Role of the Community Health Worker in the bio-behavioral early childhood caries team project APHA 138 th Annual Meeting and Expo - “Social Justice” Presented at the Community Health Worker Section November 10, 2010 – Session #5100 Colorado Convention Center - Denver, CO Burton Edelstein, Professor of Dentistry and June Levine, Project Manager Columbia University College of Dental Medicine Sally Findley, Professor of Clinical Health Columbia University Mailman School of Public Health Sergio Matos, Executive Director Community Health Worker Network of NYC

Presenter Disclosures The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: Sally Findley Burton Edelstein Sergio Matos June Levine No relationships to disclose

Any cavity in any tooth among children <6 yrs Diet dependent: Frequent sugars increase caries!! Fluoride reduces caries risk and activity Highly prevalent and increases w. age  12% by age 2  21% by age 3  34% by age 4  44% by age 5 Nicknames Baby Bottle Tooth Decay Nursing Bottle Tooth Decay Night Bottle Cavities Bottle Rot Milk Bottle Syndrome 3 What is Early Childhood Caries (ECC)?

Rampant caries process leads to destruction of the primary teeth Infectious and transmissible-  Parent to child (vertical transmission) Impacts other aspects of children’s health and welfare  Chewing  Speech development  Future alignment of permanent teeth  Pain  Stress  Infection WHY WORRY??

Appearance is stage dependent: Heavy (specific) plaque White spot lesion Brown spot lesion Cavity Broken tooth Abscessed tooth 5 What does ECC look like?

ECC: 28 month old 6 Imagine what that must feel like

Most common chronic childhood disease in US children 28% of children 2-5 in the US have visible cavities 5X more common than asthma 20X more common than diabetes Low-income and minority children at greater risk:  2X as likely to experience caries  2X the extent of disease  0.5X as likely to have dental care Who has ECC? Source: American Academy of Pediatric Dentistry

Fillings only fill the hole and restores function BUT, Fillings do not prevent future tooth decay To prevent future tooth decay the disease process must be interrupted Dental Caries is a Disease Process If not interrupted, can destroy the tooth, and then spread into primary or “adult” teeth as they come in

Focus on Disease Prevention Reduce Need for Surgical Treatment ECC Project Aims Develop, pilot test, and refine an electronic interactive, ‘ECC Risk Assessment Tool’ Train CHWs to use this tool to help poor, minority, low-literacy parents to understand ECC risks and how to prevent

TRANS-DISCIPLINARY AND COMMUNITY- PARTICIPATORY APPROACHES PUBLIC HEALTH DENTISTRY NURSING & MEDICINE NUTRITION SOCIAL WORK EDUCATIONAL TECHNOLOGY NURSING Project Team

Ongoing Community and CHW Engagement

Problem Solution Low-income, minority children at double the risk Access to dental care more limited Many parents not concerned about “baby teeth” First visits to the dentist are in response to pain after ECC has already developed– too late! CHW are trusted members of community, and able to reach parents even without a visit to a dentist CHW are culturally competent communicators who can translate the medical/dental advice into concepts people understand CHW are peer educators experienced in promoting behavioral changes Why Community Health Workers?

The original checklist proposed for CHWs to use with families, before CHW inputs!

CHWs Guide the ECC Project: Comments on ECC  Unaware of ECC as a significant health issue in the community they serve  Surprised by its high prevalence and consequences  Never had a request from parents to deal with a dental issue  Oral health only comes up when there is a problem  Seemingly unaware of solution to problem at community pediatric dental clinic

LIMITED ACCESS TO DENTISTS Few dentists in the community No child-friendly dentists Not covered by insurance VIEWS ON DENTAL SERVICES: Stigma associated with dental visit – pain, judgment, insult Dentists seen to misinform families about baby teeth Dentists only treat the problem, no preventive education… No education or positive strategies (just prescriptions) CHW INTEREST IN COLLABORATION: If trained and given appropriate tools, they would want to add oral health to their conversations with families, without actually touching the child’s mouth e.g. to demonstrate tooth brushing CHW Views on Dentists: Major Disconnect between dentistry and the community

How to help CHWs introduce ECC Need for tool to facilitate ECC education when few are aware that it is a problem Needs to be graphic, bi-lingual, and low-literacy…. And FUN if possible Preferred CHW strategy is to integrate education about the problem with promotion of steps to prevent it Avoid a complicated assessment procedure; flexible, not like a questionnaire

Educational tool to support CHW communication and education w. parents  Videos about caries process  Parent/Child story  Take home literature Bilingual:English & Spanish Built-in ECC Risk Assessment Tool Goal and Action Planning Tool My SmileBuddy

Why we are developing an electronic tool for CHWs? Soto F, Plass J, Kane, W & Papenfuss R. Health Education and Multimedia Learning: Connecting Theory and Practice. Health Promotion Practice, Portable and useable anywhere Focuses learners’ attention Allows multimedia presentation Ideal for learners with low prior knowledge and low dental health literacy Higher recognition accuracy and learning levels when information combines text and pictures audio and pictures

Risk Score Tooth brushing Sugary Drinks Sugary Foods Fluoride Use Dental Visits Vertical Transmission Sugary Drinks Action DoLearn DoLearn Do Learn Goal Setting

How will we know if the CHW with MySmileBuddy works? Validate Risk Assessment Tool versus clinical dental exams  Dental screenings at local Head Start  CHWs facilitating risk assessment tool among parents of these children Feasibility study on the use of the tool with families  Interviews with families and CHWs about use of the risk assessment tool

Possible Uses of this Approach CHWs with Smile Buddies can work with a variety of programs: WIC, Head Start and other licensed day care programs, parenting programs (e.g., Healthy Start) dental clinics serving the children of the community Still completing MySmileBuddy iPad tool, and will be testing with small group of CHWs

CONTACTS Sally Findley Professor of Clinical Population and Family Health Mailman School of Public Health Columbia University Sergio Matos Executive Director Community Health Worker Network of NYC Burton Edelstein Professor of Dentistry and Health Policy & Mgt Chair, Social & Behavioral Sciences College of Dental Medicine Columbia University June Levine Project Manager, Social & Behavioral Sciences Columbia University College of Dental Medicine