Problem Addressed: Oral Health

Healthy People 2010 Objective: 21

Web Address: http://www.kindsmiles.org

SNAPSHOT

Miles for Smiles provides comprehensive dental services and school-based dental education to children and families residing in the western slope region of Colorado. Utilizing a fully equipped coach bus, the unit travels year round and covers a service area of 16 rural and frontier counties equaling 31,019 square miles. This service area is larger than Connecticut, Massachusetts, New Hampshire, and Vermont combined. The program targets children ages 0-18 from low-income (working poor) families who would not otherwise have access to dental services. To foster community involvement and support, Miles for Smiles was designed with full partnership from local communities and is a collaboration of multiple entities.

THE MODEL

Blueprint: Miles for Smiles is a collaborative effort between Denver, Colorado-based KIND (Kids in Need of Dentistry); Southwest Community Resources (SCR) under which Miles for Smiles is housed; Montrose Memorial Hospital, which provides oversight of the mobile clinic and non-profit dental clinic; Northwest Colorado Dental Coalition; and Catholic Charities.

Miles for Smiles delivers comprehensive dental services and school-based dental education to children ages 0 to 18. These children fall through the safety net between public assistance (Medicaid) and private insurance. The mobile clinic functions as a full-service dental office including two operatories, x-ray, lab, sterilization system, and computer network for medical records and scheduling. A full-time staff dentist, dental assistant, and dental technician travel with the unit. A program director oversees the program while volunteer dentists, hygienists, dental assistants, and community volunteers aid in the program’s delivery at the local level.

Although the mobile unit travels to 16 counties, the program is operated locally through the involvement of each community. The local community is responsible for daily operations and ensuring continued community support, partnerships, and local financial sustainability. The key players at the community level include a local advisory board, sponsoring organization, local dental professionals, and a local coordinator. The local program coordinator is responsible for scheduling appointments; determining patient eligibility; coordinating and scheduling local dental professionals; invoicing, billing, and monthly reporting to KIND; and coordinating oral health education programs, marketing, outreach, and public awareness. Given the vast service area, it is impossible for the unit to provide after hours and emergency care. Therefore, local dental professionals play a vital role by providing emergency and after-hours dental services when the unit is out of town. Local dental professionals also donate in-kind storage space, supplies, equipment, and provide assistance with fundraising and community partnering. KIND staff provide supervisory support and expertise in the operation of the program.

Making a Difference: The program contracts out the evaluation component. Process, program, and outcome evaluations are conducted. The process evaluation component looks at timelines, support, and collaboration. The program evaluation looks at patient demographics, number of visits, types of follow-up, and number of dental caries. Finally, the outcome evaluation concentrates on determining if the program has made a difference in the clients served. Variables included in this measure are dental health access, dental disease, and decay. Since the program’s initiation, the Miles for Smiles unit has visited 11 communities, provided $246,000 worth of service, and seen over 600 children. For approximately half of the new patients, the mobile unit visit is the first visit to a dentist.

Beginnings: In a 1994 study of the oral health status of Coloradoans, nearly 300,000 underserved children needed restorative care, and over 50 percent of Colorado adolescents had gum disease. In a 1999 Medicaid report, it was found that 40 percent of Colorado counties (primarily rural and frontier) had no dental provider, and over 80 percent of Medicaid-eligible children are not accessing dental services. In rural areas, the predominant form of dental care is crisis and emergency care.

Denver-based Kids in Need of Dentistry is the parent organization for Miles for Smiles. KIND is a non-profit charitable organization founded in 1912 and is the oldest dental charity in the country. Until 1997, KIND focused on delivering dental services to metropolitan Denver through its five clinics. In 1997, KIND was approached by Blue Cross and Blue Shield (now ANTHEM) to determine if KIND was interested in expanding services to rural areas. KIND representatives traveled Colorado for one year to determine the most effective method(s) to provide dental health services to children. During this year-long evaluation that looked at the number of providers and the population served, it was determined children of the working poor were falling through the cracks and not receiving adequate dental care. Fully implemented in 1999, Anthem Blue Cross and Blue Shield provided the planning grant, funds for three years of operation, and purchased the van. Dental equipment was provided by Patterson Dental. Additional Year One support was derived from foundations and local community partners. Currently, the program is in Year Two of a four-year funding grant from the Robert Wood Johnson Foundation. It is necessary for the program to maintain diverse funding streams, including cash and in-kind support from local organizations. Remaining program costs are deferred by patient fees, fundraising events, and state and national grantors.

Challenges and Solutions: The western slope of Colorado presents unique challenges to the delivery of dental care. Weather and geography make delivery of and access to dental care problematic. The economy, which is largely tourist driven, presents unique challenges for families who live and work in this area as well. The cost of living is high, and service industry employees often receive low wages, do not have insurance, and do not qualify for public assistance medical and dental programs. In addition, many communities have low levels of or no fluoride in the water systems. Finally, the rural area has a dental provider shortage, making access to dental providers and staffing of the program difficult.

To address the problem of a lack of dentists, the program posted position opening notices at 54 dental schools, the American Academy of Pediatric Dentistry, the American Dental Association web pages, and international publications.

Another obstacle is the lack of data regarding school absences and emergency room visits attributable to dental problems. To address this problem, the program developed an oral health classification scheme for each patient, which allows patients to be tracked at each dental visit.

While the program is relatively new, the program’s oral health education campaign has received endorsement by the Colorado Dental Hygienists Association.

PROGRAM CONTACT INFORMATION

Michelle Thornton

Miles for Smiles Mobile Dental Clinic

2465 South Downing Street, Suite 207

Denver, CO 80210

Phone: (877) 544-5463 ext. #4

Fax: (303) 733-3670