MODELS FOR PRACTICE

FOCUS AREA: ORAL HEALTH

Program Name: Choptank Community Health System’s Oral Health Prevention Program

Location: Federalsburg, Maryland

Problem Addressed: Oral Health

Healthy People 2010 Objective: 21-1, 21-8, 21-10, 21-12

Web Address: None

SNAPSHOT

The Eastern Shore of Maryland suffers from a disproportionately high incidence of children’s dental disease compared with national averages. To combat this problem, the Choptank Community Health System (CCHS) embarked on an innovative approach to not only provide primary dental services to an otherwise underserved population but also oral health prevention services. By using a school-based oral health prevention program combined with the establishment of a dedicated dental clinic for restorative and diagnostic care, CCHS has begun to address the serious oral health problem facing this underserved rural community.

THE MODEL

Blueprint: The school-based oral health prevention program is delivered in two rural counties of Maryland’s Eastern Shore¾Caroline and Talbot. Using portable dental equipment set up onsite at elementary schools, the program provides screenings, topical fluoride applications, and dental sealants to all grades at an elementary school in Caroline County and second graders at all elementary schools in Talbot County. The program also uses an inter-oral camera that takes a picture of the children’s teeth. This picture is then sent home to parents as a means to inform parents who may be unaware of the status of their children’s oral health.

Employed by CCHS, a Federally Qualified Health Center (FQHC), are two part-time dental hygienists and a dental assistant who provide services three days per week in Caroline County and two days per week in Talbot County. Through a waiver from the Maryland State Board of Dental Examiners, the hygienists are allowed to work under the indirect supervision of the dental director. The CCHS dental director serves as the director of the school-based programs. A case manager assists with coordinating referrals and follow-ups of children requiring diagnostic and restorative care. These case management services are provided via in-kind services by the Eastern Shore Oral Health Outreach Project (OHOP).

The dental programs are designed to deliver oral health prevention services to low-income children living in rural areas, regardless of their ability to pay. All children enrolled in the school-based wellness center program are eligible to receive services through the school-based dental programs. Children requiring diagnostic and restorative care are referred to their family dentist or the Choptank Community Dental Clinic, which opened in 2001.

Making a Difference: During the initial pilot period of March through May 2001, approximately 58 percent of Caroline County Federalsburg Elementary School’s 538 students were evaluated through the school-based dental program (SBDP). Since the program’s full implementation, 229 students have received dental cleaning, oral hygiene instruction, and fluoride; 144 have received dental sealants. In the Talbot County “Jump Start” sealant program, 60 percent of second graders in the Talbot County schools were evaluated, including 154 receiving dental cleaning, oral hygiene instruction, fluoride, and 144 children receiving sealants. The program established three goals for 2002: 70 percent enrollment of children in SBDP and of those, a 50 percent sealant rate, and no more than a 35 percent rate of untreated dental caries.

The program has expanded to a second elementary school in Caroline County. Preliminary discussions are underway to expand services to another underserved county in the Eastern Shore area of Maryland, as well.

Beginnings: In the state of Maryland, only 14 percent of children on public assistance received oral health services, and in the Choptank community area, there were no dental providers for this population group prior to the initiation of the school-based dental program. The Eastern Shore counties were found to have significantly higher rates of untreated dental decay and dental caries in youth as compared to national averages. In fact, while the U.S. average for untreated dental decay in five-year-olds is 29 percent, in the Eastern Shore area, the rate of untreated dental decay in five-year-olds is 82 percent. To address this problem, a local dentist was instrumental in coordinating the initiation of the school-based dental program to coincide with the 2001 establishment of the Choptank Community Health System Dental Clinic. This clinic now serves as a referral source. This same dentist now serves as the program director.

SBDP was initiated in spring 2001 in two locations: Caroline County and Talbot County, Maryland. Also during this same time period, the Choptank Community Health System Primary Care Clinic was undergoing an expansion to house the Dental Clinic. SBDP in Caroline County is a partnership between the Choptank Community Health System, the Caroline County School-Based Wellness Center Program, the Caroline County Human Services Council, and the Eastern Shore Oral Health Outreach Project. The Talbot County SBDP “Jump Start” represents a collaborative effort between CCHS, Talbot County Health Department, Talbot County public schools, and Eastern Shore OHOP.

Year One initial funding for the Caroline County SBDP came from a grant from the Maryland Governor’s Office for Children, Youth, and Families through the Caroline Human Services Council. The Caroline County SBDP received approval for Year Two funding from the same grant source. In Talbot County, initial funding was provided by the Maryland Department of Health and Mental Hygiene. Year Two funding in Talbot County will be dependent on program income through third party patient billing, particularly Medicaid.

Challenges and Solutions: Recruitment of allied dental health professionals is the foremost challenge facing the program. Caroline County is designated as a health professionals shortage area, and there are no local training programs for dental hygienists or assistants in the local area. So dire is the need for providers, the Choptank Community Health Center paid to send one staff member to become a dental assistant.

To its funding challenge, SBDP, which operates under CCHS (a FQHC), is able to bill all third-party insurers and to bill medical assistance programs at the FQHC rate, which is cost based. It is anticipated the program will be self-sustaining in the future through third-party reimbursements.

To promote the dental program, a variety of dissemination channels are utilized including newsletter mailings, brochures, direct mailings, assistance through the Eastern Shore Oral Health Outreach Project, and local publicity.

PROGRAM CONTACT INFORMATION

Scott Wolpin, DMD, Dental Director and

Brie Breland, RN, MPH, Program Development Director

Choptank Community Health System’s Oral Health Prevention Program

Federalsburg Dental Center

215 Bloomingdale Ave.

Federalsburg, MD 21632

Phone: (410) 754-7583

Fax: (410) 754-7719