School-Based Dental Hygiene

Transcription

1 School-Based Detal Hygiee By Jea Majeski As the detal hygiee professio celebrates its 100th aiversary, it is appropriate to look back at its origis i the classroom, providig prevetive services ad educatio. Turig a eye toward the preset day, the Pew Ceter o the States has just released a report fidig that too little is beig doe at the state level to provide sealats to low-icome studets. The report characterizes permissio for detal hygieists to place sealats i school-based programs without requirig a detist s exam as a idicator that should be a part of all states prevetio strategy ad fids that too few states iclude it. 1 This article describes successful ogoig school-based programs i four differet states ad their approaches to school-based detal hygiee. Future Smiles Nevada Terri Chadler, RDH, is fouder ad executive director of Future Smiles, a school-based detal hygiee program Above: The Greater Derry Oral Health Collaborative Corporatio operates two school-based oral health programs: Childre s Detal Network ad Salem Childre s Detal Network. Here, Mary Davis, RDH (right forefrot), records a screeig while Diae Powers, RDH (ceter), places a sealat. O the left, Sarah Fie, DMD, MPH (previously a hygieist) performs a screeig. I the backgroud is assistat Debi Grochmal. (Photo by Hope Saltmarsh, RDH, MEd) that employs detal hygieists who have bee approved for a Public Health Detal Hygiee Edorsemet by the Nevada State Board of Detal Examiers. This edorsemet is critical because it allows the hygieists to provide all phases of detal hygiee care without a comprehesive detal exam by a detist, said Chadler, who characterizes Future Smiles as much more tha a detal sealat program. We strive to provide all detal hygiee services, regular recare ad detal referrals, she said. Through educatio, we support our missio to improve the detal literacy of our at-risk populatio. We work directly with school urses, couselors, teachers, pricipals ad other medical/detal professioals to esure that the childre we serve ca secure the ecessary resources that will address their eeds. Chadler poited out that there are may facets to providig school-based care the way Future Smiles does, citig isurace issues, busiess aspects, fudig ad staffig. Each of Future Smiles core group of detal hygieists holds the Public Health Detal Hygiee Edorsemet ad cardiopulmoary resuscitatio certificatio. They all are covered uder Future Smiles malpractice isurace, workers compesatio isurace ad geeral liability. Before ay health professioal ca provide schoolbased health care, the Clark Couty School District requires a formal Memoradum of Uderstadig ad specific isurace coverage, she said. Therefore, all team members must be added to these policies, which cost thousads of dollars aually, before we ca provide our detal hygiee 16 FEB 2013 access

2 Future Smiles offers a full complemet of detal hygiee services ad emphasizes oral health educatio to improve the detal literacy of populatios at risk for oral disease. services. Our grat dollars ad Medicaid reimbursemets cover the operatioal costs, supplies ad salaries. Our service delivery is limited by the fudig that we ca raise as a o-profit. I m proud to say that the detal hygieists with Future Smiles are the first i Nevada to become credetialed Medicaid providers, she said. However, there are limitatios withi the Medicaid system, ad our program cotiues to see a high percetage of uisured, low-icome childre. Chadler established Future Smiles as a 501(c)3 oprofit orgaizatio. We broker our ow fudig, we write our ow grats, ad it is 100 percet detal hygiee based, she said. Oe of my primary provisios was ayoe that is a part of this orgaizatio eeds to be a ADHA member. As a beefit, the orgaizatio pays half of the membership dues. So if someoe wated to voluteer with us, that s great, but you eed to be a ADHA member. Beig a member of our professioal associatio was (ad is) really importat to me whe I origially established Future Smiles. Chadler explaied how Future Smiles detal hygieists use portable detal uits maufactured exclusively by DNTLworks for the orgaizatio. All of our portable detal uits were purchased through grats writte by Future Smiles. This ivestmet icluded extesive research o portable detal uits, ad we foud that DNTLworks had exactly what we were lookig for i a effective delivery system. As executive director of Future Smiles, Chadler is protective of her program s ivestmet. There is defiitely a learig period whe it comes to the set-up, maiteace ad trasportatio of the portable uits, she said. We ivest time ito teachig each team member how to care for the uits ad work together durig the trasportatio to a ew school or commuity site. I prefer that two people break dow ad load the uits. Ofte, the schools are really great ad will help us load or uload equipmet. I m still amazed at how easily the uits break dow, fit ito zippered bags ad travel to the ext school site. We have special little trolleys to make it easier for us to push stuff aroud ad move ito ad out of the classroom. Ad pretty much oe detal operatory will fit i the back of my Nissa Murao SUV. Sice Future Smiles first provided school-based care o December 29, 2009, the program has served 5,778 childre ad provided 10,857 detal sealats, 2,059 prophylaxes ad 4,767 fluoride varish applicatios. The group will celebrate their milestoe of 10,000 sealats at a lucheo held i February 2013, but admitted there is always more to achieve. Our curret outreach targets 2,400 childre at 12 school sites. Chadler said. With additioal fudig, we could expad our services to serve more childre aually at more schools. Future Smiles is a erolled provider with two of Nevada s three Medicaid Maaged Care Orgaizatios (MCOs). The third ad largest MCO, UitedHealthcare s Health Pla of Nevada (HPN), has ot accepted ew providers ito their system for early two years. Accordig to Chadler, this hampers Future Smiles ability to receive reimbursemet for school-based services. What they re sayig UitedHealthcare s HPN is that there are plety of providers erolled with HPN i Nevada, Chadler recouted. They say we do t eed ay more providers; we just eed to eroll more childre ito the Medicaid system. However, Chadler cites the Ceters for Medicare ad Medicaid Services 2011 Use of Detal Services i Medicaid ad CHIP as evidece that oly 31 percet of Nevada s childre who were erolled i Medicaid accessed the system for prevetive detal services. She strogly believes that more school-based providers will icrease access ratios. Ad that is t the full story. Thirty-two percet of the childre served by my program are erolled i a Medicaid product, while 68 percet are uisured. These are families of four, workig, with a mothly icome averagig $1,200. So they would all qualify for Medicaid. Number oe, why are t they erolled? Ad umber two, eve if they were erolled i HPN, I could t receive ay reim- Youg South Caroliia Christia Burchell beefits from the services provided by Health Promotio Specialists. access FEB

3 May of the childre do t have tooth decay, she said: They just eed their teeth cleaed. I wet to Laughli, Nevada ad treated some childre at the high school that had t bee to the detist i years. They re 15, 16 years old, ad they have early periodotal disease ad gigivitis. Some of the childre had so much calculus because they ever got the opportuity to go to a detist ad have their teeth cleaed. Whe I was fiished, ad they re ruig their togues aroud their teeth sayig, Oh my gosh, thak you. Ca you imagie a 15-, 16-year-old iitially beig a little guarded, arms folded, goig What are we doig here today? ad the afterwards sayig, Thak you. Whe are you goig to be back, Miss Terri? To lear more about Future Smiles visit their website at www. futuresmiles.et. Future Smiles detal hygieists with a youg patiet. bursemet for my school-based program because I m ot able to eroll as a detal provider with HPN. Chadler ackowledged the Uited States effort to move forward by makig more low-icome families, ad especially at-risk childre, eligible for Medicaid, but poited out that gettig eligible people erolled is oly part of the picture. What the isurace idustry is doig is puttig i barriers where they re ot erollig more providers, she said. Ad that is goig to bottleeck the opportuity for health care. Just because you eroll more childre ad adults ito Medicaid does t mea they re goig to be able to access a provider. Chadler said she believes this situatio will have a egative impact o the ability of other detal hygieists to provide schoolbased care. If they caot become a erolled Medicaid provider for all Medicaid MCOs, there will ot be a substatial fudig stream to support those programs. Just because you eroll more childre ad adults ito Medicaid does t mea they re goig to be able to access a provider. Terri Chadler, RDH, Future Smiles Accordig to Chadler, it is time for the govermet to get ivolved. Are you tellig me that our state govermet ca t say, This is a school-based program that is cost-effective, removes the barrier of trasportatio for the parets ad keeps kids healthier? she asked. I thik they ca. But I thik that there has bee a busiess structure i place for so log, obody kows what to do with it. Chadler suggested that the state should take the lead positio with the MCOs to guide them to chage their service ratio that establishes the total umber of Medicaid erollees to a health care provider ad cotract all school-based providers. You re ot goig to improve health care if you ca t eroll more providers, especially school-based providers that are providig those services i a more coveiet maer for childre. Chadler says that she is hopeful ad cotiues to try to brig attetio to the eed to eroll all school-based medical ad detal providers ito the expadig Medicaid system. Ad accordig to Chadler, the problem is ot the schools. If you re targetig the right schools, the schools will bed over backwards so that you ca treat their kids, she said, because they see these kids sufferig o a daily basis with tooth decay. They ca t eat, they do t sleep well, ad they re sittig there holdig their little faces durig class. Health Promotio Specialists South Carolia Tammi O. Byrd, RDH, is the CEO/cliical director of Health Promotio Specialists, a statewide school-based detal sealat program i South Carolia. The detal hygieists it employs are assiged to a particular group of schools ad become a detal home for may childre, Byrd said. The childre served receive a detal hygiee assessmet, a prevetive detal health program based o a caries risk assessmet, prevetive services icludig prophylaxis, detal sealats ad fluoride varish, dietary couselig, ad referral for all eeds that fall outside the detal hygiee scope of practice i the school settig. We also assist i the referral process, icludig follow-up daily for all childre with urget care eeds, Byrd said. The detal hygieists work i close collaboratio with the school urses, ad also refer childre to the speech therapists, urse practitioers ad pediatricias, as well as local detists. The hygieists are paid a base salary ad a commissio based o productio, work quality ad collaborative spirit, Byrd said. The orgaizatio bills Medicaid, private isurace ad private pay. The detal hygieists use state-of-the art portable equipmet. The set-up icludes a patiet chair, operator s stool, light ad uit with high- ad low-speed suctio ad a air/water syrige, Byrd said. Piezoelectric scalers are also available if ecessary. Each detal hygieist has her ow autoclave, which is kept at home, Byrd said. She has eough had istrumets ad hadpieces to see a full day s patiets ad extras for ay exteuatig circumstaces that may arise. She keeps a pucture-proof cotaier with ezyme soak to place the istrumets i after use ad to trasport back home for sterilizatio. The hygieists also have a cart that cotais ecessary supplies. Tracey Buddi, RDH (left) ad Kelley Cato, RDH (right) of Health Promotio Specialists visit a school health fair. 18 FEB 2013 access

4 We have picked up o cases of child abuse ad sexual abuse that have potetially saved lives, Byrd said. We have worked with the Medicaid fraud departmet to report, ivestigate ad covict Medicaid abusers. We could defiitely accomplish more save more childre from trauma ad pai, ad save more moey both private ad public payers moey, Byrd said. With the icrease i access ad referral, we are seeig a lot of overtreatmet. Childre that have o visible sigs of decay, o cavitatio, shadowig or missig tooth structure, retur to the schools with pulpotomies ad stailess steel crows. Ad the you have the childre with obvious decay that do ot make it to their appoitmet ad ed up i pai. Byrd advocates for detal hygieists performig itermediate restorative techique, also called atraumatic, i school settigs ad ursig homes. There are specific guidelies already developed for this type of program, ad it has bee show to be successful, she said. I oe year, the spread of decay was slowed by 50 percet, ad after three years, the spread of decay had bee elimiated. I fact, teeth are less likely to eed edodotic treatmet if there is less disturbace to the tooth for restorative procedures. The restoratios last as well as typical restoratios do. I deciduous teeth, this may be all that is ecessary to keep a child fuctioal ad comfortable util the tooth exfoliates. Byrd also said she believes that ursig home patiets could see their quality of life improve with itermediate restorative techique, through the reductio of pai ad spread of bacteria, without the costs of trasportatio. I may cases, the restoratios may last for the rest of their lives. Health Promotio Specialists Lisa Fragopoulos, RDH, brigs equipmet ito a school. The equipmet fits i their respective cars/suvs, Byrd cotiued. For each school, the equipmet is set up i a approved locatio ad left there util all of the childre at that school who have siged coset forms have bee see. All had istrumets ad patiet records are take home each day. Health Promotio Specialists buys its equipmet from Aseptico ad DNTLworks. Over the years, we have foud that we prefer some equipmet from each compay based o reliability, customer service ad price, Byrd said. We have see a dramatic drop i childre with detal issues visitig the urse s office. We have also see a icrease i the umber of childre that are see i a detal office. Tammi O. Byrd, RDH, Health Promotio Specialists The detal hygieists workig with Health Promotio Specialists i South Carolia schools have made a differece i the lives of may childre, Byrd said. Our program sees approximately 19,000 20,000 childre a year. We have see a dramatic drop i childre with detal issues visitig the urse s office. We have also see a icrease i the umber of childre that are see i a detal office. Icreased Medicaid fees did ot chage utilizatio rates for detal care. Oce our program started i the schools, the umber of childre receivig detal sealats wet up, ad the umber of childre presetig i private detal offices also icreased. Health Promotio Specialists has realized accomplishmets i additio to the prevetive oral health cares services provided. The detal hygieists i South Carolia s Health Promotio Specialists sealat program become a detal home for may childre. Show here are Katie Ackerma, RDH, ad a youg patiet. access FEB

5 Childre s Detal Network ad Salem Childre s Detal Network New Hampshire Hope Saltmarsh, RDH, MEd, is executive director of New Hampshire s Greater Derry Oral Health Collaborative Corporatio (GDOHCC), a o-profit orgaizatio that operates two schoolbased oral health programs: Childre s Detal Network ad Salem Childre s Detal Network. New Hampshire s school-based detal programs are created at the commuity level, Saltmarsh explaied. I the late 1980s, i a move to cut costs, New Hampshire disbaded its school-based detal programs ru by the New Hampshire Departmet of Health ad Huma Services. This move closed may logstadig school-based detal hygiee programs aroud the state. As a result, 21 New Hampshire commuities have developed their ow school-based programs. May receive limited state fudig; all raise additioal fudig ecessary to support their programs. Eligibility criteria, studet services ad sposorig orgaizatios differ for each program. Because our program was created by the detal ad public school commuities workig together, we have ejoyed the active support of both from the begiig. Hope Saltmarsh, RDH, MEd Greater Derry Oral Health Collaborative Corporatio Saltmarsh had oly private practice experiece i 1993, whe GDOHCC hired her to orgaize ad deliver a mobile detal program i two pilot elemetary schools. She coordiated screeigs by voluteer detists ad provided detal prophylaxes ad fluoride applicatios oce a year for studets uable to receive routie prevetive detal care. Childre s Detal Network, the first ad larger of GDOHCC s two programs, provides i-school services twice a year at 20 schools ad Head Start, Saltmarsh said. Services iclude toothbrush prophylaxes, screeigs by voluteer detists, fluoride varish applicatios, glass ioomer sealats ad temporary filligs without excavatio usig glass ioomer cemet. Salem Childre s Detal Network provides the same prevetio ad o temporary filligs, deliverig services oce a year i seve schools. Childre s Detal Network is uique i that it has bee cosistetly well-supported fiacially, has had log-term broad support by most local detists ad serves a populatio of studets selected because they reside i tows served by a philathropic health care foudatio, Alexader Eastma Foudatio, rather tha because they go to schools with a high percetage of studets o free-adreduced luch, Saltmarsh said. This uique set of circumstaces has allowed participatig detal hygieists to collaborate with area detists usig evidece-based practices that provide comprehesive care for studets. GDOHCC employs two part-time detal hygieists ad a detal assistat i additio to Saltmarsh. All are employees of GDOHCC, ad programs are depedet o grats ad cotributios received for oe year at a time. Diae Powers, RDH, has bee workig i the schools with me sice 2000, Saltmarsh said. I additio to providig studets with prevetive services, she heads up our oral health educatio program. Last year, Saltmarsh said, Powers gave oral health presetatios usually oe classroom at a time to early 9,000 studets i kidergarte through fifth grade. Powers ad Mary Davis, RDH, help Saltmarsh deliver i-school treatmets for studets i preschool through middle school at 27 schools i seve tows ad at Derry Head Start. The past two summers, services have also bee delivered at the WIC program i Derry. Mobile equipmet is required for cliical services. GDOHCC ows two sets, each icludig a portable chair, operator stool, portable light ad capsule mixer for glass ioomer. GDOHCC purchased its mobile equipmet from maufacturers Aseptico ad DNTLworks, ad ows a doated steam autoclave. The schools provide us with tables, desks, chairs ad a reasoably private space, she said. The treatmet area varies from school to school, sometimes i the urse s office, sometimes i the hallway ad almost every room i betwee. A sik is ot required, Saltmarsh said, but electricity is. GDOHCC itself has a small office space i a Derry elemetary school where the equipmet is stored i the summer. Durig the school year, staff members trasport equipmet ad supplies to schools i their ow vehicles. I most schools, services are delivered usig two portable patiet chairs side-by-side, Saltmarsh explaied. This arragemet allows for maximal efficiecy, as our assistat, Debi Grochmal, ca help both hygieists. New Hampshire detal hygieists may place sealats uder public health supervisio, but temporary filligs require direct supervisio of a detist, Saltmarsh said. Studets with permissio for treatmet ad idetified as eedig a temporary fillig ca be treated i oe chair by a hygieist while we have detists with us performig screeigs i the adjacet chair. Last year, our hygieists treated Matthew, a sixth-grader who had participated i our program for two years, Saltmarsh said. The first time we treated him, he had six cavities, ad his family could t afford detal treatmet. We placed temporary filligs o three of his primary molars ad three of his permaet molars. Over the ext two years, we treated him four more times, applyig fluoride, sealats ad oe more temporary fillig. This year, his mother was delighted to tell me that she just got detal isurace ad had scheduled a detal appoitmet for Matthew. The decay o the remaiig teeth with temporary filligs was o worse tha two years earlier. Iterdiscipliary collaboratio is a major cotributor to the orgaizatio s success. GDOHCC has three detists o its 11-member board of directors, Saltmarsh said. All three have bee actively ivolved with the program from its iceptio, ad two have served as supervisig detists for the programs for may years, reviewig every treatmet record at least oce a year. Other board members iclude school urses ad pricipals, a pediatricia, busiessma, attorey ad public health program admiistrator. GDOHCC is located i the souther part of New Hampshire, where the populatio desity is amog the highest i the state. Accordig to Saltmarsh, may detists serve this regio. Curretly, there are also quite a few detists who accept New Hampshire Medicaid, she said. Because our program was created by the detal ad public school commuities workig together, we have ejoyed the active support of both from the begiig. Every year, detists have participated i some way to serve schoolchildre. May voluteer to do screeigs, ad quite a few accept referrals from GDOHCC to doate services to retur a studet to good health if these services would be impossible otherwise. GDOHCC detists ad hygieists use the best available evidece ad best practices from other school-based programs to develop their cliical prevetive practice models, Saltmarsh added. GDOHCC started applyig sealats i 2004 as part of a New Hampshire Statewide Sealat Project. I 2007, we adopted the protocol used by researchers at Forsyth Istitute i Bosto i the ForsythKids school-based program. This icludes treatmets twice a year: prophylaxis, fluoride varish, glass ioomer cemet sealats ad temporary filligs. The first year we used the ew protocol at two schools, Saltmarsh 20 FEB 2013 access

6 Above left: Head Start Tooth Tutor Sue Rad, RDH, ad some little frieds. Above right: Tooth Tutor/Fairy Amy Jo Motgomery, RDH, hard at work. Bottom: Tooth Tutor Robi Smith, RDH, performs a detal screeig i Head Start. Whe a child comes home excited about the iformatio they leared today from Miss So-adso, parets are goig to be more likely to sig that permissio form allowig Miss So-ad-so to do the screeig, or to help them fid a detist, because their child is excited about it. said. We leared how to make them work ad gaied the support of our local detists. By 2010, Childre s Detal Network was usig this protocol at all schools. Detists are ot the oly collaborators cotributig to GDOHCC s success. Havig a strog relatioship with school urses helps make our program as effective as possible, Saltmarsh said. Nurses ofte kow which studets are likely to eed our services ad will work hard to get permissio forms for their treatmet. Nurses are also valuable allies i the follow-up work eeded to cotact parets about their childre s treatmet eeds or resources available to them. GDOHCC s accomplishmets fall ito several categories. Oral health literacy for parets ad childre is promoted through oral health educatio i classrooms, hadouts, writte results of screeigs ad treatmet reports, follow-up calls ad letters, ad a website with may resources for parets, Saltmarsh said. The programs use fluoride varish ad sealats to maitai studets oral health by prevetig decay. For studets with tooth decay, may cavities are arrested by placemet of a iterim temporary restoratio (ITR), said Saltmarsh. These are especially successful for small cavities o occlusal, buccal ad/or ligual surfaces of primary molars. I these situatios, ITR will ofte stabilize these molars util they are replaced by permaet successors. Saltmarsh said that, i additio to stoppig or slowig decay i the affected tooth, the combiatio of glass ioomer ITRs ad sealats o primary ad permaet molars improves the oral eviromet of childre at icreased risk for decay. For studets who may ot receive detal treatmet for a exteded period, havig a ITR ca prevet a cavity from progressig util they are able to get defiitive treatmet, she said. Aother aspect of the services the program provides is istillig a positive detal attitude. Over time, eve studets with sigificat detal fears ca overcome them to some extet whe they iteract with the school hygieists every six moths ad lear to trust them, Saltmarsh said. May special eeds studets ca be treated at school. Eve whe this is ot possible, hygieists help parets fid detists to treat their childre. Robi Miller, RDH, BA Tooth Tutor Detal Access Program GDOHCC helps parets lear where to fid a detist who takes their isurace, how to apply for New Hampshire Medicaid, fid affordable care, fid specialist care, ad so o. For studets with urget or sigificat detal treatmet requiremets who lack resources to obtai it, the program coects them to a area detist who will provide doated or affordable treatmet. Last year, 22 studets received over $22,000 worth of doated care, Saltmarsh said. Workig at the state level to improve oral health i New Hampshire, Saltmarsh serves as chair of the Policy Committee of the state s Oral Health Coalitio, teaches cotiuig educatio courses at New Hampshire Techical Istitute Cocord s Commuity College for public health hygieists, ad participated i the Workforce Workgroup coveed by Pew Ceter for the States i Legislatio was passed i early 2012 to create a ew member of the detal workforce: the Certified Public Health Detal Hygieist (CPHDH), who will be able to place ITR without excavatio ad take X-rays i additio to other services already permitted uder public health supervisio. Represetig GDOHCC, Saltmarsh testified i support of that legislatio ad the safety of hygieists placig temporary restoratios. Whe GDOHCC hygieists complete the requiremets to become CPHDH, we will deliver ITRs more efficietly, Saltmarsh said. Curretly, studets have their ITR placed while we have a detist with us, but ofte eed to retur later to have the rest of their treatmet. Studets who sed i forms late or are abset whe the detist is preset will o loger miss out o the optio of receivig a ITR. GDOHCC s detal hygieists have a effective, comprehesive model to support the oral health of youg people i their area, but they could do more. Oly about 25 percet of the studet populatio we serve is covered by Medicaid, Saltmarsh said. Most lack detal isurace. Therefore, our programs require cosiderable grat fuds ad cotributios to operate. With more fudig, we could serve more childre i more schools ad commuity settigs. Tooth Tutor Detal Access Program Vermot Robi Miller, RDH, BA, is a public health detal hygieist workig at the Vermot Departmet of Health i the Office of Oral Health; she coordiates the Tooth Tutor Detal Access Program at the state level. The program has bee i existece sice Curretly there are about 30 detal hygieists (tooth tutors) workig with about 100 schools, Miller said. Approximately oe third of Vermot elemetary schools participate i the program. About 50 percet of the kids who have Medicaid isurace access detal care o a yearly basis which is quite high compared with other states, she said. Our program data shows that, i geeral, childre i the Tooth Tutor Detal Access Program have isurace, ad they have a detist who will see them. Although some of the tooth tutors are fuded by grats ad foudatios, most are fuded through reivestmet of dollars reimbursed to schools that participate i the state s Medicaid Admiistrative Claimig (MAC) program. The MAC program, admiistered by the Health Departmet s Early ad Periodic Screeig, access FEB

7 Diagosis ad Treatmet (EPSDT) staff, provides reimbursemet to schools for admiistrative activities to idetify ad eroll eligible cliets i Medicaid ad facilitate access to services covered by Medicaid. Schools ca choose to reivest MAC fuds i a umber of differet ways, Miller explais, ad oe third of the schools i Vermot use these fuds to support a detal hygieist to implemet this program. The hygieists workig as tooth tutors are ot providig cliical services i schools, so o equipmet is ecessary. The exceptio is a detal screeig for the target group studets. The childre i the target group are the childre i the school that have ot accessed detal care i the past year, Miller said. The first thig the tooth tutors do is a record review. They go through the emergecy cards ad get a list of childre who have a detist ad o date of last visit, or they have both ad the date of last visit is over a year, or they have o iformatio. Those childre are all i what we call the iitial target group. The they cotact those families, itroduce themselves ad explai the Tooth Tutor program. Immediately, they ll hear back from about 30 percet of those families, sayig Oh, yes, we just did t fill out the iformatio. So i that way, they help the school urse clea up the records. The we get what we call the true target group, Miller cotiued. Their job is to work throughout the year tryig to make coectios with those families, as well as develop their referral etwork of detists i the area. They re also doig the detal health educatio i schools. They visit each classroom oe or two times, but they re also ecouraged to be o school welless committees ad atted school health fairs ad really become embedded i the school commuity. Miller says she sees the tooth tutors as the liaiso betwee the families that are t accessig detal care ad the local detal commuity. A really importat part of their job is to kid of cavas their area ad develop a referral etwork of detists who agree to accept their referrals from the school, she said. I thik of it as they are brigig these two groups of people together who otherwise would ot have met. The tooth tutors provide oral health educatio, ad the supplies they have are provided by the state. Ofte, a supervisory uio will hire oe detal hygieist to work i the four or five schools throughout the whole supervisory uio. The hygieists i geeral work oe day a week throughout the school year, ad they alterate visitig the differet schools. The Vermot Departmet of Health provides them with a tooth tote a big bag with a detal puppet, videos, books, a mouth model, toothbrushes, that kid of thig. Miller said that, i the past, classroom visits by the tooth tutors were, to a degree, devalued. We used to kid of pooh-pooh the classroom stuff: what good does that do i the log ru? We really wated them to sped their time helpig families fid detal homes. But we realized it s that classroom, it s that familiar face, it s embeddig i the school commuity that makes the parets much more likely to respod to the offer of assistace. Whe a child comes home excited about the iformatio they leared today from Miss So-ad-so, parets are goig to be more likely to sig that permissio form allowig Miss So-ad-so to do the screeig, or to help them fid a detist, because their child is excited about it. The Tooth Tutor Detal Access Program is curretly udergoig a formal evaluatio process. Recetly, the Office of Oral Health of the Vermot Departmet of Health hired a program evaluator, Miller said. We look forward to the results because, while we thik this is a great program, we do t have ay real way of doig a cost aalysis ad sayig, a school spet this much moey, but this is how much moey was saved over the log haul. Vermot has very positive sealat rates ad detal access rates, she said, ad I thik that the Tooth Tutor Detal Access Program, with the support of the Vermot State Detal Society ad the Vermot Detal Hygieists Associatio, is a importat part of that. It s a real collaborative effort betwee the Vermot Departmet of Educatio, the Vermot Departmet of Health ad the Vermot Detal Commuity, ad it s very excitig to be a part of this program. Referece 1. Pew Ceter o the States. Fallig short: most states lag o detal sealats. Ja. 8, Available at: reports/fallig-short Accessed Ja Jea Majeski is ADHA maagig editor, Access. ADHA is lookig for artifacts to display at CLL i Bosto i Jue. We would like detal-hygiee-related photos, as well as old yearbooks istrumet cases pis ad hats schoolwork textbooks, etc. If you thik you have somethig we might be iterested i, or if you kow someoe with a item we should display, cotact Adriaa Kliedist at adriaak@adha.et by April 1, We will sed you a form explaiig shippig procedures ad details, ad we ca aswer ay questios you might have. Thak you so much for makig this a evet to remember! 22 FEB 2013 access