LA Trust Issue Brief, Summaries of Public Health

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© by The L.A. Trust

Building on Momentum | The L.A. Trust©^ and UCLA

INTRODUCTION

Dental caries, the disease that causes tooth decay and which can lead to cavities, remains the leading chronic childhood disease, although it is highly preventable.^1 Poor oral health can disrupt normal childhood development and seriously damage overall health.^2 Children in Los Angeles County face great oral health disparities, faring worse than the national average for the prevalence of tooth decay. Schools provide an effective platform for promoting oral health because they reach the majority of children and their families, including over 6 million children in California.^3 The Los Angeles Unified School District (LAUSD) recognizes the role it can play in addressing the oral health disparities their students face. To fulfill this role, LAUSD has partnered with The Los Angeles Trust for Children’s Health (The L.A. Trust)—a nonprofit organization that works to support the academic success of the nearly 638, students of LAUSD 4 by improving access to health services and programs—and community stakeholders to help implement several strategies to better address the oral health care needs of LAUSD students. One critical opportunity for LAUSD to address children’s oral health early is a state policy that requires schools to ensure children are getting oral health assessments. The Kindergarten Oral Health Assessment Mandate is a critical component of a comprehensive strategy to ensure that children are receiving oral health assessments and are connected to dental homes for necessary oral health services. This brief presents the role LAUSD, The L.A. Trust, and their partners have played in providing oral health services to children and provides recommendations for what needs to be done to advance a sustainable system of oral health care within LAUSD, including leveraging the Kindergarten Oral Health Assessment, to prevent and address children’s oral health problems. The goal of this brief is to pave the way forward so that no child in LAUSD has to suffer from preventable dental disease.

Building on Momentum | The L.A. Trust©^ and UCLA

Since its inception in 2012 and in partnership with LAUSD, The L.A. Trust’s Oral Health Initiative has been working to address oral health disparities among LAUSD’s students and families through providing community-wide oral health education, providing preventive and early intervention services on campuses, and linking students and families to restorative care. A crucial part of the strategy and success of the Initiative is the partnerships LAUSD and The L.A. Trust have forged with key stakeholders, including clinical and other providers, public health and consumer advocates, county staff, school district administrators, parents, students, and funders. In addition, with support and leadership from The L.A. Trust, LAUSD has enacted District-wide policies and activities to create an environment that integrates oral health into the day- to-day activities of schools.

Universal School-based Oral Health

Screening and Fluoride Varnish Program

Based on community needs and informed by stakeholder and community input, beginning in 2013, LAUSD and The L.A. Trust adapted Rady Children’s Hospital for Healthier Communities Dental Care Healthy Smiles Curriculum and service delivery model to implement its own oral health screening and varnish program.^19 The program entails on-site oral health education, oral disease identification, fluoride varnish, and connections to a dental home for students at schools with large numbers of underserved students. The key activity of the program is a one-day or two-day event when the oral health provider comes on site to provide oral health education and preventive oral health services to all students whose parents/ guardians have provided consent. It concludes with connecting all participating children to a dental home, prioritizing those most in need.^20 From April 2013 to June 2017, The L.A. Trust, along with LAUSD Oral Health Nurses, held 49 universal screening and fluoride varnish programs across 32 LAUSD sites. Nearly 25,000 students and 3, parents received direct oral health education, while 8,160 students received screening and fluoride varnish, in addition to oral health education. Five percent of students screened (392) were found to be in need of urgent dental care, to which they were immediately linked. In addition, screening reports and a dental referral list tailored to each local district were sent home with each student in an effort to connect them to a dental home, regardless of dental problems.^21

Community-Wide Education

Every year in February—Children’s Dental Health Month—with support from LAUSD, The L.A. Trust hosts a county-wide Tooth Fairy Convention, an event for parents, children, and the community to learn about the importance of oral health and receive resources, free oral health screenings, and dental referrals. The L.A. Trust also sponsors an annual poster contest for middle and high school students to engage in promoting the importance of proper oral health care across LAUSD. Winners receive a gift card, and their posters are copied and displayed in Wellness Centers across the District.^22

RESPONDING TO THE NEED: THE L.A. TRUST

FOR CHILDREN’S HEALTH’S ORAL HEALTH

INITIATIVE

The L.A. Trust©^ and UCLA | Building on Momentum

Supportive District-Wide Oral Health

Policies

Critical to schools’ ability to promote positive oral health and address the oral health needs of the students and families they serve is supportive leadership and policies from the school district itself. Fortunately, with support and guidance by The L.A. Trust, the LAUSD Board of Education (Board) has adopted several policies and has taken action to reinforce a strong oral health infrastructure for the District. For example, the LAUSD Health and Wellness Policy includes several points related to promoting students’ oral health, from outlining policies to identifying available services.^23 Furthermore, in January 2017, LAUSD Board of Education unanimously approved a resolution recognizing the importance of oral health in to academic achievement and committing LAUSD leadership to support efforts to advance oral health promotion activities in schools. This includes complying with the Kindergarten Oral Health Assessment Mandate, designating February as Dental Health Month, and supporting the activities of The L.A. Trust’s Oral Health Initiative.^24 In addition to this resolution, through policy bulletins and memos, District leaders have reminded elementary school leaders of the Kindergarten Oral Health Assessment Mandate, provided instructions for how to implement the requirement, and informed them about The L.A. Trust’s role in supporting oral health care activities in schools.^25 In 2017-18, the LAUSD Healthy Start program institutionalized the Oral Health Initiative by including the implementation of the Kindergarten Oral Health Assessment Mandate in their program staff scope of work. The inaugural training was held in August 2017, and this effort is being piloted in 40 target schools in high needs areas. Finally, in 2014, the Board allocated $50 million in bond funds for the expansion of existing Wellness Centers and the construction of new Centers. Wellness Centers are full service community clinics on campus that provide primary care and mental health services to students and the community. With the expansion dollars, six of the 15 Wellness Centers now provide school-based dental services, increasing access to dental care for thousands of children.^26

The L.A. Trust©^ and UCLA | Building on Momentum

Yet, implementation of the Mandate has been minimal and uneven across the State. Many schools, including those in LAUSD, have struggled to fulfill the Mandate, due to limited support from the State. Barriers to full implementation include limited technical support (such as around outreach and education and data collection) from the State and difficulty in collecting, managing, and reporting data. However, there are opportunities to take advantage of this critical policy to increase the number of children who receive assessments and who are ultimately connected to ongoing care, especially as part of a comprehensive school-based oral health strategy. And there are new supports available. For example, as part of the State Oral Health Plan, the State will be supporting a technical assistance provider to work one-on-one with school districts to help them implement the Mandate. Further, as mentioned above, the LAUSD Board of Education is supporting stricter adherence to the Mandate—including supporting Healthy Start staff in implementing the Mandate, as well as piloting implementation at 40 schools. LAUSD, The L.A. Trust, the California Department of Education, the California Oral Health Program, and key partners can take the following additional steps to better implement the Mandate.

• Support Healthy Start Coordinators—with training, resources, and technical assistance— in helping children get the assessment, talk to families about the importance of good oral health, and connect them to a dental home as well as other health and social service programs.
• Educate school staff about the importance of good oral health, the role of the assessment in facilitating oral health care, and what school staff can do to help ensure parents get assessments for their children and return the form.
• Use health fairs, kindergarten round-up, and back to-school events to educate families about oral health, provide onsite assessments, and help families connect to a dental home.
• Provide incentives to children who bring back their forms. For example, teachers can provide reminders via stickers, wristbands, or flyers in backpacks for children to take home to remind them and their parents about the assessment form. Incentives could include a bubble party, a dance party, or more time on the playground.
• Integrate the assessment into existing programs, such as the implementation of the universal oral health screening and fluoride varnish program, or other school-based oral health programs.
• Partner with local dentists to bring the assessments to the school sites and to identify dental providers to serve as dental homes for children and families.
• Identify the best strategy and support the collection and submission of data to the State as well as make the data (in aggregate form) available to the public. The data can help identify need and, consequentially, inform policies and the flow of resources.
• Take advantage of opportunities through the Office of Oral Health at the California Department of Public Health to receive technical assistance in implementing the Mandate.

Building on Momentum | The L.A. Trust©^ and UCLA

Support Additional Ways to Partner

with Clinics. Per the examples above, FQHCs

and other community clinics have played an important role in the provision of oral health services. Collaboration between clinics and LAUSD to improve oral health care access for children dates back to the early 2000s. One example is the collaboration between Eisner Health, an FQHC, and San Pedro Elementary School. Through a pilot program in 2010-11, with the support of The L.A. Trust and the Dental Health Foundation (now Center for Oral Health), Eisner Health purchased and used portable dental equipment to bring oral health care to schools. The partnership with the school has sustained past the pilot project, with the clinic expanding services to two nearby schools. Similarly, other FQHCs and community clinics in LA County have partnered with school districts to provide oral health services on school campuses. Another possibility for bringing oral health care to children in schools is through the Virtual Dental Home (VDH) or VDH-like programs, which uses telehealth technology to bring dental care to community sites. To date, the VDH has been implemented in 20 sites across LA County, including early learning sites and schools.

Collaborate with Academic Institutions.

Academic institutions can be good partners for schools to provide oral health services. In LA County, there are three dental schools that have community-based collaborations with schools. In 2011, through a grant from the federal Maternal and Child Health Bureau’s School-Based Comprehensive Oral Health Services Program, the Dental Health Foundation, in collaboration with Western University and LAUSD, designed and implemented a school-based program to bring oral health care services to schools, in which services were provided by Western University faculty and students. Because of the effectiveness of the effort, Western University has since collaborated on school-based oral health services with three additional school districts in LA County. UCLA has expanded its community involvement as part of its UCLA-First 5 LA Oral Health Program, which partnered with 22 community clinics, including 20 FQHC sites, many of which provide services for LAUSD schools. Expansion of these activities are planned as part of Medi-Cal Dental Transformation Initiative Local Dental Pilot Projects.

Take Advantage of Current State and

Local Public Oral Health Opportunities.

California’s Dental Director recently led the development of a State Oral Health Plan, which includes schools as a target for oral health activities. Related, the recently passed Proposition 56 dedicates $30 million dollars to the State Oral Health Plan, most of which goes to local oral health programs to develop and implement their own oral health plans. As LA County develops its plan, there is an opportunity to ensure LAUSD is included in the strategy to meet both the State and County’s goals, while improving the oral health of LAUSD children and families. Finally, as part of a Medi-Cal Waiver, the Department of Health Care Services is implementing a Dental Transformation Initiative (DTI), which includes the implementation of Local Dental Pilot Projects (LDPPs)—alternative, community-based strategies to provide oral health care to children enrolled in Medi-Cal. There are two LDPPs in Los Angeles with which The L.A. Trust and LAUSD can partner to bring oral health care into schools.

Building on Momentum | The L.A. Trust©^ and UCLA

About the Authors

UCLA

James J. Crall, DDS, ScD is a professor

and chair of the Division of Public Health and Community Dentistry at the UCLA School of Dentistry, and project director for the UCLA-First 5 LA 21st Century Community Dental Homes Project and UCLA-First 5 LA Children’s Dental Care Program.

Scott Cheng, MPH is the executive assistant

for the UCLA-First 5 LA Oral Health Program within the Division of Public Health & Community Dentistry at the UCLA School of Dentistry.

Brendan John, MPA is the program operations

manager for the UCLA-First 5 LA Oral Health Program within the Division of Public Health & Community Dentistry at the UCLA School of Dentistry.

Jenny Kattlove, MSSA is a consultant for

UCLA.

THE LOS ANGELES TRUST

FOR CHILDREN’S HEALTH

Maryjane Puffer, BNS, MPA is the Executive

Director for The Los Angeles Trust for Children’s Health, and responsible for the creation of the Oral Health Initiative program model.

Frances Walsh, MPHc is the Oral Health

Program Manager for The Los Angeles Trust for Children’s Health, and led the program’s implementation from the initial pilot phase to include more than 30 school sites.

ACKNOWLEDGMENTS

Funding for this brief was provided by

The L.A. Trust©^ and UCLA | Building on Momentum

(^1) US Department of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health, Oral Health in America: A Report of the Surgeon General (Rockville, MD: US Department of Health and Human Services, 2000), 63; Dental Health Foundation, Mommy, It Hurts to Chew: The California Smile Survey: An Oral Health Assessment of California’s Kindergarten and 3rd Grade Children (Oakland, CA: Dental Health Foundation, 2006), (^2) Holt, K & Kraft, K Oral Health and Learning: When Children’s Health Suffers, So Does Their Ability to Learn , 2nd ed. (Washington, DC: National Maternal and Child Oral Health Resource Center, Georgetown University, 2003): 1-2, http://www.mchoralhealth.org/pdfs/learningfactsheet.pdf. (^3) LA Unified Fingertip Facts: 2017 – 2018. October 2017, accessed December 31, 2017 https://achieve.lausd.net/site/handlers/filedownload. ashx?moduleinstanceid=41232&dataid=57579&FileName=NewlyUpdatedFingertip%20Facts2017-18_English.pdf (^4) LA Unified Fingertip Facts: 2017 – 2018. October 2017, accessed December 31, 2017 https://achieve.lausd.net/site/handlers/filedownload. ashx?moduleinstanceid=41232&dataid=57579&FileName=NewlyUpdatedFingertip%20Facts2017-18_English.pdf (^5) Dye BA, Vargas CM, Fryar CD, Ramos-Gomez F, Isman R. Oral health status of children in Los Angeles County and in the United States, 1999–2004. Community Dent Oral Epidemiol 2017; 45: 135–144. (^6) Dental Health Foundation, Mommy, It Hurts to Chew: The California Smile Survey: An Oral Health Assessment of California’s Kindergarten and 3rd Grade Children (Oakland, CA: Dental Health Foundation, 2006): 12. (^7) Dental Health Foundation, “Mommy, It Hurts to Chew” The California Smile Survey: An Oral Health Assessment of California’s Kindergarten and 3rd Grade Children, Oakland, CA: Dental Health Foundation, 2006. http: //www.centerfororalhealth.org/imaged/lib_PDF/dhf_2006_report.pdf; Madhurima Gadgil, Rosanna Jackson, Neal Rosenblatt, Azam Aleemuddin Caroline Peck, and Janet Bates, Status of Oral Health in California: Oral Disease Burden and Prevention, California Department of Public Health, April 2017, pages 26-28. (^8) Madhurima Gadgil, Rosanna Jackson, Neal Rosenblatt, Azam Aleemuddin Caroline Peck, and Janet Bates, Status of Oral Health in California: Oral Disease Burden and Prevention, California Department of Public Health, April 2017, page 25. (^9) LA Unified Fingertip Facts: 2017 – 2018. October 2017, accessed December 31, 2017 https://achieve.lausd.net/site/handlers/filedownload. ashx?moduleinstanceid=41232&dataid=57579&FileName=NewlyUpdatedFingertip%20Facts2017-18_English.pdf (^10) Huff, QA, “A Perfect Smile Comes at a Cost: How Poverty and Food Insecurity Cement Disparities in Oral Health.” July 8, 2015. Accessed on September 14, 2015. http://ilikemyteeth.org/a- perfect-smile-comes-at-a-cost-how-poverty-and-food-insecurity-cement-disparities-in-oral-health/. (^11) Mulligan R, et al. Dental carries in underprivileged children in Los Angeles. J Health Care Poor Underserved 22(2), 2011.:648-62. (^12) Mulligan R, Seirwan H. “The Oral Health Baseline Needs Assessment of Underprivileged Children.” Los Angeles, CA: The Children’s Dental Health Project; October 2009. (^13) California Department of Health Care Services, Medi-Cal Dental Services Rate Review , (Sacramento, CA: California Department of Health Care Services, 2015): 8, http://www.dhcs.ca.gov/ Documents/2015_Dental-Services-Rate-Review.pdf. (^14) Madhurima Gadgil, Rosanna Jackson, Neal Rosenblatt, Azam Aleemuddin Caroline Peck, and Janet Bates, Status of Oral Health in California: Oral Disease Burden and Prevention, California Department of Public Health, April 2017, page 55-56. (^15) LA Unified Fingertip Facts: 2017 – 2018. October 2017, accessed December 31, 2017 https://achieve.lausd.net/site/handlers/filedownload. ashx?moduleinstanceid=41232&dataid=57579&FileName=NewlyUpdatedFingertip%20Facts2017-18_English.pdf (^16) Yihong Li and WJ Wang, “Predicting Caries in Permanent Teeth from Caries in Primary Teeth: An Eight-Year Cohort Study.” Journal of Dental Research 81, No. 8 (2002): 561. (^17) Hazem Seirawan, DDS, MPH, MS, et al., “The Impact of Oral Health on the Academic Performance of Disadvantaged Children.” American Journal of Public Health 102, No. 9 (2012): 1729-34. (^18) Hazem Seirawan, DDS, MPH, MS, et al., “The Impact of Oral Health on the Academic Performance of Disadvantaged Children.” American Journal of Public Health 102, No. 9 (2012): 1729-34. (^19) Rebecca N. Dudovitz, Jonathan E. Valiente, Gloria Espinosa, Claudia Yepes, Cesar Padilla, Maryjane Puffer, Harold C Slavkin, and Paul J. Chung, “A school-based public health model to reduce oral health disparities,” Journal of Public Health Dentistry 00 (2017) 00-00. (^20) The Los Angeles Trust for Children’s Health, The L.A. Trust Oral Health Program Manual , forthcoming. (^21) The L.A. Trust Oral Health Initiative, Accessed December 31, 2017 , http://thelatrust.org/oral-health-2/oral-health-initiative/ (^22) The L.A. Trust Oral Health Initiative, Accessed December 31, 2017 , http://thelatrust.org/oral-health-2/oral-health-initiative/ (^23) Blueprint for Wellness: Healthy Choices for Lifelong Health; The LAUSD Health and Wellness Policy, January 2016, accessed November 4, 2017, https://achieve.lausd.net/cms/lib/CA01000043/ Centricity/Domain/453/MASTER_Blueprint%20for%20Wellness_061316.pdf. (^24) Dr. McKenna & Mr. Schmerelson, The Importance of Oral Health , (Res-047-16/17) (Noticed December 13, 2016), Los Angeles Unified School District Board of Education Resolution, Voted and Approved on January 10, 2017. (^25) Michelle King, Inter-Office Correspondence: Kindergarten Oral Health Assessment, Los Angeles Unified School District Office of the Superintendent, Feb 28, 2017; Judy Elliott, Los Angeles Unified School District Policy Bulletin: Oral Health Assessment for Kindergarten or First Grade, BUL-3585.5, May 10, 2010, http://oelausd.org/sites/oelausd.org/files/elementary_enrollment_ procedures/BUL-3585.5%20ORAL%20HEALTH%20ASSESSMENT%20FOR %20KINDERGARTEN%20REVISED%205-10-10.pdf ; Rene Gonzalez, Los Angeles Unified School District Policy Bulletin: Oral Health Assessment for Kindergarten or First Grade, BUL-3585.6, August 1, 2016, http://www.oelausd.org/sites/oelausd.org/files/elementary_enrollment_procedures/BUL- 3585.6%2C%20%208-2-16%20Oral%20Health.pdf (^26) Los Angeles Unified School District, Board of Education Report, Approval of the Wellness Phase 2 Facilities Plan to Identify Eleven Sites for School-Based Clinics and Wellness Center Projects and Amend the Facilities Services Division Strategic Execution Plan to Approve Seven School-Based Clinics and Wellness Center Projects, File #: Rep-207-16/17, Version: 1, December 13, 2016, accessed November 4, http://www.laschools.org/documents/download/about_fsd/sep/2012_consolidated_strategic_execution_plan/2016_sep_amendments/BOE_207_LRegistar_Format_ Wellness_Centers_Final_Signed_Board_Report_Packet.pdf?version_id= (^27) Kindergarten Oral Health Requirement, Accessed December 31, 2017 , https://www.cda.org/public-resources/kindergarten-oral-health-requirement. (^28) Stockey, JD., Fisher, M., Chung, L., et. al., “Case Study: School-Based Oral Health Screening in San Francisco as an Essential Public Health Service,” CDA Journal, Vol. 45, No. 8, August 2017, 405-417.

ENDNOTES