Health and Wellness for all Arizonans
Healthy Smiles Healthy Bodies
Survey Logistics for Data Collection
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for Data Collection Health and Wellness for all Arizonans 1 - - PowerPoint PPT Presentation
Healthy Smiles Healthy Bodies Survey Logistics for Data Collection Health and Wellness for all Arizonans 1 Healthy Smiles Healthy Bodies Survey Logistics for Data Collection Margaret Perry, BSDH, MBA, AP HSHB Clinical Trainer Connie Baine,
Health and Wellness for all Arizonans
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Health and Wellness for all Arizonans
Margaret Perry, BSDH, MBA, AP HSHB Clinical Trainer
Connie Baine, RDH, AP , BS HSHB Administrative Trainer
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Health and Wellness for all Arizonans
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Health and Wellness for all Arizonans
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Health and Wellness for all Arizonans
participate (consent)
may be up to 100 (will weigh data for reporting)
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HSHB Survey’s Field Coordinator
Screening Day
School Scheduling & T eam Assignment Summary
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Health and Wellness for all Arizonans
for K & 3rd grade children in Arizona (assessment & surveillance)
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Health and Wellness for all Arizonans
school
T eam collects consents/questionnaires, conducts screenings, record data, and processes survey forms (to school nurse/contact, parents/guardians, and ADHS Office of Oral Health)
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Health and Wellness for all Arizonans
the school (check # enrolled children in selected classes)
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Health and Wellness for all Arizonans
(low cost dental clinics list & height/weight handout)
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2. Set up “Child Screening Record” – staple white Screening Recording Form to the positive Active Consent & Questionnaire
Recorder fills in the Screening Recording Form
(one list for the screening day)
fill in data on Recording Form and Findings Form (use cm & kg)
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Packet has Parent Letter/Consent Form + Questionnaire
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AND
(school caller must document/sign/date)
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AND
(school caller must document/sign/date)
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socks on
0.1 centimeter (cm)
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center of the scale
0.1 kilogram (kg)
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that may be stapled to a Questionnaire (yellow or blue)
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Health and Wellness for all Arizonans
for screening (both Recorder & Screener should confirm)
Recording Form to the YES Consent Form and Questionnaire
YES Consent Form in middle, and Questionnaire last – have the data sides of the Recording Form & Questionnaire face outward. If only have the Recording Form and Active YES Consent, then staple them back to back.
forms before leaving the school
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2014-2015 Healthy Smiles Healthy Bodies Screening Recording Form
School Name: First Elementary School Grade: K Child Name: Adam Smith
Survey ID# ___________________ (for office use only)
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0-No 1-Yes 4 # teeth
1-Yes= At least one tooth with loss of at least ½ mm of tooth structure at the enamel surface
0-No 1-Yes 2 # teeth
1-Yes= At least one tooth:
decay OR
0-No 1-Yes
1-Yes= At least one permanent molar tooth has a dental sealant OR part of a dental sealant.
0-No 1-Yes
1-Yes= At least one permanent molar tooth needs a dental sealant on a fully erupted, virgin AND sound occlusal surface.
0-None 1-Early 2-Urgent
0-None= Routine dental care 1-Early= Dental visit within next several weeks 2-Urgent= Dental visit within 24 hours
Height – in cm’s Weight – in kg’s
1 3 3 ● 3 1 9 ● 1
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Provider ID # Signature Date RDH
4444 Mary Jones
9/1/2014 ASST
2222
Nora Smith
9/1/2014 ASST
Swelling and pain in the mouth (upper right).
Summary of Findings Form
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38 Student: Adam Smith Date: 9/1/2014 Teacher: Mrs. Cook
Dental Screening This was only a screening. Your child should still have a regular dental check-up.
Urgent! A problem has been found and your child needs to go to the dentist within the next
24 hours! Your child has signs and symptoms that include pain, swelling or infection (abscess). _______ Possible Problems Found: Your child should see a dentist as soon as an appointment can be made. _______ No Visible Problems: Not all visible problems can be seen by a dental screening. Your child should have a regular dental check-up at least once a year. _______ Sealants Needed: Sealants help to prevent cavities on the chewing surfaces of back teeth. A dentist can tell you if sealants would be helpful for your child. _______ Clean teeth and gums are important. Your child did a good job today. If your child has AHCCCS or KidsCare insurance, dental care is covered.
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Height and Weight Screening
Your child’s Height: 133.3 cm Weight: 19.1 kg
Please contact your School Health Office for more information.
Comments: Swelling and pain in the upper right part of the mouth.
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41 Date: 9/19/2014 School: First Elementary School City: Ace City The following is a list of children with urgent dental treatment needs. These children have an urgent need for a dental visit within the next 24 to 48 hours.
Grade Student Name Concern
K Betty Howard Abscess near lower left back tooth K Adam Smith Swelling and pain in upper right part of mouth 3 Jenny Garcia Painful infected teeth
Health and Wellness for all Arizonans
printed text in the Screening Findings Form edited.
Screening Recording Form (be sure to add notation to the Screening Recording Form’s Comments section)
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2014-2015 Healthy Smiles and Healthy Bodies School Summary Form/Worksheet
School Name: Active Consent Passive Consent School ID: (Nine-digit CTDS #)
123456789
School Contact:
Phone Number:
(602) 222-2222
Screening Date: 9/1/2014 Screening T eam:
Screener (ID & Name)
4444 Joyce Benson
Recorder Assistant (ID & Name) 6666 Jane Jackson Height & Weight Assistant (ID & Name) 4444 Joyce Benson
6666 Jane Jackson
First Elementary School
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# Class / Teacher Grade # Children Enrolled in
Selected Classes
# Consent YES # Consent NO (or opt out) # Children Screened # Children Absent # Children Urgent Referral 1
K 25 22 3 21 1 3
2
K 22 20 2 20 2
3
K
4
K
KINDERGARTEN GRADE TOTAL: K
47 42 5 41 1 5
# Class / Teacher Grade # Children Enrolled in
Selected Classes
# Consent YES # Consent NO (or opt out) # Children Screened # Children Absent # Children Urgent Referral 1
K 28 26 2 25 1 2
2
3rd
3
3rd
3RD GRADE TOTAL: 3rd
28 26 2 25 1 2
* SCHOOL TOTAL K+3rd
75 68 7 66 2 7
Nurse Received Copy of Urgent Referrals Signature: (Screener) Suzie Day ___________
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2. Re-pack tubs & fill out order form to replace supplies/forms
Referral Form, resource information, and extra goodie bags
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(Screening Recording Form / Consent / Questionnaire stapled packets)
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supplies/forms for the tubs & central stock; identify
central stock is low
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County Contractors:
Office of Oral Health
OOH Chief (Julia Wacloff) as needed Screeners and Recorders:
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Contractor in conducting this survey
Survey
during Calibration Workshop
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(Pledge To Protect Confidential Information)
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