Dental Public Health Activities: Descriptive Summaries
Southern Nevada Dental Initiative-Future Smiles School-based Prevention Program
Future Smiles is a Nevada non-profit, 501(c) (3) IRS status, school-based prevention program that provides services to children who attend higher-risk schools with greater than 50% free and reduced meal program enrollment (FRL). Children served by the program are from families living well below the federal poverty guidelines (FPL), Medicaid/CHIP enrollees as well as children who are uninsured/underinsured living in Southern Nevada. All at-risk children enrolled at the schools are eligible for services.
Future Smiles provides two types of school-based operational delivery modes: 1) Permanent locations, also known as School-Based Health Center for Education and Prevention of Oral Disease (EPOD); or 2) Mobile school-based sites serving students on a temporary basis (approximately 1 month duration). An EPOD operates in a dedicated classroom, School-Based Health Center (SBHC), or an unused modular (temporary classroom) to provide our school-based dental sealant program. The sponsoring school site provides space, utilities, consumables, water, and restroom facilities at no cost to the program. The Future Smiles mobile program utilizes portable dental units manufactured by DNTLworks. The dental hygienists who work for the program can easily load these units into their vehicles and move them from location to location as the units are light weight (50 pounds or less), on wheels, and fold into a suitcase-type container.
Future Smiles’ pilot program, Southern Nevada Dental Health Initiative (SNDHI), provides dental screenings, oral health education, dental hygiene prophylaxis, sealants, fluoride varnish and, when needed, case management focusing on referral to a local dentist or the UNLV School of Dental Medicine (SDM) for restorative dental care. Public Health Dental Hygienists (PHDH) must apply to the Nevada State Board of Dental examiners (NSBDE) to be approved for a Public Health Dental Hygiene Endorsement (PHDHE), which allows them to practice in a public health setting without supervision by a dentist. PHDHs specialize in preventive measures, striving to create a systematic transformation from restorative dental treatment to preventing oral disease.
Future Smiles receives funding from grants, foundations, private donations, and Medicaid/CHIP reimbursement. The program provides a full array of dental hygiene services and in School Year (SY) 2012-2013 the cost per service averaged $44 per unit. That same year, Nevada Medicaid reimbursed the program $67 per child sealed (>3 sealants per child); a cost much lower than restorative dental treatment to fill a carious lesion in a child’s tooth. The program has monitored untreated decay rates and notes that as the at-risk population’s access to dental sealants increases, the untreated tooth decay rate decreases. This measurable outcome demonstrates the benefits of dental sealants, as it quantifies an inverse relationship of sealant placement vs. untreated tooth decay, as an oral health indices in the health status of our service population.
MEDICIAD PROVIDER STATUS
While the Nevada Medicaid system recognizes a dental hygienist as an appropriate dental provider the process to become enrolled has been daunting. In the traditional private dental practice setting all billing is coded to the dentist/business owner. Therefore, Future Smiles’ dental hygienists (PHDH) who wanted to be enrolled providers with Medicaid, required new expertise to navigate the Medicaid system to become enrolled providers. This effort took time and patience but eventually 2 out of 3 Medicaid Managed Care Organizations enrolled the Future Smiles’ dental hygienists (PHDH).
Our primary concern pertains with the third Managed Care Organization, which continues to operate under the policy that it has an adequate ratio of dental providers vs enrolled customers and, therefore, substantiates that new or more dental providers is not necessary. However, through the Affordable Care Act, Nevada will see an ever expanding pool of children enrolling into either Medicaid or the Exchange. In the Las Vegas Review Journal published on 10/3/2013 (http://www.reviewjournal.com/business/health-care-round-two-expansion-states-medicaid-program) the article states that Medicaid enrollment has expanded to 477,900 from 336,000 and it’s anticipated that by 2015 the total enrollment will serve 605,000 Nevadan’s (23.5% of the state’s uninsured). As more of Nevada’s citizens enroll into a healthcare product, from either Medicaid or the Exchange, it will be critical to have a sufficient number of healthcare providers in the community.
Future Smiles uses positive consent (intake form) that is signed by the child’s parent. At the program’s inception the intake form enrolled the child for 2 years, however, families are very accepting of our school-based services and Future Smiles now uses a 5 year enrollment agreement in the intake form. This decision has created a continuous flow of school-based care (access) and has decreased costs as they pertain to printing and program operations for Future Smiles.
Future Smiles would also like to better identify “who and how” families enroll into the program. All students in the school community are given a consent form that is sent home for parent/guardian consent and to collect child/family data (average 15%-30% returned consent form). Schools selected have a high FRL (>50%) but it is unclear if a child has an established dental home (not in need of our program). Another key factor is parents/guardians taking the time to fill-out the intake form (lack of knowledge/value of services). Children with private dental insurance, outside of the Medicaid system, are encouraged to use that insurance to seek and establish a dental home. It would be ideal to survey potential/enrolled families to identify “who and how” families have chosen to enroll into the program. This information will require additional staff but could enhance and increase enrollment percentages.
As a school-based program that collaborates with the Clark County School District, Future Smiles aligned student ID protocols with the District. With a similar student tracking mechanism the two organizations can communicate effectively regarding student’s health, parent contact, and school performance. Through this tracking mechanism it is Future Smiles goal to conduct a comparative analysis of the SNDHI pilot program to illuminate the relationship of school-based health services with a dental component, student performance, discipline, and absenteeism.
INCREASE STUDENT ENROLLMENT
Future Smiles has enhanced program enrollment by conducting classroom oral health presentations prior to bringing the Mobile program to a new school. Working with the respective school nurses has allowed the program to better target children who have had an oral health issue and may have missed school days due to dental disease. Collaborating with child advocates such as Communities In Schools, allows the program to more effectively identify children with needs and match them to services , thereby creating a safety-net system.
Contact Person(s) for Inquiries:
Terri Chandler, RDH,