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Bob Russell, DDS, MPH Iowa Department of Public Health.

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Presentation on theme: "Bob Russell, DDS, MPH Iowa Department of Public Health."— Presentation transcript:

1 Bob Russell, DDS, MPH Iowa Department of Public Health

2 Title V MCH Service Areas

3 Within each county are multiple agencies (local public and private/non-private agencies) that serve families: County health departments Public health nursing services Home health care agencies Visiting nurse services Community action programs Partners

4 Open Mouth Surveys Medicaid Services Title V Databases & Reports Public Health Supervision Reports Assessment Examples 4

5 National Trends in Caries-Free Schoolchildren – Permanent Teeth Ages 5-17 years Ages 6-19 years

6 Iowa : Untreated decay is decreasing

7 Iowa: Adults

8 79 elementary schools Total: 990 elementary schools 21 Junior High Schools Total: 299 Junior High Schools 9,941 Sealant placed on 1 st molars in ,381 sealants placed on second molar teeth Penetration of Public Health Sealant Programs in Iowa

9 Decay Positive and Decay Negative

10 37.8% from East Central Iowa 22.2% Rural (Not adjacent to urban) 70.5% white, 16% unknown race/ethnicity 85.2% spoke English 95.5% had a Medical Home 61.2% had a Dental Home 49.9% Males 73.5% were younger than 5 Decay Negative 29.9% from East Central Iowa 29.1% Rural (Not adjacent to urban) 66.7% white, 16% unknown race/ethnicity 80.5% spoke English 92.2% had a Medical Home 69.3% had a Dental Home 52.7% Males 56.8% were younger than 5 Decay Positive Results

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12 Iowa : a State in Transition Demographic Trends Rapid Ethnic Diversification Aging white population Low fertility rates among whites Exodus of graduates to other states Higher birth rates among native minorities Large influx of immigrants, primarily Latinos, to work in labor shortage

13 Need for increased outreach services Need for new service hours Child Care barriers Geographic and transportation barriers Different health care utilization patterns Iowa Implications of Changing Demographics

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15 Iowa Elderly in Assisted Living Centers

16 We have stated that 92% of Iowans are receiving optimally fluoridated water. What does this % really mean?  92% of Iowans who receive their water from a Community Water Supply are receiving optimally fluoridated water.  Overall, approximately 83% of Iowa’s total population is receiving optimally fluoridated water.  This percentage may actually be higher depending on if the population who receives their water by a private well has naturally fluoridated water or is adding fluoride to their water.  We have no system for tracking private wells or monitoring leaving over 248,205 estimated Iowans potentially lacking fluoridated water! The Iowa Picture

17 Trends are Troublesome No longer provides fluoride Water SystemCounty AshtonOsceola County Columbus JunctionLouisa County Coon RapidsCarroll County ElkaderClayton County EverlyClay County FloydFloyd County Fort MadisonLee County GrangerDallas County MaxwellStory County Sac CitySac County SanbornO’Brien County SutherlandO’Brien County VictorIowa County

18 Iowa Considering discontinuation or reduction Water SystemCounty AplingtonButler County Cedar RapidsLinn County Dallas CenterDallas County DeSotoDallas County Gilmore CityHumboldt County GrangerDallas County KeokukLee County MechanicsvilleCedar County New SharonMahaska County OssianWinneshiek County TamaTama County

19 I-Smile An Overview of Iowa’s Dental Home Initiative for Children Bob Russell, DDS, MPH State Public Health Dental Director Iowa Department of Public Health

20 2005 Legislative Mandate By July 1, 2008, every recipient of medical assistance who is a child 12 years of age or younger shall have a designated dental home and shall be provided with the dental screenings and preventive care identified in the oral health standards under the EPSDT program.

21 Iowa Legislative Mandate Modified By December 31, 2010, every recipient of medical assistance who is a child 12 years of age or younger shall have a designated dental home and shall be provided with the dental screenings and preventive services, diagnostic services, treatment services, and emergency services as defined under the EPSDT program. * Language modified in 2008, HF2539

22 The dental home is a system that allows all children, even those often excluded from receiving dental care, to have early and regular care to ensure optimal oral health. Conceptual Dental Home

23 The I-Smile Dental Home PHYSICIAN DENTAL HYGIENIST DENTIST NURSE

24 I-Smile Objectives 1. Improve the dental support system for families. 2. Improve the dental Medicaid program. 3. Implement recruitment and retention strategies for underserved areas. 4. Integrate dental services into rural and critical access hospitals.

25 Partnerships and planning Link with local board of health Provide training for child health agency staff Develop agency oral health protocols Provide education and training for health care professionals Ensure completion of screenings and risk assessment Ensure care coordination services Ensure provision of gap-filling preventive services I-Smile Strategies

26 Strengthen Iowa’s Title V MCH System Establish a dental hygienist within each Title V Child Health agency as the local I- Smile Oral Health Coordinator Currently, Iowa has 24 dental hygienists working as regional I-Smile™ Coordinators They create a system to assure optimal oral health for children. Improve Dental Support System for Families

27 I-Smile Referral System

28 I-Smile Dental Home Care Plan Diagram I-Smile Oral Health Coordinator Oral Screening and Risk Assessment Preventive Care Education Medicaid, uninsured, and underinsured children from birth-12 years Low Risk No observable disease Moderate Risk No observable disease High Risk Observable disease High Risk Severe disease Level 1 Level 2 Level 3 PLANPLAN Care coordination Referral for dental exam within 1 year Oral screening, risk assessment, and preventive care in 6 months Care coordination Referral for dental exam within 6 months Oral screening, risk assessment, and preventive care in 3-6 months Care coordination Referral for dental exam within 3 months Oral screening, risk assessment, and preventive care in 3-6 months Care coordination Immediate referral to dentist/specialist Oral screening, risk assessment, and preventive care in 3 months

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32 I N 2012 :  M ORE THAN 1 ½ TIMES AS MANY CHILDREN AGES 0-12 SAW A DENTIST FOR CARE THAN IN 2005  3 ¾ TIMES AS MANY CHILDREN AGES 0-12 RECEIVED CARE FROM A HYGIENIST OR NURSE WORKING FOR A T ITLE V AGENCY THAN IN 2005  61 % OF CHILDREN AGES 3-12 SAW A DENTIST Based on SFY2012 Medicaid paid claims, Iowa Department of Human Services

33 Still too many children under the age of 3 who do not receive dental services. Lack in dentists willing to see the very young child. Low participation by dentists willing to see Medicaid children. Low Medicaid reimbursement. Decreasing and aging dental workforce Mal-distribution of available dental providers I-Smile--Challenges

34 Promote children’s oral health to parent’s and caregivers. Support gap-filling preventive services within public health and Title V agencies. Maintain partnerships with early childhood programs. Share information with stakeholders in anticipation of a changing health care system within Iowa. Continue to support “health homes” by collaborating with medical providers to include oral health as part of well-child care. Explore funding and collaborative opportunities with private organizations so that oral health becomes a priority statewide. I-Smile--Sustainability

35 Good oral health for all children beginning at birth Long-term savings in dental care costs Improved overall health of Iowa children and adults I-Smile™ Future

36 (became effective July 1, 2008) A critical step in “closing the gap” in access to care for underserved children Dental Screening Requirement

37 Elementary school –Prior to age 6, but no earlier than age 3 –Licensed physician, physician assistant, nurse, dental hygienist, dentist High School: –Within one year of enrollment –Licensed dental hygienist or dentist Dental Screening Requirements

38 What if a child has a problem getting a screening? What if a problem is detected and a child doesn’t have a dentist? Contact local I-Smile Coordinator Integration with I-Smile™

39 Dental hygienist providing direct care services in Iowa must work under the supervision of a dentist. In public health settings, this would be either public health or general supervision. Supervision

40 Recommended by IDPH, this allows hygienists working in a public health setting to provide services without the patient first being examined by a dentist. *Dentists providing public health supervision are not required to provide future dental treatment to patients served by the hygienist. Public Health Supervision

41 Educational & Experiential Requirements An Active Iowa license and a Minimum of 3 years clinical experience No special educational requirements Must collect data on services provided Must have procedure for maintaining records Practice Settings Available to a PHSH Schools Head Start FQHCs Public Health Dental Vans CHCs Nursing facilities Free Clinics State/local federal public health programs Day Care Centers Services a PHSH can Provide Assessments Screenings Data collection Educational, diagnostic, preventive and therapeutic services defined in the rules May NOT provide local anesthesia or nitrous oxide. Requirements for Practice as a Public Health Supervision Hygienist (PHSH) SettingsRequirementsServices Some services required to maintain Public Health Status:

42 Practice as Public Health Supervision Hygienist– What Else Do I Need to Know? Statutes & RulesApplicable Forms State Dental Practice Act Iowa Code 153 Iowa Code 147 Iowa Code 272C Dental Board Rules Public Health Supervision (PHS Application) PHS Reporting Form Iowa Dental Board

43 A dentist is required to see a patient prior to a dental hygienist providing certain services under general supervision Sealants Prophylaxis Radiographs General Supervision

44 Currently, a hygienist must have an Iowa license and a minimum of three years of clinical experience to work under public health supervision. Public Health Supervision

45 Two options: National Health Service Corps – federal program State Loan Repayment Program (called PRIMECARRE) Site criteria: For PRIMECARRE, must be public or non-profit; NHSC also allows for-profit Federal Health Professional Shortage Area (found at Sliding fee scale, accept Medicaid and Medicare Loan Repayment

46 Full-time or half-time (meet definition) U.S. citizen Education-related debts No unfulfilled practice obligation to federal, state, local government or other entity (such as employer) Certification or license to practice in Iowa Serve all patients regardless of ability to pay Applicant Eligibility

47 Primary care physician Dentist Dental Hygienist Physician Assistant Nurse Practitioner Certified nurse Midwife Clinical Psychologist Clinical Social Worker (LISW only) Psychiatric nurse specialist Mental Health Counselor Marriage and Family Therapist Eligible Professions

48 Both Programs: Clinician must be: working in a federally designated HPSA, US citizen, qualified student loan debt, cannot be fulfilling another obligation at the same time NHSCPRIMECARRE Online application, Application cycle once per year available on IDPH website, Current due date: October 24, 2012www.idph.state.ia.us Federally AdministeredState Administered All Federal Funds1:1 State/Federal Funds Requires Site ApplicationDoes not require site application Full time 2-year contract $60,000 Half time 2-year contract $30,000 Half time 4-year contract $60,000 Full time 2-year contract up to $100,000 or Half time 2 –year contract up to $50,000 (depending on availability of funding and number of applicants) Competitive Process based on HPSA scoresCompetitive Process with review committee Can be For-Profit, Non-Profit, or Public SitesOnly Public or Non-Profit Site Entire amount of funding provided to clinician at beginning of 2-year contract with NHSC Half of funding provided at the beginning of each year of the 2-year contract; funds go directly to lender One-year continuationsCan re-apply in two-year increments 48

49 Iowa Department of Public Health Oral Health Center Lucas State Office Building 321 East 12th Street Des Moines, Iowa Dr. Bob Russell, DDS, MPH Public Health Dental Director (515) Thank you!

50 Institute of Medicine, National Academy of Sciences. The Future of Public Health. Washington DC; National Academy Press; Public Health Functions Steering Committee. Public Health in America. Washington, DC: PHS; CDC. Ten Great Public Health Achievements - United States, MMWR. 1999;48(12); References 50


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