continues to face shortfalls and more individuals are requiring the state’s assistance to cover their medical and dental needs. The Franklin County Oral Health Coalition continues to seek funding from local and national sources. Most recently they submitted a letter of intent for the Healthy Smiles Healthy Children funding opportunity that could provide up to $20,000.00 per year to programs that have demonstrated success and/or have potential for replication in other communities. The coalition would use the funding to build programming kits and share with all 59 health departments in our 120 counties in the state of Kentucky.
 
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