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

California Department of Public Health

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 50 47.5 45.8 16.1 18 13

10 20 30 40 50 60 2011-12 2013-14 2015-16

Percent

Chart Title

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

9.4 4.6 15.9 7 13.3 3.9 3.6 3.2

2 4 6 8 10 12 14 16 18

1999-2004 2011-2014

Percent

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

98.6% 61.3%

0% 20% 40% 60% 80% 100%

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

Education & Counseling Clinical interventions Long lasting protective interventions Change the context to make individual’s default decisions healthy Socioeconomic factors Increasing population impact Increasing individual effort needed

Examples

Chairside guide Campaigns

Evidence-based practice Dental Sealants

Fluoridation/ School Screening

Insurance coverage / Health literacy

Source: Frieden TR. American Journal of Public Health | April 2010, Vol. 100, No. 4

California Department of Public Health

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

GOALS

Healthy environment & habits Linkage to clinical care Infrastructure, Capacity and Payment Communication & Health Literacy Surveillance and Evaluation

California Department of Public Health

Tooth Decay in Children

The California Smile Survey, 2006 and COHP 2028 Target

53.6 42.5 70.9 56.5

10 20 30 40 50 60 70 80 CA Kindergarten COHP 2028 Target CA 3rd Grade COHP 2028

California Department of Public Health

Proposed State Oral Health Plan Strategies

Pregnancy

Year 1

Early

childho

• d

School entrance 3rd Grade

Health Literacy – Insurance Coverage – Water Fluoridation Brushing – Reducing Sugar

Dental Visit Inter-professional Collaboration – Community Clinical Linkages – Dental Care Delivery System

71% 56%

California Department of Public Health

Moving from Planning to Action Use of Tobacco Tax Funds

State Oral Health Program Local Oral Health Program

Communication & Health Literacy

Surveillance & Evaluation Training & Technical Assistance Special Projects

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

5 3 11

Activities Strategies

Underway Yet to Begin

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

378.1 466.8 283.7 218.5 112.5 152.9 594.9 346.3 137.9

0.0 100.0 200.0 300.0 400.0 500.0 600.0 700.0

< 1 1

• 2

3

• 5

6

• 9

1

• 1

3 1 4

• 1

7 1 8

• 3

4 3 5

• 6

4 6 5

• 1

Crude Rate (per 100,000)

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

20 6 27 3

10 20 30 40 50

Activities Strategies 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)

1

3 3 18 3

5 10 15 20 25

Activities Strategies Completed Underway Yet to Begin

California Department of Public Health

First Steps:

• Engage the community
• Conduct needs

assessment

• Identify assets and

resources

• Develop a local oral

health improvement plan/ Strategic Plan Next Steps:

• Inform, educate and

mobilize

• Convene, coordinate,

collaborate

• Implement policies

and programs

• Conduct surveillance

and evaluation

Local Oral Health Program Scope of Work Objectives

From J.S. Durch, L.A. Bailey, and M.A. Stoto, eds. Improving Health in the Community, Washington, DC: National Academy Press, 1997.

Develop a Plan Implement interventions Evaluate

• utcomes

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

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

California Department of Public Health

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

6 2 15 2

5 10 15 20 25

Activities Strategies 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

7 1 2 1

2 4 6 8 10

Activities Strategies Underway Yet to Begin

California Department of Public Health

Basic Screening Survey of 3rd 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

42.1 56.2 59.5 43 66.3 69.8

10 20 30 40 50 60 70 80 90 100

California Sonoma San Francisco 2012 2015-2016

55.5 40.9 37.3 36.8 36.6 35.5 33.4 32.0 31.7 30.1 29.7 27.5 27.0 26.5 23.2 22.2 22.1 21.7 21.2 19.9 18.9 17.7 17.4 16.8 16.5 16.2 15.2 15.1 15.0 15.0 14.9 14.0 13.5 13.3 12.2 11.9 11.8 10.6 10.5 10.4 8.2 8.1 7.3 6.1 5.8 5.4 5.0 4.5 4.3 3.4 3.3 2.3 0.0 0.0 0.0 0.0 0.0 0.0 18.3 10 20 30 40 50 60

Marin San Francisco Sonoma Napa Mono San Benito Lake San Mateo Ventura Kern Yolo Tulare Orange Solano Yuba Merced Fresno San Bernardino Nevada Contra Costa Del Norte Sacramento Calaveras Siskiyou Humboldt Stanislaus Alpine Mariposa Sierra California

%

Preventive Dental Visits (%) for Age 1-2yrs by County, 2016

70.0 67.8 60.3 58.6 58.5 57.6 56.1 56.1 56.0 55.7 55.7 54.4 54.2 54.1 54.0 53.4 52.5 52.0 51.7 51.6 51.2 51.1 50.4 47.0 46.4 46.4 46.3 45.5 45.5 44.8 44.8 44.8 44.6 43.7 42.7 39.4 39.2 39.1 39.0 38.4 38.1 37.4 37.1 35.3 35.1 34.0 33.8 33.6 32.7 31.8 31.3 28.9 25.7 16.3 12.4 11.6 0.0 0.0 48.2 10 20 30 40 50 60 70 80 Marin Mono Glenn Madera San Benito Ventura Tehama Kern Sonoma Napa Los Angeles Santa Clara Stanislaus Lake Yolo Fresno Yuba Riverside El Dorado Kings Lassen Contra Costa Placer Tuolumne Sacramento Amador Siskiyou Mariposa Alpine California %

Preventive Dental Visits (%) for 3-5 years age group by County, 2016

California Department of Public Health

Conclusion

• Local Health Jurisdiction agreements
• Improvements in the Medi-Cal Dental Program
• Contract with UCSF Dental School to provide

technical assistance center

• Contract with the Public Health Survey Research

Group to conduct a statewide survey of 3rd children

California Department of Public Health

Thank you