DON MARIANOS, DDS, MPH

ORAL HEALTH 2014 INITIATIVE WEBINAR

MAY 11, 2012

Prevention & Dental Public Health (DPH) Infrastructure:

A State Oral Health Program Perspective

Webinar Agenda

Prevention

Prevention and DPH Infrastructure Linkage

ASTDD – Infrastructure Enhancement Project 2012

Discussion – Oral Health 2014 Initiative Challenges

Key Messages Summary

ACCESS = SUPPLY – DEMAND

DECREASED COSTS

OPTIMAL ORAL HEALTH

Dental Disease Prevention

The Community Focus

Define the Community of Interest

Know the Community

Engage the Community

Define the Problem(s) to be Addressed

Evaluate the Impact of Programs on the Community

Evidence Based Prevention Strategies

Community Water FluoridationSchool Based/Linked Sealant ProgramsFluoride Varnish ProgramsFluoridated ToothpasteHealth Education ProgramsOral Health LiteracyBehavior Change Others. . .

Prevention Strategies

Having defined the community of interest; collected and analyzed relevant data; engaged the community; defined the problem to be addressed; selected the prevention strategies to be implemented or enhanced,

then what?

INFRASTRUCTURE

THE BASIC PHYSICAL AND ORGANIZATIONAL STRUCTURE AND SUPPORT NEEDED FOR THE OPERATION OF A SOCIETY, CORPORATION OR COLLECTION OF PEOPLE WITH COMMON INTERESTS.

The Prevention & Infrastructure Linkage

INFRASTRUCTURE FACILITATES THE PRODUCTION OF SERVICES & PROVIDES RESOURCES REQUIRED TO PERFORM A FUNCTION.

INFRASTRUCTURE IS REQUIRED TO PROVIDE THE ORGANIZATIONAL STRUCTURE AND SUPPORT FOR THE OPERATION OF PREVENTION PROGRAMS.

The Prevention & Infrastructure Linkage

DPH Infrastructure

Complex

Dynamic

Variable

Fragile

Coordinated

DPH Infrastructure Components

Public (Governmental, Safety Net Clinics, etc.)Private (Individual practices, Local dental

societies)FederalStateLocalMedical and other Health/WellnessPhilanthropicAdvocacy OrganizationOthers (Religious, Educators, Civic Groups, etc.)

DPH Infrastructure

DPH Infrastructure Goals

Identify partners that can contribute some unique and vital aspect to assist in attaining optimal oral health for all.

To facilitate enhancing the connections between these partners to each other and to the overarching mission and vision.

Continual coordination, nurturing and evaluating of the infrastructure.

OBJECTIVE:

TO LOOK AT STATE ORAL HEALTH PROGRAM (SOHP) INFRASTRUCTURE FROM 2000 TO 2010 AND THE CAPACITY OF THOSE PROGRAMS TO ADDRESS CORE PUBLIC HEALTH FUNCTIONS AND DELIVER THE 10 ESSENTIAL PUBLIC HEALTH SERVICES.

FUNDED BY THE CDC

Association of State and Territorial Dental Directors (ASTDD)

Infrastructure Enhancement Project (IEP) 2012

ASTDD – IEP 2012 Goals

Review a decade of infrastructure and capacity building efforts

Provide new information and recommendations to help state agencies and policymakers, funders, advocates and others better understand how to build and sustain SOHP infrastructure

How to effectively use this infrastructure to leverage additional resources to improve oral health

ASTDD – IEP 2012

Methods:

Review of articles in scientific literature, governmental publication and reports and data from the the ASTDD State Synopses from 2000 - 2010 as well as numerous surveys. Conducted targeted interviews with key informants. Analyzed quantitative and qualitative information to identify key elements contributing to successful programs.

ASTDD – IEP 2012

Summary Findings:Has been significant investment of resources

during the decadePrior to 2000 very limited Oral Health (OH) data

by the end of 2011 – 44 states had submitted data to the National OH Surveillance System

In 1999 only 16 states had OH improvement plans, by 2009 30 states had plans and 10 were in process

States with full-time SOHP Directors increased from: 61% in 2000 to 80% in 2010

ASTDD – IEP 2012

Summary Findings (continued):The percentage of states with 2 or fewer FTE

staff decreased from 41% in 2000 to 12% in 2010The percentage of states with 5 - 20 OH staff

increased from 20% in 2000 to 41% in 2010In 2000 ~ 193,000 children received dental

sealants through 25 state programs while in 2011 40 states had programs serving almost 400,000 children

States are now focusing on prevention strategies for women, young children and the elderly

ASTDD – IEP 2012

Conclusions:SOHP’s have significantly improved OH

surveillance capacity

Many SOHP’s have enhanced their infrastructure and capacity to perform essential public health functions

Not all states have seen improvements and much remains to be done

ASTDD –IEP 2012

SOHP’s require strong leadership, adequate resources, internal and external support, diverse and formalized partnerships, sound plans, policies, and evaluation to support their programs.

SOHP’s must be resilient to withstand economic instability and meet current and future needs.

No one model meets the needs of all SOHP’s.

SOHP Infrastructure Elements

Resources: Funding, Technical Assistance, Program Authority

Leadership/Staffing, Partnerships, Collaborations, Coalitions, Champions and Advocates

Surveillance CapacityState Planning and Evaluation CapacityPolicy Work, Evidence-Based Prevention and

Promotion Programs

Goal – Improved Oral Health Outcomes

ASTDD Resources

www.astdd.org for the complete report and additional information of State Oral Health Programs.

GuidelinesCompetenciesBest PracticesPolicy StatementsBasic Screening SurveyNational Oral Health Surveillance System

Oral Health 2014 Initiative

What are some unique Prevention and Dental Public Health Infrastructure challenges facing the Oral Health 2014 initiative?

Key Messages

No one group or organization is capable of assuring optimal oral health for all

Importance of defining and knowing your community, their needs and desires, and the barriers to improved oral health and prevention

Develop individualized prevention programs appropriate to the needs and desires of the community

Key Messages

To develop and maintain a strong vibrant prevention program it is critical to have a robust DPH infrastructure in place that is resilient and flexible

Nurture, refine, evaluate and coordinate the DPH infrastructure and the prevention programs developed

Develop OH improvement plans and strong leadership/staff

Key Messages

Community-based oral disease prevention programs, access to comprehensive and coordinated oral health services and financing systems that create affordable oral health care and sustainable oral health programs are crucial to ensuring oral health and overall health.

Good infrastructure requires high levels of investment, expertise and political will.