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Policy Considerations in Oral Health Mary E. Foley, RDH MPH Dean, Forsyth School of Dental Hygiene Massachusetts College of Pharmacy and Health Sciences.

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Presentation on theme: "Policy Considerations in Oral Health Mary E. Foley, RDH MPH Dean, Forsyth School of Dental Hygiene Massachusetts College of Pharmacy and Health Sciences."— Presentation transcript:

1 Policy Considerations in Oral Health Mary E. Foley, RDH MPH Dean, Forsyth School of Dental Hygiene Massachusetts College of Pharmacy and Health Sciences Promoting Oral Health for South Florida A Community Dialogue A Community Dialogue October 15 th, 2007

2 What is Policy?

3 According to Webster… a definite course of action selected from among alternatives and in light of given conditions to guide and determine present and future decisions; a definite course of action selected from among alternatives and in light of given conditions to guide and determine present and future decisions; a high-level overall plan embracing the general goals and acceptable procedures especially of a governmental body a high-level overall plan embracing the general goals and acceptable procedures especially of a governmental body

4 Many Kinds of Policies Professional Professional Programmatic Programmatic State State Federal Federal Public Public

5 Professional Policies

6 Examples of Professional Policies American Academy of Pediatric Dentistry American Academy of Pediatric Dentistry Dental Home Dental Home American Dental Association American Dental Association Fluoride Varnish Fluoride Varnish Association of State and Territorial Dental Directors Association of State and Territorial Dental Directors Fluoridation Fluoridation American Academy of Pediatrics American Academy of Pediatrics First Dental Visit First Dental Visit Pros and Cons Pros and Cons Authoritative sources provide same and sometimes different viewpoints Authoritative sources provide same and sometimes different viewpoints

7 Federal Policies Public Policies Executive Branch President Legislative Branches House of Representatives Senate Policies created by the Legislature Enact Bills to protect public, promote health and prevent disease Approved/Vetoed by the President Example: SCHIP

8 Federal Policies Programmatic

9 US Department of Health and Human Services

10 State Policies Executive Branch Executive Branch Florida Governor, Charlie Crist Florida Governor, Charlie Crist Legislative Branch Legislative Branch Florida House of Representatives The Florida Senate

11 Process of Policy Development State or Federal Government Agencies Policy that leads to Programmatic Development Policy that leads to Programmatic Development Policies that Support Programs Policies that Support Programs Medicaid Medicaid

12 Process of Policy Development Federal legislation that creates programs: Authorization Federal legislation that creates programs: Authorization Authorization is not enough Authorization is not enough Dollars need to be Appropriated to support the legislation or the program Dollars need to be Appropriated to support the legislation or the program Examples: SCHIP, Head Start Examples: SCHIP, Head Start

13 Examples of Programmatic Policies Federal Level Federal Level Head Start Head Start SCHIP SCHIP State Level State Level Community Water Fluoridation Community Water Fluoridation State Oral Health Authority State Oral Health Authority Rules and Regulations that support dental care services, i.e. pregnant women; school-based dental sealant programs, CSHCN Rules and Regulations that support dental care services, i.e. pregnant women; school-based dental sealant programs, CSHCN

14 Examples of Public Policies Agency: CDC Agency: CDC Develops national policies Develops national policies Influence State Health Departments Influence State Health Departments Immunizations and School EntryImmunizations and School Entry Vision, Hearing and Oral Health ScreeningsVision, Hearing and Oral Health Screenings Community water Fluoridation Community water Fluoridation Agency: CMS Agency: CMS Programs: Medicaid and SCHIP Programs: Medicaid and SCHIP Provides rules and regulations to support programsProvides rules and regulations to support programs Provides Federal dollars to support programsProvides Federal dollars to support programs

15 US Department of Health and Human Services

16 How the Public can Impact Policy Educate policy makers on ways to increase the capacity and effectiveness of state oral health programs Educate policy makers on ways to increase the capacity and effectiveness of state oral health programs Utilize an organized approach Utilize an organized approach Message bearers (leadership, coalition, partners) Message bearers (leadership, coalition, partners) 4 evidentiary inputs (burden document, state plan, surveillance findings, results of evaluation) 4 evidentiary inputs (burden document, state plan, surveillance findings, results of evaluation) Promote support for outcome goals Promote support for outcome goals CDC/CDHP

17 Conceptual Framework www.cdhp.org

18 Identify Opportunities for Policy Change Environmental Assessment Environmental Assessment Assess state systems, social mores, political conditions, and policy directions Assess state systems, social mores, political conditions, and policy directions Systemic approach: Systemic approach: Private dental care delivery system Private dental care delivery system Safety net dental care delivery system Safety net dental care delivery system Dental/dental hygiene education system Dental/dental hygiene education system School system School system Water system Water system Political system Political system Legislative system Legislative system www.cdhp.org

19 Consider Socio-Political Agenda Identify and align with political agenda Identify and align with political agenda Economy Economy Employment Employment Individual income levels Individual income levels Demography - particularly of vulnerable populations Demography - particularly of vulnerable populations Immigrants Immigrants Migrants Migrants Minorities Minorities Age-related distribution Age-related distribution Special populations: frail elderly, adult handicapped, institutionalized Special populations: frail elderly, adult handicapped, institutionalized Geography/Rurality Geography/Rurality Epidemiology of oral diseases and competing diseases (e.g. obesity, cardiovascular health, diabetes) Epidemiology of oral diseases and competing diseases (e.g. obesity, cardiovascular health, diabetes) Political philosophy Political philosophy www.cdhp.org

20 Inform Legislature Raise awareness of issues/problems to legislators Raise awareness of issues/problems to legislators Stakeholders can use anecdotal evidence, advocacy/activism, event or press coverage, or data. Stakeholders can use anecdotal evidence, advocacy/activism, event or press coverage, or data. Data - burden document, epidemiologic studies Data - burden document, epidemiologic studies Hooks and Drivers" Hooks and Drivers" www.cdhp.org

21 Coalition Building Coalitions: Powerful Advocacy Groups that Moves Agenda Forward Coalitions: Powerful Advocacy Groups that Moves Agenda Forward Inform Legislators Inform Legislators Engage Engage Carry messages forward Carry messages forward Identify legislative champions Identify legislative champions Add volume to the voice Add volume to the voice Say things that program directors cannot say Say things that program directors cannot say Provide different perspectives Provide different perspectives Demonstrate to policymakers that issues have been well thought-out and understood by many stakeholders Demonstrate to policymakers that issues have been well thought-out and understood by many stakeholders www.CDHP.org

22 Result Through preparation, strategy, and collaboration… Through preparation, strategy, and collaboration… Generate champions… Generate champions… Shape the debate… Shape the debate… Push for legislation that promotes oral health and disease prevention… Push for legislation that promotes oral health and disease prevention… The outcome … The outcome … Policy enactment Policy enactment www.cdhp.org

23 Legislative Support for an Oral Health Authority 17 report a statutory mandate for an office/division/bureau/program of oral health 17 report a statutory mandate for an office/division/bureau/program of oral health ASTDD 2003 Survey; www.astdd.org; www.cdhp.orgwww.astdd.org ArizonaArizona ArkansasArkansas CaliforniaCalifornia FloridaFlorida HawaiiHawaii IllinoisIllinois IndianaIndiana MarylandMaryland MississippiMississippi MissouriMissouri NebraskaNebraska NevadaNevada North CarolinaNorth Carolina OklahomaOklahoma PennsylvaniaPennsylvania Rhode IslandRhode Island TexasTexas

24 Legislative Support for Community Water Fluoridation 12 states report a statutory mandate for state-wide community water fluoridation 12 states report a statutory mandate for state-wide community water fluoridation ASTDD 2003 Survey California Connecticut Delaware Georgia Illinois Kentucky Louisiana Minnesota Nebraska Nevada Ohio South Dakota

25 State Policies to Improve Early Childhood Oral Health 1. State Infrastructure: AZ 2. Medicaid EPSDT: TN 3. Medicaid Perinatal Benefit: MA 4. Fluoridation: IL 5. Sealants: OH 6. Infant Oral Health: WA 7. Fluoride Varnish: NC

26 Policy & Program Opportunities Based on the New View Adapted from SG Workshop and AMCHP in Opening the Mouth at http://ccnmtl.columbia.edu/draft/soup/openMouth/pt02.html http://ccnmtl.columbia.edu/draft/soup/openMouth/pt02.html

27 Opportunities for Policymakers from SG Workshop 1. Early & Timely Intervention A. Link oral health policies & programs to other early childhood efforts including: High risk infant toddler programs High risk infant toddler programs Visiting nurse, promotores, and care coordination programs Visiting nurse, promotores, and care coordination programs Nutrition programs/ WIC/ Head Start/ Early Head Start Nutrition programs/ WIC/ Head Start/ Early Head Start CSHCN programs CSHCN programs Primary care pediatrics Primary care pediatrics Day care accreditation and regulation Day care accreditation and regulation B. Adopt AAP and AAPD recommendations Age one dental visit, particularly for high risk children Age one dental visit, particularly for high risk children Establish a dental home along with a medical home for all Establish a dental home along with a medical home for all

28 Opportunities for Policymakers from SG Workshop 2. Assure competencies: Prepare the health care workforce –Promote a common core curriculum on oral health for OBs, pediatricians, family docs OBs, pediatricians, family docs nurse practitioners, nutritionists nurse practitioners, nutritionists dentists, hygienists dentists, hygienists public health practitioners public health practitioners –Require core competencies in oral health promotion in accreditation standards accreditation standards guidelines guidelines performance measures performance measures for state supported health professional education.

29 Opportunities for Policymakers from SG Workshop 3. Go public Partner with private sector organizations Partner with private sector organizations Initiate a public awareness campaign Initiate a public awareness campaign Promote state-level oral health coalitions Promote state-level oral health coalitions Develop and publicize disease burden documents Develop and publicize disease burden documents Develop a state oral health plan Develop a state oral health plan Champion oral health with visits, legislation, programs, press, proclamations, speeches, influence Champion oral health with visits, legislation, programs, press, proclamations, speeches, influence

30 Opportunities for Policymakers from SG Workshop 4. Fix public programs Infrastructure: ensure empowered, stable, well-staffed office of oral health Infrastructure: ensure empowered, stable, well-staffed office of oral health Financing: retain comprehensive dental benefits in Medicaid & SCHIP; adopt & promote age 1 standard Financing: retain comprehensive dental benefits in Medicaid & SCHIP; adopt & promote age 1 standard Prevention: maximize state fluoridation &promote sale of fluoridate bottled water; expand sealant programs Prevention: maximize state fluoridation &promote sale of fluoridate bottled water; expand sealant programs Safety net: expand dental care for pregnant women and young children in health centers, coordinate with WIC/ Head Start… Safety net: expand dental care for pregnant women and young children in health centers, coordinate with WIC/ Head Start… Health professional education: include early oral health education and experience Health professional education: include early oral health education and experience Special Needs Programs: integrate oral health Special Needs Programs: integrate oral health

31 Opportunities for Policymakers from SG Workshop 5. Maximize use of science Surveillance: Conduct regular epidemiologic reviews Surveillance: Conduct regular epidemiologic reviews Maximize prevention: Develop & promote risk screening, oral anticipatory guidance, and primary prevention in infants Maximize prevention: Develop & promote risk screening, oral anticipatory guidance, and primary prevention in infants Target at-risk young children in Medicaid/SCHIP: provider education/ incentives and age-defined enhancements Target at-risk young children in Medicaid/SCHIP: provider education/ incentives and age-defined enhancements Conduct pilot trials of medical management for efficacy, effectiveness, and cost-effectiveness Conduct pilot trials of medical management for efficacy, effectiveness, and cost-effectiveness Engage AHECs in provider education on early caries prevention and management Engage AHECs in provider education on early caries prevention and management Establish fluoride varnish programs with a variety of providers Establish fluoride varnish programs with a variety of providers Link programs: caries & obesity share common risks Link programs: caries & obesity share common risks

32 Resources American Academy of Pediatric Dentistry American Academy of Pediatric Dentistry American Academy of Pediatrics American Academy of Pediatrics American Dental Association American Dental Association Association of Clinicians for the Underserved Association of Clinicians for the Underserved Association of State and Territorial Dental Directors Association of State and Territorial Dental Directors Association of State and Territorial Health Officials Association of State and Territorial Health Officials CDC Division of Oral Health CDC Division of Oral Health Childrens Dental Health Project Childrens Dental Health Project HRSA Maternal and Child Health Bureau HRSA Maternal and Child Health Bureau MCHB Oral Health Policy Center, MCHB Oral Health Resource Center MCHB Oral Health Policy Center, MCHB Oral Health Resource Center NIH/NIDCR Oral Health Disparities Program CAN-DO and CREEDD NIH/NIDCR Oral Health Disparities Program CAN-DO and CREEDD Childrens Dental Health Project Childrens Dental Health Project

33 Contact Information Mary E. Foley, RDH, MPH Dean of Forsyth School of Dental Hygiene Associate Professor of Dental Hygiene Massachusetts College of Pharmacy and Health Sciences 179 Longwood Avenue Boston, Massachusetts 02115 t: 617-735.1049 f: 617-732.2225 mobile: 857-488-9046 Mary.foley@mcphs.edu


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