School-Based Oral Health Programs Operated by Health Centers

Irene V. Hilton, DDS, MPH Dental Consultant National Network for Oral Health Access Karyl Patten, DDS, MPH Dental Director Whitefoord, Inc. November 24, 2014

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Objectives 1. Describe different school-based models for providing

dental services to underserved children.

2. List sources of start-up funding for school-based oral health programs

3. Summarize the major payer categories that cover the cost of providing school-based dental care in Health Centers.

4. Describe strategies to address common operational issues in school-based dental programs.

Background

Increase in Health Center inquiries

ACA support for school-based health centers

Strategy to reach vulnerable populations

Health Center School-Based Dental Programs Little is known

2011 UDS data- 280/1,128 (25%) Health Centers provide services in schools

National Association of School-Based Health Centers Survey- Health Centers run 33% of school clinics

Survey Results

Sample

280 Health Centers with SBHC Programs

62 Completed Surveys (22%)

29 States

All 10 HRSA Regions

76% Provide Medical and Dental Care

Dental Program Size

# Schools

• Average 12 sites

• Range 1-74 sites

• 64% 10 or fewer sites

Number Students Served

Children

• Average 1,900

• 61% 1,000 or fewer

• Two Health Centers 9,000+

Months Operation

57% 9/10 months

38% 11/12 months

Delivery Models Model % Health

Centers

Portable 41.9

Fixed Clinics

27.4

Mobile Vans

8.1

Multiple 22.6

27.4%

8.1%

41.9%

22.6%

Fixed Site Only

Mobile Van Only

Portable Only

Multiple Models

Dental Service % Health Centers Providing

Education 95%

RDH Screen Exam 53

DDS Exam 81

RDH Exam 27

Radiographs 64

Prophys 79

Sealants 81

Fluoride Varnish 89

General Care 53

Specialty Care 14

Percentage of Students Served, by Grade

Grade Range % of Students

Preschool 12.9

Elementary (grades K-5 ) 50.2

Middle (grades 6-8) 17.9

High (grades 9-12) 18.9

Other 0.1

Payers

Focus Group Recommendations

Staring a School-Based Program

Assume management of existing school-based oral health programs in the local community- local charities, hospitals, or school districts

• Billing infrastructure, economies of scale

• PPS rate

Staring a School-Based Program

Contact local schools or school districts to assess interest in partnering to develop a school-based oral health program

Health Centers are approached to collaborate

Financing Start-up Expenses

When assuming control of an existing school-based oral health program, utilize existing equipment and other operating resources already present.

Financing Start-up Expenses

Grants

• HRSA

• State offices of rural health

• State or county programs targeting children’s needs

• City or county health department

• Local school districts

• Local foundations and other private grants

Enrolling Students

Implement at the beginning of the school year.

Include information about oral health services and consent forms with materials given to families when enrolling or registering children for new school year.

Back-to-school nights and parent orientations.

Enrolling Students

Continue enrollment during school year where program staff interact with parents.

• Registrar’s office

• Parents dropping children off morning

• School sports events

• Major school events

• PTA meetings

• Parent-teacher nights.

Obtaining Consent

Combine consent for all types of services-primary care, oral health, vision, and behavioral health, on one form.

Use outreach coordinators to increase program enrollment and manage relationships.

Incentive programs- reward classroom returning most enrollment/consent forms.

Obtaining Consent Traveling Programs

Distribute consent packets at the beginning of school year and then follow up with a second batch at schools scheduled for spring

Distribute consent forms 2-6 weeks before the traveling program’s visit , sending packets home with “backpack mail”

Operating During Non-School Hours/Months

Move mobile vans or portable equipment to other community locations

• HC sites that do not offer oral health services

• Head Start sites, migrant worker facilities

• Homeless shelters, nursing homes

• State division of youth services residential facilities

Referrals & Care Coordination Prevention-Only Programs

Send letters to parents of children that need restorative care and follow up with calls to the parents by program staff.

Schedule students needing restorative care into the main Health Center dental schedule through a shared HIT appointment system.

Referrals & Care Coordination Fixed Programs

Goal of minimizing referrals

• Important in rural schools, high schools

Oral surgery, endodontics, and pediatric behavior management most common

Recordkeeping & Billing

Bill at the time of service in programs where the school-based dental software and the main Health Center billing system are integrated.

Recordkeeping & Billing

Programs with dental software that does not interface with the main Health Center billing system

• Paper encounter form sent to the main Health Center for manual entry

• Encounter data sent electronically to the main Health Center for re-entry into the billing system.

Community Challenges

Pushback from local dentists

• Does not appear to be a barrier to program functionality at the local level.

• Felt private-sector dentists need education that school-based program target students not receiving services in private dental practices.

“The Future is Very Bright” Several plan to double the number of schools

& increase the number of school districts

Programs continue to receive requests from other school districts to provide oral health services for their students.

Programs plan to expand the scope of services offered and/or to incorporate services for adults.

Whitefoord Inc.

Whitefoord Elementary School

Coan Middle School

Maynard Jackson High School

Crim High School

Karyl C. Patten, DDS, MPH

Dental Director

Assistant Professor Emory University

School Based Description

• Number of schools: 4

• Number of children: 1,323

• Type of program: Fixed Clinic

• Grades served: Pre-school through HS, adults

• Open: Year round

• Services: Full scope of service

How the Program Started….

the Vision

In 1995, Dr. George Brumley and his former

student, Dr. Veda Johnson, established

Whitefoord, Inc. to address the health and

educational needs of children and families of

the Whitefoord Elementary School District in

southeast Atlanta

Partners

• United Way of Metro Atlanta

• Best Buy Foundation

• Bright From the Start

• Fulton County “Fresh”

• Health Resources and

Service Administration

• Georgia Department of Health

and Human Services

• The Georgia Association For

Primary Health Care

• Zeist Foundation

• National Association for the

Education of Young Children

• Georgia State University

• School-Based Health Alliance

• Emory University

• Chris Kids

• Atlanta Public School

• National Association of

Community Health Centers

• Atlanta Speech School

Funding Capital Equipment and/or

Clinic Build-out Expenses

School Grants

Federal Grants-HRSA 95%

In-kind Donations- (architect, desks, etc.)

Clinic Protocols • Consent process:

School registration, screening, PTA

• Clinical chart documentation process:

Open Dental (eClinical Works)

• Referral process:

FQHC and private providers

• After/non-school hours emergency resource:

Grady Hospital

• Interdisciplinary collaboration:

Primary care clinic-on site

Finances • Bill for services:

Billing company

• Receive FQHC rate:

YES

• Billing documentation:

Bill at the time of service through eCW

• Payer mix?

Private insurance, sliding fee, Medicaid

95%

• School- based program financial status:

Revenue neutral

Strategies for Success

• Open year round

• Families like to come because ALL their

health needs are met

• Continuity of care is strategic

• People trust us because we care and it

shows

Challenges

• Consent forms

• Contact numbers

• Combining medical and dental in electronic health record

• Clinical space development

• APS undergoing changes

Future

• Redesigning work space for oral health

patients

• Continue to develop and enhance student

training

• Embracing ACA…enrolling new patients in

clinic to making Whitefoord their patient

centered medical home. Engage current

stakeholders while cultivating new

stakeholders and collaborative!

Whitefoord Elementary Clinic

Patient Centered Health Home

Trauma

Esteem

Conclusions

Wide variety of delivery models

Main revenues from public insurance

Strategies exist for addressing implementation challenges

HC school-based oral health programs are community supported & successful

http://www.nnoha.org/nnoha-content/uploads/2014/07/SBHC-Report-FINAL_2014-07-28.pdf

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Contact Information Irene Hilton, DDS, MPH| Dental Consultant, NNOHA irene@nnoha.org Karyl Patten, DDS, MPH| Dental Director, Whitefoord, Inc. kcpatte@emory.edu National Network for Oral Health Access 181 E. 56th Ave, Suite 501 Denver, CO 80216 Phone: (303) 957-0635 www.nnoha.org

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