san francisco children’s oral health strategic plan...
TRANSCRIPT
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San Francisco Children’s Oral Health Strategic Plan 2014-2017
Coordinated bySan Francisco Health Improvement Partnership
November 2014
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Table of Contents
Introductory Letters 1
Introduction 3
Our Vision, Guiding Principles, and Indicators 12
Overview of Strategies 14
Individual Strategies and Tactics 15
Appendix 24 StrategicPlanSteeringCommittee Strategic Planning Workgroup Members 25 StrategicPlanningRetreatParticipants 26 Glossary of Terms 28 References 31
Acknowledgments 33
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Tomás Aragón, MD, DrPH HealthOfficer,CityandCountyofSanFranciscoDirector,PopulationHealthDivisionSanFranciscoDepartmentofPublicHealth
WorkingontheSFHIPChildren’sOralHealthStrategicPlanhasbeeninspiringandtransformational!Whenweworktogetheronacommonagenda,withsharedmeasurementsandmutually-reinforcingstrategies,wecanhavecollectiveimpactontheoralhealthofourchildren,whichwillhavealasting,lifelongimpactontheirhealthandqualityoflife.Ourgoalsaretoreducedisparitiesinoralhealth,reducedisparitiesinaccesstopreventiveservices,andtoimplementtargetedupstreampreventioninthecommunity(medicalvisits,WIC,HeadStart,etc.).
Children’soralhealthisaheadlineindicatorintheSanFranciscoStrategicPlanforPopulationHealthbecauseitcontributestotheoverallhealthofSanFrancisco.TheSFHIPChildren’sOralHealthStrategicPlanistheroadmapwithinthisoverallplan,guidingtheworkofbothourSanFranciscoDepartmentofPublicHealth,aswellasourcommunityeffortstoidentifyandsystematicallyeliminatethecausesofdentaldisease.
Thevisionofthisplanisaspirational–“AllchildreninSanFranciscotobecaries-free.”Thegoalisnotjusttoreducedentaldecay.Thereisaclearfocustoalsoreducedisparities,sothatallSanFranciscochildrenhaveaccesstoearlyandroutineoralhealthpreventiveservices.Dentaldecayispreventable.Studiesshowus,however,thatthechildrenwhoaremostvulnerabletothisepidemicareexactlythosewhodonotreceiveneededdentalservices.Oralhealthhasbeenartificiallysegregatedfromoverallhealth,andcriticalpreventiveguidanceandtreatmentisoftendelayeduntilachildis3yearsold.Withoutintegratingoralhealthintotheoverallhealthsystemwewillbecontinuallyplaying‘catch-up’.WewillneverbeabletofillallthedecayedteethinSanFrancisco.Thisplanpromotestheintegrationoforaldiseasepreventionintolocationswherechildrenandnewparentsareseenbyhealthcareproviders–thewellchildvisit–andincreasesearlyaccesstodentalprovidersatlocationssuchasWICsites,preschoolcentersandelementaryschools.Byinstitutingthisplan,wecanpreventthediseaseprocessfrombecomingestablished.
Congratulationsandthankyoutothemanycommunitycollaboratorswhohavethevisionofacaries-freeSanFrancisco,andthecommitmenttodotheworkrequiredtodevelopanorganizedroadmaptothatend.
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Kevin Grumbach, MD Chair,UCSFDepartmentofFamilyandCommunityMedicineCo-Director,UCSFClinicalTranslationalScienceCommunityEngagement andHealthPolicyProgram
ThisStrategicPlanrepresentsavisionwhichstartedamongagroupoforalhealthadvocatesrespondingtoachallenge:toidentifyandaddresswhatwouldmakethegreatestimpactonchildren’soralhealthinSanFrancisco.InSanFrancisconearly40%ofchildrenhaveexperiencedcariesbythetimetheyreachkindergarten,wellabovethenationalHealthyPeople2020targetof30%.Untreatedcariesis2-3timesmoreprevalentinchildrenofcolor,andthisdisparityhasworsenedsince2000.Attheinitialconveningoforalhealthstakeholdersinearly2012asaSanFranciscoHealthImprovementPartnership(SFHIP)Children’sOralHealthworkinggroup,itwasmadeclearthattomakethemostimpact,thereneededtobeacoordinated,citywidestrategicplanningeffort.Wenowhaveathree-yearplan–aguidethatwillmoveourcityclosertoachievingourgoal:tomake San Francisco’schildrencaries-free.Wehavethetoolsandtheknowledge;withthecoordinatedeffortandresourcesdescribedinthisStrategicPlan,wealsohavethemeanstoachieveourgoal.
Theplanreflectsatruecollaborativeeffortsuccessfullyengagingovereightyindividuals’inputandexpertise.Theenthusiasmandhardworkofsomanycontributedbothtothecreationofthisplanandtoraisingtheoverallawarenessandprofileoforalhealthanditsimportanceforourchildrentothriveandsucceedinlife.Ourfocusisonfivekeyareas:Accesstocare,IntegrationoforalhealthintooverallHealth,Promotion,EvaluationandCoordination.Eachhasbeencarefullyassessedforfeasibilityandrelatedbestpractices,thoughtfullydiscussedinmultiplemeetings,andfurtherdevelopedasimplementationstepsdetailedinaseparatereport.
I’mparticularlyencouragedtoseethekeystrategyemphasizingintegrationoforalhealthintoroutineprimarycareservicesforchildren.Althoughbarrierspersistforyoungchildrentoreachadentist’soffice,mostchildrenhavemultiplevisitstoprimarycareclinicsandpracticesforwell-childexamsinthefirstfewyearsoflife.Yettoooftenthoseofuswhoareprimarycaremedicalprovidershavenotintegratedbasicoralhealthpreventivemeasures,suchasacarefulexamforearlycariesandapplicationoffluoridevarnish,intoourroutinewellchildexampractice.TheStrategicPlanprovidesaconcreteplanforintegratingoralhealthintoroutineprimarycarechildren’sservices.
Thisisanexcitingtimeandawonderfulopportunitytohelpshapethefutureofchildren’soralhealthinSanFrancisco.TheStrategicPlanexhibitshowwecanbetteraddressthisgreathealthneedinacommunity-centered,integrated,andcoordinatedapproach.Congratulationsandthankyoutoallthoseinvolvedinthiscollaborationincludingthesupportersandfundersthatmadethispossible.I’mconfidentthatthesamevisionanddedicationthatcreatedthisplanwillfuelitsimplementationandbringSanFranciscoclosertohealthequityforallofourchildren.
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Why is oral health important?
Oralhealthisessentialtooverallhealth,well-being,andqualityoflife.Itaffectschildren’snutritionalintake,self-esteem,andtheabilitytoconcentrateandsucceedinschool.Dental
caries(toothdecay)remainsoneofthemostcommonchronicdiseasesinchildhoodintheU.S.andoftenpersistsintoadulthoodandacrossthelifespan.In2012,35%ofSanFranciscoUnifiedSchoolDistrict(SFUSD)studentsexperienceddentalcariesintheirprimaryandpermanentteethbythetimetheyenteredkindergarten,resultinginreducedattendanceandcontributingtopooracademicperformance.Therecanalsobehighcosts;dentalcaries-relatedemergencyroomvisitscanbetentimesthecostofprovidingpreventivecare.
Oral health status of San FranciscoOverthepastdecadetherehasbeensteadyimprovementintheoralhealthstatusofSanFranciscochildren:theprevalenceofuntreatedcariesdeclinedfrom26%ofkindergartenersin2007to17%in2012.Duringthesameperiod,cariesexperiencewhichreflectsnotonlycurrentbutpasttoothdecayhasalsodeclinedfrom45%to35%.(Figure1)However,the2020HealthyPeople(HP)objectivetoreducetheproportionofchildrenaged3to5yearswhoexperiencedentalcariesintheirprimaryteethto30%hasnotbeenmetforSanFrancisco4-5yearolds. Wecandomoretoreducedentaldecayinourinfants,toddlersandpreschoolers.
Introduction
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2007-‐2008 2008-‐2009 2009-‐2010 2010-‐2011 2011-‐2012 2012-‐2013
% of Kindergarteners
who have experienced dental
caries HP 2020 goal for 3-‐5 year olds -‐
30%
SFDPH-‐SFUSD-‐SFDS San Francisco Kindergarten Screening, [San Francisco, 2005-‐11]/Prepared by SFDPH MCAH Epidemiology, February 2013
Figure 1: San Francisco has not met HP 2020 goals for children’s caries experience
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Oral health disparities persistDespitetheoverallimprovementsincariesprevalencenationallyandlocally,therearesegmentsofouryouthpopulationthatcontinuetocarrytheheaviestburdenofdentaldecay.Therateofuntreatedcaries(40%)amongkindergartenchildreninlow-incomeSFUSDschools(schoolswithhigh%ofNationalSchoolLunchProgram(NSLP)eligibility)is8timeshigherthantheratefoundinchildrenfromhigherincomeschools(5%).(Figure2)Moreover,whiletheprevalenceofcarieshas declinedinhigherincomeschoolsovertime,ithasincreasedinlow-incomeschools.
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Schools of various % of children eligible for NaWonal School Lunch Program
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Higher income schools: decreasing
untreated decay
% of Kindergarteners with untreated
caries
Figure 2: Low income children in San Francisco are 8 Wmes more likely to have untreated caries
28%
22%
0%
10%
20%
30%
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Low-‐income pre-‐schools (0-‐4 year olds)
Kindergarten (4-‐5 year olds)
% of preschool and Kindergarten children with
untreated caries
SFDPH Child Care Health Project 2011-‐2012, SFUSD Kindergarten 2010 CDC/NCHS, NaKonal Health and NutriKon ExaminaKon Survey, 2009–2010.
Figure 3: San Francisco children experience more untreated caries than the naKonal average
NHANES 2009-‐10: 3-‐5 year olds:
14.4%
Amongouryoungerlow-incomechildren,28%ofpreschoolersinstatesubsidizedpre-schoolsexperiencedentaldecay,demonstratingtheneedfordentalcareatanearlyage.(Figure3)
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Childrenwholiveinsomegeographicareas,experience2-3timestherateofcariesaschildreninotherareasofthecity.(Figure5)
Chinatown North Beach
Nob Hill/Russian Hill/Polk Tenderloin
South of Market Bayview/Hunter’s Point
VisitaAon Valley Excelsior Portola
Figure 5: Certain San Francisco neighborhoods have 2-‐3 Ames more children with caries
Caries Experience (% of Students Screened)
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“Itisalarmingthatthehighestburdenofchildren’sdentalcariesisfoundinSanFranciscoChinatownneighborhoods.Ifwewanttomakeequitableimprovementsinourcity,wemustconsiderapproachesthataddressthisdiseasenotonlyonanindividuallevel,butalsoonthefamily,community,andneighborhoodlevelsthattakeintoaccountmoreupstreamsocialandculturalfactors.”
AmorSantiago,MPH,AsianPacificIslanders'HealthParityCoalition
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Inadditiontothesedisparities,overhalf(52%)ofDenti-CalenrolledchildreninSanFranciscodidnotseeadentistin2011-12.However,ananalysisofdatafromDenti-CalandtheSanFranciscoKindergartenDentalScreeningProgramshowsthatDenti-Calutilizationbychildrenages0-3yearsissignificantlyassociatedwithreducedprevalenceofcariesexperienceamongSFUSDkindergartenersoneyearlater.
Toaddressthesedisparitiesinoralhealthandaccesstodentalcare,atargeted,coordinatedeffort,asoutlinedinthisStrategicPlan,iscriticallyimportantforthehealthofSanFrancisco’schildren.
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Prevention WorksThegoodnewsisthatdentalcariesislargelypreventable.Prioritizingpreventioninchildrenisimperativebecausecariesestablishedinchildhoodincreasestheriskofdentaldecayacrossthelifetime.Population-basedstrategies,suchascommunitywaterfluoridationandschool-basedsealantprogramsareeffectiveatpreventingcaries.Thewidelypromotedstandardsofproperoralhygienepracticesandearlyandroutineprofessionaldentalcarecanalsoincreasecariesprevention.Ourchallengeiseffectiveeducationandpromotion,enablinghealthybehaviorsandcare-seekingpractices,andprovidingasupportivephysicalandsocialenvironmentforadoptingandmaintainingthesepractices.
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Best practices for good children’s oral health include: ✓ Perinatalcareandeducation✓ DentalvisitbyAGE1✓ Routinedentalvisits(2xyearbasedonrisk)✓ Limitedfrequencyofsugaryfoods/drinks✓ Topicalfluoride
• Brushingwithfluoridatedtoothpaste2x/day• Drinkingfluoridatedwater(SanFranciscoisfluoridated)• Fluoridevarnishapplication2-4x/year
✓ Sealantson1st(6yearold)and2nd(12yearold)molars• ADArecommendssealantsforprimaryteethtoo
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San Francisco’s Kindergarten Dental Screening ProjectSince2000,acoordinatedannualeffortorganizedbytheSanFranciscoDepartmentofPublicHealth(SFDPH)incollaborationwiththeSanFranciscoDentalSociety,NationalDentalAssociation,andtheSFUSD,hasbeenprovidingdentalscreeningstoallkindergartenchildrenattendingSFUSDschools.AstheonlyschooldistrictinthediversecityandcountyofSanFrancisco,theinformationobtainedfromthescreeningsofferstheopportunitytoassessandmonitortheoralhealthstatusoftheSanFranciscopublicschoolkindergarten-agepopulationandidentifyassociateddisparities.
Safety Net for Oral Health Mostlow-incomechildreninSanFranciscoareeligibleforsomeformofsubsidizeddentalinsurance:eitherMedi-Cal/Denti-Cal,orHealthyKidsInsuranceforundocumentedorslightlyhigherincomefamilies.In2015,therewillbeanewrequirementbyCoveredCalifornia,thestate’simplementationoftheAffordableCareAct(ACA)healthinsurancemarketplace,topurchasedentalplansformembersunderage19.Havingdentalcoveragehasproveninvaluabletogettingneededcareforunderservedchildren.
InSanFrancisco,therearefiveFederallyQualifiedHealthCenter(FQHC)systemsthathavedentalclinicslocatedwithintheirlargerclinic.These“SafetyNet”dentalclinicsarewheremanylow-incomechildrenandadultsreceiveneededdentalcare.Wealsohavetwouniversitydentalschoolsthatofferspecializeddentaltreatment,includinghospitaldentistryandpediatricdentalcare.
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“TheSanFranciscoKindergartenDentalScreeningprogramincreasesaccesstocareanddentaleducationforapopulationthatmayotherwisenotseetheneedfordentalcare.Iamproudtovolunteerforaprogramthatgiveschildrenandparentsthenecessarytoolstomaintaintheiroralhealthwhileprovidingapositivedentalexperience.”
JohnFong,DDS,SanFranciscoDentalSocietyDentist
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Where can we improve? AcomprehensiveassessmentofthecurrentstateofSanFrancisco’schildren’soralhealthresources,gaps,bestpractices,andopportunitiesidentifiedthefollowingareasforimprovement:
Access to dental care. ComparedtoourrichmedicalsafetynetsystemwhichincludesFQHCclinics,largehospital/medicalclinics,andmultipleprimarycarepediatricprivatemedicalofficesthatacceptMedi-Cal,ourdentalsafetynetisweakandinadequate.The50dentalclinics/officesinSanFranciscothatacceptedDenti-Calin2011havedecreasedto43in2014.Atthesametime,demandisincreasing.AsaresultofexpansionofMedi-CalunderACA,andthereinstatementofsomeadultMedi-Caldentalbenefits,itisestimatedthatin2013-14,52,000newSanFranciscobeneficiariesnowhaveMedi-Caldentalbenefits.Withoutanadequatenetworkofdentalproviders,wewillnotbepreparedtomeetthisincreaseddemandforcare.Currentlychildrenareexperiencing2-3monthwaittimesatmanyofoursafetynetclinics,asavailabilityfordentalappointmentsisbecomingmoreandmorelimited.GiventheinsufficientsafetynetsystemfororalhealthinSanFrancisco,findingstrategiestoimproveaccesstodentalcareisofhighimportance.
Integration of oral health into primary care. Becausemedicalprovidersseechildrenupto11timespriortochildreneverseeingadentist,‘wellchild‘visitsareopportunitiestoprovideoralassessments,toapplyhighlypreventivefluoridevarnish,andtosharekeyoralhealtheducationmessageswithparents.Thereare,however,veryfewclinicsandmedicalproviderswhoofferfluoridevarnishtotheir0-5yearoldpatients.
“Manythingsinfluenceachild’sprogressandsuccessinschool,includinghealth.Poororalhealthimpactsachild’sdevelopmentandabilitytolearn.Therearetoomanychildreninourschoolsthatsufferandareinpainduetodentalproblems,andafocusedandstrategicefforttoaddressthisisessentialforahealthyandsuccessfulfutureforallourchildren.”
RichardCarranza,Superintendent,SanFranciscoUnifiedSchoolDistrict
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Promotion of the importance of oral health among parents/caregivers and pregnant women.Wenotonlyneedtostrengthenthedentalsafetynet,wealsoneedtofocusonpreventiontoreducetheneedfordentaltreatmentservices.Parents’/caregivers’lackofunderstandingoftheimportanceofpreventiveoralhealthcareathomeandfromadentalprofessionalcancontributetotheirchild’sriskofdevelopingcaries.BecauseoftherichdiversityofSanFrancisco’spopulation–35%ofthepopulationisimmigrants,thelargestgroupfromChina–itisessentialthatawarenessandknowledge-buildingeffortsbeculturallyappropriatetoeffectivelypromoteoralhealthincommunitiesthathavethehighestratesofdentalcaries.
Systematic evaluation of oral health status. Besidestheannualkindergartendentalscreeningproject,wearelimitedinthecollection,analysis,anddisseminationoforalhealthdata.Moreinfrastructureisneededtosystematicallyassessandmonitortheoralhealthstatusofourchildrencitywide.
Coordination citywide.Overthepastdecade,dentalandmedicalprofessionalorganizations,clinics,universities,SanFranciscoUnifiedSchoolDistrict,andcommunityorganizationshaveeachlaunchedeffortstoimprovetheoralhealthofchildreninSanFrancisco.Tobemosteffective,wemustcoordinatetheseeffortstostrengthenadvocacywithpolicyanddecision-makers,reduceredundancy,utilizeresourcesefficiently,andultimatelyimproveourchildren’soralhealthefficiently,equitably,andsustainably.
Available revenue stream.Finally,weareroutinelyprovidingsomedentalservicesthatmaybereimbursable,butforwhichwearenotbilling.Thislostrevenue,ifsuccessfullyobtained,couldopenthedoortoself-sustainingprojects,andthecreationandexpansionofnewprograms for greater reach.
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“Althoughoralhealthisanimportantcomponentofwholepersoncare,historically,ithasnotbeenwellintegratedintoprimarycareandweareseeingtheconsequencesofthatinourclinics.Itisacomplexproblemthatneedsmultipleapproachesincludingincreasingaccesstocare,anddecreasingtheneedforcarethroughbetterpreventionandhealthpromotioninterventions.”
AlbertYu,MD,MedicalDirector,SanFranciscoDepartmentofPublicHealth
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Methodology – Developing a PlanAnimportantpreludetotheStrategicPlanprojectwastheconveningofagroupoforalhealthadvocatesaspartoftheSanFranciscoHealthImprovementPartnership(SFHIP)Children’sOralHealthPartnershipWorkingGroupinearly2012.Thisgroupmetthreetimes,withtheobjectivetoidentifyprojectsthatwouldresultinmeasurableimprovementsinchildren’soralhealthwithinfiveyears.Theneedforcoordinated,citywidestrategicplanningandgoalsettingwasexpressedearly,andquicklygainedstrongsupportandmomentumamongthegroup.
WithfundingfromtheMettaFund,acoreleadershipteamwasformedandtheyear-longstrategicplanningprocesswasunderwayintheFallof2013.ASteeringCommitteeoforalhealthandchildren’shealthadvocatesfromthecommunity,civic,academic,public,andprivatesectorswasconvenedtoprovideleadershiptothestrategicplanningprocess.SteeringCommitteemembersdesignedtheplanningprocess,chairedworkgroups,andplannedstakeholderretreats.InFall2013/Winter2014,theSteeringCommitteeconductedanenvironmentalassessmentofSanFranciscochildren’soralhealthstatus,whichidentifieddisparities,strengthsandgapsinoralhealthservices,aswellaspromisingpracticesinpreventionandtreatment.
OverfiftycommunityandinstitutionalstakeholdersattendedafulldayretreatinJanuary2014toreviewtheenvironmentalassessmentandadviseonthedevelopmentoftheStrategicPlan.Theirinputhelpedtoselecttheplan’smainpriorityareas:Access,IntegrationwithOverallHealth,Promotion,EvaluationandCoordination.Overfortyretreatattendeesandotherstakeholderswererecruitedtojoinworkgroupsassignedtothesepriorityareas.TheworkgroupsmetinMarchandApril2014todevelopstrategiesandtactics.Basedontheirwork,theSteeringCommitteedevelopedadraftStrategicPlan.InJune2014,communityandinstitutionalstakeholdersattendedahalf-dayretreattoprovidefeedbackonadraftoftheStrategicPlananddevelopinitialideasforimplementation.
ThisStrategicPlanwascreatedbythedozensofpartnerorganizationsandindividualswhowillbepartofitsimplementation.Theplanningprocessresultednotonlyinthisdocumentbutalsoraisedawarenessamongcityandcommunityleadersofthecriticalimportanceoforalhealth,anddevelopedconsensusonwhatmustbedonetoimprovechildren’soralhealthstatusinSanFrancisco.
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Guiding Principles:
Strategieswillfocuson:
◆ Prevention(nottotheexclusionoftreatment)
◆ Ages0-10andpregnantwomen
Populationswhoaremostat-risk,includinglow-income, communitiesofcolor,childrenwithspecialneeds,and recent immigrants
◆ Sustainableefforts;utilizeallavailablefundingstreams
◆ Policyandsystemslevelschange
◆ Coordinatedcity-wideefforts
◆ Inclusionofcommunityperspective
“All San Francisco children are caries-free”
Vision
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Three-year Indicators:
Toguideoureffortsandevaluateoursuccesswehavedevelopedthefollowingtargets
Caries Experience1. Reducethepercentageofkindergartnerswithdentalcariesexperiencefrom37%in
2012to27%in2017
Untreated Decay2. Reducethepercentageofkindergartnerswithuntreateddentaldecayfrom16%in
2012to8%in2017
Caries Disparities3. ReducethegapbetweenChinese,BlackandHispanic/Latinokindergartners
andWhitekindergartenerswithrespecttoriskofcariesexperiencefroma20percentagepointdifferencein2012toa15percentagepointdifferencein2017, arelativereductionof25%.
Access4. IncreasethepercentageofchildrenonMedi-Calunderage10whoreceivedany
dentalservicebilledtoDenti-Calduringthepastyearbyabsoluteincreaseof10%*
5. IncreasethepercentageofchildrenonMedi-Calwhohaveseenadentalproviderbyage1,byanabsoluteincreaseof10%.
6. IncreasethepercentageofwomenonMedi-Calthathadadentalvisitduringpregnancybyanabsoluteincreaseof20%
Dental Sealants7. Increasethepercentageoflow-incomechildreninSanFranciscoUnifiedSchool
District(SFUSD)aged7-8yearsoldwhohavereceiveddentalsealantsontheirpermanentmolarteethbyanabsoluteincreaseof10%.(InSchoolYear2012–2013,sealantsappliedon248secondgraders.)
*BecauseDenti-CalcurrentlydoesnotdifferentiatepreventivefromrestorativeservicesprovidedbyFQHCs,abaselineforutilizingdentalcareforpreventiveservicescannotbeestablished.Inthefuture,wewouldliketobeabletousepreventivedentalservicesasanindicator.
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Overarching Strategies:
Toaccomplishtheseobjectives,wehaveidentifiedthe followingfivemajorstrategies:
1. Access IncreaseaccesstooralhealthcareservicesforSanFrancisco childrenandpregnantwomen
2. Integration Integrateoralhealthwithoverallhealth
3. Promotion Increaseawarenessandpracticeofoptimalchildren’soralhealthbehaviorsamongdiversecommunitiesinSanFrancisco
4. EvaluationDevelopandestablishanongoingoralhealthpopulationbasedsurveillancesystemtoaddresstheoralhealthofSanFranciscochildren
5. CoordinationProvidecoordinationandoversightfortheimplementationof the Strategic Plan
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Tactics:1. Establish a sustainable funding stream.Developafeasiblemechanismfor
providerstobillDenti-Calfordentalcaredeliveredoutsideofthetraditionaldentaloffice/clinicsetting,anddisseminateaclearlyarticulatedprocesstoguidesafety-netdentalproviderscitywide.
2. Increase service delivery to settings children and families frequent such asSupplementalNutritionProgramforWomen,InfantsandChildren(WIC),HeadStartandEarlyHeadStartsites.Provideoralhealthscreenings,parent/caregivereducation,fluoridevarnish,casemanagement,referralstodentalcare.
Strategy 1:
ACCESS
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Increase access to oral health care services for San Francisco children and pregnant women.Byestablishingasustainablefundingstream,expandingservicedeliveryintosettingschildrenfrequent,increasingthenumberofsafetynetdentalprovidersservinglow-incomechildren,andexpandingcasemanagement,wewillsignificantlyexpandchildren’sandpregnantwomen’saccesstodentalservices.
Strategy 1:
Access
“Itookmy3yearoldsontotheoralhealthscreeningatWIC.Itwasagreatexperience,welearnedaboutnutritionandcorrectbrushing.HavingdentalservicesavailableatWICmakesallthedifferenceinbeingabletogetthisinformationanddentalcareforsomanyparents!”
LillianaCazares,motherof3yearoldEthan
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3. Expand the oral health program at SFUSD. IncreasethenumberofSanFranciscoUnifiedSchoolDistrict(SFUSD)elementaryschoolsservedbytheSFDPHsealantprogramfrom9schoolsto12-15schools,andadd5thgradetotheprogram;expandthekindergartenscreeningprogramtoincludepre-K,andaddfluoridevarnishapplicationstotheprogram.
4. Expand safety net dental provider capacity to serve low-income young children and pregnant women.Trainandeducatefutureandcurrentdentalprovidersandtheirsupportstafftoservechildren0-3yearsoldandpregnantwomen;trainsafetynetdentalprogramsonportable,school-basedhealthortele-healthmodalities;andexplorepartnershipswithFederallyQualifiedHealthCenters(FQHCs)thatwouldallowhigherreimbursementsforprivatedentalproviders.
5. Expand Case Management. Increasecasemanagement for childrenwithdentaltreatmentneedsatSFUSD,pre-schools/HeadStart,WIC,aswellasthroughtheChildHealth & Disability Prevention(CHDP)program.
“Itookmy3yearoldsontotheoralhealthscreeningatWIC.Itwasagreatexperience,welearnedaboutnutritionandcorrectbrushing.HavingdentalservicesavailableatWICmakesallthedifferenceinbeingabletogetthisinformationanddentalcareforsomanyparents!”
LillianaCazares,motherof3yearoldEthan
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Strategy 1:
ACCESSStrategy 2:
Integration
Tactics: 1. Institute fluoride varnish applications and oral health education in well child
pediatric visits and immunizations, withincommunityclinicsandprivatemedicalofficestargetingunderservedneighborhoods.
2. Standardize Electronic Medical Records (EMR). IncludeoralhealthquestionsandmanagementofdentalreferralsintheEMRsystemusedinmedicalofficesandclinicsthroughoutSanFrancisco.
3. Incorporate oral health care for children more prominently into the Managed Care Health PlansincludingAnthemBlueCrossandSanFranciscoHealthPlan(SFHP)programs.Includeincentives(i.e.,giftcards)forfamiliesthatreceivefluoridevarnishandoralhealthassessmentsandeducationforchildrenandpregnantwomen;incorporateoralhealthintoPracticeImprovementProjecttrainingforpediatriciansandnurses;andconsiderinstitutingreimbursementforfluoridevarnish.
Integrate oral health with overall health.Byintegratingoralhealthpromotionandservicesintoprimarycarewellchildandpre-natalvisits,pregnantwomenandchildrenaremuchmorelikelytoreceiveeffectiveoralhealthpreventioninformation andservicesatatimewhentheycanbemosteffective.Thisplancallsforsystem-widechangesaswellaseducationandtrainingofmedicalproviderstosignificantlyexpandthispromisingpractice.
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4. Provide trainings and resources to medical providers (MDs, PHNs, CMAs, RNs, CNMs, etc.) andancillarysupportstaffinmedicalofficesandclinics(behaviorists,nutritionists,RNs,socialworkers,CHW,healtheducators,etc.)tounderstandtheimportanceoforalhealth,andtoincorporateoralhealthassessment,referralandapplicationoffluoridevarnishintoallpatientcaresettingswherechildren’shealthandprenatalcareisaddressed.Providetrainingsatregularpediatricmedicalmeetingsandgrandrounds;promoteexistingtrainingresourcesonlineonprofessionalhealthorganizationwebsites(i.e.,SocietyfortheTeachersofFamilyMedicine,SmilesforLifecurriculum);developdetailedprotocolstoguideimplementationoforalhealthscreeningsandfluoridevarnishindifferentsettings;andincorporateoralhealthintonursingandmedicaleducationandresidencytrainingprograms.
“AtKaiserPermanenteweareimplementingoralhealthskillsintoourroutinewellcarevisitsevenbeforethefirsttootherupts.Bybeingabridgetoestablishingadentalhome,wehopewecanofferouryoungmembersmanyyearsofbeautifulsmilesandoverallgoodhealth!”
CeciliaGonzalez,MD,SanFranciscoKaiserPediatrics
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Strategy 3:
Promotion
Tactics:1. Coordinate oral health education citywide. Supportandexpandtheefforts
oftheSanFranciscoChildren’sDentalHealthCommittee,whichcoordinatesdentalhealtheducationanddentalhealthfairsinSanFrancisco.MapcurrentservicesandeducationinSanFranciscoandidentifygapsinoutreach.
2. Integrate oral health promotion into overall health promotion. IntegrateoralhealthintootherDPHhealthpromotionefforts.Includeothercitydepartmentsthattargetyouththroughdedicatedoralhealthstaff.Joinexistingsocialmarketinghealthcampaignsandreachouttocommunitylayhealthworkerprograms.
Increase awareness and practice of optimal children’s oral health behaviors among diverse communities in San Francisco. While avarietyoforalhealthpromotioneffortsexistinSanFrancisco,theireffectivenesswillbemagnifiedthroughcoordination,consistentmessaging,integrationintootherhealthefforts,aswellasensuringthatinformationiscreated,targetedanddeliveredinculturallyappropriateways.
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3. Develop and include consistent, culturally relevant messaging of appropriate healthliteracylevelsaimedtowardhealth-promotingbehaviorchangeinalleducationefforts.
4. Organize and mobilize most-impacted communities to develop and implement culturally specific oral health education campaigns relevant to their neighborhoods.Determineoralhealtheducationcontent,developstrategiestoreachneighborhoodresidents,identifykeymessengers,anddeterminehowtoleverageexistingresources.Prioritizeandtargetoralhealthpromotioneffortsatlocationsparents/caregiversofchildren0-5andpregnantwomenfrequent,suchasfoodbanks,backtoschoolnights,andWICclinics.
“Ourdentalclinicacceptstheveryyoungchildforearlydentalvisits;toeducatetheparents,andprovidepreventivecareforthebaby.Manynewimmigrantparentsdonotknowabouttheimportanceofbabyteethandgoodoralhealth,andwaituntiltheirchildis3forthefirstdentalvisit.Bythattime,thechildmayalreadyhaveseveretoothdecay.”
CordeliaAchuck,DDS,NorthEastMedicalServicesDentalDirector
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Strategy 4:
Evaluation
Tactics: 1. Increase infrastructure at DPH and SFUSD for data collection, analysis, and
dissemination. Secureadditionalpersonnelanddedicatedtime;establishacommitteethatincludesanepidemiologistfromtheSFDPHandexternalmemberswithexpertiseinoralepidemiology,biostatistics,andprogramevaluation.
2. Identify and prioritize oral health status indicators to be assessed, frequency of collection, and population groups to be assessed in support of the Strategic Plan. Identifyandassessexistingoralhealthdatasourcesfordesiredinformationonspecificpopulations;identifyanddevelopdatasurveillancesystemsfordesiredpopulationsnotcurrentlyassessedfororalhealthstatuswheredesirableandpracticaltodoso,particularlyinsupportoftheinitiativesrecommendedthroughouttheStrategicPlan.
Develop and establish an ongoing oral health population-based surveillance system to address the oral health of San Francisco children. Regularandsystematicdatacollectiontomonitorandevaluatechildren’soralhealthoutcomes,associateddisparities,andprogressovertimeiscriticaltostakeholders,programplanners,andpolicymakers.Increasedcapacityforthisactivitywillensurethedevelopmentofresources,qualityimprovementandsustainabilityofcity-wideoralhealthservicesthatadvancetheoverallgoalsoftheStrategicPlan.
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3. Coordinate efforts to identify and obtain the resources needed for ongoing data collection and analysis. Developmechanismsanddatasharingagreementsforregularcollectionofdataacrossinstitutions;reviewprogressatleastannually.
4. Document and disseminate annual reports to key stakeholders to build understanding of importance of oral health and inform intervention development and program planning. KeystakeholderstoincludeSFDPH,SFUSD,dentalandmedicalproviders,communitypartnersandcitywidepolicymakersanddecisionmakers.
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“WhenIlookinachild’smouthduringaroutineexamandfindextensivedecay,itsaddensmetoknowthattheselittleoneshavelearnedtolivewithsomuchdiseaseanddiscomfortforyearsandnoonehastakencareofit.Ihavefoundthatdiscussingoralhealthwiththesamedegreeofimportasothermedicalissuesduringvisitshelpsteachparentshowsignificantthisaspectoftheirchild’swellnessis.”
ZeyaMalawa,MD,BayviewChildHealthCenter
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Strategy 5:
Coordination
Tactics:1. Identify and establish a committee that will provide oversight of the
implementation, prioritization, and quality assurance of the Strategic Plan. Establishacommitteetodirectandmonitorprogressineachstrategicpriorityarea;developprocessforregularmonitoringandevaluationofStrategicPlanimplementation;facilitatecollaboration,coordination,andcommunicationamongstakeholders.
2. Develop workgroups for each of the strategies to enact the implementation of its tactics. Identifyachairpersontoleadeachworkgroup;determinepriorityandimplementationstepsforeachtactic;check-inmonthlywiththeoversight/coordinatingcommittee.
3. Increase infrastructure and staffing at SF DPH to support the coordination of the implementation of the Strategic Plan.Thisstaffpersonwouldberesponsibleforcoordinatingmeetings;communicatingwiththeSanFranciscoHealthCommission,communitystakeholdersandDPHadministration;anddisseminatingreports.
Provide coordination and oversight for the implementation of the Strategic Plan. InordertoensurethattheStrategicPlanisimplementedandresultsinrealchangeintheoralhealthof SanFranciscochildren,abodyofcommittedstakeholdersisneededtoprovideoverallguidanceandoversight.Havingworkgroupswillhelpmoveforwardthevariousstrategies andtacticsdetailedintheStrategicPlan.
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STRATEGICPLANNINGSTEERINGCOMMITTEE
Steven Ambrose,DDS, SanFranciscoDepartmentofPublic Health
Tomás Aragón,MD,DrPH, SanFranciscoDepartmentofPublic Health
Carolyn Brown,DDS, SanFranciscoCommunityClinicConsortium
Curtis Chan,MD,MPH, SanFranciscoDepartmentofPublic Health
Lisa Chung,DDS,MPH,UniversityofCalifornia, SanFrancisco
Kim Coates,MA, SanFranciscoUnifiedSchoolDistrict
Deborah Elam,MS,CAE, SanFranciscoDentalSociety
Margaret Fisher, RDHAP,BS, SanFranciscoDepartmentofPublic Health
Susan Fisher-Owens, MD,MPH,UniversityofCalifornia,SanFrancisco;SanFranciscoDepartment of Public Health
Catherine Fuller, RN, MSN,FNP, SanFranciscoUnifiedSchoolDistrict
Stuart Gansky,MS,DrPH,UniversityofCalifornia, SanFrancisco
Cecilia Gonzalez, MD, Kaiser Permanente SanFrancisco
Kevin Grumbach,MD, UniversityofCalifornia, SanFrancisco
Irene Hilton,DDS,MPH, SanFranciscoDepartmentofPublic Health
Mary Jue,MSN,RN,PHN, SanFranciscoUnifiedSchoolDistrict
Christine Miller,RDH,MHS,MA,UniversityofthePacific
Marcellina Ogbu,DrPH, SanFranciscoDepartmentofPublic Health
Sharon Rose,MPH, UniversityofCalifornia, SanFrancisco
Jaime Ruiz,MD, MissionNeighborhood Health Center
Amor Santiago,DPM,MPH,AsianPacificIslandersHealthParityCoalition
Claire Sit,RDH,BS, SanFranciscoDepartmentofPublic Health
Appendices:
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STRATEGICPLANNINGWORKGROUPS
ACCESSChair: Carolyn Brown,DDS, SanFranciscoCommunityClinicConsortium
Cordelia Achuck,DDS, NorthEastMedicalServices
Andrea Almario, RDH, South of Market Health Center
Steven Ambrose,DDS, SanFranciscoDepartmentof Public Health
Curtis Chan, MD,MPH, SanFranciscoDepartmentof Public Health
Deborah Elam,MS,CAE, SanFranciscoDentalSociety
Jared Fine,DDS,MPH,AlamedaCounty Public Health Department
Catherine Fuller, RN,MSN,FNP, SanFranciscoUnifiedSchoolDistrict
Paul Glassman, DDS,MA,MBA,UniversityofthePacific
Nancy Kwon Hsieh,DDS,MS,CaliforniaSocietyofPediatricDentistry
Magdalena Louie,MS,RD, SanFranciscoDepartmentof Public Health
Walter Lucio,DDS,MPH, Delta Dental
Maryna Pechereska, MPH, MissionHeadStart/EarlyHeadStart
Steven Silverstein,DMD,MPH,UniversityofCalifornia, SanFrancisco
INTEGRATIONChair: Susan Fisher-Owens,MD,MPH,UniversityofCalifornia,SanFrancisco;SanFranciscoDepartment of Public Health
Jennifer Do, MD,SutterHealth
Sean Dongre, AB,SanFranciscoHealthPlan
Margaret Fisher, RDHAP,BS, SanFranciscoDepartmentof Public Health
Fernando Gomez-Benitez, MissionNeighborhoodHealthCenter
Cecilia Gonzalez, MD,KaiserPermanenteSanFrancisco
Kevin Grumbach,MD, UniversityofCalifornia,SanFrancisco
Irene Hilton, DDS,MPH,SanFranciscoDepartmentofPublic Health
Jeanne Lee,MD,MPH,SanFranciscoDepartmentofPublic Health
Christine Pecci, MD, UniversityofCalifornia,SanFrancisco;SanFranciscoDepartment of Public Health
Jessenya Ramirez-Sacasa,SutterHealth
Kenneth Tai, MD,NorthEastMedicalServices
PROMOTIONChair: Amor Santiago,DPM,MPH,E.D.,AsianPacificIslandersHealthParityCoalition
Bahar Amanzadeh,DDS,MPH,UniversityofCalifornia, SanFrancisco
Derick Aoki, MPH, First5SanFrancisco-Children andFamiliesCommission
Judith Barker, PhD,MA,MSc,UniversityofCalifornia, SanFrancisco
Vanessa Bohm,MA,CARECEN
Kristin Hoeft,MPH, UniversityofCalifornia, SanFrancisco
Gabrielle Jones, MA,MPH, NationalChildren’sOralHealthFoundation
Sharon Rose,MPH, UniversityofCalifornia, SanFrancisco
Gisselle Rullier,RDH, SanFranciscoDentalHygieneSociety
Marianne Szeto,MPH, SanFranciscoDepartmentof Public Health
EvALUATION&COORDINATIONChair: Stuart Gansky, MS,DrPH,UniversityofCalifornia, SanFrancisco
Lisa Chung,DDS,MPH,UniversityofCalifornia,SanFrancisco
Robert Isman,DDS,MPH,CaliforniaDepartmentofHealthCareServices
Mary Jue, MSN,RN,PHN, SanFranciscoUnifiedSchoolDistrict Christine Miller, RDH,MHS,MA,UniversityofthePacific
Claire Sit,RDH, SanFranciscoDepartmentof Public Health
Jodi Stookey, PhD, SanFranciscoDepartmentof Public Health
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STRATEGICPLANNINGRETREATPARTICIPANTSMiriam Abrams, MiriamAbramsandAssociates
Cordelia Achuck,DDS, NorthEastMedicalServices
Andrea Almario, RDH, South of Market Health Center
Bahar Amanzadeh, DDS,MPH,UniversityofCalifornia, SanFrancisco
Steven Ambrose, DDS, SanFranciscoDepartmentof Public Health
Derik Aoki, MPH, First5SanFrancisco–Children andFamiliesCommission
Tomás Aragón,MD,DrPH, SanFranciscoDepartmentof Public Health
Judith Barker, PhD,MA,MSc,UniversityofCalifornia, SanFrancisco
Lynda Boyer-Chu, RN,MPH, SanFranciscoUnifiedSchoolDistrict
Nina Boyle,SupportforFamilies ofChildrenwithDisabilities
Carolyn Brown, DDS, SanFranciscoCommunity ClinicConsortium
Jean Calvo,DDScandidate,UniversityofCalifornia, SanFrancisco
Curtis Chan,MD,MPH, SanFranciscoDepartmentof Public Health
Justin Chu,BS,CDIHeadStart
Lisa Chung, DDS,MPH,UniversityofCalifornia,SanFrancisco
Kim Coates,MA, SanFranciscoUnifiedSchoolDistrict
Greg Cutcher, MS,RN,PHN, SanFranciscoDepartmentof Public Health
Mylene Deano,RDA, South of Market Health Center
Jennifer Do, MD,SutterHealth
Fanny Duong Wool, WuYeeChildren’sServices
Deborah Elam, MS,CAE, SanFranciscoDentalSociety
Patricia Erwin,MPH, SanFranciscoDepartmentof Public Health
Jane Evans, BSN,RN,PHN, SanFranciscoDepartmentof Public Health
Gemma Ferrer, DMD, South of Market Health Center
Jared Fine, DDS,MPH,AlamedaCounty Public Health Department
Margaret Fisher,RDHAP,BS, SanFranciscoDepartmentof Public Health
Susan Fisher-Owens, MD,MPH,UniversityofCalifornia,SanFrancisco,SanFranciscoDepartment of Public Health
Paula Fleisher,MA,University ofCalifornia,SanFrancisco
Catherine Fuller, RN,MSN,FNP, SanFranciscoUnifiedSchoolDistrict
Stuart Gansky,MS,DrPH,UniversityofCalifornia, SanFrancisco
Paul Glassman,DDS,MA,MBA,UniversityofthePacific
Cecilia Gonzalez,MD, Kaiser Permanente
Jolie Goodman,DDScandidate,UniversityofCalifornia, SanFrancisco
Kevin Grumbach, MD, UniversityofCalifornia, SanFrancisco
Hali Hammer, MD, UniversityofCalifornia, SanFrancisco,SanFranciscoDepartment of Public Health
Mary Hansel, BS,MPH,DrPH, SanFranciscoDepartmentof Public Health
Irene Hilton, DDS,MPH, SanFranciscoDepartmentof Public Health
Kristin Hoeft, MPH,UniversityofCalifornia,SanFrancisco
Nancy Kwon Hsieh, DDS,MS,CaliforniaSocietyofPediatricDentistry
Robert Isman, DDS,MPH,CaliforniaDepartmentofHealthCareServices
Anna Jaffe,StanfordUniversity
Gabrielle Jones,MA,MPH, NationalChildren’sOralHealthFund
Mary Jue, MSN,RN,PHN, SanFranciscoUnifiedSchoolDistrict
Thuan Le,DDS,PhD, UniversityofCalifornia, SanFrancisco
Jeanne Lee, MD,MPH, SanFranciscoDepartmentof Public Health
Brent Lin, DMD, UniversityofCalifornia, SanFrancisco
Katrina Liu, MD, NorthEastMedicalServices
Wylie Liu,MPH,MPA, UniversityofCalifornia, SanFrancisco
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Magdalene Louie, MS,RD, SanFranciscoDepartmentof Public Health
Walter Lucio,DDS,MPH, Delta Dental
Ursula Maberley,RDH,MS, SanFranciscoDentalHygieneSociety
Christine Miller, RDH,MHS,MA,UniversityofthePacific
Adrian Nunez, SanFranciscoHealthPlan
Marcellina Ogbu, DrPH, SanFranciscoDepartmentof Public Health
Christine Pecci, MD, UniversityofCalifornia, SanFrancisco;SanFranciscoDepartment of Public Health
Maryna Pechereska,MPH, MissionHeadStart/EarlyHeadStart
Karen Pierce, JD, SanFranciscoDepartmentof Public Health
Randy Quezada,MPP, OfficeofEconomicandWorkforceDevelopment
Sharon Rose,MPH, UniversityofCalifornia, SanFrancisco
James Rouse Iniguez, MA,UniversityofCalifornia, SanFrancisco
Amor Santiago, DPM,MPH,ED,AsianPacificIslandersHealthParityCoalition
Carol Schulte, MSW,LCSW, SanFranciscoDepartmentof Public Health
Steven Silverstein,DMD,MPH,UniversityofCalifornia, SanFrancisco
Claire Sit, RDH, SanFranciscoDepartmentof Public Health
Jodi Stookey,PhD, SanFranciscoDepartmentof Public Health
Joel Streiker, PhD,CARECEN
Marianne Szeto, MPH, SanFranciscoDepartmentof Public Health
Kenneth Tai,MD,NorthEastMedicalServices
Sharine Thenard, DDS,MS,AlamedaPediatricDentistry
Gloria Thornton, AnthemBlueCross
Roberto Vargas,MPH,UniversityofCalifornia, SanFrancisco
Linda Wilson, MPA KaiMingHeadStart
Allen Wong, DDS, SFDS
Yuaner Wu,RN,PHN,PhDN,UniversityofCalifornia, SanFrancisco
Simona Zompi, MD,MPH,Immunology&GlobalHealthConsulting
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Glossary of Terms Affordable Care Act (ACA):Legislation,includingthePatientProtectionandAffordableCareAct(P.L.111-148)andtheHealthCareandEducationReconciliationActof2010(P.L.111-152),thatexpandsMedicaidcoveragetomillionsoflow-incomeAmericansandmakesnumerousimprovementstobothMedicaidandtheChildren’sHealthInsuranceProgram(CHIP).
Best Practice:Thebestclinicaloradministrativepracticeorapproachatthemoment,giventhesituation,thepatient’sorcommunity’sneedsanddesires,theevidenceaboutwhatworksforthissituation/need/desire,andtheresourcesavailable.
Caries (tooth decay or cavities): Amultifactorialinfectiousdiseasethatresultsinthedestructionofthetoothstructurebydemineralizationandultimatelycavitationofthetoothsurfaceifleftuntreated.Itisthemostcommonchronicchildhooddisease,andyethighlypreventable.
Caries experience:anycurrentorpastdentalcariesasdefinedbyhavingatleastonedecayed,extracted,orfilledtoothduetocaries.
Case Management: Acollaborativeprocessofassessment,planning,facilitation,carecoordination,evaluation,andadvocacyforoptionsandservicestomeetanindividual’sandfamily’scomprehensivehealthneedsthroughcommunicationandavailableresourcestopromotequality,cost-effectiveoutcomes.
Certified Medical Assistants (CMA):Multi-skilledpractitionerswhoassumeawiderangeofadministrativeandclinicaldutiesinphysicians’officesandotherhealthcaresettings.
Certified Nurse Midwife (CNM):Registerednursewithatleastamaster’sdegreeinnursingandadvancededucationinthemanagementoftheentirematernitycycle
Early Childhood Caries (ECC): Anyprimarytoothinachildunder6yearsoldthatisaffected by caries
Federally Qualified Health Centers (FQHCs): AllorganizationsreceivinggrantsunderSection330ofthePublicHealthServiceAct(PHS).FQHCsqualifyforenhancedreimbursementfromMedicareandMedicaid,aswellasotherbenefits.FQHCsmustserveanunderservedareaorpopulation,offeraslidingfeescale,providecomprehensiveservices,haveanongoingqualityassuranceprogram,andhaveagoverningboardofdirectors.
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Fluoride varnish (FV): Athincoatingoffluoridethatisappliedtotoothsurfacesinordertopreventorstopdecay.Ithasbeenproveneffectiveininfantsandchildrenwithhighriskofdecay.
Healthy People 2020: Thefederalgovernment’spreventionagendaforbuildingahealthiernation.Itisastatementofnationalhealthobjectivesdesignedtoidentifythemostsignificantpreventablethreatstohealthandtoestablishnationalgoalstoreducethesethreats.TheoverarchinggoalsofHealthyPeople2020areto:attainhigh-quality,longerlivesfreeofpreventabledisease,disability,injury,andprematuredeath;achievehealthequity,eliminatedisparities,andimprovethehealthofallgroups;createsocialandphysicalenvironmentsthatpromotegoodhealthforall;andpromotequalityoflife,healthydevelopment,andhealthybehaviorsacrossalllifestages.
Head Start:HeadStartisafederalprogramthatpromotestheschoolreadinessofchildrenagesbirthto5fromlow-incomefamiliesbyenhancingtheircognitive,socialandemotionaldevelopment.Inadditiontoeducationservices,programsprovidechildrenandtheirfamilieswithhealth,nutrition,social,andotherservices.
Indicator: aquantitativeorqualitativeexpressionofaprogramorpolicythatoffersaconsistentwaytomeasureprogresstowardthestatedtargetsandgoals.Thedatawewillmeasuretodetermineifwehaveachievedourresult
Managed Care Plans: Managedcareplansareatypeofhealthinsurance.Theyhavecontractswithhealthcareprovidersandmedicalfacilitiestoprovidecareformembersatreducedcosts.
National School Lunch Program (NSLP): afederallyassistedmealprogramoperatinginpublicandnonprofitprivateschoolsandresidentialchildcareinstitutions.Itprovidesnutritionallybalanced,low-costorfreelunchestoeligiblechildreneachschoolday.Becauseincomeeligibilityisarequirement,thepercentageofchildrenwhoqualifyforNSLPor“freeand/orreduced”lunchprogramservesasaproxyforincomelevelofaschool.
Obstetrics & Gynecology (OB/GYN): OBforobstetricsorforanobstetrician,aphysicianwhodeliversbabies.GYNforgynecologyorforagynecologist,aphysicianwhospecializesintreatingdiseasesofthefemalereproductiveorgans.
Outcomes: Theresultsofimplementingtheplan,asexperiencedbythepopulation.
Public Health Nurse (PHN): Publichealthnursesintegratecommunityinvolvementandknowledgeabouttheentirepopulationwithpersonal,clinicalunderstandingsofthehealthandillnessexperiencesofindividualsandfamilieswithinthepopulation.
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Safety Net: Individualsandorganizationsthatprovidehealthcaretolow-incomeandothervulnerablepopulations,includingtheuninsuredandthosecoveredbypublicinsurancesuchasMedicaid.
Sealants:Aresinmaterialappliedtothechewingsurfacesofmolarandpremolarteethtopreventcaries.
Strategy: Acarefullydesignedoralhealthplanofactionforobtainingaspecificgoaloroutcome. Tactic:Anactionimplementedasoneormorespecifictasksforcarryingoutastrategy
Women, Infants and Children (WIC):TheSpecialSupplementalNutritionProgramforWomen,Infants,andChildren(WIC)providesFederalgrantstoStatesforsupplementalfoods,healthcarereferrals,andnutritioneducationforlow-incomepregnant,breastfeeding,andnon-breastfeedingpostpartumwomen,andtoinfantsandchildrenuptoagefivewhoarefoundtobeatnutritionalrisk.
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References Ahovou-Saloranta,A.,Forss,H.,Walsh,T.,Hiiri,A.Nordblad,A.Makela,M.&Worhtington,H.v.(2013).Sealantsforpreventingdentaldecayinthepermanentteeth.CochraneDatabaseofSystematicReviews.
CaliforniaHealthcareFoundation.(2009).EmergencyDepartmentvisitsforPreventableDentalConditionsinCalifornia.Oakland,CA:CaliforniaHealthcareFoundation.Retrievedfrom http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/D/PDF%20DentalCountySupplement.pdf.
CaliforniaMedi-CalDental.(2013,August).RestorationofSomeAdultDentalServicesin2014. Denti-CalBulletin.
CentersforDiseaseControlandPrevention(CDC).DivisionofOralHealth,NationalCenterforChronicDiseasePreventionandHealthPromotion.(2013).PreventingDentalCarieswithCommunityProgramsFactSheet.Atlanta,GA.Retrievedfrom http://www.cdc.gov/oralhealth/publications/factsheets/dental_caries.htm.
CentersforDiseaseControlandPrevention(CDC).NationalCenterforHealthStatistics(NCHS).(2010).NationalHealthandNutritionExaminationSurveyData,2009-2010.Hyattsville,MD:U.S.DepartmentofHealthandHumanServices,CDC.Retrievedfrom http://wwwn.cdc.gov/nchs/nhanes/search/nhanes09_10.aspx.
ChildrenNow.(2013)[Infographic,interactivemapofmixed2013data].Denti-CaldentistsbyCACounties.Retrievedfromhttp://www.childrennow.org/index.php/learn/infographic-counties-denti-cal.
Glassman,P.&Harrington,M.(2013)ThevirtualDentalHome:Improvingtheoralhealthofvulnerableandunderservedpopulationsusinggeographicallydistributedtelehealth-enabledteams.SanFrancisco,CA:UniversityofthePacific,ArthurA.DugoniSchoolofDentistry.
HiltonIv,StephenS,BarkerJC,Weintraub.(2007).Culturalfactorsandchildren’soralhealthcare:aqualitativestudyofcarersofyoungchildren.CommunityDentistryandOralEpidemiology.35:429–438
Kelly,S.E.,Binkley,C.J.,Neace,W.P.,&Gale,B.S.(2005).BarrierstoCare-SeekingforChildren’sOralHealthAmongLow-IncomeCaregivers.AmericanJournalofPublicHealth,95(8):1345-1351.
Marinhov.C.,Higgins,J.P.,Logan,S.,&Sheiham,A.(2002).Fluoridevarnishesforpreventingdentalcariesinchildrenandadolescents.CochraneDatabaseofSystematicReviews.(3).
Mofidi,M.,Rozier,R.G.,&King,R.S.(2002)ProblemswithaccesstodentalcareforMedicaid-insuredchildren:Whatcaregiversthink.AmericanJournalofPublicHealth,92(1),53-58.
Pourat,N.&Nicholson,G.(2009).Unaffordabledentalcareislinkedtofrequentschoolabsences. HealthPolicyResearchBrief.LosAngeles,CA:UCLA.
Revels,M.&Holland,K.(2013).SystematicScreeningandAssessmentofWorkforceInnovationsintheProvisionofPreventiveOralHealthServices.Anniston,AL:SarrellDentalProgram.
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SanFranciscoUnifiedSchoolDistrict.(2013).DentalEncounters,Aug-Oct2013.SanFrancisco,CA:SFUSD.SFDPH-SFUSD-SFDSSanFranciscoKindergartenScreening,[SanFrancisco,2005-11](2013). PreparedbySFDPHMCAHEpidemiology.
Sierawan,H.,Faust,S.&Mulligan,R.(2012).Theimpactoforalhealthontheacademicperformanceofdisadvantagedchildren.AmericanJournalofPublicHealth.102(9):1729-34.
Terpak,C.H.,Yu,Z.Martin,K.Curtis,M.(2010,April).AmbulatorySurgeryofEarlyChildhoodCariesinCalifornia,2005.PosterpresentedatNationalOralHealthConference,Dallas,TX. http://www.cdph.ca.gov/programs/MCAHOralHealth/Documents/MO-OralHealthP-AmbulatorySurgery.pdf
ThomsonWM,PoultonR,MilneBJ,CaspiA,BroughtonJR,AyersKM.Socioeconomicinequalitiesinoralhealthinchildhoodandadulthoodinabirthcohort.CommunityDentistryandOralEpidemiology.2004;32(5):345-53.
U.S.DepartmentofHealthandHumanServices.(2013)KeepKidsSmiling:PromotingOralHealthThroughtheMedicaidBenefitforChildren&Adolescents.Washington,D.C.:USDHSS.
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Acknowledgments Writing and EditingMiriamAbramsLisaChungMargaretFisherKaraLugtuSharon RoseJodiStookey Publication AdvisorsStrategicPlanningSteeringCommittee Strategic Planning ConsultantMiriamAbrams,MiriamAbramsandAssociates Copy EditingJoshuaNossiterSanFranciscoDepartmentofPublicHealthMaternalChildandAdolescentHealthSection Graphic Design MikeOrtizCity&CountyofSanFrancisco ReproMail Funding for the Strategic Planning ProcessCalifornia Department of Public Health MettaFundTheUnitedWay
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Comments, questions, and requests for information can be directed to:
Lisa Chung, DDS,MPHDivisionofOralEpidemiology&DentalPublicHealthUniversityofCalifornia,SanFrancisco3333CaliforniaStreet,Suite495SanFrancisco,[email protected]
Margaret Fisher, RDHAP,BSChildHealth&DisabilityPrevention(CHDP)ProgramCityandCountyofSanFrancisco–DepartmentofPublicHealth30vanNessAvenue,Suite210SanFrancisco,[email protected]