SF HIP Children’s Oral Health Strategic Plan 2014 -2017

http://assets.thehcn.net/content/sites/sanfrancisco/Final_document_Nov_2014_20141126111021.pdf

Strategic Planning

 

Children’s oral health identified by the community as a top unmet health need in San Francisco Created the SF HIP Children’s Oral Health Partnership Working Group (2011) • • •

 

Included many diverse partners and advocates in oral health Convened three times to discuss and identify projects San Francisco needs a strategic plan!

Funding – Metta Fund for Planning Consultant (2012) Hellman Foundation – Implementation grant support for 2 years $400,000 (2014-16)

Childcare programs

Health care plans Denti-Cal, Delta Dental, SF Health Plan

Safety Net Dental Clinics

WIC

Universities UCSF, University of the Pacific

Community Resource Centers

Steering Committee

SF DPH clinics, Native American Health Center, Mission Neighborhood Health Center, SOMA, Northeast Medical Services

Family Health Programs

Head Start, First Five

Core team - SF DPH–UCSF (co-leads) - Professional consultant

San Francisco Unified School District Kindergarten Screening, Sealant Program, Tenderloin School health center

SF Dept. of Public Health

Hospital Systems

APA Family Support Services, Carecen

St. Luke’s Kaiser, SFGH

SF Dental & Dental Hygiene Societies

Population Health Division, Primary Care, MCAH, Child Health & Disability Prevention (CHDP) Program, Child Care Health Program

“All San Francisco children are caries-free”

Tooth decay affects overall health and development  Speech and communication  Eating and dietary nutrition  Sleeping  Learning  Playing  Overall quality of life  Increased risk for a lifetime of dental problems

Most Common Chronic Childhood Disease is PREVENTABLE

Poor oral health has high costs Emergency Department (ED) visits • $5,000 per child with hospitalization in CA1

Students’ absences due to dental problems cost CA school districts approximately $29.7 million annually2 • Students with toothache in last 6 months were 4x more likely to have low grade point average3 • More than 5 million American school-age children missed ≥ 1 day of school due to a dental problem3

Caries Experience

Healthy People 2020 goal: Target is 30%

30%

Children in some SF neighborhoods have experienced 2-3x more caries Chinatown North Beach Nob Hill/Russian Hill/Polk Tenderloin South of Market Bayview/Hunter’s Point Visitation Valley Excelsior Portola

Caries Experience (% of Students Screened)

Children of color are 2-3x more likely to have untreated decay as white children % of SFUSD Kindergarten Children with Untreated Caries by Race/Ethnicity, 2012-2013

% of Children With Untreated Caries

30

23 20 17

10

16

8

0 White

Black

Chinese

Hispanic

SFUSD: San Francisco Unified School District; Untreated caries: A loss of at least 1/2mm of tooth structure at the enamel surface, with brown coloration of the walls of the cavity. Data represent the proportion of children needing any dental care beyond routine checkups, dental care within the next few weeks for caries without symptoms, or urgent dental care for large carious lesions with pain infection or swelling. Data source: San Francisco Kindergarten Dental Screening Project data collected by the SFDPH, SF Dental Society, National Dental Association & SFUSD

Low income children in SF are 8x more likely to jjhave untreated tooth decay

Untreated decay

2000

2008 Lower income schools: increasing untreated decay

Higher income schools: decreasing untreated decay

40 26

9

5

Schools of various % of children participating in the free /reduced school lunch program

Disparities are Increasing % of Children in SFUSD Kindergarten with Caries Experience in San Francisco by Race/ethnicity

% of Children Screened

100

80

60

Asian

Black

White

66 60 59 45

40

Hispanic

14 %

20

43 38 37

16

0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 Data source: San Francisco Department of Public Health Oral Health Screening Program.

21% points

Half (52%) of Denti-Cal enrolled children in SF did not see a dentist in the past year

Children’s dental caries ~100% preventable Best practices for good COH include: Perinatal Care and Education Dental visit by AGE 1 Routine dental visits (2x year) Limited frequency of sugary foods/drinks Topical fluoride • Brushing with fluoridated toothpaste 2x/day • Drinking fluoridated water (SF is fluoridated) • Fluoride varnish application 2-4x/year Sealants on 1st (6 year olds) and 2nd (12 year olds) molars

CDC promotes sealants and fluoride as proven strategies for prevention1 Fluoride Varnish: Prevents 37% 3 of decay in high risk 0-5 y.o. Rx strength fluoride is brushed on by any trained care provider. It is low cost, low tech, and can be applied in 5 minutes in almost any setting.

Sealants: Prevents 88% of decay in permanent molars2 Plastic resin protects grooves on molars. CDC recommends school-based application, which requires RDH/DDS/RDA with special equipment, and about 30 minutes. 1. 2. 3.

http://www.cdc.gov/oralhealth/ Ahovuo-Saloranta et al. Sealants for preventing dental decay in the permanent teeth. Cochrane Database Syst Rev 2013 Marinho et al. Fluoride varnishes for preventing dental caries in children and adolescents. Cochrane Database Syst Rev 2013

Gaps in SF children’s oral health landscape 

ACCESS TO CARE • • • • •



PROMOTION/EDUCATION •



Uncoordinated education effort for parents and pregnant women

DATA • •



Small dental safety net vs medical safety net • Further burdened by ACA, adult Denti-Cal, and Healthy Families transition to Medi-Cal Long wait time at Denti-Cal clinics Few general dentists who see young children Low Sealant & Low Fluoride Varnish application Lacking “Case Management”

Lack of data for older youth, teens Lack of infrastructure to collect/analyze/disseminate data

FUNDING STREAMS •

Under-utilization of available funding

Guiding Principles 1. Prevention (not to the exclusion of treatment) 2. Ages 0-10 and pregnant women 3. Populations who are most at-risk, including lowincome, communities of color, children with special needs, and recent immigrants 4. Sustainable efforts; utilize all available funding streams 5. Policy and systems levels change 6. Coordinated city-wide efforts 7. Inclusion of community perspective

Indicators Caries Experience: Reduce the percentage of kindergartners with dental caries experience from 37% in 2012 to 27% in 2017 Untreated Decay: Reduce the percentage of kindergartners with untreated dental decay from 16% in 2012 to 8% in 2017 Caries Disparities: Reduce the gap between Chinese, Black and Hispanic/Latino kindergartners and White kindergarteners with respect to risk of caries experience from a 20 percentage point difference in 2012 to a 15 percentage point difference in 2017, a relative reduction of 25%.

Indicators Access: Increase the percentage of children on Medi-Cal under age 10 1. who received any dental service billed to Denti-Cal during the past year by absolute increase of 10% 2. who have seen a dental provider by age 1 by absolute increase of 10% Increase the percentage of women on Medi-Cal that had a dental visit during pregnancy by an absolute increase of 20%

Indicators Dental Sealants:

Increase the percentage of low-income children in San Francisco Unified School District (SFUSD) aged 7-8 years old who have received dental sealants on their permanent molar teeth by an absolute increase of 10%. (FY 12/13 sealants applied on 248 second graders.)

Overarching strategic priority areas

Access

Integration

Promotion

Evaluation

Coordination

Strategies ACCESS: Increase access to oral health care services for San Francisco children and pregnant women INTEGRATION: Integrate oral health with overall health PROMOTION: Increase awareness and practice of optimal children’s oral health behaviors among diverse communities in San Francisco EVALUATION: Develop and establish an ongoing oral health population-

based surveillance system to address the oral health of San Francisco children COORDINATION: Provide coordination and oversight for the implementation of the Strategic Plan

Tactics : Year 1 Examples • ACCESS – Establish billing mechanism for “non-traditional site” billing. Work with FQHCs and other key stakeholders to share information and strategies on billing.

– Hired FQHC Billing Consultant to develop SF FQHC Billing Handbook – Meeting with SF HN to expand dental services to WIC

• INTEGRATION – Institute fluoride varnish and OH education with-in well-child visits and immunizations.

– SF HN Ambulatory Care – Pilot at FHC for FV – SF Health Plan: exploring FV reimbursement – Survey sent out to MDs/NPs

• PROMOTION – Organize and mobilize most-impacted communities to develop and implement culturally specific oral health education campaigns relevant to their neighborhoods

– Two oral health briefings – Funding for Oral Health Coordinator for 1 year at DPH

• EVALUATION – Develop an oral health surveillance plan

Promotion – Community Stakeholders Meetings

• April 30 Chinatown • June 9 Mission • Late Summer Bayview/ Hunter’s Point

Dissemination & Communication • • • • • •

SFDPH Integrated SC SF Health Commissioners SF Community Clinic Consortium SF Health Plan (SF HP) Supervisor Wiener Supervisor Christensen

• SF First 5 • SF Pediatric Advisory Committee

Dissemination & Communication Targeted • SF Medical Society • Department of Children Youth & Families board • FQHC medical directors • Large pediatric clinics • SFUSD board

Successes & Opportunities • Strategic Plan is our blueprint; we now have direction • Momentum-building & Commitment – Committed Steering Committee – 20 members- meet quarterly – Implementation Teams (4 teams) – meet monthly

• Oral health finally has people’s attention – Several articles in news: print & radio

• Dental and public health leaders and experts – Health Commission Resolution – NICOS Chinatown Task Force

• Grants: Metta Fund, Hellman, CDPH • Timing: Alignment to DPH goal to have Public Health Accreditation

Challenges & Threats • Maintaining momentum • Motivating continued engagement: – Implementation Coordinating Committee (ICC) – Community and DPH Leadership

• Continued coordination of diverse efforts • Tendency to work in silos • Competing health priorities among decision makers and city leaders – oral health getting left behind • Aligning multiple agencies’ leadership with our goals • Ensuring action by leadership • Lack of dedicated time

How can SF HIP Leadership help? Promote and advocate for: INTEGRATING Oral Health into Overall Health • Fluoride Varnish in well child visits – Leadership

Supporting and expanding ACCESS • FQHC Dental Clinics: – Providing Care at “Non Traditional Sites” – Increasing dental infrastructure

Make Connections for $$: • Funding - Grants

Thank you!

Metta Fund  United Way  Hellman Foundation  CDPH  SF DPH  SF HIP (UCSF CTSI)