PROBLEM
Dental caries is the most prevalent oral disease in children and the most common infectious disease in childhood. While caries levels in U.S. children have declined steadily over the past 25 years, children living in poverty have not shared equally in this decline. It is estimated that 25% of children have 80% of all childhood dental disease in the United States. Caries among children aged 12-23 months is found primarily in children living below 200% of the federal poverty level. Among children 6-8 years of age, 43% Hispanic children and 36% of non-Hispanic African-American children experience untreated caries. In Rochester, New York – home of the historic Eastman Dental Center, children are experiencing alarming rates of dental caries. High percentages (23%) of kindergartners have never visited a dentist, and only 26% of Medicaid-eligible children and 28% of Child Health Plus (SCHIP) recipients have utilized dental services in fiscal year 2000. That Rochester ranks 11th per capita in child poverty nationwide, and has the 2nd highest per capita poverty rate among all 720 school districts in New York State, only compounds the problem. Founded in 1917, Eastman Dental Center is the largest provider of pediatric dental services in the Rochester area, serving a mostly urban, low-income population. In 2002, Eastman Dental Center (excluding its mobile units and school-based sites) provided dental treatment to approximately 6,500 children, of whom 65 % were Medicaid-insured. In that same year, nearly 2,000 children received emergency dental treatment. Of the families that sought emergency care, a small percentage were considered clinical dental emergencies. The remainder were children who primarily receive episodic urgent care or whose entry to dental care occurs as an urgent event. These children are characterized by periods of intermittent pain, premature loss of primary and permanent teeth, and varying degrees of untreated dental disease.
GOALS & OBJECTIVES
The Dental Home for Children Project has two goals: 1) to improve the oral health of targeted children by changing their utilization of pediatric dental services at Eastman Dental Center and 2) to improve communication between the dental and primary pediatric care health systems, thereby improving both dental and primary medical care for impoverished, underserved children. To achieve these goals a social work outreach system of care will be developed and implemented to respond to children’s urgent dental care needs. Family-centered, strength-based, culturally-sensitive interventions will be utilized by an outreach worker to successfully engage targeted families and a formal system of communication between Eastman Dental Center and the pediatric primary care community will be established to ensure that pediatricians are better informed of their patients’ oral health status and more directly engaged in the process to reduce oral health disparities.
METHODOLOGY
The Dental Home for Children Project proposes to develop and implement a system of care that is based on existing and highly successful models of social work outreach programs within the University of Rochester Medical Center and the Monroe County Department of Human and Health Services. Approximately 250 children per year will be identified, referred, tracked and monitored by the Outreach Worker, hired and trained for this purpose. Referral criteria include: children and adolescents who present to Eastman Dental Center for emergency care and: a history of dental disease that has been untreated for at least one year; are unaccompanied by a parent/guardian; are currently in foster care and/or actively followed by Child Protective Services; and/or children with special health care needs. The Outreach Worker will perform psychosocial assessments that will sensitively elicit information pertinent to the establishment of rapport, the identification of real and perceived barriers, and the mobilization of internal and external resources to move the family forward in the treatment process. Based on their individual needs and particular barriers to care, families will be offered a range of outreach services including: appointment scheduling; reminder phone calls; transportation; assistance with applications for Medicaid and Child Health Plus; referrals to local agencies and community resources; and ongoing support and guidance. Early communication with targeted families’ primary care providers will be initiated and maintained by project staff with support from the pediatric dental staff, residents and faculty. The Outreach Worker will become a positive liaison between targeted families, the child’s Medical Home, and Eastman Dental Center and will function as a patient advocate within these larger systems.
COORDINATION
The Dental Home for Children Project is a natural outgrowth of existing collaboration between Eastman Dental Center and the Strong Health Social Work Division of the University of Rochester Medical Center which share a history of providing direct services to vulnerable families in the Rochester community.
EVALUATION
The project’s evaluation will measure changes in health system
communication and changes in utilization of dental services by targeted families. Since the vast majority of children will be patients of record, it will be possible to evaluate their oral health status pre and post outreach interventions.
ANNOTATION
The Dental Home for Children Project expects to demonstrate that a social work model utilizing an Outreach Worker will result in improved attendance at scheduled appointments, a reduction in broken appointments, completed treatment plans for targeted children, and enhanced communication between dental providers and pediatric primary care providers
KEYWORDS
Access to Health Care, Case Management, Cost Effectiveness, Cultural Sensitivity, Dental Treatment of Children, Health Care Utilization, Low Income Population, Dental Home, Medical Home, Oral Health, Pediatric Dentistry, Social Work, Outreach, Preventive Health Care, Children with Special Health Needs
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