essential elements for the state oral health program quilt bev isman, rdh, mph, els reg louie, dds,...
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Essential Elements for the State Oral Health Program Quilt
Bev Isman, RDH, MPH, ELSReg Louie, DDS, MPH
UCSF Dental Public Health Seminar SeriesFebruary 5, 2013
Funded by CDC Cooperative Agreement 5U58DP001695-05
Presentation Overview
ASTDD and State Oral Health Programs
Background and Purpose of Infrastructure and Capacity Enhancement Project
ASTDD Resources Developed for States
Research Methods, Study Findings and Lessons Learned
Selected State Case Studies
Recommendations & Possible “Next Steps”
ASTDD
A national non-profit organization representing staff of state public health agency programs for oral health.
Collaborates with more than 25 organizations and federal agencies to accomplish its mission and to share best practices, evidence-based strategies and resources to support improvements in oral health programs.
State members and 100+ associate members
State Oral Health Program (SOHP)
Unit of state government, usually in the public health department
Each state differs in how the program is designated, funded, and staffed and what services are provided
States are charged with monitoring the health (including oral health) of its citizens and promoting proven, cost-effective ways to prevent disease
Programs partner with other state and community groups to perform the 3 core public health functions of 1) assessment, 2) policy development and 3) assurance
Background Recognition that improved OH infrastructure
is needed at national, federal, state & community levels to assure oral health for US Surgeon General’s Report: Oral Health in America Healthy People Objectives National Call to Action NIDCR study by Tomar
CDC and ASTDD recognized the need to review status of SOHP Infrastructure and Capacity
CDC Funded Baseline Survey: 1999 Delphi Survey; 43 state
responses 19% had a state-based oral health
surveillance system 38% had a state oral health improvement
plan 48% had an oral health advisory
committee/coalition representing a broad-based constituency
Efforts Since 1999 ASTDD 2000 report, Building Infrastructure
& Capacity in State and Territorial Oral Health Programs - 10 top infrastructure and capacity elements to address 10 Essential PH Services
CDC and HRSA used the elements in their funding opportunities
CDC funded ASTDD to develop resources and provide technical assistance to states
Definitions Infrastructure is the basic physical and
organizational structure and support needed for the operation of a society, corporation or collection of people with common interests
Capacity is the actual or potential ability to perform activities or withstand threats
Quilt is a single piece that can be a work of art, constructed by a team following a pattern and comprised of many individual elements
10 Essential PH Services for OH10 Essential PH Services to Promote Oral Health in the US*
Assessmentt
1. Assess oral health status and implement an oral health surveillance system
2. Analyze determinants of oral health and respond to health hazards in the community
3. Assess public perceptions about oral health issues and educate/empower them to achieve and maintain optimal oral health**
Policy Development
4. Mobilize community partners to leverage resources and advocate for/act on oral health issues
5. Develop and implement policies and systematic plans that support state and community oral health efforts
Assurance6. Review, educate about and enforce laws and regulations that promote oral health and ensure
safe oral health practices
7. Reduce barriers to care and assure utilization of personal and population-based oral health services
8. Assure an adequate and competent public and private oral health workforce
9. Evaluate effectiveness, accessibility and quality of personal and population-based oral health promotion activities and oral health services
10. Conduct and review research for new insights and innovative solutions to oral health problems
*
Guidelines for State and Territorial Oral
Health Programs Key document based on 10
Essential Public Health Services to Promote Oral Health in the US and the 3 core PH functions
Matrix of State Roles, Activities and Resources
Used in the mentoring program; program reviews; advocacy for oral health, state program support and policy change; to develop a state oral health plan
Competencies for State Oral Health Programs
78 Competencies in 7 domains with progression of skill levels
Focus on Core PH Functions and Essential Services for the whole program; clinical competencies not included
Integrated into mentoring program, state OH program reviews and technical assistance (TA)
State and local health agencies use for strategic planning, to develop scopes of work, align staffing skills, advocate for additional resources to fill gaps in skills, and to create team or individual professional development plans.
Orientation and Mentoring Program
Orientation webinars acquaint new members and associate members with ASTDD and the resources available
Mentoring program pairs a new dental director with an experienced dental director to communicate via phone, email or site visits to provide guidance/peer support in developing and administering a strong state program to improve the oral health of a state’s residents
Mentees note how this program
increased their knowledge,
confidence and skills in a
variety of areas
State Oral Health Program Review (SOHPR)
Includes a variety of self-assessment tools: SWOT analysis, core data set checklist, budget worksheet, briefing booklet
Guide for states to request a comprehensive oral health program review by a team with diverse areas of expertise
Reviews help with strategic planning and program prioritization, rallying support from and collaboration with multiple stakeholders, increasing program visibility and highlighting successes, identifying TA needs and need for additional resources
20 reviews since 1986, most recent in AK and MA (will discuss later)
Best Practices Project•Purpose: Build more effective state, territorial and community oral health programs
•Best Practice Approach Reports: 12 with more coming
•State and Community Practice Examples: 200+
•Most viewed portion of the ASTDD website
•States use to make decisions and improve programs
ASTDD 7 Step Model
Designed to make needs assessment simpler and more manageable
Step-by-step guide Can be adapted to
specific community resources and objectives
The process provides integrated information about health status, the existing health system and health resources
National Oral Health Surveillance System (NOHSS)
Designed to monitor burden of oral disease, use of the oral health care delivery system, and status of community water fluoridation on a national and state level
9 indicators: 4 adult OH, 3 child OH, 1 fluoridation status, and 1 oral cancer
Programs use frequently for state comparisons and in grant writing and reports to policymakers
State Profiles
To view oral health summaries click on a state above or select a
state by name:
Alabama GO
This system was developed with the collaboration of the Centers for Disease Control and Prevention (CDC) and the Association of State and Territorial Dental Directors (ASTDD).
Basic Screening Survey (BSS)
A tool for obtaining data for an oral health surveillance system to monitor the burden of oral disease without overtaxing limited human resources in collecting data
Manuals, examiner training videos, implementation packets and other associated materials are available for children (primarily 3rd grade and preschool) and for older adults
ASTDD consultants provide more than 100 hours of TA to states each year
Many states have published oral disease burden documents 3rd grade data have been submitted by 44 states to NOHSS as of
2012 Translated into Spanish and used by Children International in 11
countries last year to screen 125,610 children to triage into care
State Synopses of Oral Health Programs
An annual report and a website contain state information useful in tracking progress toward Healthy People objectives
Display trends in demographics, infrastructure, workforce, administration, budget, and programs across multiple years
Programs use the information similar to how they use NOHSS; ASTDD uses for trend analysis
Policy Assistance
ASTDD Committees and Focus Areas to Help States
Best Practices Communications CSHCN Data and Surveillance Emergency
Preparedness and Response
Evaluation Fluorides Head Start and Early
Childhood
Healthy Aging Perinatal Policy School and Adolescent
Oral Health State Development and
Enhancement
ASTDD Communication Tools
Annual report Quarterly newsletter Weekly News Digest Website Multiple targeted listservs Webinars Exhibit booth Annual meeting and the
National Oral Health Conference in April
Infrastructure Enhancement Project (2010-present)
CDC funded ASTDD to review current status of SOHPs and progress over the past decade
Final report: State Oral Health Infrastructure and Capacity: Reflecting on Progress and Charting the Future
Report Methodology Reviewed and analyzed:
State Synopses and other data from 2000-2010 CDC DOH-Funded States’ Evaluation Reports CDC, HRSA and ASTDD Investments in State
Oral Health Programs Conducted Interviews of Collaborations
between State MCH-Title V and SOHP (20 states)
Conducted Interviews of SOHPs and other stakeholders (10 states)
Format and Content of IEP Report
Identified Key Infrastructure/Capacity Elements for SOHPs
IEP Study Findings: Current status and trends for SOHP structure/org
placement/staffing, funding SOHP ability to perform Core Public Health Functions
and 10 Essential Public Health Services Lessons Learned and Recommendations
by Infrastructure/Capacity Elements Next Steps
State Oral Health Program Infrastructure Elements
IEP Overall Study Findings From 2000-10, considerable investments
from Federal/state governments & others > tools, resources and funding opportunities Enhanced/broadened OH surveillance and
epidemiology infrastructure, capacity, expertise
> states with state oral health plans Overall increased SOHP budgets and staffing
but many fluctuations and recent decreases No “ideal” staffing model > evidence-based primary prevention
policies and programs
SOHP Placement and Authority in Health Agency
Statutes in 20 states require a state oral health program in the public health agency
16 require a state dental director 13 require both organized as programs (21), offices (9), units
(5), sections (5), bureaus (4); the rest are branches, divisions or service areas; these change with reorganizations in health agency
Dental Directors (SDD)
In 2010, 7 states had SDD vacancies 21/43 SDD (48.8%) had held the position for less
than five years, 13 (30.2%) for five to nine years, and 9 (20.9%) for 10-24 years
12 states had directors that had been in the position for less than one year
States with a full-time director increased from 61% in 2000 to 80% in 2010
10 (19.6%) did not have a dental professional as the director; 17 states (33.3%) had a dental professional with a public health degree
Staffing
States that provide or support clinical service programs have larger staffs, e.g. three states have 500, 120, and 63 staff
States with two or fewer FTE staff has decreased from 41% in 2000 to 12% in 2010
Those with 5 to 20 staff has increased from about 20% to 41%
Improved access to staff within or outside agency with specific expertise, e.g., epi, evaluation
No one staffing model is appropriate for all
states
Program Funding Concerns
21 states reported budget decreases from 2010 to 2011; one state lost their primary funding source (state general fund dollars); another state’s budget decreased from more than $3 million to less than $250,000, with corresponding elimination of programs and staff
10 states reported no budget change; 16 reported a budget increase; budgets vary widely depending on grants available
8 states received 100% of funding from one primary source
14 states receive no direct MCH Block Grant funding, while three are 100% MCH funded
State Oral Health Program Activities
Oral health education and promotion (92%)
Dental sealants (78%) Dental screening (74%) Early childhood caries
prevention (74%) Access to care (64%) Fluoride varnish (62%) Programs for pregnant
women (54%)
Fluoride mouthrinse (50%)
Abuse/neglect education or PANDA (20%)
Fluoride supplements (tablets) (18%)
Mouthguard/injury prevention (10%).
Prevention Program Successes
In 2000, about 193,000 children received dental sealants through 25 state sealant programs
In 2010, 40 states had a sealant program that served almost 400,000 children
Fluoride varnish program increased from 23% of states in 2002 to 62% of states in 2010
Programs for pregnant women have increased from 45% in 2005 to 54% of states in 2010
Problems with Snapshot Reports
Recent Pew Report, Falling Short. Most States Lag on Dental Sealants
Examples: MO, CA Need for continued
trend analysis paired with reasons for changes
Oral Health Needs Assessment and Planning
Substantial improvement since 2000 in collecting core state OH data for N/A and planning
Nine states reported improvements in OH defined as a decrease in the prevalence of untreated decay or an increase in prevalence of sealants in 3rd graders
20 states collect OH data from their state’s PRAMS 50 states are reporting water system fluoridation status
and updates, while 28 states report some level of monthly operational data to CDC’s Water Fluoridation Reporting System (WFRS)
In 2010 CDHP collected state OH plans from 42 states
Oral Health Coalitions
In 2007, an Oral Health America survey showed 41 states with a state oral health coalition
As of 2011, 28 state coalitions had joined the American Network of Oral Health Coalitions (ANOHC)
Children’s Dental Health Project is creating a database of OH coalitions
Lessons Learned – SOHP Placement and Resources
Organizational placement of SOHP can be influential
Diversified funding is advantageous Support for more than just the SOHP is
key, e.g., support for local programs Single funding source can jeopardize a
SOHP
Lessons Learned – Leadership, Staffing & Partnerships
Successful SOHP needs a continuous, strong, credible leader to create partnerships and leverage available assets
Key to address 10 Essential PH Services & SOHP Competencies
SOHP need not be BIG – but need to be strong and forward thinking/visionary
Need advocates/coalition/partners with financial and political clout
Must take advantage of leadership/professional development opportunities
Lessons Learned – Surveillance Capacity
Data drives decision-making and needs to be current (within 5 years)
Need surveillance with sound analysis and dissemination
Strategic and effective sharing of data reports promote understanding of OH and disease prevention programs and the need for and value of funding these evidence-based programs
Lessons Learned – State Planning & Evaluation Capacity
Need current/comprehensive SOHP plan with a practical evaluation component. Allows SOHP to assess and communicate its relevance, progress, efficiency, effectiveness and impact
Evaluation must engage stakeholders Evaluation can help build infrastructure and
enhance sustainability when results are used to improve programs, increase program visibility and demonstrate program achievements
Lessons Learned – Evidence-Based Prevention & Promotion Programs
& Policies
States with documented improvements in OH status of residents have strong EB local programs with quality guidance/support from the SOHP
Local programs without guidance/support are not always successful
States with local programming limited to OH education have not seen improvements in OH status of the children they serve
Lessons Learned - Resiliency
Resiliency of an organization relates to the ability to bounce back following some environmental, financial, political, public relations or other challenge, misfortune or disaster
The ability to scale programs up and down in response to the environment, and the ability to identify and sustain core elements can help to sustain programs in challenging times
Key Messages from the IEP Report
State oral health programs make an essential contribution to public health and must be continued and enhanced.
Successful SOHPs need: diversified funding for state and local evidence-based programs a continuous, strong, credible, forward-thinking leader complement of staff, consultants and partners with proficiency in the
ASTDD Competencies one or more broad-based coalitions that include partners with fiscal
and political clout valid data (oral health status and other) to use for evaluation, high
quality oral health surveillance, a state oral health plan with implementation strategies, and evidence-based programs and policies
State Case Studies from Previous UCSF Seminars
North Carolina New Mexico New York California
Case Study: New Hampshire
Leadership/staffing Use of national and regional resources Integration within Health Dept and focus of
activities Planning, policies, legislation Diversified funding Links to local programs
Results from SOHPR - Alaska
SOHPR Documents support SOHP Planning Leadership/staffing Promotion of Oral Health within Department
of Public Health and focus of activities Planning, policies, legislation Importance of linkages with other programs
and partners Links to local programs
Results from SOHPR- Massachusetts
SOHPR Documents support SOHP Planning Leadership/staffing Promotion of Oral Health within Department
of Public Health and focus of activities Planning, policies, legislation Importance of linkages with other programs
and partners Links to local programs
IEP Recommendations (1)
RECOMMENDATIONS(in order of the infrastructure elements as shown in Figure 3, but not prioritized)
STAKEHOLDERS
Federal Govern-
ment
ASTDD,National
Organiza-tions &
Partners
State Public HealthAgency
State Oral Health
Program
Other State
Organiza-tions &
Partners
Local Public Oral
Health Program
Other Local
Organiza-tions &
Partners
RESOURCES
1. Provide coordinated and sustainable base funding for federal, State and local oral health programs.
2. Identify and procure diversified funding sources for state and local oral health programs.
3. Leverage resources to support oral health programs and initiatives.
4. Expand and strengthen the availability of local oral health resources to bring public oral health programs to diverse and under-served populations.
5. Promote use of current tools and technical assistance to strengthen state and local oral health programs.
6. Position public oral health programs in a prominent position within the public health agency structure.
IEP Recommendations (2)RECOMMENDATIONS
(in order of the infrastructure elements as shown in Figure 3, but not prioritized)
STAKEHOLDERS Federal Govern-
ment
ASTDD,National Organiza-tions &
Partners
State Public HealthAgency
State Oral
HealthProgram
Other State
Organiza-tions &
Partners
Local Public Oral
Health Program
Other Local
Organiza-tions &
Partners
LEADERSHIP, STAFFING, PARTNERSHIPS
7. Develop and adopt a common vision and goals for oral health among federal, state and local agencies and national partners while acknowledging there are dif-ferent strategies and structures for achieving the goals.
8. Promote, provide and support leadership and professional development opportunities.
9. Staff federal, state and local oral health programs with qualified public health/oral health professionals whose skills match the job functions.
10. Strengthen State oral health leadership, consistent with the ASTDD Competencies.
11. Promote and support partnerships between the public and private sectors to improve oral health at the State and local levels.
12. Promote and support partnerships between maternal and child health, chronic disease, and other public health programs and payors to address social determinants and other factors that impact public health.
13. Increase emphasis on dental public health issues in undergraduate and graduate dental and dental hygiene programs, dental residencies, and any new specialty programs for dental hygienists.
IEP Recommendations (3)
RECOMMENDATIONS(in order of the infrastructure elements as shown in Figure 3, but not prioritized)
STAKEHOLDERS
Federal Govern-
ment
ASTDD,National
Organiza-tions &
Partners
State Public HealthAgency
State Oral Health
Program
Other State
Organiza-tions &
Partners
Local Public Oral
Health Program
Other Local
Organiza-tions &
Partners
SURVEILLANCE CAPACITY
14. Ensure that there is capacity for development, implementation, and evaluation of State oral health surveillance systems; data analysis; and use of data to guide decision making and educate the public and policymakers.
15. Ensure there is high quality oral health surveillance and broad dissemination as part of overall public health surveillance.
16. Collaborate to integrate oral health data with other health survey data, e.g., height and weight.
IEP Recommendations (4)
RECOMMENDATIONS(in order of the infrastructure elements as shown in Figure 3, but not prioritized)
STAKEHOLDERS Federal Govern-
ment
ASTDD,National Organiza-tions &
Partners
State Public HealthAgency
State Oral
HealthProgram
Other State
Organiza-tions &
Partners
Local Public Oral
Health Program
Other Local
Organiza-tions &
Partners
STATE PLANNING, EVALUATION CAPACITY
17. Engage in ongoing and strategic collaborative state-level oral health planning to address the oral health of the population throughout the lifespan and to promote equity among all subpopulations.
18. Develop and sustain capacity to conduct comprehensive evaluation of public oral health infrastructure and programs at all levels and use evaluation findings to guide decision making.
IEP Recommendations (5)RECOMMENDATIONS
(in order of the infrastructure elements as shown in Figure 3, but not prioritized)
STAKEHOLDERS Federal Govern-
ment
ASTDD,National
Organiza-tions &
Partners
State Public HealthAgency
State Oral Health
Program
Other State
Organiza-tions &
Partners
Local Public Oral
Health Program
Other Local
Organiza-tions &
Partners
EVIDENCE-BASED PREVENTION & PROMOTION PROGRAMS & POLICIES
19. Develop and monitor public policies that promote oral health and evaluate the impact of policy changes.
20. Assess public opinions, awareness, knowledge, and behaviors and use the data to design effective communication strategies targeted to the public and policymakers to promote oral health and the importance of oral health to the overall health of the population throughout the lifespan.
21. Promote and support the translation/transferring of research evidence into promising implementation models at State/local levels and evaluate the impact.
22. Implement culturally relevant, evidence-based programs that prevent disease and promote oral health across the lifespan.
Next Steps for ASTDD and Partners
Resources Leadership, Staffing and Partnerships Surveillance Capacity State Planning, Evaluation Capacity Evidence-Based Prevention &
Promotion Programs & Policies
Key References
State Oral Health Infrastructure and Capacity: Reflecting on Progress and Charting the Future : http://www.astdd.org/docs/Infrastructure_Enhancement_Project_Feb_2012.pdf
ASTDD Guidelines for SOHPs: http://www.astdd.org/state-guidelines/
ASTDD Competencies for SOHP and Tools for Competency Assessment: http://www.astdd.org/docs/CompetenciesandLevelsforStateOralHealthProgramsfinal.pdf
