SAA Webinar – The Relationship Between Oral Health and Student Per
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Transcript of SAA Webinar – The Relationship Between Oral Health and Student Per
Smiles Across America Webinar Series
Date: 11/17/2015
The Relationship Between
Oral Health and Student
Performance
/Oral Health America @Smile4Health
Connect with OHA!
/Oral Health America @Smile4Health
HOUSEKEEPING INFORMATION
• Please remember to MUTE your phone.
• Questions are welcome! We’ll allow 10-15 minutes after the presentation for questions.• Questions will be accepted in writing through the control
panel on the upper right hand of your screen.
• Submit questions at any time; we will address them at the end of the presentation.
• Webinar is being recorded; for rebroadcast on OHA’s website – OralHealthAmerica.org
• Your feedback is important to us. Please take our brief webinar evaluation after this session; link will be sent via email.
OUR MISSION
Oral Health America’s mission is to change lives by
connecting communities
with resources to drive access to care, increase
health literacy, and advocate for policies that
improve overall health through better oral health for
all Americans, especially those most vulnerable.
OHA PRIORITIES
ADVOCACYHEALTH
LITERACYACCESS
OHA’s Programs and Campaigns are designed to improve
access to care, oral health literacy and policies that
prioritize the impact of oral health on the overall health of all
Americans – particularly those most vulnerable.
Campaigns for Oral Health Equity
Educate the public, including policy makers, about the importance of oral health for overall health
Emphasize the need to prioritize oral disease alongside other serious health conditions
Advocate for policies that positively impact programs and stakeholders
Current campaigns include:
toothwisdom.org Demonstration
Projects
Professional
Symposia
Advocacy Health Education &
Communications
Technical Assistance
Product Donation
Grant Funding
Terri Chandler, RDHFounder/Executive Director
Email: [email protected]: www.futuresmiles.net
C: (702) 521-4550
School Partnerships: The relationship between oral health and student
performance
1) Participants will learn about Future Smiles and our different school-based oral health delivery models.
2) Participants will learn how the evaluation team determined and analyzed the different “categories of care” within the evaluation design.
3) Participants will learn about our preliminary evaluation of oral health status and student performance.
EDUCATIONAL OBJECTIVES
MEET BELLA~THIS IS WHAT SUCCESS LOOKS LIKE!
OUR MISSION
Increase access to oral health education and services for underserved populations.
Research shows that students who are in poor oral health are more likely to experience dental pain, miss school, and perform poorly in school. It is estimated that 51 million hours per year are missed due to dental related illness.
Most barriers stem from overarching health, family and community issues.
WHY SCHOOL-BASED CARE
OUR FAMILIES
The average family accessing oral health services at our school-based EPOD sites has 4 members and an income of $1,416 per month.
That’s $16,992 per year for a family of 4!
MAP AND LOCATIONS
Future Smiles began providing preventive oral health care at School A through a generous donation from Oral Health America.
FUTURE SMILES OUTCOMES
Outreach efforts since December 29, 2009:
18,745 oral health presentations
5,071 child cleanings
25,719 teeth with dental sealants
10,801 fluoride varnish
51% are uninsured
41% have untreated decay
11% are urgent
2014 Georgetown University’s Center for Children and Families report 9.6% uninsured rate- NV is 1 of the 5 highest in US.
Equals 63,732 children in NV.
AZ is also one of the 5 highest with 10% of its children uninsured.
2011 Quality Report from Medicaid revealed that Nevada has a 37% dental utilization placing Nevada at the bottom quartile for access to dental services.
NEVADA ORAL HEALTH FACTS
2012 Burden of Oral Disease NV 3rd Grade Findings
6 out of 10 (65%) children in Nevada have experienced tooth decay.
Statewide 35% have untreated tooth decay.
In minority children 71% have experienced tooth decay.
11% have urgent dental needs and live with dental pain.
Nevada’s Oral Health Need
DENTAL DISEASE IS PREVENTABLE
Case Management Can Make a Difference
Unmet oral health needs are addressed through case management.
School-Based Health Centers are a cost effective and accessible way to deliver health care to the most vulnerable members of our community.
WE FIND SOLUTIONS
SCHOOL-BASED ORAL HEALTH CARE
FUTURE SMILES EPOD
EPOD~ What does it stand for?
SCHOOL-BASED HEALTH CENTER FOR EDUCATION AND PREVENTION OF ORAL DISEASE
SBHC, Modular or Classroom
Services Include: Screening Education Prophylaxis Fluoride Varnish Sealants Digital X-rays *limited locations Case Management *referral
5 EPOD-Education and Prevention of Oral Disease
Future Smiles Mobile
Sealant Program
16 CCSD Title I Schools
Our Project Evaluated
2 EPODs
1 Mobile
SCHOOL-BASED LOCATIONS
CATEGORIES OF CARE
School SBHC
School-Based
Health Center
Medical
Future
Smiles
EPOD
Future
Smiles
Sealant
Program
Restorative
Dental
Case
Management
Communities
In Schools
Student
Enrichment
A
B
C
School A
792 students with 208 FS participants
79% Free and Reduced Lunch
$1,427 income family of 4
Title I – 3 Star School
School B
717 students with 202 FS participants
95% Free and Reduced Lunch
$1,122 income family of 4
Title I – 2 Star School
School C
698 students with 136 FS participants
91% Free and Reduced Lunch
$1,166 income family of 5
Title I – 3 Star School
2013-2014 Snapshot of Elementary Schools
Medicaid EnrollmentSY’12-’13 SY ‘13-’14
School A 36% 39%School B 52% 55%School C 63% 62%
SCHOOL POPULATION SY 2012-2013
School A Demographics
Caucasian
African American
Indian/Hawaiian/Island
Asian
Hispanic
School B Demographics
Caucasian
African American
Indian/Hawaiian/Island
Asian
Hispanic
School C Demographics
Caucasian
African American
Indian/Hawaiian/Island
Asian
Hispanic
SCHOOL POPULATION SY 2013-2014
School A Demographics
Caucasian
African American
Indian/Hawaiian/Island
Asian
Hispanic
School B Demographics
Caucasian
African American
Indian/Hawaiian/Island
Asian
Hispanic
School C Demographics
Caucasian
African American
Indian/Hawaiian/Island
Asian
Hispanic
0%
10%
20%
30%
40%
50%
60%
70%
2009-2010 2010-2011 2012-2013 2013-2014
TRENDS IN UNTREATED DECAY AMONG FS CLIENTS PER
SCHOOL AND BY SCHOOL YEAR
School A School B School C
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
2009-2010 2010-2011 2012-2013 2013-2014
TRENDS IN URGENT DENTAL NEEDS AMONG FS CLIENTS
PER SCHOOL AND BY SCHOOL YEAR
School A School B School C
FUTURE SMILES OUTCOMES
50%
36%42%
58%
31%
22%14% 17%
41%
63%
47%
29%
97% 95% 95% 94%
0%
20%
40%
60%
80%
100%
120%
SY 2010-2011 baseline SY 2011-2012 SY 2012-2013 SY 2013-2014
Figure 1: School A
Untreated Decay Urgent Needs Sealants Present Sealants Post Event
School Intervention School-Based Health Center Future Smiles~EPOD Communities In Schools
FUTURE SMILES OUTCOMES
49%43%
39%32%
42%
17%13%
7%
20%
37%
60%
29%
100% 100%94%
99%
0%
20%
40%
60%
80%
100%
120%
SY 2010-2011 baseline SY 2011-2012 SY 2012-2013 SY 2013-2014
Figure 2: School B
Untreated Decay Urgent Needs Sealants Present Sealants Post Event
School Intervention Future Smiles~EPOD
FUTURE SMILES OUTCOMES
42%
29%
46%
31%
17%11% 13%
8%
26%
70%63%
29%
100% 98% 100% 99%
0%
20%
40%
60%
80%
100%
120%
SY 2010-2011 baseline SY 2011-2012 SY 2012-2013 SY 2013-2014
Figure 3: School C
Untreated Decay Urgent Needs Sealants Present Sealants Post Event
School Intervention School-Based Health Center Future Smiles~Sealant Program Communities In Schools
SEALANTS
• Sealant application post service event was consistently high in all three sites.
95-100%
• Consistently reaching children who did not yet have sealants.
• We know sealants are a powerful tool in preventing caries.
ORAL HEALTH TRENDS IN CHILDREN AGE 7-11
Medicaid EnrollmentSY’12-’13 SY ‘13-’14
School A 36% 39%School B 52% 55%School C 63% 62%
ORAL HEALTH TRENDS IN CHILDREN AGE 7-11
Medicaid EnrollmentSY’12-’13 SY ‘13-’14
School A 36% 39%School B 52% 55%School C 63% 62%
FIRST MOLAR DFT IN CHILDREN AGE 7-11
Medicaid EnrollmentSY’12-’13 SY ‘13-’14
School A 36% 39%School B 52% 55%School C 63% 62%
FIRST MOLAR DFT BY AGE
Medicaid EnrollmentSY’12-’13 SY ‘13-’14
School A 36% 39%School B 52% 55%School C 63% 62%
PARTICIPATION OVER TIME
24%
76%
School A
Program Participation %
Retained New
37%
63%
School B
Program Participation %
Retained New
53%
47%
School C
Program Participation %
Retained New
Comparison from SY 2012-2013 to SY 2013-2014
% OF STUDENTS WHO RECEIVED RESTORATIVE DENTAL SERVICES FROM SY ‘12-’13 TO ‘13-’14
18%
82%
School A
Program Participation %
Restorative Prevention
87 students with caries
38%
62%
School B
Program Participation %
Restorative Prevention
86 students with caries
42%
58%
School C
Program Participation %
Restorative Prevention
36 students with caries
Medicaid Enrollment
SY’12-’13 SY ‘13-’14
School A 36% 40%
School B 52% 55%
School C 63% 62%
HIGHLIGHTS OF PRELIMINARY OUTCOME ANALYSES
Preliminary Analyses Examined:
• Patterns/trends in total preventive care received by school by school year.
• Trends in sealant application rates by school by school year.
• Associations between FS care and student attendance and performance.
METHOD
• Total Care Index Score: Summation of prophylaxis, sealants, and varnish applications per study.
• Repeated Measures ANOVA used to examine changes over time in the Total Care Index Score and Sealants.
• To examine FS student performance and school attendance, we conducted exploratory analyses that assessed for differences in these outcomes by school and over time.
PRELIMINARY FINDINGS
Between school differences in total care and sealant applications existed across study years
Total care index and sealant applications generally decreased over time.
Some school level differences for some study years.
Variation in rates of existing sealants and cohort effects may explain this pattern.
There were no significant patterns in absenteeism related to oral health status
There was no correlation between total # of visits with FS and absenteeism.
PARENT INTERVIEWS
• Feedback on the value of the school-based dental hygiene program provided by Future Smiles.
• Benefits to children—oral health, education.
• Family oral health practices.
• Barriers to oral health care.
• Recommendations for improving FS services.
IN THEIR WORDS….“My son talked about the program and was really interested. To enroll I only had to sign a paper he brought home.”
“Before the program it was hard to get my son to brush his teeth, but because of the lessons they gave him explaining how to do it and how important it is, he does it!”
“Before we got educational materials from the program, I didn’t know we should change our tooth brushes every 3 months. Now we do.”
INTERVIEWS WITH TEACHERS
• Teachers/staff participating in FS activities in 2014-15
Brush at Lunch
5 respondents per school ~ 3 schools
n=15
• Phone interviews
• $25 gift cards incentive
• Future Smiles Evaluation Report
TEACHER/STAFF PERCEPTIONS
• Feedback on the value of the school-based dental hygiene program provided by Future Smiles.
• Benefits to children—oral health, education.
• Benefits to families of participants.
• Facilitators and barriers to FS services in their school.
• Recommendations for improving FS services.
IN THEIR WORDS….“Kids always come back happy from their visits with the hygienist.”
“For parents, anything that benefits the child benefits them. This area is at-risk, low socioeconomic status, money is limited. Saving money on dental care helps put food on the table. Other basic needs will be met if dental care needs are taken care of.”
“Preventative treatment helps kids have good experiences with dental professionals and they will be more willing to continue going. It avoids bad experiences and trauma.”
Student Records from Future Smiles Patients in SY 2010-2014
Attendance Rates
Nevada Criterion Reference Tests (CRTs)
Future Smiles Oral Health Records
Restorative Care
Optimal oral health (visual screening)
Number of sealants, fluoride varnish treatments and prophylaxis
Family demographics
Method for Pilot Study
State Grade-Level Achievement Tests Measures how well a child has mastered the expected
content. Aligned to Nevada State standards.
Annual Reading and Math CRT Given to students from third to eighth grade. Science once in elementary, middle and high school.
Measure How Well a Child has Learned Subject Matter Student only competes against him/herself.
NEVADA CRITERION REFERENCE TESTS (CRT TESTS)
Four Levels of Scoring Emergent/developing Approaches standard Meets standard Exceeds standard
Possible Federal Sanctions Loss of federal funds Providing free tutoring Allowing students to transfer to another schools Complete restructuring of the school
NEVADA CRITERION REFERENCE TESTS (CRT TESTS)
2012-2013 SCHOOL YEAR
0
20
40
60
80
100
120
140
160
Emerging//Developing Approaches Meets Exceeds
CRT Reading Scores- Comparison of Three Schools
School A School B School C p < 0.001
SY’12-’13
CRT Reading Standards
Visual Exam
Caries Present
Visual Exam
No Caries
Emerging 11% 13%
Approaches 9% 12%
Meets 15% 21%
Exceeds 6% 11%
2013-2014 SCHOOL YEAR
0
20
40
60
80
100
120
140
160
180
Emerging//Developing Approaches Meets Exceeds
CRT Reading Scores – Comparison of Three Schools
School A School B School C
SY’13-’14
CRT Reading Standards
Visual Exam
Caries Present
Visual Exam
No Caries
Emerging 12% 13%
Approaches 9% 13%
Meets 15% 22%
Exceeds 6% 8%
2012-2013 SCHOOL YEAR
0
20
40
60
80
100
120
140
160
Emerging//Developing Approaches Meets Exceeds
CRT Math Scores- Comparison of Three Schools
School A School B School C
SY’12-’13
CRT Math Standards
Visual Exam
Caries Present
Visual Exam
No Caries
Emerging 8% 10%
Approaches 11% 15%
Meets 19% 23%
Exceeds 4% 10%
2013-2014 SCHOOL YEAR
0
20
40
60
80
100
120
140
160
180
Emerging//Developing Approaches Meets Exceeds
CRT Math Scores- Comparison of Three Schools
School A School B School C
SY’13-’14
CRT Math Standards
Visual Exam
Caries Present
Visual Exam
No Caries
Emerging 11% 12%
Approaches 10% 16%
Meets 18% 21%
Exceeds 4% 6%
% OF STUDENTS WHO PARTICIPATED WITH CIS
10%
95%
School A
Program Participation %
CIS & FS FS Only
0%
100%
School B
Program Participation %
CIS & FS FS Only
23%
91%
School C
Program Participation %
CIS & FS FS Only
SY 2012-2013 Data
★★★★★
A composite of several performance indicators.
Maximum number of points.
Index score is the sum of all of these factors that is then measured against the star rating criteria.
NEVADA SCHOOL RATINGS
2012-2013 2013-2014
School A
School B
School C
NEVADA SCHOOL RATINGS
Positive Findings - Frequency of Visits
33%
67%
Students Seen Four or More Times by Future Smiles
Untreated Caries Present Visual Screening- No Caries
CONCLUSIONS
Confounding Factors English Language Learners Other Health Factors Family Influences Transient Population
Follow-Up Evaluation Comparative Groups to Include
o Oral Health Statuso Account for Other Health and
Disabilities in Students Comparative Socio-Economic Status
o Low Income o High Income
• Future evaluation will compare school performance between FS vs. non-FS students using a quasi-experimental design Match 3 FS schools to 1 non-FS schools with similar student
characteristics within a low socio-economic schools.
Match 1 high socio-economic school for comparison.
• Conduct a prospective study with 3rd grade students receiving FS in the intervention schools v. matched comparison schools Conduct oral health screening of all youth (FS and non-FS) at baseline.
Validate visual oral health status screening with a full oral exam performed by a dentist to ensure visual screening is a sensitive assessment tool.
FUTURE EVALUATION DESIGN
“We are shifting the focus of our country's health care system from sickness and disease to wellness and prevention.”
President Barack ObamaNational Public Health Week, 2015 Published April 6, 2015
BRIGHTER FUTURE FOR ALL
Terri Chandler, RDHFounder/Executive Director
Email: [email protected]: www.futuresmiles.net
C: (702) 521-4550
Question and Answer Session
• Questions are welcome! This session may last for 10-15 minutes.
• Write your questions in your control panel on the upper right hand of your screen.
• Submit questions at any time.