Ohio Department of HealthSchool-based Dental Sealant Programs

Carrie FarquharOral Health Section AdministratorOhio Department of Health May 30, 2013

Ohio’s Sealant Program:

• Targets high risk schools

– (>40% of children enrolled in free & reduced price meal program)

• Students in grades 2 & 6 are eligible• Follow-up in grades 3 & 7

Ohio’s Sealant Program•Portable dental equipment •Ohio statute requires a dentist screen each child and indicate which teeth are to be sealed •RDH-DA teams apply sealants•Each team is to provide sealant for ≥15 children/day•Children in need of additional dental care (~1/4) have notes sent home and the school nurse is notified.

ParticipationAll children in target grades at high risk schools are eligible, however the parental consent form encourages families with access to have child receive sealants in private dental office~41%return consent*

– 94% screened – 95% receive sealants (2012)

* Will discuss further

ODH Dental Sealant Program

21 programs in Ohio, serve 50 counties– 18 funded with ODH grants– 25,321 children received sealants in school in

2012 through the ODH-funded programs

Continually working to expand program to additional eligible schools

Ohio’s SBSP Expansion Plan

ODH sealant programs:• Limited resources + accountability = utilizing the most effective and cost-efficient services

(sealants)

ODH has chosen to limit our sealant programs to providing sealants, exclusively. • This is providing the right service to the right people at the right time and place. • More children receive the most effective caries prevention measure

Contents of Ohio’s Sealant Manual• Compliance with ODH reporting and policies• Sample programs forms• Infection control• Materials and sealant application technique• Retention checks• Medicaid billing, collection & reimbursement• ODH program reviews (quality assurance)

SBSP On-line Curriculum• Required of all ODH-funded programs• Background• Infection control• Tooth Surface Assessment and Selection• Materials and Application Techniques• Operating Effective Programs• Post-tests for 2 hrs ADA CERP CE free

Increasing Program ParticipationBack to basics--assure support from:• Local oral health community• School officials (school board/superintendent)• School principals• School nurses• Parent/Teacher Associations

• Reference seal america

Local Oral Health CommunityPotential concerns include:•Assessments conducted without bitewing X-rays•Dental sealants placed over incipient caries•Dental hygienists applying dental sealants•Quality of care provided in a portable program

Local Oral Health Community (cont)• Effective infection control• Methods used to target participants• Disruption to established dentist-client relations• Insufficient follow-up for students with tooth decay or other oral health problems

School personnel and parentsKey messages:•Assure understanding of what sealants are (and aren’t)•Benefit of sealants and targeting grades •Contribution toward learning readiness•Minimal classroom disruption

Find a sealant champion

Try to identify a principal, secretary, school nurse or teacher who can be a strong program advocate and help convince others of the value of the sealant program

Improving Participation RatesPotential reasons for non-participation:• Consent form doesn’t get to parents• Parents lack knowledge about sealants• Parents have had negative dental experiences• Other health, social, cultural and family factors

Distributing consent forms• Make presentations to students, show video (Seal in a Smile in Ohio) follow with Q&A• Distribute with other forms at beginning of school year• Second distribution of forms with personal notes/phonecalls or “second notice”

Distributing consent forms (cont)• Provide info to parents via a variety of school communication mechanisms:

• school website • calendar • email • newsletter • lunch menus • parent meetings, etc. Remind them of dates

Collecting consent forms• Schedule specific date and time to return to school and collect consent forms• Call ahead and confirm when the forms will be collected• Make sure forms from all classrooms have been collected before leaving the school• Encourage staff to accept completed consent forms after the due date

Use of Incentives• Sticker, pencil, sugar-free candy or gum• Offer pizza party to classes with 100% return of consent forms• Teachers offer additional recess, “blue jean day” other school-determined incentives• Items for school nurses or teachers, e.g., gift cards for school supply store or personal use

Concerns:

Response of teachers, nurses and students if incentives are discontinued later in the program. May have negative impact on participation.

Ohio’s experience• Highest participation is in two rural programs, around 56% and 57%• Among the longest running programs• Continuity (staff and schools served)• Relationships with school personnel and presence in the school system

Ohio’s experience• Efforts to increase rate of returned consent forms resulted in

receiving more “no” responses, not increased participation• No simple solution

More about Ohio’s sealant programsStrengths:• Pointed out earlier, significant, sustainable funding source• Provide sealants to large number of higher-risk children (25,321)• Effective quality assurance component

• Strong data reporting system• Technical assistance/support• Periodic on-site reviews• Distance learning/sealant manual• Continuing education as appropriate

Ohio’s sealant programsWeaknesses:• Low return of consent forms (~41%)

• Low oral health literacy• Low priority• Incentives result in more forms returned, not increased consent to participate

• Do not provide needed dental care for participating students• Must rely on dentists to screen students before sealants may be applied by the sealant team.

Contact me:

Carrie Farquhar Oral Health Section AdministratorOhio Department of HealthCarrie.Farquhar@odh.ohio.gov614 466-4180

Available Information Resources:

• Seal America: The Prevention Invention, school-based dental sealant program manual, 2012, National Maternal & Child Oral Health Resource Center.

• Seal in a Smile, videotape, brochure, bookmarks and posters designed for use by school-based dental sealant programs. National Maternal and Child Oral Health Resource Center Website: http://www.mchoralhealth.org

• The School-based Dental Sealant Program (S-BDSP) Manual provides information and clearly states expectations of, and standards for; ODH-funded S-BSPs. ODH-funded S-BSPs must comply with the requirements in this manual.

• School-Based Dental Sealant Program distance learning curriculum National Maternal and Child Oral Health Resource Center, Georgetown University and the Ohio Department of Health. http://www.ohiodentalclinics.com/distancelearning.html