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Dental Public Health Activities: Descriptive Summaries

Leading Chicago Children to Oral Health Improvement: A Community Based Public-Private Collaboration

Practice Number: 16013
Submitted By: The Oral Health Forum/Heartland Health Outreach
Submission Date: October 2016
Last Reviewed: October 2016
Last Updated: October 2016
Best Practice Approach Example Name of the Dental Public Health Activity: Leading Chicago Children to Oral Health Improvement: A Community Based Public-Private Collaboration
 

The Chicago Public School System (CPS) is the third largest school district in the United States with more than 600 schools providing education to approximately 400,000 children. Healthy CPS is an initiative created to demonstrate schools’ commitment to a safe/healthy learning environment by offering access to daily physical activity, nutritious foods, school-based health services, health education, and supporting students with chronic conditions.

As a component of the Healthy CPS initiative, the Chicago Department of Public Health (CDPH) School–Based Oral Health Program (SBOHP) provides dental screening, oral prophylaxis, fluoride varnish treatment and dental sealants (if prescribed) to CPS students based on positive consent return. The program is operational in 547 out of the 600 CPS schools. Dental Referrals (walk-out letter) is given to each student seen. The letter provides a “snapshot” of the student’s oral health and phone numbers for access to the Medicaid (Managed Care Organizations) oversight companies. Student oral health status is recorded as Oral Health Score (OHS) of 1 (healthy), 2 (non-urgent need), 3 (urgent need). Each contracted dental provider’s team is responsible for calling parents of students with OHS-2 or 3, and providing either a referral to their dental practice or dental providers around the school. However, if the school is located in two specific Chicago zip code areas identified as having a very high number of children with urgent dental needs, students are enrolled in an intensive Case Management (CM) Pilot lead by the Oral Health Forum (OHF).

The OHF CM pilot was initiated in School-Year 2014-15 (SY15) targeting schools with a very high number of children with OHS-3. An environmental scan of health resources in the two zip codes showed no publicly-funded dental programs and limited access to 56 community dental providers. Building on community relations, two bilingual case managers have been actively working with families from 39 schools in the targeted area to enhance their ability to access dental care.

Data from the first year of the CM pilot revealed that 50% of the children with OHS-3 were in three of the 39 schools. The same three schools had a very high number of children with OHS-2.  Based on this information, an incentive model (Oral Health (OH) Champion Program) was implemented in SY16 targeting the whole school community: children, families, teachers and school-personnel from the three schools. Changes in students oral health status (from SY15 to SY16) has been used to evaluate improvements. However, at the end of the 3-years CM pilot (SY17) the program will be better positioned to measure success.

Lessons Learned:

  1. Utilization of school-based services: Chicago has the largest school-based oral health program in the country; however, due to many factors, the program is highly underutilized with only 25% of the student body obtaining services. The active case management program and the OH champion program have brought better understanding of the many factors effecting utilization of school based services:
  • Lack of parental knowledge regarding the services offered and the significance of those services.
  • School personnel lack information about the SBOHP, the OH status of children in their own school, and how they can be empower to improve the oral health of their children.
  • Services competition between community dental providers and the SBOHP due to Medicaid rules.
  • Community dental providers misinformed about the services they can bill for after a child has been seen in the SBOHP.
  1. Culturally sensitive case managers:  According to the initial demographic assessment of the population in the schools, in November of 2014 at the start of the project, OHF hired two case managers- one Latino bilingual community liaison and one African American case manager.  However, when the first list of children with urgent dental needs was evaluated, demographics of this group of children showed that 97% were Latinos with Spanish speaking parents.  The program staff shifted instead to two bilingual case managers that could communicate with parents and better understand cultural and other barriers they faced in accessing care. Additionally, case manager have to be able to work late afternoon hours in order to be able to reach working parents.
  1. Data driven intervention: The OH Champion mini-grant program was added in the second year of the intervention based on findings from the first year of the pilot. It is an intensively focused intervention targeting the most disadvantaged children in the two zip code areas. In order to improve community outcomes, it is important to monitor all parts of an intervention and modify or add components according to findings. 
  1. Data sharing agreements: Initially OHF planned to start providing case management to children by January 2015, however, difficulties on agreements with CDPH, City of Chicago Legal Department and HIPAA concerns delayed starting this stage of the project until March 2015. Collaborations between public and private partners targeting school-age children will require clear data sharing agreements in place before starting any project to avoid any difficulties and protect children.
  1. Health equity approach: When developing and implementing this intervention, our ultimate purpose was to raise the opportunities that the most disadvantage children in CPS had to attain their higher level of oral health.  We have faced many challenges, however, keeping our main purpose in mind has helped us to invest our limited resources and efforts where has been most needed.

Contact Person(s) for Inquiries:

Alejandra Valencia, Director, The Oral Health Forum/ Heartland Health Outreach, 1100 W Cermak Rd - Suite 518, Chicago, IL 60608, Phone: 773-491-2632, Email: avalencia@heartlandalliance.org  

Mary Pat Burgess, Program Director, School-Based Oral Health Program/ Chicago Department of Public Health, 4314 So. Cottage Grove - Room 204, Chicago, Illinois 60653, Phone: 312-747-8304 (o), Email: marypat.burgess@cityofchicago.org 

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