1. Dental Program for Low-Income Families Presentation to: Association of Local PUBLIC HEALTH Agencies (alPHa) February 25 th, 2010 Presented by: Dianne Alexander / Donna Dupont Public Health Planning & Implementation Branch Public Health Branch, MOHLTC

2. 2 2007 Platform Commitment / 2008 Budget As part of Ontario’s Poverty Reduction Strategy, the government has committed $45 million a year to provide access to dental services for low income families. Phase I – Improve and enhance the delivery of the Children In Need Of Treatment (CINOT) program to include children in low-income families until their 18 th birthday (implemented January 2009) Phase II – The government will work with Public Health Units, Community Health Centres, dentists and dental hygienists to deliver prevention and treatment services for low-income Ontarians.

3. 3 Ontario’s Poverty Reduction Strategy This strategy is a comprehensive plan focusing on the way government supports low-income families, with an eye to improving the services that are offered to people living in poverty. It also commits to measuring and reviewing the progress that is being made. The low-income dental program is a key program within Ontario’s Poverty Reduction Strategy.

4. 4 Low-Income Dental Program Overview Will contribute to building a foundation for children and youth to lead healthier, more productive lives as they enter into adulthood. The program will build upon and link with current public health dental investments, as well as expand access to services, starting with children and youth as the first priority. Scope: Investment in Community Dental Infrastructure: Developing Public Health Unit-Community Dental Models New Dental Program: Prevention and early treatment services for low-income children 0-17 years Investing in Community Health Promotion Initiatives

5. 5 Low-Income Public Health Dental Services Pre-investment from Poverty Reduction Strategy Age in Years0-34-1314-17 Oral Health Screening (OPHS) X√X Preventive Services (OPHS) - Limited √√X Preventive/Early Treatment (non-urgent care) XXX CINOT Program (urgent care) √√X

6. 6 Low-Income Public Health Dental Services Post-investment from Poverty Reduction Strategy Age in Years0-34-1314-17 Oral Health Screening (OPHS) LIDP-Phase II √ Preventive Services (OPHS) - Limited √√ LIDP-Phase II Preventive/Early Treatment (non-urgent care) LIDP-Phase II CINOT Program (urgent care) √√ LIDP-Phase I

7. 7 Stages of Program Implementation and Associated Activity Stage I: Strategic and Program Planning Stage Public Health Units had up to January 29, 2010 to submit their business cases outlining their planning approach to service delivery. Stage II: Pre-Operational Stage One-time start-up funding to be provided at 100% to Public Health Units to develop or expand existing community-based dental infrastructure. Stage III: Operational Stage Ongoing operational funding to be provided at 100% to Public Health Units to support implementation of a basic dental program for low-income children/youth.

8. 8 Stage I: Strategic and Program Planning Stage The business case packages submitted by Public Health Units are being reviewed and evaluated based on the following 6 pre-determined criteria: Availability of Community Dental Services: the characteristics of the geographic region, prevalence of oral disease and availability of existing dental care providers/services. Partnership(s) to support Community Dental Model: planned collaborations with community partners Use of Dental Care Providers and Human Resource Strategy: strategic use of dental care providers for service efficiency Health Promotion/Community Outreach: integration of health promotion as part of oral health service delivery Guidelines: adherence to infection prevention and control best practices and compliance with guideline on the Use of Sedation and General Anaesthesia in Dental Practice (if applicable). Readiness to Operate: the length of time that will likely be required for the community dental model to become operational

9. 9 Stage II: Pre-Operational Stage One-time start-up funding at 100% to be made available to Public Health Units to develop or expand existing community-based dental infrastructure to facilitate delivery of all public health dental programs and services that are part of the Ontario Public Health Standards. This funding may be used to support the purchase of related equipment and necessary leasehold improvements to support service delivery. Program investments would support integrated services planning to facilitate the delivery of all public health dental programs and services. Local planning efforts should take this into consideration.

10. 10 Stage III: Operational Stage Ongoing operational funding at 100% is expected to be made available to Public Heath Units starting in 2010 to deliver program services. Funding will be based on Public Health Unit readiness to become operational with approvals on a rolling basis. Based on the dental model proposed in the business case, funding may be utilized to support costs associated with program delivery such as provider remuneration (i.e. fee-for-service, sessional, salaries/benefits), educational outreach activities and program administration. Operational funding to be based on fixed costs as well as needs-based variables.

11. 11 Implementation Process and Structure Dental Model Implementation Program Eligibility Health Promotion Performance Measures and Program Evaluation Internal Steering Committee Dental Advisory Group (external stakeholders) Ministry Approval Process Consultation as required

12. 12 Dental Stakeholder Advisory Group Role To provide advice related to program development and implementation at the operational level. Membership Association of Local Public Health Agencies (alPHa) Public health unit representation. Ontario Agency for Health Protection and Promotion (OAHPP) Ontario Association of Public Health Dentistry (OAPHD) Ontario Dental Association (ODA) Ontario Dental Hygienist’s Association (ODHA) University of Toronto, Faculty of Dentistry Dental Public Health, Ontario Public Health Association (OPHA)

13. 13 Next Steps Complete business case evaluation process Follow-up directly with Public Health Units regarding business case and funding request for program implementation. Confirm approval of business case and provide timeline for Public Health Units to receive funding.