DOoR. (DOoR): Access to Urgent Treatment. CPHA Conference June 2009 Health Inequalities & Inequities Barb Olsen RN BSc Psychology

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1 (DOoR): Access to Urgent Treatment CPHA Conference June 2009 Health Inequalities & Inequities Barb Olsen RN BSc Psychology

2 300,000 population 60,000 sq. km Red Deer population 83,000 (2006)

3 How Big is the Problem? DTHR 2005 Health Report 11 % population in households with low income 13 % children, 17 years and younger, living in low income families 12% receiving government transfer income 55% of our population over 12 years get their teeth checked

4 How Big is the Problem? Changing Face 25% workers classed as low income earning less than $12/hour.* City growth 22% since 2001** Immigration growth 32.4% since 2001 ** Off-reserve Métis growth 34% since 2001** Number of young families increasing*** *Source: Public Interest Alberta **Source: Demographic and Social Trends Red Deer 2008 ***DTHR

5 How Big is the Problem? Dental Health Indicators DTHR 2004 Oral Health Survey 60% grade 2 children had dental caries of these with disease, an average 5 teeth were affected per child 28% needed fillings 50% required sealants 15% had two or more carious lesions Urgent needs 4%

6 What s Currently Available Through Public Health? Public health has variety of services across region including: 8 fixed dental clinics in various community health centres (none in Red Deer) dental screening, prophylaxis, fluoride applications, sealants, education 47 target schools dental screening, fluoride varnish and in select schools dental sealants, education Additional health promotion services to preschool, long term care, chronic care But No Dental Treatment!

7 Public Health dental staff repeatedly see the same children in need of urgent care. What s getting in the way?

8 Thinking Outside the Box Approach the dental professionals who provide dental care Look at pooling our knowledge and resources New community health centre presents opportunities Regional support for funding and equipment

9 of Red Deer (DOoR) Public Health working with local dental health professionals to provide treatment Getting treatment to children who have urgent unmet dental needs Removing barriers to care Providing ongoing preventive services

10 Opening the DOoR January 2006 The DOoR working committee was formed and identified: support from DTHR dental public health, new facility & funding support from the dental community Central Alberta Dental Society (CADS) and Dental Assistants need for provision of urgent treatment for children need to address barriers for private practitioner volunteer service

11 Barriers to Address Children screened for urgent treatment Low income substantiated and ineligibility for other benefits and insurance Pre- and post-work with children and families completed by public health dental program Time limited services to help children restore dental health A neutral site established for service provision whereby dentist s offices were not involved Proper equipment and facility

12 Opening the DOoR Wider A Program model has been built that clearly identifies: The children we will see What is an urgent need Family income thresholds Volunteer recruitment, job descriptions and orientation Treatment service School participation

13 Opening the DOoR Wider The DOoR Model Screening from high risk target schools by DPH staff for urgent dental needs, children 5-18 and their siblings Income eligibility determination DTHR cover costs of equipment, materials, bookings, clinic operations, etc. Treatment as per Social Services contract with ADA+C- diagnostic, restorative, surgical Local private practitioners provide dental care

14 Income Eligibility Set at $1 over Alberta Child Health Benefit Upper limits based on Working Poor or Making a Living Public Interest Alberta coalition, 35% above ACHB Tax form or 3 pay stubs, no other insurance DOoR Income Eligibility Table Eligibility Line Income Range # of Children A $24,397 - $32, 935 Single parent 1 child B $29,073 - $39,248 Single parent 2 children C $ $45,975 Single parent 3 children D $39,336 - $53,103 Single parent 4 children E $29,285 - $39,534 Couple 1 child F $34,346 - $46,367 Couple 2 children G $38,997 - $52,645 Couple 3 children H $44,000 - $59,400 Couple 4 children Add $4663 for each additional child

15 Building Support for DOoR The DOoR brand Correspondence to volunteers Correspondence to schools Posters, flyers PPT presentations to CADS, Regional Authority, Dental Hygienists, Dental Assistants School principals Red Deer Public Health staff presentations DOoR Open House DOoR DENTAL OUTREACH of RED DEER Dedicated to improving children s oral health Dear We invite your support for an exciting new dental treatment program for Red Deer children in need of urgent care. We need committed dental health professionals such as you to volunteer your time and expertise to provide dental treatment for children with urgent care needs who live with pain and whose growth and development may be affected. Children ages 5 to 12 will be identified through the DTHR school screening program. DTHR dental hygienists will contact parents to address the child s treatment needs. If the family does not qualify for the Alberta Child Health Benefit program, they will be asked to complete a financial assessment for the (DOoR) program. If the family qualifies for service, the public health dental program will book treatment, and address any barriers such as language, transportation, childcare etc. DOoR started in June 2006 when a group of interested dental health professionals from the private practice community and Public Health, David Thompson Health Region, met to share concerns over access to dental care for children from low-income families. The DOoR committee has identified these issues: Some families need help but don t qualify for the Child Health Benefit program The same children with urgent treatment needs are repeatedly seen in screening programs Families of these children may have other barriers such as language, transportation, and competing priorities that make it difficult to access care Dental offices may have difficulty treating these clients due to the same barriers. Can you give us some of your time and expertise? We are looking for enthusiastic dentists, assistants and hygienists to volunteer their time to provide treatment services. Whether you have a few hours during the weekday, on a weeknight or part of a day on the weekend, we would like to hear from you. The new David Thompson Health Region Johnstone Crossing Community Health Centre has a fully supplied dental treatment suite that comes equipped with: ADEC 5000 ambidextrous dental chair and unit Fibre optic handpieces Xray and development Nitrous oxide Onsite sterilization Reception and appointment booking Effective April 2008, with your participation, we will be able to offer treatment services to children with urgent needs and help them maintain their general health and well-being, improve their overall school performance, and reduce their burden of dental disease as adults. Please help us break the cycle of dental disease for the next generation. We look forward to working with you. Interested inquires from dentists, assistants and hygienists who would like to volunteer their time to provide clinic treatment services may be directed to: Dr. Barry Fleming, DOoR committee member Gaetz Avenue Red Deer, AB T4N 4C drbpf@hotmail.com

16 Coming To the DOoR In April 2008, the DOoR Clinic began operation at the new Johnstone Crossing Community Health Centre

17 DOoR Clinic Pilot April 28 - June 15, 2008 Clinics are held on Saturday Day is split into 2 shifts Different volunteers each shift I hour appointments Language, transportation, childcare and other barriers will be addressed ADEC 5000 dental chair and unit, fibre optic handpieces, xray and development, nitrous oxide, onsite sterilization

20 A Look Inside...

21 A Look Inside...

22 A Look Inside... Our first DOor Clinic April 2008

23 A Look Inside...

24 Results We ve held the Door open: 17 local dentists have volunteered 19 dental assistants are on board support from hygienists

25 Results April December 2008 (7 months) 162 urgent clients identified 32 clients seen in clinic, av. # of visits 2 17 dentists & 19 dental assistant volunteers 143 volunteer hours estimated $17,119 of work completed restorative 96, extractions 26, sealants 55, pulpotomies 10, sealants 55

26 Results Comments (families): Appointment times acceptable Can t believe something like this exists Prefer community health centre over dentist s office- less stigma Comfortable setting Comments (volunteers): Suggestions re: equipment, layout Happy to help, more comfortable second visit More time per client, more relaxed, time with family Comments (schools): Welcomed information, requested staff presentations

27 Dedication: Dr. Mona Billey Dental Treatment Room

28 Lessons learned clear procedures, roles communication, documentation, scripts involve dentists from beginning, address barriers connecting with parents building trust timing of calls adapt to client needs awareness of DTHR policies and procedures

29 Next Steps ensure sustainability acknowledge volunteers expand client base establish preventive clinics Friends & supporters

30 Questions?

State of North Carolina. Medicaid Dental Review

State of North Carolina. Medicaid Dental Review State of North Carolina Medicaid Dental Review October 2010 EXECUTIVE SUMMARY The Centers for Medicare & Medicaid Services (CMS) is committed to improving pediatric dental care in the Medicaid program