California Oral Health Program - California Pan-Ethnic ......California Oral Health Program...

California Department of Public Health

California Oral Health Program

Planning, Implementation, and Opportunities for Public and Community Engagement

The State Oral Health Plan Development Process

CPEHN Spring Convening Series on Oral Health EquityOakland, April 26, 2016


Agenda

• Issues, Challenges, and Opportunities

• State Oral Health Plan – Planning & Development Process

• Advisory Committee/Staff Roles and Responsibilities

• State Oral Health Plan Goals, Objectives, and Strategies

• Implementation

• Opportunities for Public and Community Engagement


ISSUES, CHALLENGES, AND OPPORTUNITIES

State Oral Health Plan


Oral Health Disparities Among Poor Children and Children of Color:Race/Ethnicity

In California, Latino children, other minority children, and poor children experience more tooth decay, untreated tooth decay, and have more urgent dental care needs than non-Latino white children.

Oral Health of Kindergarten and 3rd Grade Children

by Race and Ethnicity

48%

20%

2%

72%

33%

5%

61%

29%

5%

0%

20%

40%

60%

80%

History of Decay Untreated Decay Urgent Dental Care

White

Latino

Other

Private Insurance Status Among Kindergarten and 3rd Grade Children by Race and Ethnicity

59%

20%

39%

0%

20%

40%

60%

80%

White Latino Other

Source: California Smile Survey (2006)


Oral Health Disparities Among Poor Children and Children of Color: Socioeconomic Status

Kindergarten and 3rd Grade Children Participation in Free/Reduced Price Lunch Program Participation

by Race and Ethnicity 1

21%

65%

45%

0%

20%

40%

60%

80%

White Latino Other

72%

33%

6%

52%

22%

3%

0%

20%

40%

60%

80%

History of Decay Untreated Decay Urgent Dental Care

Eligible

Not Eligible

Oral Health of Kindergarten and 3rd Grade Children

by Eligibility for the Free/Reduced Price Lunch Program

1 Annual Family income for a family of four not to exceed $34,873. U.S. Department of Agriculture, Child Nutrition Programs, School Lunch Program, Income Eligibility Guidelines 2004-2005, http://www.fns.usda.gov/cnd/governance/notices/iegs/IEGs04-05.pdf


18%

69%

45%

53%

77%

66%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Private Dental Insurance Visited a Dentist in the PastYear

Parents That Speak Englishat Home

FRL Participation Do Not Participate

Kindergarten and 3rd Grade Children Who Participate in the Free/Reduced Price Lunch Program Compared to Those Who Do Not

http://www.fns.usda.gov/cnd/governance/notices/iegs/IEGs04-05.pdf


Children’s Oral Health –Bottom Line:

If you are a child living in California, the poorer you are, the more likely it is that your teeth hurt all the time – this is especially likely if you are Latino, or a member of some other racial or ethnic minority.



OVERVIEW – TIMELINE, LOGIC MODELING, EVIDENCE-INFORMED

State Oral Health PlanPLANNING & DEVELOPMENT PROCESS


State Oral Health Plan Development Timeline2015 2016 SFY 16/17

Aug Sept Oct Nov Dec Jan Feb Mar Apr May June Ongoing

3rd AC Meeting

• Key Priority Area Refinement – Goals, Objectives, Strategies Development

4th AC Meeting

• Developing Strategies

5th AC Meeting

• Moving from Planning to Action

1st AC Meeting

• AC Development, R&Rs, SOHP Planning Process

2nd AC Meeting

• ID Key Priority Areas + Working Group Process

Stat

e O

ral H

eal

th P

lan

Imp

lem

enta

tio

n +

Ad

voca

cy

We are

here


Core Functions and the 10 Essential Public Health Services

Source: CDC


An Evidence-Informed & Best Practices Approach

• CDC State Oral Health Plan Development Tools

• ASTHO – Developing a State Health Improvement Plan

• CDC Community–Clinical Linkage

• CSTE/ASTDD – State-Based Oral Health Surveillance Systems

• Community-Based Best Practices

• CDC-Funded States• Infrastructure Development Tools• State-by-State Reports• State Oral Health Information and Links


An Evidence-Informed & Best Practices Approach

• CDC State Oral Health Plan Development Tools

• ASTHO – Developing a State Health Improvement Plan

• CDC Community–Clinical Linkage

• CSTE/ASTDD – State-Based Oral Health Surveillance Systems

• Community-Based Best Practices


PLANNING PROCESS



California Wellness Plan 2014A Roadmap to Prevention

Focus areas:

– Healthy Communities

– Optimal Health Systems Linked with Community Prevention

– Accessible and Usable Health Information

– Prevention, Sustainability and Capacity

Goal: Equity in Health and Wellbeing


Planning a State Oral Health PlanInputs & Activities

Source: ASTHO

Advisory Committee

• Guide overall direction

• Select frameworks, goals, objectives

• Chair workgroups and guide their work

• Review strategies, action steps and workplans

Workgroups

• Develop Strategies and action steps

• Develop strategies for implementation of workplans

• Identify tools, resources and opportunities

Partnership

• Collaborate with existing initiatives to maximize impact

• Inform the overall implementation process

• Act as champions to educate regarding SOHP priorities

Advise

Develop

Inform and implement

Statewide Partnership

CDPHDHCS

PARTNERS

Providing leadership and

fostering collaborative solutions and opportunities

for engagement


ST

AK

EH

OL

DE

R

INV

OLV

EM

EN

T

EV

AL

UA

TIO

NOverall Planning, Development &

Implementation

State Oral Health Program

Advisory Committee Statewide Partnership

Workgroup Meetings

Statewide Meetings

Plan Development & Dissemination

Implementation & Technical Assistance

Impact & Quality Improvement


FRAMEWORKS – DEFINING A MEASURABLE APPROACH


California Department of Public Health20

Framework for Comprehensive

State Oral Health Plans

Knowledge forEvidence-BasedDecision Making

What should be done?

Setting Optimal National

and State Objectives:

(data-driven)

What can be done?

Planning Feasible Strategies

(capacity-driven)

What is achieved?

Implementing

Effective Strategies

(outcome-driven)

What could be done?

Determining

Possible Strategies

(science-driven)

Data: societal influences,

current capacity,

environmental analysis

SurveillanceData: unmet

needs, serviceand data gaps

Data: provenprevention and

best processes

Data: process,outcome, impact

evaluations

Data: disease

burden, targetpopulations, and

implementation

barriers

Source: CDC


A Framework for Action: Surgeon General’s Report

Change Perceptions

Increase Collaboration

Replicate Effective Programs

Increase workforce diversity, capacity,

flexibility

Build Science Base Improving Oral

Health


A Framework for Public Health Action: The Health Impact Pyramid

Education & Counseling

Clinical Interventions

Long lasting protective interventions

Change the context to make individuals’ default decisions

healthy

Socioeconomic Factors

Source: Frieden, T. (2010). A Framework for Public Heath Action: The Health Impact Pyramid. American Journal of Public Health.

SmallestImpact

LargestImpact

Chairside Guide Campaigns

Evidence-Based Practice

School Dental Sealant Programs

Fluoridation

Insurance Coverage

Examples


GOALS AND OBJECTIVES



GOAL 1: Improve the oral health of Californians by addressing determinants of health, specifically promoting healthy habits and population-based prevention interventions to attain healthier status in healthy communities

1. Build community capacity to integrate oral health into the decision-making process for health policies and programs.

2. Provide dental health professionals with the protocol and tools to screen for social determinants and link patients to community resources.

3. Maintain and expand evidence-based programs and best practice approaches.

Goal 1 PrioritiesDeterminants of Health

DRAFT


Goal 2 PrioritiesCommunity-Clinical Linkages

GOAL 2: Align dental health care delivery system, payment systems and community programs to support and sustain community-clinical linkages for increasing utilization of dental services.

DRAFT

Children

Pregnant Women and Children <

Age 6

People with Diabetes

Oral and Pharyngeal

Cancer

Vulnerable Populations

Focus Areas

• Maintain and expand community-clinical linkage programs in targeted sites such as WIC programs Head-Start, preschools and schools.

Examples

• Leverage the HRSA’s Perinatal and Infant Oral Health Quality Improvement grant to identify and address barriers to care.

• Incorporate oral health into diabetes management protocols and include an annual dental examination as a recommendation.

• Integrate tobacco cessation counseling and oral cancer screening as part of dental visit protocol.

• Provide information and support to facilities and dental practitioners regarding care delivery models and the availability of training.


Goal 3 PrioritiesInfrastructure and Capacity

1. Increase the capacity to provide dental services to young children.

2. Expand the dental student loan repayment program.

3. Encourage Community Health Workers and Home Visitors to promote oral health and address barriers to care.

4. Increase the number of FQHCs that provide dental services in community sites.

5. Develop a guide to use for funding non-clinical dental public health program activities and address building dental scopes of work language into county level agreements.

GOAL 3: Collaborate with payers, public health, health care systems, foundations, and professional organization and educational institutions to expand infrastructure, capacity and payment systems for supporting prevention and early treatment services.

DRAFT

Capacity

Payment System

Infrastructure

Examples


Goal 4 PrioritiesSurveillance

1. Develop a 5-year surveillance plan consistent with the National Oral Health Surveillance System (NOHSS) to provide current data on diseases/conditions, risk/protective factors, and use of dental services.

2. Gather and use data to guide oral health needs assessment, policy development and assurance functions.

GOAL 4: Develop and implement a surveillance system to measure key indicators of oral health and identify key performance measure for tracking progress.

DRAFT

Evaluation & Monitoring to Track

Progress

ID Key Performance

Measures

Measure Key Indicators


Goal 5 PrioritiesCommunications/Education

Develop a communication plan that: 1) increases oral health awareness and visibility through innovative marketing

approaches;

2) identifies and shares best-practices for in-person communication, online communication, and community outreach;

3) streamlines provider and patient oral health resources through standardized collection, evaluation, promotion of best-practices, toolkits, and resources;

4) increase coordination, consistency, and reach of oral health messages in multiple languages; and

5) generate positive media coverage through promotion of key findings and outcomes of the State Oral Health Plan.

GOAL 5: Develop and implement communication strategies to inform and educate the public, providers, and decision makers about oral health information, programs, and policies.

DRAFT


DEVELOPING STRATEGIES THROUGH PARTNERSHIP – MOVING FROM PLANNING TO ACTION



Strategy Development


Priority Area ComponentsThe Path to Partnership and Implementation

PARTNERSHIP


Opportunities for Public and Community Engagement

PA R T N E R S H I P

Public/Community/ClinicalEngagement

Community-clinical linkages1 connect health care providers, community organizations, and public health agencies to collectively improve access to preventive and chronic care services.

1 Agency for Healthcare Research and Quality. Clinical-Community Linkages. Available: http://www.ahrq.gov/professionals/ prevention-chronic-care/improve/community.


Proposed State Oral Health Plan Strategies

Pregnancy

Year 1

Early childhood

School entrance

3rd Grade

Health Literacy – Insurance Coverage – Water Fluoridation

Brushing – Reducing Sugar

Dental Visit Inter-professional Collaboration – Community Clinical Linkages –

Dental Care Delivery System


PRIORITIES, GOALS & IMPACT –ACHIEVING THE VISION OF HEALTHY PEOPLE IN HEALTHY COMMUNITIES



Priorities

• Oral disease burden document

• State Oral Health Plan development

• Oral Health Surveillance System

• Development of a statewide partnership

• Plan implementation, tracking, and continuous quality improvement


State Oral Health Plan GoalsEquity in Health and Wellness

• Address determinants of oral health, promote healthy habits and population-based interventions

• Improve access to continuous high quality, and culturally and linguistically competent care

• Expand the infrastructure and capacity to promote community based programs through community-clinical linkages


State Oral Health Plan GoalsAchieving Success Together

• Collaborate to expand infrastructure, capacity and payment systems

• Develop and implement a surveillance system

• Develop innovative solutions and evaluate outcomes

• Develop and enhance communication capacity to educate policymakers, public, providers and organizations

• Track progress and share results


Collective Impact

• Common agenda

• Shared measurement systems and approaches to evaluating progress

• Mutually reinforcing activities

• Continuous, consistent, and open communication

• “Backbone” support organization(s) to convene and coordinate, including dedicated staff.


Achieving the Vision of Healthy People in Healthy Communities

Making California the Healthiest State in the Nation


Thank you!

Neal RosenblattResearch Scientist II

California Department of Public HealthOral Health Program

[email protected]

mailto:[email protected]

California Oral Health Program - California Pan-Ethnic ......California Oral Health Program...

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