1. Oral Health Regional Assessment & Planning Project (RAPP) 2002-2005 Greater Cincinnati, Northern Kentucky & Southeastern Indiana

2. October 10, 2000

3. Cincinnati Enquirer 9/8/00

6. What was the RAPP? Rising interest in dental issues Small funds available United Way looking for initiatives Planning process needed

7. RAPP Process Created United Way and Health Foundation funding Oral Health Council project management Advisory Council leadership Broad community participation by stakeholders

8. How the Process Worked

9. What We Found

10. EconomicCultural conditionsnorms HistoricalMedia trendsmessages Public sector practices Private sector practices Neighborhood System characteristics relationships FamilyPersonal characteristicschoices Health care system practices Educational system practices Families @ 200% of the FPL Lack Access to Dental Care (~450,000) Multiple factors in the community contribute to poor dental access to care

11. Tooth decay is on the rise – more than 45% of inner city children have untreated decay Emergencies cases have tripled at the Cincinnati Health Dept. Clinics over the past 8 years. Existing dental clinics are at capacity

12. No sliding scale dental clinics in some counties; discounts often insufficient for working poor & others Some areas have no prevention, education or treatment programs Families choose rent, food, clothing over dental care Multiple factors in the community contribute to poor dental access to care

13. Impact on employment potential Culture of poverty – --postpone treatment --poor appointment compliance Perpetuating norms of tooth loss Dental pain & infection is the #1 one reason why people go to the University Hospital Emergency Room. Multiple factors in the community contribute to poor dental access to care

14. Recommendations What should each county have?  Treatment for pain & infection  Basic restorative care  Essential esthetics  Effective early prevention  Effective educational programs  Water fluoridation

15. Recommendations Improved Prevention sealants, use of pediatricians & ob/gyns, oral cancer exams, mouthguards Increased Education health promotion & education on the importance of oral health community-wide Expanded Access to Treatment Expand and build, lower fees, Urgent Care Center, dental vans

16. Regionalized Efforts Public Policy Provider Education Head Start & School Support MRDD Program Nursing Home Program Strategies for cultural competence/relevance

17. Public Policy Recommendations Gain Public/government financing/support Improving state Medicaid programs Exploring new systems to provide care

18. Strategies for addressing cultural needs & disparities Training for dentists & staffs Training in dental schools Mentoring programs for children from low income/minority families to develop dental careers.

19. Early Accomplishments Sealant Program in Northern Kentucky Mobile van for Cincinnati Public Schools UH GP residency program Clermont County Head Start dental project Babies Milk Fund/Rocking Horse fluoride varnish pilot in pediatric offices October 6, 2002 Enquirer article Expansion of Lincoln Hgts. Clinic 2 school-linked dental programs Northern Ky Clinic expansion Fluoride varnish programs Cincinnati Dental Society clinic

20. Cost One tenth of 1% of the region’s total health care expenditures $13 million of $13 billion health expenditures per year in the region

21. Funding Possibilities Shifts in priorities User taxes (sugar-based drinks, candy) Share of levies New levy Dental insurance underwriters assessment “Sales Tax” on dental fees

22. An integrated, collaborative system with community involvement at the nucleus

23. Current Status: Rebirth? Internal changes at United Way= end of funding and support 2 year gap prior to publication. Some progress continues Advisory Committee & Oral Health Council intend to continue with plan implementation.