Prevention & Dental Public Health (DPH) Infrastructure: A State Oral Health Program Perspective

1. Prevention & Dental Public Health (DPH) Infrastructure:A State Oral Health Program Perspective DON MARIANOS, DDS, MPH ORAL HEALTH 2014 INITIATIVE WEBINAR MAY 11, 2012

2. Webinar Agenda • Prevention • Prevention and DPH Infrastructure Linkage • ASTDD – Infrastructure Enhancement Project 2012 • Discussion – Oral Health 2014 Initiative Challenges • Key Messages Summary

3. Dental Disease Prevention ACCESS = SUPPLY – DEMAND DECREASED COSTS OPTIMAL ORAL HEALTH

4. The Community Focus • Define the Community of Interest • Know the Community • Engage the Community • Define the Problem(s) to be Addressed • Evaluate the Impact of Programs on the Community

5. Evidence Based Prevention Strategies • Community Water Fluoridation • School Based/Linked Sealant Programs • Fluoride Varnish Programs • Fluoridated Toothpaste • Health Education Programs • Oral Health Literacy • Behavior Change • Others. . .

6. Prevention Strategies Having defined the community of interest; collected and analyzed relevant data; engaged the community; defined the problem to be addressed; selected the prevention strategies to be implemented or enhanced, then what?

7. The Prevention & Infrastructure Linkage INFRASTRUCTURE THE BASIC PHYSICAL AND ORGANIZATIONAL STRUCTURE AND SUPPORT NEEDED FOR THE OPERATION OF A SOCIETY, CORPORATION OR COLLECTION OF PEOPLE WITH COMMON INTERESTS.

8. The Prevention & Infrastructure Linkage INFRASTRUCTURE FACILITATES THE PRODUCTION OF SERVICES & PROVIDES RESOURCES REQUIRED TO PERFORM A FUNCTION. INFRASTRUCTURE IS REQUIRED TO PROVIDE THE ORGANIZATIONAL STRUCTURE AND SUPPORT FOR THE OPERATION OF PREVENTION PROGRAMS.

9. DPH Infrastructure • Complex • Dynamic • Variable • Fragile • Coordinated

10. DPH Infrastructure Components • Public (Governmental, Safety Net Clinics, etc.) • Private (Individual practices, Local dental societies) • Federal • State • Local • Medical and other Health/Wellness • Philanthropic • Advocacy Organization • Others (Religious, Educators, Civic Groups, etc.)

11. DPH Infrastructure

12. DPH Infrastructure Goals • Identify partners that can contribute some unique and vital aspect to assist in attaining optimal oral health for all. • To facilitate enhancing the connections between these partners to each other and to the overarching mission and vision. • Continual coordination, nurturing and evaluating of the infrastructure.

13. Association of State and Territorial Dental Directors (ASTDD) Infrastructure Enhancement Project (IEP) 2012 OBJECTIVE: TO LOOK AT STATE ORAL HEALTH PROGRAM (SOHP) INFRASTRUCTURE FROM 2000 TO 2010 AND THE CAPACITY OF THOSE PROGRAMS TO ADDRESS CORE PUBLIC HEALTH FUNCTIONS AND DELIVER THE 10 ESSENTIAL PUBLIC HEALTH SERVICES. FUNDED BY THE CDC

14. ASTDD – IEP 2012 Goals • Review a decade of infrastructure and capacity building efforts • Provide new information and recommendations to help state agencies and policymakers, funders, advocates and others better understand how to build and sustain SOHP infrastructure • How to effectively use this infrastructure to leverage additional resources to improve oral health

15. ASTDD – IEP 2012 Methods: Review of articles in scientific literature, governmental publication and reports and data from the the ASTDD State Synopses from 2000 - 2010 as well as numerous surveys. Conducted targeted interviews with key informants. Analyzed quantitative and qualitative information to identify key elements contributing to successful programs.

16. ASTDD – IEP 2012 Summary Findings: • Has been significant investment of resources during the decade • Prior to 2000 very limited Oral Health (OH) data by the end of 2011 – 44 states had submitted data to the National OH Surveillance System • In 1999 only 16 states had OH improvement plans, by 2009 30 states had plans and 10 were in process • States with full-time SOHP Directors increased from: 61% in 2000 to 80% in 2010

17. ASTDD – IEP 2012 Summary Findings (continued): • The percentage of states with 2 or fewer FTE staff decreased from 41% in 2000 to 12% in 2010 • The percentage of states with 5 - 20 OH staff increased from 20% in 2000 to 41% in 2010 • In 2000 ~ 193,000 children received dental sealants through 25 state programs while in 2011 40 states had programs serving almost 400,000 children • States are now focusing on prevention strategies for women, young children and the elderly

18. ASTDD – IEP 2012 Conclusions: • SOHP’s have significantly improved OH surveillance capacity • Many SOHP’s have enhanced their infrastructure and capacity to perform essential public health functions • Not all states have seen improvements and much remains to be done

19. ASTDD –IEP 2012 SOHP’s require strong leadership, adequate resources, internal and external support, diverse and formalized partnerships, sound plans, policies, and evaluation to support their programs. SOHP’s must be resilient to withstand economic instability and meet current and future needs. No one model meets the needs of all SOHP’s.

20. SOHP Infrastructure Elements • Resources: Funding, Technical Assistance, Program Authority • Leadership/Staffing, Partnerships, Collaborations, Coalitions, Champions and Advocates • Surveillance Capacity • State Planning and Evaluation Capacity • Policy Work, Evidence-Based Prevention and Promotion Programs Goal – Improved Oral Health Outcomes

21. ASTDD Resources www.astdd.org for the complete report and additional information of State Oral Health Programs. • Guidelines • Competencies • Best Practices • Policy Statements • Basic Screening Survey • National Oral Health Surveillance System

22. Oral Health 2014 Initiative What are some unique Prevention and Dental Public Health Infrastructure challenges facing the Oral Health 2014 initiative?

23. Key Messages • No one group or organization is capable of assuring optimal oral health for all • Importance of defining and knowing your community, their needs and desires, and the barriers to improved oral health and prevention • Develop individualized prevention programs appropriate to the needs and desires of the community

24. Key Messages • To develop and maintain a strong vibrant prevention program it is critical to have a robust DPH infrastructure in place that is resilient and flexible • Nurture, refine, evaluate and coordinate the DPH infrastructure and the prevention programs developed • Develop OH improvement plans and strong leadership/staff

25. Key Messages • Community-based oral disease prevention programs, access to comprehensive and coordinated oral health services and financing systems that create affordable oral health care and sustainable oral health programs are crucial to ensuring oral health and overall health. • Good infrastructure requires high levels of investment, expertise and political will.