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Dental Public Health Activities: Descriptive Summaries

Tennessee School Based Dental Prevention Program (SBDPP)

Practice Number: 48006
Submitted By: Tennessee Department of Health, Oral Health Services
Submission Date: March 2009
Last Reviewed: August 2016
Last Updated: August 2016
Best Practice Approach Example Tennessee School Based Dental Prevention Program (SBDPP)
 

Tennessee’s School- Based Dental Prevention Program (SBDPP) is a statewide comprehensive preventive program that has been operational in its current design for 15 years.  It is contracted by our State’s TennCare program and provides services to eligible children for free.  TennCare is the state of Tennessee’s Medicaid program that provides health care for approximately 1.3 million Tennesseans and operates with an annual budget of approximately $10 billion.  TennCare members are primarily low-income pregnant women, children and individuals who are elderly or have a disability.  TennCare covers approximately 20 percent of the state’s population, 50 percent of the state’s births, and 50 percent of the state’s children.

Staffing consists of 77 licensed dentists and registered dental hygienists who are providing services.  The SBDPP is supported by an additional 14 clerical staff. 

The program aims to reach high-risk children from low income families who have reduced access to care.  Children in grades K – 8th in schools with 50% of the student population on free and reduced lunch programs are eligible to receive the SBDPP services regardless of economic status. 

Details for program implementation in each school and region vary.  Program’s core include component areas:

  • Oral Health Education
  • Dental Hygienist General Screening – Definition: oral screening performed by a registered dental hygienist to evaluate dental needs – sealant placement and dental referral need (s)
  • Dentist oral evaluation – Definition: oral evaluation performed by a licensed dentist to chart existing conditions and treatment need(s)
  • Sealant Application
  • Fluoride Varnish
  • Referral for Treatment
  • TennCare Outreach (Tennessee’s Medicaid program)

Production for Fiscal Year 2014/2015:

  • 118,590 dental screenings
  • 12,265 dental evaluations
  • 179,107 oral health education
  • 224,665 sealants placed on 41,213 children in 357 schools
  • 1,432 high priority children identified with unmet dental needs (a high priority child is any child with immediate dental needs such as abscess and rampant decay)
  • 633 direct contacts made by professional outreach workers with the Department of Health.

The Fiscal Year 2013-2014 SBDPP was funded by TennCare in the amount of $6,215,019.00.  

Coordinated School Health component areas are aligned with the Centers for Disease Control and Prevention’s (CDC) Whole School, Whole Community, Whole Child (WSCC) model.  Partnership with Coordinated School Health (CSH) in our target schools is a promising new partnership that can aid in maintaining and ensuring our presence in schools.

The need to have staff in isolated areas share programs, ideas, techniques has been recognized.  Regional meetings have been put in place to facilitate an exchange of best practices.  The opportunity to network face-to-face is invaluable.  As a result of better communication, programs are being shared from region-to-region.

Lessons Learned:

Lesson Learned – Dental hygienists in the schools were being limited by the dentist’s need to perform oral evaluations prior to dental sealant placement.  An oral evaluation is performed by the dentist and includes a clinical evaluation of the status of the child’s oral health diagnosis and involves no radiographic (x-rays) evaluation.  State Health Commissioner Dr. John Dreyzehner worked with the State Dental Director to amend the State practice act for dental hygienists.  This allowed for another line of access to care by allowing the dental hygienist to utilize their education and provide dental sealants prior to a dental evaluation.  As a result, production in the school is better achieved without the time restraints of limited dental personnel.

Lesson Learned – Parents did not understand the implications of passive consent in the consent form.  Definition:  Passive consent – no parent/guardian consent needed to perform a visual inspection of the child’s oral health using a flashlight and tongue depressor.  As a result, some parents were not pleased with screening being performed.  This caused unnecessary stress on the SBDPP staff and school officials.  In light of this, the passive consent was eliminated and only children who have a signed consent form receive a dental screening.

Lesson Learned – With the growing number of groups targeting children in the school setting, we recognize the importance of establishing and fostering the relationships with our partners.  Together we are able to reach our common goals of providing life-enhancing information and services to the children of our state.  We recognize the importance of teamwork with public and private entities to deliver our program in the most effective and efficient manner.

As school systems and officials have changed over the years, we continue to identify key allies in maintaining our place in the school and time with children, teachers and parents.  We know that from school-to-school and from one school system to another school system the allies may be different.  We have come to know that one of the critical keys to taking a program into the school is to have the full support of the school leadership (superintendent, school director, school principal, etc.).  Once in the school it is critical to identify within that school the other core school officials who can be a liaison and/or guide to better ensure a best outcome.

There is growing partnership with the Coordinated School Health representative in our target schools.  Their component areas are aligned with those of the CDC’s Whole School, Whole Community, Whole Child (WSCC) model.  We want to ensure and maintain our place in the school providing free dental preventive services to the State’s most at-risk children.

Addressing Change – In the more recent past we have come to realize that our data collection program could be enhanced to for users as well as for data collection purposes. The State Dental Director is currently in the process of identifying and upgrading the data collection component of the program and is working with personnel in data programing and development to design a program specific to the needs of the SBDPP.  The modeling of the web-based program is based on the CDC’s Sealant Efficiency Assessment for Locals and States (SEALS) software program.  After reviewing ASTDD’s Best Practice Approach Reports it was determined that a number of these programs found the CDC’s SEALS software to meet their needs.  Researching the SEALS program and talking with program developers from another state, it was determined that this program could be greatly enhanced with the development of a program that would capture more data and allow for a more diverse list of queries and reports. It is envisioned that the new program will be an asset to allow for better monitoring of program areas and identifying areas that may need to be adjusted and/or modified.   The new system will be able to target long-term tracking of individual students and develop insight on the oral health status of Tennessee’s children.  Additionally, the new system will help determine changes that may need to be made to our current strategies in delivering the preventive services of our SBDPP.

This new program is scheduled to be launched by summer 2016.  Training will be provided state-wide to all SBDPP in each of the 13 rural and metropolitan regions.  Training will be facilitated by the central office staff, the State Dental Director and Oral Health Services Administrative Assistant.  The format for training will be “Train-the-Trainer” model, allowing Dental Directors opportunity to train all SBDPP staff.  It will be provided on site at each of the regional offices to the SBDPP. Training will be provided as needed as future versions of the program are created and launched.

The need to have staff in isolated areas share programs, ideas, techniques has been recognized.  Regional meetings have been put in place to facilitate an exchange of best practices.  The opportunity to network face-to-face is invaluable.  As a result of better communication, programs are being shared from region-to-region.  The effort to re-create the wheel is eliminated.

Plans for Addressing Change – Many program areas experience a 35-45% return rate for the consent form.  One of the chief complaints across the state is the return rate for the consent forms.  The current document that has been used in the program to date is a two-sided document; one for parent use/information and one for program/office use.  The front side of the consent contains program information and information about the child along with a place for the parent’s signature.  The back side of the current document is the treatment record for that child.  By sending the treatment record home with the parent we have come to recognize a missed opportunity to utilize that space for more appropriate information for children and families.

Recognizing this missed opportunity we began to do some research about consent forms in general.  Additionally, we utilized the CDC’s Clear Communication Index Widget | The CDC Clear Communication Index | Centers for Disease Control and Prevention to rate the current consent/treatment record.  Sadly, this document scored 9%.  The document lacked color; focus; behavior messages; numbers; and various other aspects key to good communication for our audience.  We studied a variety of consent forms and statistical information pertinent to our program and with the professional assistance of a graphic artist, a new document was created.

This new document has been approved, printed and shipped for use in the upcoming 2016-2017 school year.  What is the score of this new document you ask???  The new document has scored a 95% using the CDCs Clear Communication Index.  We are excited to be implementing this NEW information/consent sheet and look forward to tracking the return rates.

Plans for Addressing Change – Development of SharePoint.  Oral Health Services is actively working with internal Information Technology Department to create a platform where information may be accessed and shared with SBDPP staff.  The Oral Health Services SharePoint site is expected to be launched by the fall of 2016.  SharePoint will be accessible by all SBDPP staff (Rural and Metro) state-wide, providing opportunity to share ideas, projects, troubleshooting, program resources, continuing education materials, etc.  Information available will include:

  • Calendar – to include national, state, regional and local meetings
    • Library – program educational materials; program documents (forms, Manual) continuing education materials; training; etc.
  • Discussion area – discuss ideas; troubleshooting; etc.
  • Announcements
  • Links

As challenges arise to be given direct time with students to deliver services to students, we continue to seek alternatives to getting the information and/or messages to the children, school officials and parents.  The program design has evolved since its inception in 2001 and to date, is structured differently from one region to the next as well as internal structure.  We have grown and adjusted to the changing environment of the school and have been creative in our methods to be successful.  Like Coordinated School Health, our systematic approach to promoting student oral health is based on annual data, evidence-based science that a sealant placed prevents decay from occurring, evaluation of our program outcomes and review to identify areas where there may be gaps in services and/or redundancy.  In some regions staffing numbers and/or staffing structure may prevent a region from completing programs in their target school in two to three years.  This issue may lead to a longer period of return time to schools on the target list.  This is something we are currently looking at and are in the process of making some needed staffing adjustments.

In the 15 years of this statewide program’s existence, there has not been a designated (100%) support personnel in central office for the SBDPP.  This has posed a variety of problems through the years and has required significant amounts of personnel time in providing troubleshooting for program, data, and technical issues.  In addition, managing monthly, quarterly, and annual reports and ensuring these are submitted in a timely manner has, at times, been a challenge.

Recently, the State Dental Director was successful in requesting TennCare to increase the SBDPP budget and add a line item to allow central office to hire an administrative staff to be designated to the SBDPP 100%.  The hiring process to fill this position will be initiated July 1, 2016.  It is expected that this support personnel will greatly facilitate culminating reports and provide prompt expert troubleshooting support statewide.

Space to setup the program is often seen as a barrier by school officials as they think of our dental program needs in line with what would be the typical dental office needs – plumbing, electrical, sinks, and such.  One of the strong attributes of our staff is their ability to go into the school and identify space that would meet program criteria – the stage in a gym, concession stand area, breezeway of unused hallways, closets, unused classrooms, science rooms, and others.  This is often one of our greatest opportunities to educate the school staff on how ‘little’ it takes to meet our program needs with regard to space. 

The data system currently being used to capture the data is undergoing a major transformation, with hopes of it being ready for fiscal year 2017. 

Recently the TN.Gov website underwent significant restructuring.  During this process the pages designated to Oral Health Services images were removed from within the content.  Oral Health Services is actively working with the TN.Gov webmaster to add graphics and enhance the information about all of our programs and to make available to parents and the public, credible and current information.  This is an opportunity to greatly enhance the information available to parents and consumers.  In an effort to bring parents and consumers to our website, a Quick Response (QR) Code was included in the new design of our SBDPP Information and Consent form (PH4294/PH4294S).

AA Quick Response Code (QR Code) is a machine readable code consisting of an array of black and white squares, typically used for storing URLs or other information not included on the document.  The QR code is typically read using a free application installed on a smart phone or other device such as a tablet or pad.  As part of 

Communication and sharing of ideas in any statewide program can be challenging.  In the past the office of Oral Health Services has held annual multi-day training/continuing education meetings. In an effort to provide continuing education and networking opportunities, the State Dental Director has encouraged the 13 rural and metropolitan regions to work locally to hold an annual single day Grand Division Meetings.  To date, four such Grand Division meetings have been held with good success. The remaining Grand Division is scheduled to meet in summer 2016.  The intent of the meeting is to have regions come together to network and learn from presentations and through sharing of challenges and overcoming barriers to program success.

The meetings have typically included two rural regions and one metropolitan region.  The Grand Division meeting is held in a central location in their respective area of the state.  The dental directors of each region participating in the Grand Division work together in the planning process to include meeting location and logistics, presenters, and other aspects involved in planning a single day meeting.  Attendees include all dental staff in the region which consists of the SBDPP and the dental clinic staff.  Attending the meeting are dental directors, dentists, dental hygienists, dental assistants and support staff.  Continuing education hours are awarded to attendees at the conclusion of the meeting.

Contact Person(s) for Inquiries:

Veran Fairrow, DDS, State Dental Director, Tennessee Department of Health, Oral Health Services, 710 James Robertson Parkway, 7th Floor, Nashville, TN  37243, Phone:  (615) 741-8618, Email:  veran.fairrow@tn.gov

Lesa Byrum, RDH, BS, Administrative Assistant, Tennessee Department of Health, Oral Health Services, 710 James Robertson Parkway, 7th Floor, Nashville, TN  37243, Phone:  (615) 532-7770, Emaillesa.byrum@tn.gov

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