Margaret Drozdowski, DMD, Dental Director

Margaret Flinter, APRN, VP/Clinical Director

Model For Successful Model For Successful Implementation Implementation

Of A Mobile Dental Of A Mobile Dental Program Program

To Increase Dental Access To Increase Dental Access For School Aged For School Aged

ChildrenChildren

Who We AreWho We Are

Largest FQHC community health center in CT

1972: dentistry was CHC’s first clinical services

CHC has grown to 9 primary care centers across

CT,

rural to urban; large to small

• New Britain, Meriden, Middletown, Clinton, New

London, Groton and Norwalk

4 school-based health centers, elementary to

high

school

Who We AreWho We Are

Who We AreWho We Are

Medical, dental,

mental health,

HIV, OB and

domestic violence

services

180,000 visits FY 2005 - 40,000 dental visits

Who We AreWho We Are

We are collaborators,

organizers, and innovators

As an FQHC, we have a

particular set of mandates and responsibilities

The scope of our project has to be able to expand to the scope of the needs of our target communities and

service areas

Dental Disease In Dental Disease In ChildrenChildren

Dental disease in children is the most common preventable infectious disease

Fewer than 1 in 5 medicaid covered children have an annual dental preventative visit

Situation In ConnecticutSituation In Connecticut

Over 400,000 total medicaid recipients

1 in 4 kids in CT on medicaid

2/3 receive no dental care

Only 26% preventative care and 14% treatment

Statewide 30-50% of elementary school kids have untreated decay

Provider CrunchProvider Crunch Few safety net dentists

Less than 15% of private dentists participate

Shrinking dental workforce

Statewide oral health conference

• need for increased access

• need for additional services

Action TakenAction Taken

Connecticut Health Foundation

•oral health major focus

•major funder to build collaboration and

increase care delivery

•statewide involvement

Universal Goals

•Double utilization

•Self sustainable systems within 5 yrs

Potential SolutionsPotential Solutions

Increased # of participating private providers

Increased # of safety net providers/clinics

Expand into non traditional service delivery site• School based• HeadStart

School Based Dental School Based Dental ServicesServicesAt one time, the norm rather than the new

Proven effective

Provide access

Crumbles barriers, allow for early identification of decay, preventative treatment, and education

Resurrecting A “New Resurrecting A “New Old” ModelOld” ModelCHC in partnership

Portable equipment utilized

• cost efficient with significantly less start up costs

• more versatile due to portability

• Schools love it!!!

Non-clinical staff focused on developing relationship with school staff and parents

Delivery Models: CHC New Delivery Models: CHC New BritainBritain New Britain’s Start Smiling Program

Established in 2002

CHF grant to CHC as fiduciary agent

3 primary mechanisms:

1) community outreach and dental health education

2) delivery of preventive dental services

3) referral to treatment resources for children requiring restorative, emergent, and specialty care

Delivery Models: CHC New Delivery Models: CHC New BritainBritain February 2005 CHC added a dental unit at

New Britain High School: Connecticut’s largest public high school with almost 3,000 students

Addition of dental component into an already existing SBHC

161 children were seen for preventative visits

Step By StepStep By Step

Global support

Seed money

Lease hold improvement

Equipment

Hygienist

License and approvals

ChallengesChallenges

Mid year start date•promotion and marketing

•consent forms and medical histories

Class time interruptionTracking Follow up and completion of treatmentChair time not optimized Access ≠ delivery especially in

adolescent group

Success In New BritainSuccess In New Britain

161 kids treated in 6mos by part time hygienist

FinancialsFinancialsInitial investment

• $26,000 equipment• $4,000 space improvements

On-going expenses• “rent” space provided in-kind by the school• staff: hygienist and care coordinator• supplies

Profit/Loss: reimbursement and “utilization”• fixed medicaid rate• sliding fee scale rate for uninsured• unused chair time

Expansion In NB Expansion In NB Elementary SchoolsElementary SchoolsLocal hygiene student program data collection

•58% HUSKY kids with untreated decay

•63% uninsured kids with untreated decay

School board strongly supports a dental program

Pilot at the “neediest” school

Delivery Models – Delivery Models – Southeast CTSoutheast CTSoutheast CT Smiles program

•Local Health district

•Connecticut Health Foundation

•CHC is one of two participating FQHC’s

Age group of focus for this project is the elementary and middle school population

Mobile dental equipment first piloted

Delivery Models – Delivery Models – Southeast CTSoutheast CT CHC subcontract with Health District to

provide service

In school year 2004-2005, CHC joined mobile team

17% of enrolled elementary students were seen by the CHC’s mobile hygiene team

Unique Difference In CHC Unique Difference In CHC New LondonNew London

No pre-existing school based

health center

Identify location with school

Advance coordination of appointments

2nd trip coordination for sealants

MORE COMPLEX COORDINATION NEEDED

Success In New LondonSuccess In New London

279 kids seen by mobile team

56% 61%

30%

0%

10%

20%

30%

40%

50%

60%

70%

UntreatedDecay

NeededSealants

CompletedTreatment

Delivery Models –HeadStart Delivery Models –HeadStart in Norwalkin NorwalkEarly detection and prevention is key

Over 170 children screened

•48% had dental decay

•18% of the children had decay in more than 3 areas

Far away from Healthy People 2010 goal

Community rallied together to affect change

2 mobile dental clinics in the works

Collaboration Leads To Collaboration Leads To SuccessSuccess

Innovation and plan

Key members

•community leader support

•safety net sites and providers

•private parishioners

•community agencies

Board of Education support

“If there’s a will there’s a way”

$$$ = Sustainability

Next Steps…Next Steps…

Start as early as possible Increase participating centers Maximize utilization

Key PointsKey Points

Collaboration

Sustainability

Access ≠ care

Success is

possible

Contact InformationContact Information

Margaret Drozdowski, DMDCommunity Health Center of New BritainOne Washington SquareNew Britain, CT 06051 ph: 860.224.3642 x5167 email drozdom@chc1.com

Margaret Flinter, APRNCommunity Health Center, Inc.635 Main StreetMiddletown, CT 06457 ph: 860.347.6971 x3622 email flintem@chc1.com