1. GOAL – ELIMINATE ORAL HEALTH DISPARITIES 1 Promoting Oral Health for South Florida A Community Dialogue Jungle Island, Miami Florida October 15, 2007 Harry W. Davis, DDS, MPH Dental Director Florida Department of Health

2. 2 Floridas State Oral Health Improvement Plan Facilitating Collaborative Partnerships Working Towards Common Goals

3. 3 Outline History/Background Components Recommendations and Strategies Activities

4. 4 History 1997 - A Dental Summit was held by the Department of Health and the Agency for Health Care Administration. This began dialog Resulting In 1998 – The creation of the Statewide Dental Coordinating Council, which began increased integration and strategic planning efforts with expanded participation by stakeholder organizations in oral health

5. 5 History 2001 - National Governors Association Oral Health Policy Academy participation highlighted the importance of oral health and of community coalition development to combat oral health disparities 2003 - Federal Grant was awarded to facilitate development of an Oral Health Improvement Plan for Disadvantaged Floridians

6. 6 Advisory Committee (Development Team) Core Members of the Statewide Dental Coordinating Council and the National Governors Association Oral Health Policy Team Additional Members as broad based as possible representing Public and Private Organizations as Possible Communication through : An Extensive E-mail Distribution List and Face to Face Meetings

7. 7 Email Distribution List Florida Dental Association Florida Dental Hygiene Association Florida Dental Assistants Association Florida Academy of Pediatric Dentistry Florida Medical Association UF College of Dentistry Nova SE College of Dental Medicine Florida Board of Dentistry Florida Assoc. of Comm. Health Centers Florida Healthy Kids Florida Head Start Collaboration Office Florida Developmental Disabilities Council Sunrise Community, Inc Florida Institute of Family Involvement Florida Baptist Convention USF School of Public Health Sunshine State Dental Association Suncoast Community Health Center Community Voices Miami ACORN Clinic Suwannee River AHEC Florida Health Care Association AHCA Medicaid Program Developmental Disabilities Agency Department of Elder Affairs

8. 8 The E-mail Distribution List Also Included the Following from the Florida Department of Health Adult and Community Health Child Nutrition Childrens Medical Services Chronic Disease Public Health Dental Program Disease Control - HIV/AIDS Family and Community Health Family Health Services Maternal and Child Health School Health Minority Affairs Volunteer Program Alachua We Care WIC Program Broward CHD Duval CHD Flagler CHD Jefferson/Madison CHDs Palm Beach CHD The distribution list is kept updated with organizations who wish to participate in implementation activities and collaborative partnerships Currently over 100 organizations

9. 9 Components Background information on oral health issues Recommendations with strategies Action plan with objectives Website: Oralhealthflorida.com

10. 10 Oralhealthflordia.com website The Starting Point for Finding Oral Health Information in Florida A comprehensive source for: SOHIP Overview, History and News SOHIP Documents and Reports Background Information Fact Sheets (under development) Current SOHIP Initiatives Workgroups and Community Coalitions Oral Health Profiles for Each County and the State Partner and Other Oral Health Resource Links

11. 11 STATE ORAL HEALTH IMPROVEMENT PLAN Recommendations 1.Improve access to community and school-based preventive programs for all ages 2.Improve access to community and school-based education programs for children and adults 3.Increase public and governmental awareness of oral health issues 4.Improve state and county-based oral health data collection and research 5.Improve access to care by assuring a highly trained, diverse, appropriately allocated dental workforce 6.Improve access to care by assuring adequate statewide, publicly focused infrastructure and support programs 7.Improve the integration of oral health prevention and education into general health

12. 12 Activities Advisory committee and workgroup meetings Conference Calls Email Communications Statewide forums Local coalition development

13. 13 CONDUCT STATE FORUMS TO DEVELOP SPECIFIC POPULATION STRATEGIES oHead Start 6/2005 oEarly Childhood Caries 7/2006 oSeniors 6/2007 oChildren with Special Needs8/2007 Future Forums oMinority Health oMigrant Workers and Refugees oHIV/AIDS oWomen Statewide Forums

14. 14 Statewide Workgroups Open for ParticipationStatewide Workgroups Open for Participation o Early Childhood Caries Prevention o Migrant Oral Health o Oral Health for the Elderly o Special Needs o Independent Non-profit Coalition Future Workgroups o HIV/AIDS o Teledentistry o Women o Minorities o Integration of Oral Health into Medical Professional Education o Periodicity Schedules for Medicaid Patients o Incentives to Provide Dental Care through Publicly Funded Programs Current Workgroups

15. 15 Local Coalition Development Uses state plan as foundation to develop local strategies and partnerships Coalitions in various stages of development AlachuaMiami Dade Baker/St. JohnsOkeechobee Dixie/GilchristOsceola Gadsden Polk Indian River Santa Rosa Martin Wakulla

16. 16 New Federal Grant To continue and enhance activities over next four years Increase statewide forums Increase workgroups Increase local coalition development Enhance website

17. GOAL – ELIMINATE ORAL HEALTH DISPARITIES 17 State Initiatives County Health Department Programs County Health Department Programs –Onsite treatment programs –Mobile units –Community dental projects –Early childhood caries prevention –Teledentistry –Oral health integration into general health Fluoridation Governors Office Policy Initiatives

18. GOAL – ELIMINATE ORAL HEALTH DISPARITIES 18 County Health Department Programs County Health Department Programs Onsite treatment programs (R6S2) Onsite treatment programs (R6S2) –44 CHDs 81 Clinics - Reaching over 130,000 persons yearly –Doubled capacity over last 6-7 years –Provide care to over 20% of Medicaid recipients – Up to 80% in smaller counties –3 new programs under development –Expansion of existing programs

19. GOAL – ELIMINATE ORAL HEALTH DISPARITIES 19 County Health Department Programs County Health Department Programs Mobile Units (R6S2) Mobile Units (R6S2) –Most effective way to provide school-based preventive services –Currently 8 programs – 1 under development –3 started within last several months

20. GOAL – ELIMINATE ORAL HEALTH DISPARITIES 20 County Health Department Programs County Health Department Programs Community Dental Projects Community Dental Projects –Based on local needs - flexible –Basic configuration – Coordinator and expenses –Currently 6 projects – 6 under development –Activities include School-based preventive and educational (R1S2/3; R2S3) School-based preventive and educational (R1S2/3; R2S3) Fluoridation promotion (R1S1) Fluoridation promotion (R1S1) Contractual providers for uninsured (R5S1) Contractual providers for uninsured (R5S1) Referral and follow up (R6S3) Referral and follow up (R6S3) Coalition development/partnerships (R3S4) Coalition development/partnerships (R3S4) Surveys (R4S1) Surveys (R4S1)

21. GOAL – ELIMINATE ORAL HEALTH DISPARITIES 21 County Health Department Programs County Health Department Programs Early Childhood Caries Prevention (R3S4;R7) Early Childhood Caries Prevention (R3S4;R7) –Utilize medical staff during routine child visits –Protocol and training –Activities for ages 0 to 4 include Risk assessment Risk assessment Anticipatory guidance Anticipatory guidance Preventive services (fluoride varnish) Preventive services (fluoride varnish) Referral to establish dental home Referral to establish dental home

22. GOAL – ELIMINATE ORAL HEALTH DISPARITIES 22 County Health Department Programs County Health Department Programs Teledentistry Pilot Projects (R6S10) Teledentistry Pilot Projects (R6S10) –Supervise dental hygienist at remote site –Fixed site to fixed site (Nassau CHD) Recently started Recently started –Fixed site to mobile site (Wakulla CHD) Under development Under development

23. GOAL – ELIMINATE ORAL HEALTH DISPARITIES 23 County Health Department Programs County Health Department Programs Oral health integration into general health Oral health integration into general health (R7S1) (R7S1) –Guidelines under development for specific programs –Systemic disease relationships

24. GOAL – ELIMINATE ORAL HEALTH DISPARITIES 24 Fluoridation (R1S1) Fluoridation (R1S1) Foundation of dental public health Foundation of dental public health Most cost effective prevention of dental caries Most cost effective prevention of dental caries 2005 – Exceeded Healthy People 2010 objective of 75% 2005 – Exceeded Healthy People 2010 objective of 75% Currently at 78% Currently at 78% Last several years Florida has had largest increase in persons served by fluoridating systems Last several years Florida has had largest increase in persons served by fluoridating systems

25. GOAL – ELIMINATE ORAL HEALTH DISPARITIES 25 Governors Office Policy Initiatives Governors Office Policy Initiatives Workforce issues related to public health practice (R5S4) Workforce issues related to public health practice (R5S4) –Licensure for dentists –Supervision levels for dental hygienists

26. GOAL – ELIMINATE ORAL HEALTH DISPARITIES 26 Questions/Comments Questions/Comments

27. 27 STATE ORAL HEALTH IMPROVEMENT PLAN Recommendation 1. Improve access to community and school-based prevention programs for all ages. Strategies: 1. Increase access to fluoridation. 2. Advocate for improved diet and nutrition in schools in at least one area of the state. 3. Expand school-based and school-linked dental sealant programs. 4. Expand school-based fluoride mouthrinse programs. 5. Develop school-based fluoride varnish programs

28. 28 STATE ORAL HEALTH IMPROVEMENT PLAN Recommendation 2. Improve access to community and school-based education programs Strategies: 1.Enlist support from and train school health providers and educators on oral health issues. 2.Provide appropriate grade-level oral health education curricula in both public and private schools. 3.Provide community-based oral health education presentations throughout communities. 4.Advocate for increased funding for community and school-based oral health education programs.

29. 29 STATE ORAL HEALTH IMPROVEMENT PLAN Recommendation 3. Increase public and governmental awareness of oral health issues Strategies: 1.Educate lawmakers and policymakers about the importance of oral health. 2.Educate the public about the importance of oral health and the connection between oral health and general health 3.Educate non-dental health care providers on the importance of oral health. 4.Conduct work groups, forums, or summits to develop strategies, objectives, and action steps for specific disadvantaged population groups including those with specific health care needs. 5.Utilize internet resources for oral health information and education.

30. 30 STATE ORAL HEALTH IMPROVEMENT PLAN Recommendation 4. Improve state and county-based oral health surveillance and research Strategies: 1.Develop an outcome/disease-based surveillance system and develop and maintain state and county-specific profiles. 2.Develop a systematic, annual analysis of the Medicaid and KidCare programs 3.Advocate for a statewide oral health research agenda.

31. 31 STATE ORAL HEALTH IMPROVEMENT PLAN Recommendation 5. Improve access to care by assuring a highly trained, diverse, appropriately allocated dental workforce Strategies: 1.Assure that an adequate number of appropriate dental care provider types exist and increase the diversity of dental care providers. 2.Expand professional training opportunities regarding care for special needs populations. 3.Expand volunteer incentives. 4.Consider reforms to better utilize the existing dental workforce to achieve improved access to care.

32. 32 STATE ORAL HEALTH IMPROVEMENT PLAN Recommendation 6. Improve access to care by assuring adequate statewide, publicly focused infrastructure and support programs Strategies: 1.Promote improvement of the Medicaid program. 2.Expand community-based safety-net fixed clinics and mobile units. 3.Promote school oral health screenings at periodic intervals with appropriate referrals. 4.Improve the dental services through the State Childrens Health Insurance Program (SCHIP). 5.Expand number of dental care providers/practitioners and centers with expertise in caring for disadvantaged and special needs populations. 6.Promote continuity of care through targeted case management and patient education.

33. 33 STATE ORAL HEALTH IMPROVEMENT PLAN Recommendation 7. Improve the integration of oral health prevention and education into general health Strategies: 1.Develop protocols to integrate oral health into all appropriate DOH programs. 2.Utilize existing community networks to identify and educate patients with systemic diseases that relate to oral health. 3.Advocate for oral health screenings to become a routine part of medical examinations. 4.Advocate for increased oral health training for medical professionals.