Collaboration to Implement the California Oral Health Plan Jayanth - PowerPoint PPT Presentation

Collaboration to Implement the California Oral Health Plan Jayanth Kumar, DDS, MPH State Dental Director California Department of Public Health California Department of Public Health

Vision • Make California the healthiest state in the nation • Healthy individuals and families in healthful communities • Healthy mouth for all Californians California Department of Public Health

State Oral Health Program: Core Functions and Essential Public Health Services Source: Centers for Disease Control and Prevention California Department of Public Health

Status of Oral Health in California • Oral diseases are highly prevalent • Disparities are persistent • Effective preventive measures are underutilized California Department of Public Health

Trends in prevalence of total dental caries and untreated dental caries in primary or permanent teeth among youth aged 2–19 years: United States, 2011–2012 through 2015–2016 Chart Title 60 50 47.5 45.8 50 40 Percent 30 18 16.1 13 20 10 0 2011-12 2013-14 2015-16 Total Dental Caries Untreated Dental Caries NCHS Data Brief ■ No. 307 ■ April 2018 California Department of Public Health

Trends in prevalence of SEVERE primary tooth dental caries among children aged 2–5 years: United States, 1999–2004 through 2011–2014 18 15.9 16 13.3 14 12 10 Percent 7 9.4 8 6 3.9 4 4.6 3.6 2 3.2 0 1999-2004 2011-2014 Total Dental Caries <100 FPG 100%-199% FPG 200% FPG Source: Dye BA, Mitnik GL, Iafolla TJ, Vargas CM. JADA 2017;148(8):550-565 California Department of Public Health

California Department of Public Health

Percent with Dental Insurance, California Health Interview Survey, 2016 100% 98.6% 80% 61.3% 60% 40% 20% 0% 2-11 18+ California Department of Public Health

Oral Health Planning Objectives • Assess and address oral health burden • Enhance infrastructure • Mobilize support • Utilize data/research/evaluation • Build partnerships • Institutionalize initiatives California Department of Public Health

Source: CDC California Department of Public Health

California Department of Public Health

A Framework for Public Health Action: The Health Impact Pyramid Examples Education Increasing Increasing & Chairside guide population individual Counseling impact effort needed Campaigns Clinical Evidence-based interventions practice Long lasting protective Dental Sealants interventions Change the context to make Fluoridation/ School individual’s default decisions Screening healthy Insurance coverage / Socioeconomic factors Health literacy California Department of Public Health Source: Frieden TR. American Journal of Public Health | April 2010, Vol. 100, No. 4

Integrate Oral Health and Primary Care Source: Hummel J, Phillips KE, Holt B, Hayes C. Oral Health: An Essential Component of Primary Care. Seattle, WA. Qualis Health, June 2015. California Department of Public Health

Healthy environment & habits Surveillance and Linkage to Evaluation clinical care GOALS Communication Infrastructure, & Health Capacity and Literacy Payment California Department of Public Health

Tooth Decay in Children The California Smile Survey, 2006 and COHP 2028 Target 80 70.9 70 56.5 53.6 60 42.5 50 40 30 20 10 0 CA COHP 2028 CA 3rd Grade COHP 2028 Kindergarten Target California Department of Public Health

Proposed State Oral Health Plan Strategies 71% 3 rd School Grade entrance Early 56% childho Year od 1 Pregnancy Brushing – Reducing Sugar Dental Visit Inter-professional Collaboration – Community Clinical Linkages – Dental Care Delivery System Health Literacy – Insurance Coverage – Water Fluoridation California Department of Public Health

Moving from Planning to Action Use of Tobacco Tax Funds Training & State Oral Local Oral Technical Health Program Health Program Assistance Surveillance & Communication & Special Projects Evaluation Health Literacy California Department of Public Health

Goal 1 Strategies: Build community capacity, address social determinants of health, and promote evidence-based programs and best practice approaches Underway Yet to Begin 3 Strategies 5 11 Activities California Department of Public Health

Evidence-based Programs • Grants to support – Community Water Fluoridation – School-based/linked Dental Sealant Programs California Department of Public Health

Opportunities for Collaboration with hospitals Emergency Department Visits for Dental Conditions Crude Rate (per 100,000) 700.0 594.9 600.0 466.8 500.0 378.1 346.3 400.0 283.7 218.5 300.0 152.9 137.9 112.5 200.0 100.0 0.0 1 2 5 9 3 7 4 4 0 < - - - 1 1 3 6 0 1 3 6 - - - - 1 0 4 8 5 - 1 1 1 3 5 6 California Department of Public Health

Goal 2: Assess and address the needs of Children, Pregnant Women, People with Diabetes and Oral & Pharyngeal Cancer, and Vulnerable populations 6 3 Strategies 20 27 Activities 0 10 20 30 40 50 Underway Yet to Begin California Department of Public Health

Medi-Cal Dental Program • Dental Transformation Initiative • Proposition 56 Supplemental Payments • Restoration of adult benefits • Improvements in the administration • Loan Repayment Initiative • Smile California Campaign California Department of Public Health

Goal 3 Strategies: Develop capacity to manage young children and vulnerable adults, workforce (loan repayment, CHWs, Home Visitors), payment strategies, and infrastructure (LHJs) 3 3 Strategies 3 18 1 Activities 0 5 10 15 20 25 Completed Underway Yet to Begin California Department of Public Health

Local Oral Health Program Scope of Work Objectives First Steps: Develop a Plan Next Steps: • Engage the community • Inform, educate and mobilize • Conduct needs assessment • Convene, coordinate, Implement collaborate interventions • Identify assets and resources • Implement policies and programs • Develop a local oral health improvement Evaluate • Conduct surveillance plan/ Strategic Plan and evaluation outcomes From J.S. Durch, L.A. Bailey, and M.A. Stoto, eds. Improving Health in the Community, Washington, DC: National Academy Press, 1997. California Department of Public Health

Kindergarten Oral Health Assessment • Dental screening – Helps to identify children who need dental care – Informs parents to take positive action – Helps to avoid future problems and missed school days • Provides data to – track progress with respect to children’s oral health – increase awareness about the importance of oral health – inform the community to address the needs – plan public health programs California Department of Public Health

San Francisco Unified School District implemented oral health assessment and tracked tooth decay experience. It declined from 60% in 2000 to 34% in 2012. Percentage of kindergarteners in public schools in San Francisco with caries experience by race/ethnicity, 2001- 2012 California Department of Public Health

A coordinated system Families Dental professionals Ob-gyns Medical Head Start/EHC/WIC Community Health Workers Community organizations Policymakers and Advocates Electronic health records Water fluoridation

Goal 4 Communication Strategies: Convene a workgroup, gather and market educational materials and approaches, promote and provide resources on how to use social media, improve dental teams’ communication with patients 2 2 Strategies 6 15 Activities 0 5 10 15 20 25 Underway Yet to Begin California Department of Public Health

Promote Oral Health Literacy • Create a shame-less environment • Use plain language – Visuals and drawings • Use teach-back method California Department of Public Health

Goal 5: Surveillance Strategies: Develop a surveillance plan, analyze, communicate and use data 1 1 Strategies 7 2 Activities 0 2 4 6 8 10 Underway Yet to Begin California Department of Public Health

Basic Screening Survey of 3 rd Grade Children Survey of approximately • 15,000 children from 180 schools (excluding Los Angeles County) • 7500 children from 71 schools in LA County California Department of Public Health

Dental Visit During Pregnancy MIHA 2012 and 2015-16 100 90 80 69.8 66.3 70 59.5 56.2 60 43 42.1 50 40 30 20 10 0 California Sonoma San Francisco 2012 2015-2016 California Department of Public Health

% 10 20 30 40 50 60 0 55.5 Marin 40.9 37.3 San Francisco 36.8 36.6 Sonoma 35.5 33.4 Napa 32.0 31.7 Mono 30.1 29.7 San Benito 27.5 27.0 Lake 26.5 San Mateo 23.2 22.2 Ventura 22.1 21.7 21.2 Kern Preventive Dental Visits (%) for Age 1-2yrs by County, 2016 19.9 18.9 Yolo 17.7 17.4 Tulare 16.8 16.5 Orange 16.2 15.2 Solano 15.1 15.0 Yuba 15.0 14.9 Merced 14.0 13.5 Fresno 13.3 12.2 San Bernardino 11.9 11.8 Nevada 10.6 10.5 Contra Costa 10.4 8.2 Del Norte 8.1 Sacramento 7.3 6.1 Calaveras 5.8 5.4 5.0 Siskiyou 4.5 4.3 Humboldt 3.4 3.3 Stanislaus 2.3 0.0 Alpine 0.0 0.0 Mariposa 0.0 0.0 Sierra 0.0 18.3 California