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Philadelphia’s Multi-faceted Approach to Increase Children’s Access to Oral Health Care Services

Philadelphia’s Multi-faceted Approach to Increase Children’s Access to Oral Health Care Services. Who are we?. Tracey Williams – twilliams2@philasd.org Philadelphia School District Judy Gelinas – julianna.gelinas@tenethealth.com

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Philadelphia’s Multi-faceted Approach to Increase Children’s Access to Oral Health Care Services

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  1. Philadelphia’s Multi-faceted Approach to Increase Children’s Access to Oral Health Care Services

  2. Who are we? Tracey Williams – twilliams2@philasd.org Philadelphia School District Judy Gelinas – julianna.gelinas@tenethealth.com St. Christopher’s Foundation for Children Ronald McDonald Care Mobile Roxy Woloszyn – roxyw@pccy.org Public Citizens for Children and Youth - PCCY Colleen McCauley – colleenmccauley@pccy.org Public Citizens for Children and Youth - PCCY

  3. Overview • Status of children’s oral health in Philadelphia • The “facets” of our approach: 1) Southeastern Pennsylvania Oral Health Task Force 2) PCCY Child Health Watch Helpline 3) Oral Health Resource Guide 4) Give Kids a Smile Day 5) School-based oral health care services • Identifying child advocacy and other potential partners in your area

  4. Status of Children’s Oral Health in Philadelphia

  5. Medicaid enrollment • Pennsylvania – 1,043,337 children • Philadelphia – 255,842 children • double the number of the second highest county’s enrollment in the state • 1 in 3 persons in Philadelphia are enrolled in Medical Assistance • Philadelphia demographics include a rising number of new immigrants from Europe and Asia. Data Source: April 2009 Office of Medical Assistance, Pennsylvania

  6. Children in Philadelphia with Public Health Insurance • 255,842 children on Medicaid and 30,000 on CHIP • 3 out of 4 children in Philadelphia on public health insurance

  7. A Profile of Dental Health among Children in Philadelphia • 1 in 5 children between the ages of 4 – 17 have not been examined by a dentist – true? • 1 in 10 children did not receive needed dental treatment • Top 3 reasons why children did not go to a dentist: “don’t need it” “cost” “not a priority” Data Source: 2006 Southeastern Pennsylvania Household Health Survey. Public Health Management Corporation, Community Health Data Base, 2008.

  8. PCCY • PCCY has been around for 27 years working to improve the lives and life chances of children in Southeastern Pennsylvania through thoughtful and informed advocacy and policy on a spectrum of children’s issues – from health to child care to public education, juvenile justice, and child welfare. • PCCY does not generally provide direct service to children, but it does identify and define issues and their solutions, raise public awareness, build coalitions, conduct research and distribute information.

  9. Facet #1: The Southeastern Pennsylvania Oral Health Task Force

  10. Task Force • Mission: Increase children’s access to oral health care services. • Convened by PCCY in 2002 – and we function as a “neutral partner”. • Created because we heard from many people working with children that kids were not getting dental care.

  11. Task Force • Comprised of a cross-section of stakeholders including: • dentists and professionals who work in dental offices (FQHCs, city-run health centers, private practices) • dental school faculty from Temple University and the University of Pennsylvania • dental director of PA’s Medicaid agency • Philadelphia School District personnel • Medicaid and CHIP insurance companies • Representatives from the child care community

  12. Facet #2: Oral Health Resource Guide

  13. Oral Health Resource Guide Why did we create the guide? • Task Force members identified a significant barrier to care is parents not knowing where to take their kids for care. • School nurses and primary care providers also said they didn’t know where to refer kids for care. • Fewer dentists in the city accept Medicaid than private insurance.

  14. Resource Guide - English

  15. Resource Guide – Spanish

  16. Resource Guide - Features • List of over 50 practices with at least two chairs that accept Medicaid • List indicates: • insurance plans accepted • discount or free services offered • languages spoken other than English • services for children with special needs offered • Map of practices • Information about obtaining health insurance • Basic oral health education

  17. Resource Guide

  18. Resource Guide

  19. Resource Guide • Dental student intern took the lead in writing the guide. • We primarily distributed guides to places where children are: in school with school nurses and community-based health centers/primary care providers. • Find the guides at www.pccy.org

  20. Facet #3: Child Health Watch Helpline

  21. Helpline • PCCY has maintained a helpline for 15+ years • Services offered: • Over the phone, help a parent complete an insurance application for Medicaid or CHIP • Refer parents to health services including primary care, dental, mental, family planning, etc. • Problem solve insurance and health access issues with parents, school nurses and counselors and other professionals who work with children • Help non-English speaking parents with insurance applications, referrals and access issues using “Language line”

  22. Helpline • We’ve alerted dentists that they can refer uninsured children to us for assistance to apply for coverage • Refer callers to dentists • Train dental practices to help parents apply for coverage

  23. Facet #4: Give Kids a Smile Day

  24. Give Kids a Smile Day • PCCY first got involved in 2003 - helping to recruit a few dentists and garnering some media coverage to raise public awareness. • Over the last five years, we steadily increased the number of participating providers and greatly expanded our outreach efforts to parents.

  25. Smile Day • The Philadelphia Smile Day is a decentralized event: parents take their children to the offices of participating dentists to receive care. • We do not hold Smile Day on the official ADA day. • We schedule Smile Day on a weekday when children are off from school and parents are more available to take their children for care.

  26. Smile Day 2009 Outcomes at a Glance • 28 practice sites participated • 1,000 slots created • 892 appointments made • 676 children received care • 300 children identified as under or uninsured

  27. Why does the School District of Phila. participate in Smile Day? PLEDGE OF RESPONSIBILITY FOR CHILDREN We pledge responsibility for children who put chocolate fingers everywhere, who like to be tickled, who stomp in puddles and ruin their new pants, who sneak popsicles before supper, who erase holes in math workbooks, who can never find their shoes. And we pledge responsibility for those whose nightmares come in the daytime, who will eat anything, who have never seen a dentist, who aren’t spoiled by anybody, who got to go to bed and cry themselves to sleep, who live and move, but have not being. We pledge responsibility for children who want to be carried and for those who must, for those we never give up on and for those who don’t get a second chance. For those we smother and for those who will grab the hand of anybody kind enough to offer it. Ina J. Hughes

  28. School District of PhiladelphiaStatement of the Problem • Dental disease is most common chronic & infectious disease of childhood. • Fifty two million school hours are lost each year due to oral health problems. • More than 60% of school-aged children do not receive dental care annually. • Oral diseases are linked to total health & well-being throughout life, undermining self-image and self-esteem, discouraging normal social interaction, & leading to chronic stress and depression. • Poor oral health may impede vital functions of life such as breathing, eating, speaking, and ultimately diminishes quality of life.

  29. School District of Philadelphia, PAWhy Screen? • Every child of school age attending a public or non-public school is required by the Commonwealth of Pennsylvania to have the dental screenings completed within one year prior to the original entry to school, one year before or during third grade & one year before or during seventh grades (Public School Code of 1949).

  30. School District of PhiladelphiaGive Kids a Smile Day • Provide oral health services to SD students • Make the connection of having a dental home for students & families • Increase state mandated reporting requirements • Expand community partnerships

  31. School District of PhiladelphiaGive Kids a Smile Day • PCCY Coordinates • Mass media outreach campaign • District – wide event • Partner with providers throughout the City • Robo-dial capability • GKS Day conducted on non-school day

  32. Why does the Ronald McDonald Care Mobile participate in Smile Day? The need for care in our target population in North Philadelphia is great. Clients entering the Ronald McDonald Care Mobile Dental Program from 2007 to 2008 (2527 children, ages 3 to 9): • 43.3% of 3 year olds had cavities 10% had 8 or more • 72.9% of 7 year olds had cavities 18.8% had 8 or more Data Source: 2009 Retrospective Study, St. Christopher’s Foundation for Children; Black, Gelinas, Yu

  33. GIVE KIDS A SMILE DAY How We Do It from Beginning to End

  34. LAYING THE FOUNDATION FOR GIVE KIDS A SMILE DAY

  35. CREATE A TIMELINE • We prepare for the big day about 2 months in advance. • We construct a reverse timeline starting from Smile Day and work backwards.

  36. CREATE A TIMELINE • Recruit dentists • Obtain donations of toothbrush kits • Recruit volunteers • Publicize the event • Final follow-up with participating dentists • Call week: taking calls and doing appointment reminders • Manage Smile Day • Mail thank-you’s and framed certificates of appreciation • Collect evaluation forms from dentists • Follow-up with families who said their children are uninsured

  37. RECRUITING DENTISTS • Mix of public and private providers: • Federally qualified health centers • Dental schools • School of Hygiene at community college • Small and large private practices – accepting anywhere from 3 to 75 patients on Smile Day • Try to recruit from all parts of the city – because parents call us from all over

  38. RECRUITING DENTISTS • Promote restorative care! – because parents call with children in need. • Encourage providers to overbook by at least 25% in anticipation of children who do not show.

  39. RECRUITING DENTISTS MOST IMPORTANTLY We try to make it very easy for practices/dentists to participate in Smile Day Providers decide: • how many children they will see • what hours of the day they will see them • if they’d like to schedule their patients or have us schedule them (we prefer the latter)

  40. RECRUITING DENTISTS Sources of recruitment: • PCCY’s Oral Health Resource Guide • State Medicaid agency for a list of Medicaid providers • Local dental society (in Philly, most members are not Medicaid providers, however) • Medicaid plans’ on-line list of providers • Dental insurance subcontractor sent out Smile Day recruitment letters with checks to its providers • Ask past participants to enlist their colleagues for the coming year

  41. OBTAIN DONATED TOOTHBRUSH KITS • ADA Smile Day kits • Local Medicaid and CHIP insurance plans donate kits • Distribute the kits to dentists a week or two before Smile Day – with an evaluation form enclosed

  42. VOLUNTEERS We can’t do Smile Day without volunteers. This past year, over the course of a week, we received about 1,500 phone calls from parents making appointments.

  43. VOLUNTEERS Sources: • Colleges and universities (dental schools, dental hygiene schools, public health programs) • Health and dental insurance companies – employee time as corporate giving • Staff at participating provider offices

  44. PUBLICIZING SMILE DAY • Via the school district’s auto-dial technology that sends out a recorded message to 168,000 student households in the city. • Goes out 1 week before Smile Day • A Philadelphia Eagles football player recorded the call one year • Local media – newspapers of record, neighborhood papers, radio, t.v. PSAs

  45. FOLLOW-UP WITH DENTISTS • Confirm the time of service, number of patients, type of care delivered, address, etc. • Confirm that the dental office received the toothbrush kits – and the enclosed evaluation form to ideally be completed and returned at the end of Smile Day.

  46. SCHOOL DISTRICT CALL GOES OUT • Calls from parents to make appointments come rolling in . . !

  47. APPT. REMINDER CARDS Dear _____________________, Thank you for calling Public Citizens for Children and Youth (PCCY) to schedule a dental appointment for Give Kids a Smile Day 2009 and congratulations in taking an important step in ensuring your child’s dental health! We would just like to remind you that _____________________’s appointment with Dr. _____________________ located at ___________________________________ is scheduled for Thursday, February 5, 2009 at _________. The doctor’s office can be reached by taking SEPTA’s ________________________________________. In order to respect the needs of other Philadelphia families, please call PCCY at 215-563-5848 ext. 32 if you need to cancel or reschedule your appointment. Again congratulations on scheduling your dental appointment!

  48. ON SMILE DAY • Phone volunteers available to take troubleshooting calls from parents (i.e. can’t find dentist’s office, need to cancel appt.) • Visit some dentists’ offices

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