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2010 State Oral Health Workforce

Grants to States to Support Oral Health Workforce Activities: FY 2010 Abstracts (three-year projects)

CaliforniaDelawareFloridaKansas
MassachusettsMinnesotaMontanaNorth Carolina
New YorkNorth DakotaOhioTexas
Virginia   

 CALIFORNIA

Reorienting the California Oral Health Workforce Project

The California Department of Public Health-Oral Health Unit
1616 Capitol Avenue, MS 7210
P.O. Box 997377
Sacramento, California 95899-7337
Phone: 916-552-9896
FAX: 916-552-9910
E-mail: Rosanna.Jackson@cdph.ca.gov
Website: www.cdph.ca.gov/

The California Department of Public Health- Oral Health Unit (CDPH) will initiate an innovative multi-pronged approach to address oral health workforce gaps in federally qualified dental health professional shortage areas (DHPSAs) and other underserved areas in the state.

California is experiencing unprecedented budget deficits and by February 2010 reached an unemployment rate of 12.8 %. As a result of the budget deficits, the Department of Health Care Services eliminated the optional dental benefit for adults from its Medicaid program in July 2009. In addition, state general funds for the State’s only school based prevention program were eliminated due to the budget crisis. The California Children’s Dental Disease Prevention Program (CDDPP) which provided sealants, fluoride supplements, and education in schools that had at least fifty percent participation in the National School Lunch (aka Free and Reduced Lunch) Program served approximately 300,000 children per year in over 1,000 schools statewide. After thirty years, this left a significant gap for children that were low-income, minority, and had special needs or were in rural or underserved areas. The CCDDPP was the only access to preventive dental services for many of these children.

The elimination of both of these programs increased access issues for low-income Californians to unprecedented levels. Additionally, these cuts had unintended consequences such as significant lay-offs among the oral health workforce in safety-net dental providers, as well as private dental offices that served the adult Medicaid (Denti-Cal) dental population. However, the number of Californians requiring prevention and treatment from community clinics and health centers has never been higher as the unemployment rate escalates and citizens are losing their health and dental benefits.

Addressing the oral health workforce needs of underserved Californians is a priority for the state. It will require an innovative approach that includes identifying new models for dental safety net providers such as community clinics and health centers, improving their financial viability to integrate these models such as incorporating school based or community based preventive and restorative services; and to assist safety net providers to use new classifications of mid-level dental providers for cost effective service delivery. This unique public/private partnership between CDPH and the Dental Health Foundation, California Primary Care Association, and the University of the Pacific School of Dentistry have come together to address these pressing oral health workforce issues.

The goals for this project are:

  1. Increase or maintain California’s current oral health workforce by identifying new models of service provision in school-based or community health settings.
  2. Increase the number of high-risk, low-income elementary school children who receive preventive and restorative oral health services.
  3. Provide an affordable training program for mid-level dental personnel for the new California oral health license category referred to as the Registered Dental Assistant in Expanded Functions (RDAEF) category to develop a diverse and culturally competent oral health workforce to increase the ability of Community Clinics and Health Center (CCHCs) to deliver oral health services to California’s most vulnerable populations.

Key activities:

  1. Develop a school-based/community based dental prevention and treatment pilot project in four or more counties in California. The initial counties are Alameda, Lake, Los Angeles, and Tulare of which two are urban and two are rural. Four pre-identified Federally Qualified Health Centers will provide services to twenty additional elementary schools by the end of Year Two and eight additional CCHCs by the end of Year Three.
  2. Tailor a Healthy Teeth Toolkit a web-based application that enables community-based dental programs to collect, track the delivery of preventive dental services and the oral health status of children; including a case management toolset to help coordinate restorative care
  3. Identify policy barriers and financial feasibility models and create resources for CCHCs to implement new models of service delivery in school and community based settings.
  4. Develop a low-cost culturally competent curriculum for midlevel allied dental personnel to better reflect California’s rich diversity and to increase capacity of CCHCs to serve high risk, underserved populations in California.
  5. Identify a Planning and Advisory Committee made up of key stakeholders such as representatives from program partners, and the California Dental Association, Oral Health Access Council, California Indian Health Services, Welcome Back Initiative, California Department of Health Care Services and other interested individuals.
  6. Pilot the mid-level training program and make adjustments to the curriculum as needed.

 DELAWARE

Oral Health Workforce Activities

Delaware Health and Social Services
Division of Public Health
417 Federal Street
Dover, Delaware 19901
Phone: 302-744-4554
FAX:  302-6617229
E-mail:  Greg.McClure@state.de.us
Website: http://www.dhss.delaware.gov/dhss/dph/hsm/ohphome.html

In August 2008, the Delaware Division of Public Health received a one-year grant from the Health Resources and Service Administration (HRSA) through “Grants to States to Support Oral Health Workforce Planning Activities.”  That resulted in a detailed plan for improving access to care in underserved areas of Delaware, particularly southern Delaware, by focusing on three high-impact strategies to expand the oral health infrastructure and strengthen the dental workforce.  In 2009, Delaware was awarded the implementation phase of the Grants to Support Oral Health Workforce Activities.  These activities are focused on the establishment of a dental clinic in Sussex County to improve access to care in a critically underserved area, support for the mobile dentistry program, and the establishment of a dental residency program in Sussex County. 

The purpose of this project with supplemental funding is to expand the planned activities to specifically target increase opportunities to improve the oral health of persons with disabilities and disadvantaged children.   This will be accomplished with three additional major objectives:

Objective 1:  Increase the number of pediatric dentists in designated underserved areas.  This will be accomplished by augmenting the existing loan repayment funds with additional funds for a pediatric dentist to serve in an underserved area.

Objective 2: Increase the opportunities for access to dental care and reduce the prevalence of dental disease for persons with disabilities.  Training will be provided to dental professionals and caregivers to improve access to dental care and the oral health status. 

Objective 3:  Increase the availability of dental services for children who participate in the Mobile Dentistry program and children who are eligible for Medicaid.    This will be accomplished with expansion of an existing DPH dental clinic to increase services for children.

Delaware recognizes a critical need to improve access to dental care, particularly in the underserved areas of Kent and Sussex County and for persons with disabilities.  Therefore, the Division of Public Health is collaborating with key stakeholders to improve access objectives that will expand dental services for persons with disabilities and children.

 FLORIDA

2010 HRSA Workforce Grant – New Funding for Projects Addressing Florida’s Oral Healthcare Workforce Needs

Florida Department of Health
Florida Department of Health
Public Health Dental Program
4052 Bald Cypress Way, Bin # A14
Tallahassee, Florida 32399-1724
Douglas T. Manning DMD, JD, MPH
Phone Number: 941-925-2906 (w); 941-726-0931 (c); 850-245-4333 (program office)
FAX: 850-414-7552; 850-414-6091
E-mail: douglas_manning@doh.state.fl.us

In 2004, in response to the U.S. Surgeon General’s Report and Healthy People 2010, the Florida
Department of Health’s (DOH) Public Health Dental Program (PHDP) established Oral Health
Florida, a broad-based coalition that developed and continues to advance a State Oral Health Improvement Plan for Disadvantaged Persons (SOHIP). In early 2008, the State Surgeon General, concerned that many Floridians were not receiving necessary dental care due to provider availability, established an Oral Healthcare Workforce Ad Hoc Advisory Committee (Committee). The Committee provided recommendations on dental workforce and access to oral health care to the Governor’s office. In August of 2008, HRSA awarded a $200,000 grant to the DOH’s PHPD for the purpose of convening an Oral Healthcare Workforce Workgroup (Workgroup) and developing a strategic plan on dental workforce issues. Additionally, the project includes an independent needs assessment on oral health access and workforce in Florida.
The Workgroup completed its mission in the end of 2009. In September of 2009, HRSA awarded the PHDP a $498,493 grant (2009 Workforce Grant) for the purpose of address in demonstrated oral health workforce needs in the state of Florida.

With the 2009 Workforce grant, the PHDP funded a number of activities aimed at improving Florida’s oral health workforce and increasing access to care in Florida. However, the HRSA funded 2009 Florida Oral Health Workforce Strategic Plan and other recent documents such as the Pew Center on the States “The Cost of Delay: State Dental Policies Fail One in Five
Children” demonstrate that Florida has many other areas related to oral health workforce that need improvement. Consequently, the PHDP is requesting new funding to support activities as part of the 2010 HRSA Grants to States to Support Workforce Activities. The PHDP proposes to collaborate with partners such as the Florida Dental Association, the University of Florida
College of Dentistry, Nova Southeastern College of Dental Medicine, Special Olympics and other organizations and agencies around the state to advance such activities as: a school-based dental sealant program; a provider directory for individuals with special health care needs; oral health training programs for medical providers and behavioral training programs for dental providers in the care of individuals with special health care needs; a statewide oral health surveillance system; an oral health curriculum as part of school health programs; and equipment to expand local community water fluoridation efforts.

 KANSAS

Kansas Children’s Oral Health Initiative

Kansas Bureau of Oral Health
Dr. Katherine Weno, Director
1000 S.W. Jackson, Ste. 300
Topeka, Kansas 66612-1365
Phone: 785-296-5116
FAX: 785-291-3959
E-mail: kweno@kdheks.gov
Website: http://www.kdheks.gov/ohi/index.html

Shortages in the dental workforce have resulted in Kansas children that are unable to access preventive and restorative dental treatment through conventional dental practices. The purpose of the 2010 Kansas Children’s Oral Health Initiative grant is to provide multiple opportunities for Kansas children to access oral health preventive treatment and education in schools, Head Start, early childhood centers and pediatric medical offices. Services will be targeted at children at risk of dental disease living in dentally underserved areas, in addition to children enrolled in the Medicaid and/or the free and reduced lunch program. The Initiative will also collect data on the oral health status of Kansas children through a Basic Screening Survey and the maintenance of the statutorily mandated School Screening Program.

Grant Objectives: 
Objective 1: Create a Kansas Statewide School Sealant Program Strategies:

  1. Finalize Contracts with Seven Regional Sealant Program Coordination Sites
  2. Conduct Statewide School Sealant Training for Program Sites
  3. Perform Oral Health Screenings in Regional Sites
  4. Program Sites Contract with Regional Schools and Prepare Communities
  5. Provide Preventive Services in Schools

Objective 2: Create a Network for Oral Health Services for Children under Five in Coordination with the Kansas Cavity Free Kids Program
Strategies:

  1. Utilize Fixed and Portable Equipment and Local Dental Professionals to Create Dental Access Points in Head Starts and Early Learning Centers
  2. Provide Training for Early Childhood Staff on Oral Health using the Cavity Free Kids Oral Health curriculum
  3. Co-facilitate the Early Childhood Oral Health Advisory Council with Oral Health Kansas

Objective 3: Medical Pediatric Providers Completing Oral Health Assessments and Applying Fluoride Varnish during Well Child Examinations
Strategies:

  1. Provide In-Office Education to Pediatric Medicaid Providers and their Office Staff
  2. Receive Regular Claims Data to Measure Program Success

Objective 4: Create and Maintain a Kansas Oral Health Surveillance System
Strategies:

  1. Complete Yearly School Oral Health Screenings and Data Collection
  2. Complete a 2012 Smiles Across Kansas Basic Screening Survey of Kansas Third Graders
  3. Include Kansas State Specific Oral Health Questions in the Behavioral Risk Factor Surveillance System

 MASSACHUSETTS

Massachusetts Oral Health Workforce Initiative in New Sites II Supplemental Activities (MA OH WINS II SA)

Massachusetts Department of Public Health Office of Oral Health
250 Washington Street
Boston, Massachusetts 02108
Lynn Bethel, RDH, MPH, Director 
Lynn.Bethel@state.ma.us
Phone:  617-624-6074
FAX:  617-624-6062
Website: www.mass.gov/dph/oralhealth

The primary purpose of MASS OH WINS II Supplemental Activities (SA) is to improve the oral health of underserved populations by increasing the oral health workforce and expanding community-based prevention programs by three complementary initiatives:

  1. Identify, assess and measure oral health needs and resources in underserved communities focusing on workforce and shortage designations with proposed funding for the expansion of the Office of Oral Health’s (OOH) infrastructure;
  2. Support, promote and implement effective community-based prevention programs and support a statewide oral health coalition with a focus on workforce initiatives and promoting prevention; and
  3. Ensure a dental home and comprehensive oral health services for developmentally and intellectually disabled children and adults.

Population(s) Served:  Rural, underserved and/or DHPSA communities; the low income, minorities, children with special health needs and the developmentally disabled.

Needs Assessment:  Massachusetts has overwhelming unmet oral health and workforce needs.  More than one million residents live in DHPSAs.  Four counties have less than 20 MassHealth (Medicaid) dentists and just 13% of dentists statewide are actively treating MassHealth members. About 1 million of the state’s residents are considered disabled and more than 850,000 residents are over the age of 65.  Of these seniors, 53% have untreated tooth decay with 29.7% having major to urgent dental needs, and 17% have no dentures. One dental clinic serving the developmentally disabled was forced to close, and another, the largest, will be closing in FY 2011. To respond to these issues MA OH WINS II SA was developed.

Methodology:  Initiative 1:  The OOH will create a Dental Workforce/Dental Health Professional Shortage Area Specialist position which will collect and monitor workforce data and prevention program needs and resources to establish and renew DHPSA designations.  Initiative 2:  The OOH will promote and support community water fluoridation through one-time grants to support the upgrade of existing fluoridation equipment and support a statewide oral health coalition to promote prevention and ensure the availability of a qualified workforce to address oral heath needs, essential to the overall health of all Massachusetts residents  Initiative 3:  The OOH with the Hospital Bureau will expand a hospital/school-based dental clinic to increase its capacity to serve developmentally and intellectually disabled adults from the community and expand dental student, AEGD and GPR placements serving this population.

Evaluation:  An Advisory Committee made up of key stakeholders such as the state’s dental and dental hygiene societies, primary care association, dental and dental hygiene schools, several offices within MDPH, and three dentists’ board certified in dental public health will oversee this proposal by planning, monitoring and evaluating the progress of the objectives and activities of each initiative.

 MINNESOTA

Minnesota Oral Health Workforce Innovation Supplemental Project

Minnesota Department of Health
P.O. Box 64882
St. Paul, Minnesota 55164-0882
Principal Investigator: Merry Jo Thoele
Phone Number: 651-201-3749
FAX: 651-201-5800
E-mail: merry.jo.thoele@state.mn.us
Website: www.health.state.mn.us

Minnesota is re-energizing its oral public health effort. Current funding provides a basis to develop the oral health infrastructure in Minnesota by development of an oral health plan, a state-wide open mouth screening survey, an ongoing oral health surveillance system, support for a statewide oral health coalition and activities to strengthen oral health partnerships both within the Department of Health and the overall community. However, funding is insufficient to address the urgent oral health workforce needs that have been identified. We propose to provide significant additional support for oral health workforce priorities that will both improve the impact and availability of Minnesota’s oral health workforce for underserved populations, and also increase the comprehensiveness of Minnesota’s oral health improvement effort. Over the past several months a group of stakeholders has met to develop a plan for improving the coordination and breadth of activities related to training and recruiting Minnesota oral health workforce.

PROPOSED ELEMENTS OF SUPPLEMENTAL FUNDING

  • To support a viable and sustainable community clinic outreach site for development and training of dental therapists to increase access to care. This will support the infrastructure of the dental hygienists and dentists who work under the collaborative agreement and further the education and outreach of the Dental Therapist and Advanced Dental Therapist.
  • Collaborate with the medical and dental profession to promote, develop and implement a primary caries prevention program that implements fluoride varnish for young children.
  • Funding to improve the fluoridation capacities of local water systems to improve fluoridation compliance across the state.
  • Integrate, analyze and report on patterns and trends of Minnesota’s dental hygienist workforce across the state of Minnesota to increase the strategies for the treating the underserved population.

Each element is a critical piece to building the oral health infrastructure for long-term sustainability of an effective and efficient workforce.

 MONTANA

Improving Oral Health in Montana

Montana Department of Public Health and Human Services
1400 E. Broadway, Rm. A116  
Helena, Montana 59620-2951
Phone:  406-444-0276
FAX:  406-444-2606
E-mail: vnewhart@mt.gov
Website: http://www.dphhs.mt.gov/publichealth/oralhealth/

Improving Oral Health in Montana plans to serve the population of Montana by creating a strategic vision for Montana’s oral health program and strengthening programs that address dental workforce needs. Improving Oral Health in Montana is modeled on the Association of State and Territorial Dental Directors’ (ASTDD) Guidelines for State and Territorial Oral Health Programs recommendation that assessment be the first step in the development and operation of oral health programs at the state level.  Montana recognizes that efforts to develop a strong state oral health program which addresses the needs of our population must begin with a thorough assessment of oral health needs, state and local resources and capacity, and the development of a comprehensive plan. This grant will fund an External Evaluator who will work closely with the oral health coordinator to perform a thorough assessment of the oral health status and needs of the Montana population and analyze determinants of identified oral health needs, including resources.  As part of this first phase of our plan, we will also develop an oral health surveillance system to identify, investigate, and monitor oral health problems and needs.  Funds from this grant will also strengthen the MT Area Health Education Center (AHEC) Office of Rural Health’s existing dental recruitment and retention programs and their educational programs which promote oral health professions in Montana’s elementary and secondary schools.

The oral health program is currently funded 100% by the Maternal and Child Health Block Grant (MCH BG).  Montana’s MCH BG funding has experienced a continual decline in federal funds over the years and the oral health coordinator position has been reduced to .25 FTE.  It is time to assess our strengths and weaknesses and develop a strong oral health program that meets the needs of the population and addresses our dental workforce needs.  People in Montana face critical access problems in oral health care due to an inadequate supply and maldistribution of dental professionals, very high uninsured population and poverty levels, and limited access to dental services for low income and special populations.  Rural and frontier communities face special challenges that require community ingenuity and partnership efforts at both the state and grassroots levels. 

Montana is aware that the Healthcare Reform bill may have a huge impact on our Department’s oral health program.  This grant will assist MT in establishing a strong base for restructuring our oral health program and strengthening programs that address our dental workforce needs.

 NORTH CAROLINA

Expanding the Oral Health Workforce to Improve Access in North Carolina

East Carolina University School of Dentistry
Lakeside Annex #7
Greenville, North Carolina 27834
Phone:  252-737-7401
FAX:  252-737-7401
E-mail: chadwickg@ecu.edu
Website: http://www.ecu.edu/dentistry/

The School of Dentistry at East Carolina University proposes to establish two Community Service Learning Centers (CSLCs) in rural northeastern North Carolina in order to meet both educational and access to care objectives.  The CSLCs are to be located in Hertford and Pasquotank counties, each being federally designated dental care shortage areas for both counties.  The approach we are taking is innovative in that the CSLCs will provide 24 weeks of clinical experience for fourth year dental students and 12 month residencies for graduates.  The students and residents will be taught by one full time dental school faculty member, who will divide his/her time approximately 30% instructing students/residents and 70% providing service delivery.  Each CSLC will be a fully functioning general dental office with 14 operatories, patient waiting, reception, consultation, business office, Panorex, sterilization/lab, electrical/IT room, mechanical equipment room, 2 dentist/faculty offices, one resident/student office with 8 carrels, hygiene/assistant workspace, staff room, and will feature a 12 seat videoconference room so students can participate in lectures and seminars conducted at the main campus in Greenville, NC.

The establishment of the CSLCs will address the educational needs of students and residents for significant clinical hands-on experience with procedures that span a comprehensive scope of service, including diagnosis, prevention, prophylaxis, restorations, periodontics, oral surgery, implants, endodontics, fixed and removable prosthetics and pediatric dentistry. Students will perform many of the procedures within these treatment categories at the CSLCs to establish competency while developing an in-depth understanding of the populations they are serving.  

The establishment of the CSLCs will also address the oral health needs of the local population and those in nearby counties without access to oral health care, especially people with incomes below 200% of the federal poverty level, which accounts for approximately one third of the population to be served.  We anticipate that most of our patients will have Medicaid or be uninsured, although 5% may have some form of dental insurance.  We are including wheelchair lifts in each CSLC so the population of special needs children and limited mobility adults can receive treatment as well.

We will address the oral health needs of the populations of both counties and surrounding areas in northeastern NC, which includes high rates of dental caries in children, the most common chronic disease of childhood.  Common adult oral health needs in the region include

 NEW YORK

New York State Oral Health Workforce Initiative

New York State Department of Health/Health Research Inc. Bureau of Dental Health
542 ESP Tower
Albany, New York 12237
Contact Phone Numbers: 518-474-1961
E-mail: jvk01@health.state.ny.us

In New York State, even with the availability of all essential dental coverage for low-income children enrolled in the Medicaid program, only one-third of all eligible children received any type of dental care in 2008. According to a recent report published by the Pew Charitable Trusts, there are three systemic factors that significantly contribute to poor dental health and the lack of access to care among disadvantaged children: (1) too few children having access to proven prevention measures, (2) too few dentists willing to treat Medicaid-enrolled children; and (3) limited number of dentists available to provide care in many communities.

In New York State, the distribution of dental workforce is uneven. Currently, there are 117 designated dental Health Professional Shortage Area (HPSA) locations. Most of these are facility designations (59 percent), while 7 percent are geographic, and 34 percent are population groups. Population group designations primarily target low-income or Medicaid-eligible New Yorkers.

The majority of dental HPSAs statewide are located in metropolitan areas rather than non-metropolitan areas (68 percent versus 32 percent). Overall, an estimated 222 dental full-time equivalents (FTEs) would be needed in New York State to eliminate the dental shortage designations, (i.e., meet a minimum 4,000:1 ratio) while 371 dental FTEs would be needed to achieve a 3,000:1 population-to-dentist ratio.

This grant proposes to: 1) reduce the need for dental services by focusing on prevention and early intervention, 2) recruit dentists to adopt schools in Health Professional Shortage Area (HPSA) locations to provide access to care; and 3) recruit dentists to serve in underserved communities by establishing linkages with community organizations.

To accomplish this, we will partner with Area Health Education Centers, New York State Dental Association, New York State Academic Dental Centers and New York State Oral Health Technical Assistance Center.

 NORTH DAKOTA

Workforce Initiative to Improve North Dakota’s Access to Oral Health Care

North Dakota Department of Health
600 East Boulevard Avenue, Department 301
Bismarck, North Dakota 58505-0200
Phone: 7 01-328-4930
FAX:  701-328-1412
E-mail:  kyineman@nd.gov
Website:  http://www.ndhealth.gov/oralhealth/

Access to oral health services is a growing concern for low-income and special populations in

North Dakota. As the number of dental providers in rural areas decreases, the dental access problem becomes more acute; few dentists accept Medicaid clients, the cost of dental care rises, families lack dental insurance coverage and lack an understanding of the impact of oral health on overall health. Access to free or reduced-fee dental services for low-income, uninsured and underinsured is extremely limited with only three dental public health clinics in the state. There is no dental school in the state, sixteen counties lack a dentist, there is no statewide dental sealant program and there are no mobile dental clinic programs in the state. In 2008, there were 15 counties that lacked an enrolled Medicaid dental provider; and in 2009, only 32.5 percent of the Medicaid enrolled children aged 0-20 received dental services.

The Workforce Initiative to Improve North Dakota’s Access to Oral Health Care is a collaborative project of three agencies – the North Dakota Department of Health’s Oral Health Program, Bridging the Dental Gap, and Ronald McDonald House Charities-Bismarck. The goal of the project it to increase access to oral health services for individuals in rural and underserved areas of the state. This collaborative project proposes a three-pronged approach to improve access to dental care for the state’s most vulnerable citizens: 1) developing and implementing a statewide dental sealant program, 2) building the capacity and infrastructure of Bridging the Dental Gap clinic to increase their delivery of dental services, and 3) implementing a mobile dental clinic to improve access to dental care for the children in rural and underserved areas.

The North Dakota Department of Health’s Oral Health Program, dental sealant program, will reach children at high risk for oral disease by targeting schools with greater than 50 percent of their children eligible for free- and reduced fee school lunch. Bridging the Dental Gap will expand their capacity to reach underserved individuals in long term care facilities by using portable equipment to bring the services to the residents. They will also expand the capacity to serve more clients at their current site with the addition of equipment, treatment rooms, and employing additional dentists and assistants. The Ronald McDonald House Charities Dental Care

Mobile will employ dental staff to bring dental services to low-income and underserved children age 0-21 in the frontier areas of western North Dakota. Together these agencies can bring dental services to thousands of additional North Dakota children and adults.

 OHIO

Ohio’s Supplemental State Oral Health Workforce Proposal

Ohio Department of Health
246 N. High Street, Columbus, OH 43215
Phone Numbers: 614-466-4180 (voice); 614-564-2421 (fax)
E-mail:  Mark.Siegal@odh.ohio.gov
Website:  http://www.odh.ohio.gov/

In Ohio, dental care is the number one unmet healthcare need. The greatest needs have been documented primarily for low- income populations, minorities and residents of the state’s 29-county Appalachian region. About 13% of Ohioans live in poverty and another 17% are near poor (with incomes between 101% and 200% of the federal poverty level). Ohio’s unemployment rate stood at 10.8% in January 2010. Forty-one percent of adults and 18% of children lack dental coverage. The bottom line has been an escalation in the number of Ohioans without access to dental care. Ohio has been hit especially hard by the economic crisis resulting in increased demand for affordable dental care by the growing proportion of the population that is uninsured or has Medicaid. The economic downturn has not only increased the need for access to affordable dental care for more Ohioans, it has diminished the resources for the dental care safety net. The Ohio Department of Health (ODH) experienced significant state budget cuts in SFY09 and in the SFY10-11 biennial budget. Even with the 2009 HRSA Workforce Activities grant, the ODH had to cut its support to two important sub-grant programs that address access to dental care: the Dental OPTIONS referral/case management program and support for safety net dental clinics. These cuts resulted in reduced services at the local level.

The purpose of this project is to supplement the 2009 HRSA Workforce Activities grant and state funding to provide operational support to Dental OPTIONS and the dental care safety net through sub-grants for serving primarily low-income uninsured individuals and Medicaid consumers. The sub-grants for safety net dental clinics were competitively awarded at the start of 2010 and will receive continuation funding in 2011 and 2012. The OPTIONS sub-grants were competitively awarded for SFY07 and will receive continuation awards through SFY11.

This two-year proposal has two goals: 1) to increase access to direct oral health care services for high-risk Ohioans through safety net programs and 2) to increase access to case management and direct oral health care services for high-risk Ohioans through the Dental OPTIONS program.

The objectives are: 1) during each funding year, 8,750 additional unduplicated patients will be served by dental clinics receiving ODH Safety Net Dental Care sub-grants as a result of HRSA

Oral Health Workforce Activities grant dollars and 2) during each funding year, 2000 additional unduplicated patients will receive referral and case management services by regional Dental

OPTIONS offices funded by ODH as a result of HRSA Oral Health Workforce Activities grant dollars.

Using a combination of data analysis and face-to-face contact with sub-grantee agencies, we will evaluate both process and impact measures to ensure accomplishment of our goals and objectives. Quarterly meetings of the state oral health program’s Access to Dental Care Team will serve to assess progress on accomplishing plan activities and addressing barriers that may arise.

OHIO

Ohio’s New State Oral Health Workforce Proposal

Ohio Department of Health
246 N. High Street, Columbus, OH 43215
Phone: 614-466-4180
Fax:  614-564-2421
E-mail:  Mark.Siegal@odh.ohio.gov
Website: http://www.odh.ohio.gov/

In Ohio, dental care is the number one unmet healthcare need. The greatest needs have been documented primarily for low- income populations, minorities and residents of the state’s 29- county Appalachian region. About 13% of Ohioans live in poverty and another 17% are near poor (with incomes between 101% and 200% of the federal poverty level). Ohio’s unemployment rate stood at 10.8% in January 2010. Forty-one percent of adults and 18% of children lack dental coverage. The bottom line has been an escalation in the number of Ohioans without access to dental care. Ohio has been hit especially hard by the economic crisis resulting in increased demand for affordable dental care by the growing proportion of the population that is uninsured or has Medicaid. The economic downturn has not only increased the need for access to affordable dental care for more Ohioans, it has reinforced the importance of evidenced-based oral disease prevention.

The purpose of this project is to use new HRSA Workforce Activities funding to: 1) provide dental care to more of Ohio’s most vulnerable citizens and 2) provide evidence-based community prevention services (i.e., dental sealants through school-based programs) to more higher-risk children. This will be accomplished by expanding two existing activities of the Ohio

Department of Health (ODH), Bureau of Oral Health Services (BOHS) which is the State Oral Health Program: dentist loan repayment and the school-based dental sealant program (S-BSP).

This three-year proposal has two goals:

  1. Increase and maintain access to oral health care services for high risk Ohioans in designated dental health professional shortage areas (DHPSAs) through dentist loan repayment.
  2. Increase and maintain the number of higher-risk students receiving preventive dental sealants through school-based dental sealant programs (S-BSPs).

The objectives are:

  1. During each funding year, 25,600 Ohioans will obtain needed dental care in Dental Health Professional Shortage Areas (DHPSAs) from dentists who receive loan repayment from the ODH as a result of HRSA Oral Health Workforce Activities grant dollars.
  2. During each funding year, at least 25,000 students in higher-risk schools will receive dental sealants through ODH-funded School-Based Sealant Programs (S-BSPs) as a result of HRSA Oral Health Workforce Activities grant dollars.

We will analyze patient activity reports to ensure that dentists receiving loan repayment are providing oral health care services to high risk Ohioans. Using a combination of data analysis and face-to-face contact with sub-grantees, we will evaluate the extent to which programs are meeting performance benchmarks. The Dentist Workforce Loan Repayment Program Advisory

Committee and the School-Based Services Team will assess progress on accomplishing planned activities and addressing barriers as they arise.

 TEXAS

Texas Oral Health Workforce Project

David P. Cappelli, DMD, MPH, PhD
Department of Community Dentistry
University of Texas Health Science Center at San Antonio
7703 Floyd Curl Drive, San Antonio, Texas 78229-3900 Telephone: 210-567-3186
FAX: 210-567-4587
E-mail: Cappelli@uthscsa.edu

While access to oral health services was identified as a critical need in the Report of the Surgeon General: Oral Health in America, certain populations still face overwhelming disparities in accessing oral health services. This disparity is greatest in those living in poverty and racial/ethnic minorities. This application is a collaboration between the University of Texas Health Science Center at San Antonio (UTHSCSA) and the San Antonio Metropolitan Health District (Metro Health).

The purpose of this application is to plan, develop, implement and evaluate a model that can be used to address access to oral health care for children across the State of Texas.

Three program objectives are proposed to address these disparities: 1) to plan, develop, implement and evaluate a model community-based oral health program, utilizing public-private partnerships, 2) to disseminate the model to other Texas communities, and 3) to plan, develop, implement and evaluate an oral health workforce roundtable.

This proposal integrates a comprehensive oral health prevention program for children in elementary schools located in economically-disadvantaged areas in Bexar County (San Antonio), TX. Using a Basic Screening Survey (BSS), children in kindergarten will be screened and those children with unmet dental needs will be referred to a dentist. A referral network of dentists in public and private practices will be developed through a case management system. Children in second grade will receive dental sealants through a school-based prevention program that spans districts within the city. Children identified with oral health needs will be referred to a dentist through the case management program. Children in third grade will be screened using BSS to again identify disease and verify sealant retention.

This proposal describes the initiation of an oral health coalition. Using this model as a template, a similar school-based prevention program will be implemented in both school districts in Laredo, TX (Laredo ISD and United ISD). This application outlines the development of an oral health coalition that will be used to identify partners who are willing to provide dental homes to the children. Children who are screened in the school-based prevention program will be referred to treatment through this network. This proposal will examine the primary care dental workforce in Texas to better understand the supply and distribution of dentists and explore issues related to access to oral health care using existing geocoded oral health workforce data. A series of regional roundtables will be held in five Texas communities that will gather recommendations for improving oral health workforce based on the findings of the oral health workforce assessment.

 VIRGINIA

Virginia State Oral Health Workforce Activities Supplemental Grant

Karen C. Day, DDS, MPH, MS
State Dental Director
Virginia Department of Health
109 Governor Street, 9th floor
Richmond, Virginia 23219
Phone Number: 804-864-7775
FAX:  804-864-7783
E-mail: karen.day@vdh.virginia.gov
Website: www.vahealth.org/teeth

The Commonwealth of Virginia continues to face numerous challenges to improving access to oral health services for citizens in underserved areas of the state. A 2009 survey of Virginia school children shows that nearly 50% have had decay experience. Approximately 34% of Virginia adults do not have access to dental insurance, and according to a 2006 state manpower analysis, 80% of Virginia’s counties and independent cities qualify as dentist shortage areas. Although improvements have been made in the dental Medicaid program, there are still inadequate numbers of dental Medicaid providers, pediatric and general dentists in underserved areas, and safety net programs to meet the needs of low-income children and adults.

The purpose of this proposal from the Virginia Department of Health (VDH) is to improve the state's oral health workforce and service delivery infrastructure for underserved populations by using a multifocal approach that includes prevention and treatment services. This grant will supplement the existing Workforce grant by expanding to five additional health districts (Central Virginia, Central Shenandoah, Danville/Pittsylvania, Rappahannock/Rapidan, and Lord Fairfax). Activities include expansion of an existing program operated by the state dental society that provides dentures to individuals in need; establishing or expanding community-based prevention services including community water fluoridation, school-based dental sealants and fluoride rinse programs, fluoride varnish, and home visitation/care coordination; and working with entities that serve children with special health care needs to improve their access to care and preventive services.

State laws and regulations are often a barrier in access to care, by limiting the type of practice settings and imposing restrictive supervision requirements. Legislative changes made in 2009 allow dental hygienists employed by VDH to work under less restrictive supervision requirements in three health districts; expansion of this legislation to the five districts targeted by this proposal is anticipated within the next year. This is a new concept for public health practice in Virginia and if successful, has potential for replication and dissemination to other underserved areas of the state, as well as sustainability through Medicaid billing.