san francisco children’s oral health strategic plan...

San Francisco Children’s Oral Health Strategic Plan 2014-2017

Coordinated bySan Francisco Health Improvement Partnership

November 2014

Table of Contents

Introductory Letters 1

Introduction 3

Our Vision, Guiding Principles, and Indicators 12

Overview of Strategies 14

Individual Strategies and Tactics 15

Appendix 24 StrategicPlanSteeringCommittee Strategic Planning Workgroup Members 25 StrategicPlanningRetreatParticipants 26 Glossary of Terms 28 References 31

Acknowledgments 33

Tomás Aragón, MD, DrPH HealthOfficer,CityandCountyofSanFranciscoDirector,PopulationHealthDivisionSanFranciscoDepartmentofPublicHealth

WorkingontheSFHIPChildren’sOralHealthStrategicPlanhasbeeninspiringandtransformational!Whenweworktogetheronacommonagenda,withsharedmeasurementsandmutually-reinforcingstrategies,wecanhavecollectiveimpactontheoralhealthofourchildren,whichwillhavealasting,lifelongimpactontheirhealthandqualityoflife.Ourgoalsaretoreducedisparitiesinoralhealth,reducedisparitiesinaccesstopreventiveservices,andtoimplementtargetedupstreampreventioninthecommunity(medicalvisits,WIC,HeadStart,etc.).

Children’soralhealthisaheadlineindicatorintheSanFranciscoStrategicPlanforPopulationHealthbecauseitcontributestotheoverallhealthofSanFrancisco.TheSFHIPChildren’sOralHealthStrategicPlanistheroadmapwithinthisoverallplan,guidingtheworkofbothourSanFranciscoDepartmentofPublicHealth,aswellasourcommunityeffortstoidentifyandsystematicallyeliminatethecausesofdentaldisease.

Thevisionofthisplanisaspirational–“AllchildreninSanFranciscotobecaries-free.”Thegoalisnotjusttoreducedentaldecay.Thereisaclearfocustoalsoreducedisparities,sothatallSanFranciscochildrenhaveaccesstoearlyandroutineoralhealthpreventiveservices.Dentaldecayispreventable.Studiesshowus,however,thatthechildrenwhoaremostvulnerabletothisepidemicareexactlythosewhodonotreceiveneededdentalservices.Oralhealthhasbeenartificiallysegregatedfromoverallhealth,andcriticalpreventiveguidanceandtreatmentisoftendelayeduntilachildis3yearsold.Withoutintegratingoralhealthintotheoverallhealthsystemwewillbecontinuallyplaying‘catch-up’.WewillneverbeabletofillallthedecayedteethinSanFrancisco.Thisplanpromotestheintegrationoforaldiseasepreventionintolocationswherechildrenandnewparentsareseenbyhealthcareproviders–thewellchildvisit–andincreasesearlyaccesstodentalprovidersatlocationssuchasWICsites,preschoolcentersandelementaryschools.Byinstitutingthisplan,wecanpreventthediseaseprocessfrombecomingestablished.

Congratulationsandthankyoutothemanycommunitycollaboratorswhohavethevisionofacaries-freeSanFrancisco,andthecommitmenttodotheworkrequiredtodevelopanorganizedroadmaptothatend.

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Kevin Grumbach, MD Chair,UCSFDepartmentofFamilyandCommunityMedicineCo-Director,UCSFClinicalTranslationalScienceCommunityEngagement andHealthPolicyProgram

ThisStrategicPlanrepresentsavisionwhichstartedamongagroupoforalhealthadvocatesrespondingtoachallenge:toidentifyandaddresswhatwouldmakethegreatestimpactonchildren’soralhealthinSanFrancisco.InSanFrancisconearly40%ofchildrenhaveexperiencedcariesbythetimetheyreachkindergarten,wellabovethenationalHealthyPeople2020targetof30%.Untreatedcariesis2-3timesmoreprevalentinchildrenofcolor,andthisdisparityhasworsenedsince2000.Attheinitialconveningoforalhealthstakeholdersinearly2012asaSanFranciscoHealthImprovementPartnership(SFHIP)Children’sOralHealthworkinggroup,itwasmadeclearthattomakethemostimpact,thereneededtobeacoordinated,citywidestrategicplanningeffort.Wenowhaveathree-yearplan–aguidethatwillmoveourcityclosertoachievingourgoal:tomake San Francisco’schildrencaries-free.Wehavethetoolsandtheknowledge;withthecoordinatedeffortandresourcesdescribedinthisStrategicPlan,wealsohavethemeanstoachieveourgoal.

Theplanreflectsatruecollaborativeeffortsuccessfullyengagingovereightyindividuals’inputandexpertise.Theenthusiasmandhardworkofsomanycontributedbothtothecreationofthisplanandtoraisingtheoverallawarenessandprofileoforalhealthanditsimportanceforourchildrentothriveandsucceedinlife.Ourfocusisonfivekeyareas:Accesstocare,IntegrationoforalhealthintooverallHealth,Promotion,EvaluationandCoordination.Eachhasbeencarefullyassessedforfeasibilityandrelatedbestpractices,thoughtfullydiscussedinmultiplemeetings,andfurtherdevelopedasimplementationstepsdetailedinaseparatereport.

I’mparticularlyencouragedtoseethekeystrategyemphasizingintegrationoforalhealthintoroutineprimarycareservicesforchildren.Althoughbarrierspersistforyoungchildrentoreachadentist’soffice,mostchildrenhavemultiplevisitstoprimarycareclinicsandpracticesforwell-childexamsinthefirstfewyearsoflife.Yettoooftenthoseofuswhoareprimarycaremedicalprovidershavenotintegratedbasicoralhealthpreventivemeasures,suchasacarefulexamforearlycariesandapplicationoffluoridevarnish,intoourroutinewellchildexampractice.TheStrategicPlanprovidesaconcreteplanforintegratingoralhealthintoroutineprimarycarechildren’sservices.

Thisisanexcitingtimeandawonderfulopportunitytohelpshapethefutureofchildren’soralhealthinSanFrancisco.TheStrategicPlanexhibitshowwecanbetteraddressthisgreathealthneedinacommunity-centered,integrated,andcoordinatedapproach.Congratulationsandthankyoutoallthoseinvolvedinthiscollaborationincludingthesupportersandfundersthatmadethispossible.I’mconfidentthatthesamevisionanddedicationthatcreatedthisplanwillfuelitsimplementationandbringSanFranciscoclosertohealthequityforallofourchildren.

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Why is oral health important?

Oralhealthisessentialtooverallhealth,well-being,andqualityoflife.Itaffectschildren’snutritionalintake,self-esteem,andtheabilitytoconcentrateandsucceedinschool.Dental

caries(toothdecay)remainsoneofthemostcommonchronicdiseasesinchildhoodintheU.S.andoftenpersistsintoadulthoodandacrossthelifespan.In2012,35%ofSanFranciscoUnifiedSchoolDistrict(SFUSD)studentsexperienceddentalcariesintheirprimaryandpermanentteethbythetimetheyenteredkindergarten,resultinginreducedattendanceandcontributingtopooracademicperformance.Therecanalsobehighcosts;dentalcaries-relatedemergencyroomvisitscanbetentimesthecostofprovidingpreventivecare.

Oral health status of San FranciscoOverthepastdecadetherehasbeensteadyimprovementintheoralhealthstatusofSanFranciscochildren:theprevalenceofuntreatedcariesdeclinedfrom26%ofkindergartenersin2007to17%in2012.Duringthesameperiod,cariesexperiencewhichreflectsnotonlycurrentbutpasttoothdecayhasalsodeclinedfrom45%to35%.(Figure1)However,the2020HealthyPeople(HP)objectivetoreducetheproportionofchildrenaged3to5yearswhoexperiencedentalcariesintheirprimaryteethto30%hasnotbeenmetforSanFrancisco4-5yearolds. Wecandomoretoreducedentaldecayinourinfants,toddlersandpreschoolers.

Introduction

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45  43  

41   41  39  

35  

20  

30  

40  

50  

2007-­‐2008   2008-­‐2009   2009-­‐2010   2010-­‐2011   2011-­‐2012   2012-­‐2013  

%  of  Kindergarteners  

who  have  experienced  dental  

caries   HP  2020  goal  for    3-­‐5  year  olds  -­‐  

30%  

SFDPH-­‐SFUSD-­‐SFDS  San  Francisco  Kindergarten  Screening,  [San  Francisco,  2005-­‐11]/Prepared  by  SFDPH  MCAH  Epidemiology,  February  2013  

Figure  1:  San  Francisco  has  not  met  HP  2020  goals  for  children’s  caries  experience  

Oral health disparities persistDespitetheoverallimprovementsincariesprevalencenationallyandlocally,therearesegmentsofouryouthpopulationthatcontinuetocarrytheheaviestburdenofdentaldecay.Therateofuntreatedcaries(40%)amongkindergartenchildreninlow-incomeSFUSDschools(schoolswithhigh%ofNationalSchoolLunchProgram(NSLP)eligibility)is8timeshigherthantheratefoundinchildrenfromhigherincomeschools(5%).(Figure2)Moreover,whiletheprevalenceofcarieshas declinedinhigherincomeschoolsovertime,ithasincreasedinlow-incomeschools.

9  

29  

39  

26  

5  

14  

40   40  

0  

20  

40  

60  

80  

100  

0-­‐24   25-­‐49   50-­‐74   75+  

Schools  of  various  %  of  children  eligible  for  NaWonal  School  Lunch    Program                                                                                                                                            

2000   2008  

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Higher income schools: decreasing

untreated decay

%  of  Kindergarteners  with  untreated  

caries  

Figure  2:    Low  income  children  in  San  Francisco  are  8  Wmes  more  likely  to  have  untreated  caries  

28%  

22%  

0%  

10%  

20%  

30%  

40%  

50%  

Low-­‐income  pre-­‐schools      (0-­‐4  year  olds)  

Kindergarten                                                    (4-­‐5  year  olds)  

%  of  preschool  and  Kindergarten  children  with  

untreated  caries  

SFDPH  Child  Care  Health  Project  2011-­‐2012,  SFUSD  Kindergarten  2010    CDC/NCHS,  NaKonal  Health  and  NutriKon  ExaminaKon  Survey,  2009–2010.    

Figure  3:  San  Francisco  children  experience  more  untreated  caries  than  the  naKonal  average  

NHANES  2009-­‐10:  3-­‐5  year  olds:  

14.4%  

Amongouryoungerlow-incomechildren,28%ofpreschoolersinstatesubsidizedpre-schoolsexperiencedentaldecay,demonstratingtheneedfordentalcareatanearlyage.(Figure3)

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Childrenwholiveinsomegeographicareas,experience2-3timestherateofcariesaschildreninotherareasofthecity.(Figure5)

Chinatown  North  Beach  

Nob  Hill/Russian  Hill/Polk  Tenderloin  

South  of  Market  Bayview/Hunter’s  Point  

VisitaAon  Valley  Excelsior  Portola  

Figure  5:  Certain  San  Francisco  neighborhoods  have  2-­‐3  Ames  more  children  with  caries  

Caries  Experience    (%  of  Students  Screened)  

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“Itisalarmingthatthehighestburdenofchildren’sdentalcariesisfoundinSanFranciscoChinatownneighborhoods.Ifwewanttomakeequitableimprovementsinourcity,wemustconsiderapproachesthataddressthisdiseasenotonlyonanindividuallevel,butalsoonthefamily,community,andneighborhoodlevelsthattakeintoaccountmoreupstreamsocialandculturalfactors.”

AmorSantiago,MPH,AsianPacificIslanders'HealthParityCoalition

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Inadditiontothesedisparities,overhalf(52%)ofDenti-CalenrolledchildreninSanFranciscodidnotseeadentistin2011-12.However,ananalysisofdatafromDenti-CalandtheSanFranciscoKindergartenDentalScreeningProgramshowsthatDenti-Calutilizationbychildrenages0-3yearsissignificantlyassociatedwithreducedprevalenceofcariesexperienceamongSFUSDkindergartenersoneyearlater.

Toaddressthesedisparitiesinoralhealthandaccesstodentalcare,atargeted,coordinatedeffort,asoutlinedinthisStrategicPlan,iscriticallyimportantforthehealthofSanFrancisco’schildren.

Prevention WorksThegoodnewsisthatdentalcariesislargelypreventable.Prioritizingpreventioninchildrenisimperativebecausecariesestablishedinchildhoodincreasestheriskofdentaldecayacrossthelifetime.Population-basedstrategies,suchascommunitywaterfluoridationandschool-basedsealantprogramsareeffectiveatpreventingcaries.Thewidelypromotedstandardsofproperoralhygienepracticesandearlyandroutineprofessionaldentalcarecanalsoincreasecariesprevention.Ourchallengeiseffectiveeducationandpromotion,enablinghealthybehaviorsandcare-seekingpractices,andprovidingasupportivephysicalandsocialenvironmentforadoptingandmaintainingthesepractices.

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Best practices for good children’s oral health include: ✓ Perinatalcareandeducation✓ DentalvisitbyAGE1✓ Routinedentalvisits(2xyearbasedonrisk)✓ Limitedfrequencyofsugaryfoods/drinks✓ Topicalfluoride

• Brushingwithfluoridatedtoothpaste2x/day• Drinkingfluoridatedwater(SanFranciscoisfluoridated)• Fluoridevarnishapplication2-4x/year

✓ Sealantson1st(6yearold)and2nd(12yearold)molars• ADArecommendssealantsforprimaryteethtoo

San Francisco’s Kindergarten Dental Screening ProjectSince2000,acoordinatedannualeffortorganizedbytheSanFranciscoDepartmentofPublicHealth(SFDPH)incollaborationwiththeSanFranciscoDentalSociety,NationalDentalAssociation,andtheSFUSD,hasbeenprovidingdentalscreeningstoallkindergartenchildrenattendingSFUSDschools.AstheonlyschooldistrictinthediversecityandcountyofSanFrancisco,theinformationobtainedfromthescreeningsofferstheopportunitytoassessandmonitortheoralhealthstatusoftheSanFranciscopublicschoolkindergarten-agepopulationandidentifyassociateddisparities.

Safety Net for Oral Health Mostlow-incomechildreninSanFranciscoareeligibleforsomeformofsubsidizeddentalinsurance:eitherMedi-Cal/Denti-Cal,orHealthyKidsInsuranceforundocumentedorslightlyhigherincomefamilies.In2015,therewillbeanewrequirementbyCoveredCalifornia,thestate’simplementationoftheAffordableCareAct(ACA)healthinsurancemarketplace,topurchasedentalplansformembersunderage19.Havingdentalcoveragehasproveninvaluabletogettingneededcareforunderservedchildren.

InSanFrancisco,therearefiveFederallyQualifiedHealthCenter(FQHC)systemsthathavedentalclinicslocatedwithintheirlargerclinic.These“SafetyNet”dentalclinicsarewheremanylow-incomechildrenandadultsreceiveneededdentalcare.Wealsohavetwouniversitydentalschoolsthatofferspecializeddentaltreatment,includinghospitaldentistryandpediatricdentalcare.

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“TheSanFranciscoKindergartenDentalScreeningprogramincreasesaccesstocareanddentaleducationforapopulationthatmayotherwisenotseetheneedfordentalcare.Iamproudtovolunteerforaprogramthatgiveschildrenandparentsthenecessarytoolstomaintaintheiroralhealthwhileprovidingapositivedentalexperience.”

JohnFong,DDS,SanFranciscoDentalSocietyDentist

Where can we improve? AcomprehensiveassessmentofthecurrentstateofSanFrancisco’schildren’soralhealthresources,gaps,bestpractices,andopportunitiesidentifiedthefollowingareasforimprovement:

Access to dental care. ComparedtoourrichmedicalsafetynetsystemwhichincludesFQHCclinics,largehospital/medicalclinics,andmultipleprimarycarepediatricprivatemedicalofficesthatacceptMedi-Cal,ourdentalsafetynetisweakandinadequate.The50dentalclinics/officesinSanFranciscothatacceptedDenti-Calin2011havedecreasedto43in2014.Atthesametime,demandisincreasing.AsaresultofexpansionofMedi-CalunderACA,andthereinstatementofsomeadultMedi-Caldentalbenefits,itisestimatedthatin2013-14,52,000newSanFranciscobeneficiariesnowhaveMedi-Caldentalbenefits.Withoutanadequatenetworkofdentalproviders,wewillnotbepreparedtomeetthisincreaseddemandforcare.Currentlychildrenareexperiencing2-3monthwaittimesatmanyofoursafetynetclinics,asavailabilityfordentalappointmentsisbecomingmoreandmorelimited.GiventheinsufficientsafetynetsystemfororalhealthinSanFrancisco,findingstrategiestoimproveaccesstodentalcareisofhighimportance.

Integration of oral health into primary care. Becausemedicalprovidersseechildrenupto11timespriortochildreneverseeingadentist,‘wellchild‘visitsareopportunitiestoprovideoralassessments,toapplyhighlypreventivefluoridevarnish,andtosharekeyoralhealtheducationmessageswithparents.Thereare,however,veryfewclinicsandmedicalproviderswhoofferfluoridevarnishtotheir0-5yearoldpatients.

“Manythingsinfluenceachild’sprogressandsuccessinschool,includinghealth.Poororalhealthimpactsachild’sdevelopmentandabilitytolearn.Therearetoomanychildreninourschoolsthatsufferandareinpainduetodentalproblems,andafocusedandstrategicefforttoaddressthisisessentialforahealthyandsuccessfulfutureforallourchildren.”

RichardCarranza,Superintendent,SanFranciscoUnifiedSchoolDistrict

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Promotion of the importance of oral health among parents/caregivers and pregnant women.Wenotonlyneedtostrengthenthedentalsafetynet,wealsoneedtofocusonpreventiontoreducetheneedfordentaltreatmentservices.Parents’/caregivers’lackofunderstandingoftheimportanceofpreventiveoralhealthcareathomeandfromadentalprofessionalcancontributetotheirchild’sriskofdevelopingcaries.BecauseoftherichdiversityofSanFrancisco’spopulation–35%ofthepopulationisimmigrants,thelargestgroupfromChina–itisessentialthatawarenessandknowledge-buildingeffortsbeculturallyappropriatetoeffectivelypromoteoralhealthincommunitiesthathavethehighestratesofdentalcaries.

Systematic evaluation of oral health status. Besidestheannualkindergartendentalscreeningproject,wearelimitedinthecollection,analysis,anddisseminationoforalhealthdata.Moreinfrastructureisneededtosystematicallyassessandmonitortheoralhealthstatusofourchildrencitywide.

Coordination citywide.Overthepastdecade,dentalandmedicalprofessionalorganizations,clinics,universities,SanFranciscoUnifiedSchoolDistrict,andcommunityorganizationshaveeachlaunchedeffortstoimprovetheoralhealthofchildreninSanFrancisco.Tobemosteffective,wemustcoordinatetheseeffortstostrengthenadvocacywithpolicyanddecision-makers,reduceredundancy,utilizeresourcesefficiently,andultimatelyimproveourchildren’soralhealthefficiently,equitably,andsustainably.

Available revenue stream.Finally,weareroutinelyprovidingsomedentalservicesthatmaybereimbursable,butforwhichwearenotbilling.Thislostrevenue,ifsuccessfullyobtained,couldopenthedoortoself-sustainingprojects,andthecreationandexpansionofnewprograms for greater reach.

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“Althoughoralhealthisanimportantcomponentofwholepersoncare,historically,ithasnotbeenwellintegratedintoprimarycareandweareseeingtheconsequencesofthatinourclinics.Itisacomplexproblemthatneedsmultipleapproachesincludingincreasingaccesstocare,anddecreasingtheneedforcarethroughbetterpreventionandhealthpromotioninterventions.”

AlbertYu,MD,MedicalDirector,SanFranciscoDepartmentofPublicHealth

Methodology – Developing a PlanAnimportantpreludetotheStrategicPlanprojectwastheconveningofagroupoforalhealthadvocatesaspartoftheSanFranciscoHealthImprovementPartnership(SFHIP)Children’sOralHealthPartnershipWorkingGroupinearly2012.Thisgroupmetthreetimes,withtheobjectivetoidentifyprojectsthatwouldresultinmeasurableimprovementsinchildren’soralhealthwithinfiveyears.Theneedforcoordinated,citywidestrategicplanningandgoalsettingwasexpressedearly,andquicklygainedstrongsupportandmomentumamongthegroup.

WithfundingfromtheMettaFund,acoreleadershipteamwasformedandtheyear-longstrategicplanningprocesswasunderwayintheFallof2013.ASteeringCommitteeoforalhealthandchildren’shealthadvocatesfromthecommunity,civic,academic,public,andprivatesectorswasconvenedtoprovideleadershiptothestrategicplanningprocess.SteeringCommitteemembersdesignedtheplanningprocess,chairedworkgroups,andplannedstakeholderretreats.InFall2013/Winter2014,theSteeringCommitteeconductedanenvironmentalassessmentofSanFranciscochildren’soralhealthstatus,whichidentifieddisparities,strengthsandgapsinoralhealthservices,aswellaspromisingpracticesinpreventionandtreatment.

OverfiftycommunityandinstitutionalstakeholdersattendedafulldayretreatinJanuary2014toreviewtheenvironmentalassessmentandadviseonthedevelopmentoftheStrategicPlan.Theirinputhelpedtoselecttheplan’smainpriorityareas:Access,IntegrationwithOverallHealth,Promotion,EvaluationandCoordination.Overfortyretreatattendeesandotherstakeholderswererecruitedtojoinworkgroupsassignedtothesepriorityareas.TheworkgroupsmetinMarchandApril2014todevelopstrategiesandtactics.Basedontheirwork,theSteeringCommitteedevelopedadraftStrategicPlan.InJune2014,communityandinstitutionalstakeholdersattendedahalf-dayretreattoprovidefeedbackonadraftoftheStrategicPlananddevelopinitialideasforimplementation.

ThisStrategicPlanwascreatedbythedozensofpartnerorganizationsandindividualswhowillbepartofitsimplementation.Theplanningprocessresultednotonlyinthisdocumentbutalsoraisedawarenessamongcityandcommunityleadersofthecriticalimportanceoforalhealth,anddevelopedconsensusonwhatmustbedonetoimprovechildren’soralhealthstatusinSanFrancisco.

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Guiding Principles:

Strategieswillfocuson:

◆ Prevention(nottotheexclusionoftreatment)

◆ Ages0-10andpregnantwomen

Populationswhoaremostat-risk,includinglow-income, communitiesofcolor,childrenwithspecialneeds,and recent immigrants

◆ Sustainableefforts;utilizeallavailablefundingstreams

◆ Policyandsystemslevelschange

◆ Coordinatedcity-wideefforts

◆ Inclusionofcommunityperspective

“All San Francisco children are caries-free”

Vision

◆

Three-year Indicators:

Toguideoureffortsandevaluateoursuccesswehavedevelopedthefollowingtargets

Caries Experience1. Reducethepercentageofkindergartnerswithdentalcariesexperiencefrom37%in

2012to27%in2017

Untreated Decay2. Reducethepercentageofkindergartnerswithuntreateddentaldecayfrom16%in

2012to8%in2017

Caries Disparities3. ReducethegapbetweenChinese,BlackandHispanic/Latinokindergartners

andWhitekindergartenerswithrespecttoriskofcariesexperiencefroma20percentagepointdifferencein2012toa15percentagepointdifferencein2017, arelativereductionof25%.

Access4. IncreasethepercentageofchildrenonMedi-Calunderage10whoreceivedany

dentalservicebilledtoDenti-Calduringthepastyearbyabsoluteincreaseof10%*

5. IncreasethepercentageofchildrenonMedi-Calwhohaveseenadentalproviderbyage1,byanabsoluteincreaseof10%.

6. IncreasethepercentageofwomenonMedi-Calthathadadentalvisitduringpregnancybyanabsoluteincreaseof20%

Dental Sealants7. Increasethepercentageoflow-incomechildreninSanFranciscoUnifiedSchool

District(SFUSD)aged7-8yearsoldwhohavereceiveddentalsealantsontheirpermanentmolarteethbyanabsoluteincreaseof10%.(InSchoolYear2012–2013,sealantsappliedon248secondgraders.)

*BecauseDenti-CalcurrentlydoesnotdifferentiatepreventivefromrestorativeservicesprovidedbyFQHCs,abaselineforutilizingdentalcareforpreventiveservicescannotbeestablished.Inthefuture,wewouldliketobeabletousepreventivedentalservicesasanindicator.

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Overarching Strategies:

Toaccomplishtheseobjectives,wehaveidentifiedthe followingfivemajorstrategies:

1. Access IncreaseaccesstooralhealthcareservicesforSanFrancisco childrenandpregnantwomen

2. Integration Integrateoralhealthwithoverallhealth

3. Promotion Increaseawarenessandpracticeofoptimalchildren’soralhealthbehaviorsamongdiversecommunitiesinSanFrancisco

4. EvaluationDevelopandestablishanongoingoralhealthpopulationbasedsurveillancesystemtoaddresstheoralhealthofSanFranciscochildren

5. CoordinationProvidecoordinationandoversightfortheimplementationof the Strategic Plan

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Tactics:1. Establish a sustainable funding stream.Developafeasiblemechanismfor

providerstobillDenti-Calfordentalcaredeliveredoutsideofthetraditionaldentaloffice/clinicsetting,anddisseminateaclearlyarticulatedprocesstoguidesafety-netdentalproviderscitywide.

2. Increase service delivery to settings children and families frequent such asSupplementalNutritionProgramforWomen,InfantsandChildren(WIC),HeadStartandEarlyHeadStartsites.Provideoralhealthscreenings,parent/caregivereducation,fluoridevarnish,casemanagement,referralstodentalcare.

Strategy 1:

ACCESS

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Increase access to oral health care services for San Francisco children and pregnant women.Byestablishingasustainablefundingstream,expandingservicedeliveryintosettingschildrenfrequent,increasingthenumberofsafetynetdentalprovidersservinglow-incomechildren,andexpandingcasemanagement,wewillsignificantlyexpandchildren’sandpregnantwomen’saccesstodentalservices.

Strategy 1:

Access

“Itookmy3yearoldsontotheoralhealthscreeningatWIC.Itwasagreatexperience,welearnedaboutnutritionandcorrectbrushing.HavingdentalservicesavailableatWICmakesallthedifferenceinbeingabletogetthisinformationanddentalcareforsomanyparents!”

LillianaCazares,motherof3yearoldEthan

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3. Expand the oral health program at SFUSD. IncreasethenumberofSanFranciscoUnifiedSchoolDistrict(SFUSD)elementaryschoolsservedbytheSFDPHsealantprogramfrom9schoolsto12-15schools,andadd5thgradetotheprogram;expandthekindergartenscreeningprogramtoincludepre-K,andaddfluoridevarnishapplicationstotheprogram.

4. Expand safety net dental provider capacity to serve low-income young children and pregnant women.Trainandeducatefutureandcurrentdentalprovidersandtheirsupportstafftoservechildren0-3yearsoldandpregnantwomen;trainsafetynetdentalprogramsonportable,school-basedhealthortele-healthmodalities;andexplorepartnershipswithFederallyQualifiedHealthCenters(FQHCs)thatwouldallowhigherreimbursementsforprivatedentalproviders.

5. Expand Case Management. Increasecasemanagement for childrenwithdentaltreatmentneedsatSFUSD,pre-schools/HeadStart,WIC,aswellasthroughtheChildHealth & Disability Prevention(CHDP)program.

“Itookmy3yearoldsontotheoralhealthscreeningatWIC.Itwasagreatexperience,welearnedaboutnutritionandcorrectbrushing.HavingdentalservicesavailableatWICmakesallthedifferenceinbeingabletogetthisinformationanddentalcareforsomanyparents!”

LillianaCazares,motherof3yearoldEthan

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Strategy 1:

ACCESSStrategy 2:

Integration

Tactics: 1. Institute fluoride varnish applications and oral health education in well child

pediatric visits and immunizations, withincommunityclinicsandprivatemedicalofficestargetingunderservedneighborhoods.

2. Standardize Electronic Medical Records (EMR). IncludeoralhealthquestionsandmanagementofdentalreferralsintheEMRsystemusedinmedicalofficesandclinicsthroughoutSanFrancisco.

3. Incorporate oral health care for children more prominently into the Managed Care Health PlansincludingAnthemBlueCrossandSanFranciscoHealthPlan(SFHP)programs.Includeincentives(i.e.,giftcards)forfamiliesthatreceivefluoridevarnishandoralhealthassessmentsandeducationforchildrenandpregnantwomen;incorporateoralhealthintoPracticeImprovementProjecttrainingforpediatriciansandnurses;andconsiderinstitutingreimbursementforfluoridevarnish.

Integrate oral health with overall health.Byintegratingoralhealthpromotionandservicesintoprimarycarewellchildandpre-natalvisits,pregnantwomenandchildrenaremuchmorelikelytoreceiveeffectiveoralhealthpreventioninformation andservicesatatimewhentheycanbemosteffective.Thisplancallsforsystem-widechangesaswellaseducationandtrainingofmedicalproviderstosignificantlyexpandthispromisingpractice.

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4. Provide trainings and resources to medical providers (MDs, PHNs, CMAs, RNs, CNMs, etc.) andancillarysupportstaffinmedicalofficesandclinics(behaviorists,nutritionists,RNs,socialworkers,CHW,healtheducators,etc.)tounderstandtheimportanceoforalhealth,andtoincorporateoralhealthassessment,referralandapplicationoffluoridevarnishintoallpatientcaresettingswherechildren’shealthandprenatalcareisaddressed.Providetrainingsatregularpediatricmedicalmeetingsandgrandrounds;promoteexistingtrainingresourcesonlineonprofessionalhealthorganizationwebsites(i.e.,SocietyfortheTeachersofFamilyMedicine,SmilesforLifecurriculum);developdetailedprotocolstoguideimplementationoforalhealthscreeningsandfluoridevarnishindifferentsettings;andincorporateoralhealthintonursingandmedicaleducationandresidencytrainingprograms.

“AtKaiserPermanenteweareimplementingoralhealthskillsintoourroutinewellcarevisitsevenbeforethefirsttootherupts.Bybeingabridgetoestablishingadentalhome,wehopewecanofferouryoungmembersmanyyearsofbeautifulsmilesandoverallgoodhealth!”

CeciliaGonzalez,MD,SanFranciscoKaiserPediatrics

Strategy 3:

Promotion

Tactics:1. Coordinate oral health education citywide. Supportandexpandtheefforts

oftheSanFranciscoChildren’sDentalHealthCommittee,whichcoordinatesdentalhealtheducationanddentalhealthfairsinSanFrancisco.MapcurrentservicesandeducationinSanFranciscoandidentifygapsinoutreach.

2. Integrate oral health promotion into overall health promotion. IntegrateoralhealthintootherDPHhealthpromotionefforts.Includeothercitydepartmentsthattargetyouththroughdedicatedoralhealthstaff.Joinexistingsocialmarketinghealthcampaignsandreachouttocommunitylayhealthworkerprograms.

Increase awareness and practice of optimal children’s oral health behaviors among diverse communities in San Francisco. While avarietyoforalhealthpromotioneffortsexistinSanFrancisco,theireffectivenesswillbemagnifiedthroughcoordination,consistentmessaging,integrationintootherhealthefforts,aswellasensuringthatinformationiscreated,targetedanddeliveredinculturallyappropriateways.

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3. Develop and include consistent, culturally relevant messaging of appropriate healthliteracylevelsaimedtowardhealth-promotingbehaviorchangeinalleducationefforts.

4. Organize and mobilize most-impacted communities to develop and implement culturally specific oral health education campaigns relevant to their neighborhoods.Determineoralhealtheducationcontent,developstrategiestoreachneighborhoodresidents,identifykeymessengers,anddeterminehowtoleverageexistingresources.Prioritizeandtargetoralhealthpromotioneffortsatlocationsparents/caregiversofchildren0-5andpregnantwomenfrequent,suchasfoodbanks,backtoschoolnights,andWICclinics.

“Ourdentalclinicacceptstheveryyoungchildforearlydentalvisits;toeducatetheparents,andprovidepreventivecareforthebaby.Manynewimmigrantparentsdonotknowabouttheimportanceofbabyteethandgoodoralhealth,andwaituntiltheirchildis3forthefirstdentalvisit.Bythattime,thechildmayalreadyhaveseveretoothdecay.”

CordeliaAchuck,DDS,NorthEastMedicalServicesDentalDirector

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Strategy 4:

Evaluation

Tactics: 1. Increase infrastructure at DPH and SFUSD for data collection, analysis, and

dissemination. Secureadditionalpersonnelanddedicatedtime;establishacommitteethatincludesanepidemiologistfromtheSFDPHandexternalmemberswithexpertiseinoralepidemiology,biostatistics,andprogramevaluation.

2. Identify and prioritize oral health status indicators to be assessed, frequency of collection, and population groups to be assessed in support of the Strategic Plan. Identifyandassessexistingoralhealthdatasourcesfordesiredinformationonspecificpopulations;identifyanddevelopdatasurveillancesystemsfordesiredpopulationsnotcurrentlyassessedfororalhealthstatuswheredesirableandpracticaltodoso,particularlyinsupportoftheinitiativesrecommendedthroughouttheStrategicPlan.

Develop and establish an ongoing oral health population-based surveillance system to address the oral health of San Francisco children. Regularandsystematicdatacollectiontomonitorandevaluatechildren’soralhealthoutcomes,associateddisparities,andprogressovertimeiscriticaltostakeholders,programplanners,andpolicymakers.Increasedcapacityforthisactivitywillensurethedevelopmentofresources,qualityimprovementandsustainabilityofcity-wideoralhealthservicesthatadvancetheoverallgoalsoftheStrategicPlan.

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3. Coordinate efforts to identify and obtain the resources needed for ongoing data collection and analysis. Developmechanismsanddatasharingagreementsforregularcollectionofdataacrossinstitutions;reviewprogressatleastannually.

4. Document and disseminate annual reports to key stakeholders to build understanding of importance of oral health and inform intervention development and program planning. KeystakeholderstoincludeSFDPH,SFUSD,dentalandmedicalproviders,communitypartnersandcitywidepolicymakersanddecisionmakers.

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“WhenIlookinachild’smouthduringaroutineexamandfindextensivedecay,itsaddensmetoknowthattheselittleoneshavelearnedtolivewithsomuchdiseaseanddiscomfortforyearsandnoonehastakencareofit.Ihavefoundthatdiscussingoralhealthwiththesamedegreeofimportasothermedicalissuesduringvisitshelpsteachparentshowsignificantthisaspectoftheirchild’swellnessis.”

ZeyaMalawa,MD,BayviewChildHealthCenter

Strategy 5:

Coordination

Tactics:1. Identify and establish a committee that will provide oversight of the

implementation, prioritization, and quality assurance of the Strategic Plan. Establishacommitteetodirectandmonitorprogressineachstrategicpriorityarea;developprocessforregularmonitoringandevaluationofStrategicPlanimplementation;facilitatecollaboration,coordination,andcommunicationamongstakeholders.

2. Develop workgroups for each of the strategies to enact the implementation of its tactics. Identifyachairpersontoleadeachworkgroup;determinepriorityandimplementationstepsforeachtactic;check-inmonthlywiththeoversight/coordinatingcommittee.

3. Increase infrastructure and staffing at SF DPH to support the coordination of the implementation of the Strategic Plan.Thisstaffpersonwouldberesponsibleforcoordinatingmeetings;communicatingwiththeSanFranciscoHealthCommission,communitystakeholdersandDPHadministration;anddisseminatingreports.

Provide coordination and oversight for the implementation of the Strategic Plan. InordertoensurethattheStrategicPlanisimplementedandresultsinrealchangeintheoralhealthof SanFranciscochildren,abodyofcommittedstakeholdersisneededtoprovideoverallguidanceandoversight.Havingworkgroupswillhelpmoveforwardthevariousstrategies andtacticsdetailedintheStrategicPlan.

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STRATEGICPLANNINGSTEERINGCOMMITTEE

Steven Ambrose,DDS, SanFranciscoDepartmentofPublic Health

Tomás Aragón,MD,DrPH, SanFranciscoDepartmentofPublic Health

Carolyn Brown,DDS, SanFranciscoCommunityClinicConsortium

Curtis Chan,MD,MPH, SanFranciscoDepartmentofPublic Health

Lisa Chung,DDS,MPH,UniversityofCalifornia, SanFrancisco

Kim Coates,MA, SanFranciscoUnifiedSchoolDistrict

Deborah Elam,MS,CAE, SanFranciscoDentalSociety

Margaret Fisher, RDHAP,BS, SanFranciscoDepartmentofPublic Health

Susan Fisher-Owens, MD,MPH,UniversityofCalifornia,SanFrancisco;SanFranciscoDepartment of Public Health

Catherine Fuller, RN, MSN,FNP, SanFranciscoUnifiedSchoolDistrict

Stuart Gansky,MS,DrPH,UniversityofCalifornia, SanFrancisco

Cecilia Gonzalez, MD, Kaiser Permanente SanFrancisco

Kevin Grumbach,MD, UniversityofCalifornia, SanFrancisco

Irene Hilton,DDS,MPH, SanFranciscoDepartmentofPublic Health

Mary Jue,MSN,RN,PHN, SanFranciscoUnifiedSchoolDistrict

Christine Miller,RDH,MHS,MA,UniversityofthePacific

Marcellina Ogbu,DrPH, SanFranciscoDepartmentofPublic Health

Sharon Rose,MPH, UniversityofCalifornia, SanFrancisco

Jaime Ruiz,MD, MissionNeighborhood Health Center

Amor Santiago,DPM,MPH,AsianPacificIslandersHealthParityCoalition

Claire Sit,RDH,BS, SanFranciscoDepartmentofPublic Health

Appendices:

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STRATEGICPLANNINGWORKGROUPS

ACCESSChair: Carolyn Brown,DDS, SanFranciscoCommunityClinicConsortium

Cordelia Achuck,DDS, NorthEastMedicalServices

Andrea Almario, RDH, South of Market Health Center

Steven Ambrose,DDS, SanFranciscoDepartmentof Public Health

Curtis Chan, MD,MPH, SanFranciscoDepartmentof Public Health

Deborah Elam,MS,CAE, SanFranciscoDentalSociety

Jared Fine,DDS,MPH,AlamedaCounty Public Health Department

Catherine Fuller, RN,MSN,FNP, SanFranciscoUnifiedSchoolDistrict

Paul Glassman, DDS,MA,MBA,UniversityofthePacific

Nancy Kwon Hsieh,DDS,MS,CaliforniaSocietyofPediatricDentistry

Magdalena Louie,MS,RD, SanFranciscoDepartmentof Public Health

Walter Lucio,DDS,MPH, Delta Dental

Maryna Pechereska, MPH, MissionHeadStart/EarlyHeadStart

Steven Silverstein,DMD,MPH,UniversityofCalifornia, SanFrancisco

INTEGRATIONChair: Susan Fisher-Owens,MD,MPH,UniversityofCalifornia,SanFrancisco;SanFranciscoDepartment of Public Health

Jennifer Do, MD,SutterHealth

Sean Dongre, AB,SanFranciscoHealthPlan

Margaret Fisher, RDHAP,BS, SanFranciscoDepartmentof Public Health

Fernando Gomez-Benitez, MissionNeighborhoodHealthCenter

Cecilia Gonzalez, MD,KaiserPermanenteSanFrancisco

Kevin Grumbach,MD, UniversityofCalifornia,SanFrancisco

Irene Hilton, DDS,MPH,SanFranciscoDepartmentofPublic Health

Jeanne Lee,MD,MPH,SanFranciscoDepartmentofPublic Health

Christine Pecci, MD, UniversityofCalifornia,SanFrancisco;SanFranciscoDepartment of Public Health

Jessenya Ramirez-Sacasa,SutterHealth

Kenneth Tai, MD,NorthEastMedicalServices

PROMOTIONChair: Amor Santiago,DPM,MPH,E.D.,AsianPacificIslandersHealthParityCoalition

Bahar Amanzadeh,DDS,MPH,UniversityofCalifornia, SanFrancisco

Derick Aoki, MPH, First5SanFrancisco-Children andFamiliesCommission

Judith Barker, PhD,MA,MSc,UniversityofCalifornia, SanFrancisco

Vanessa Bohm,MA,CARECEN

Kristin Hoeft,MPH, UniversityofCalifornia, SanFrancisco

Gabrielle Jones, MA,MPH, NationalChildren’sOralHealthFoundation

Sharon Rose,MPH, UniversityofCalifornia, SanFrancisco

Gisselle Rullier,RDH, SanFranciscoDentalHygieneSociety

Marianne Szeto,MPH, SanFranciscoDepartmentof Public Health

EvALUATION&COORDINATIONChair: Stuart Gansky, MS,DrPH,UniversityofCalifornia, SanFrancisco

Lisa Chung,DDS,MPH,UniversityofCalifornia,SanFrancisco

Robert Isman,DDS,MPH,CaliforniaDepartmentofHealthCareServices

Mary Jue, MSN,RN,PHN, SanFranciscoUnifiedSchoolDistrict Christine Miller, RDH,MHS,MA,UniversityofthePacific

Claire Sit,RDH, SanFranciscoDepartmentof Public Health

Jodi Stookey, PhD, SanFranciscoDepartmentof Public Health

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STRATEGICPLANNINGRETREATPARTICIPANTSMiriam Abrams, MiriamAbramsandAssociates

Cordelia Achuck,DDS, NorthEastMedicalServices

Andrea Almario, RDH, South of Market Health Center

Bahar Amanzadeh, DDS,MPH,UniversityofCalifornia, SanFrancisco

Steven Ambrose, DDS, SanFranciscoDepartmentof Public Health

Derik Aoki, MPH, First5SanFrancisco–Children andFamiliesCommission

Tomás Aragón,MD,DrPH, SanFranciscoDepartmentof Public Health

Judith Barker, PhD,MA,MSc,UniversityofCalifornia, SanFrancisco

Lynda Boyer-Chu, RN,MPH, SanFranciscoUnifiedSchoolDistrict

Nina Boyle,SupportforFamilies ofChildrenwithDisabilities

Carolyn Brown, DDS, SanFranciscoCommunity ClinicConsortium

Jean Calvo,DDScandidate,UniversityofCalifornia, SanFrancisco

Curtis Chan,MD,MPH, SanFranciscoDepartmentof Public Health

Justin Chu,BS,CDIHeadStart

Lisa Chung, DDS,MPH,UniversityofCalifornia,SanFrancisco

Kim Coates,MA, SanFranciscoUnifiedSchoolDistrict

Greg Cutcher, MS,RN,PHN, SanFranciscoDepartmentof Public Health

Mylene Deano,RDA, South of Market Health Center

Jennifer Do, MD,SutterHealth

Fanny Duong Wool, WuYeeChildren’sServices

Deborah Elam, MS,CAE, SanFranciscoDentalSociety

Patricia Erwin,MPH, SanFranciscoDepartmentof Public Health

Jane Evans, BSN,RN,PHN, SanFranciscoDepartmentof Public Health

Gemma Ferrer, DMD, South of Market Health Center

Jared Fine, DDS,MPH,AlamedaCounty Public Health Department

Margaret Fisher,RDHAP,BS, SanFranciscoDepartmentof Public Health

Susan Fisher-Owens, MD,MPH,UniversityofCalifornia,SanFrancisco,SanFranciscoDepartment of Public Health

Paula Fleisher,MA,University ofCalifornia,SanFrancisco

Catherine Fuller, RN,MSN,FNP, SanFranciscoUnifiedSchoolDistrict

Stuart Gansky,MS,DrPH,UniversityofCalifornia, SanFrancisco

Paul Glassman,DDS,MA,MBA,UniversityofthePacific

Cecilia Gonzalez,MD, Kaiser Permanente

Jolie Goodman,DDScandidate,UniversityofCalifornia, SanFrancisco

Kevin Grumbach, MD, UniversityofCalifornia, SanFrancisco

Hali Hammer, MD, UniversityofCalifornia, SanFrancisco,SanFranciscoDepartment of Public Health

Mary Hansel, BS,MPH,DrPH, SanFranciscoDepartmentof Public Health

Irene Hilton, DDS,MPH, SanFranciscoDepartmentof Public Health

Kristin Hoeft, MPH,UniversityofCalifornia,SanFrancisco

Nancy Kwon Hsieh, DDS,MS,CaliforniaSocietyofPediatricDentistry

Robert Isman, DDS,MPH,CaliforniaDepartmentofHealthCareServices

Anna Jaffe,StanfordUniversity

Gabrielle Jones,MA,MPH, NationalChildren’sOralHealthFund

Mary Jue, MSN,RN,PHN, SanFranciscoUnifiedSchoolDistrict

Thuan Le,DDS,PhD, UniversityofCalifornia, SanFrancisco

Jeanne Lee, MD,MPH, SanFranciscoDepartmentof Public Health

Brent Lin, DMD, UniversityofCalifornia, SanFrancisco

Katrina Liu, MD, NorthEastMedicalServices

Wylie Liu,MPH,MPA, UniversityofCalifornia, SanFrancisco

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Magdalene Louie, MS,RD, SanFranciscoDepartmentof Public Health

Walter Lucio,DDS,MPH, Delta Dental

Ursula Maberley,RDH,MS, SanFranciscoDentalHygieneSociety

Christine Miller, RDH,MHS,MA,UniversityofthePacific

Adrian Nunez, SanFranciscoHealthPlan

Marcellina Ogbu, DrPH, SanFranciscoDepartmentof Public Health

Christine Pecci, MD, UniversityofCalifornia, SanFrancisco;SanFranciscoDepartment of Public Health

Maryna Pechereska,MPH, MissionHeadStart/EarlyHeadStart

Karen Pierce, JD, SanFranciscoDepartmentof Public Health

Randy Quezada,MPP, OfficeofEconomicandWorkforceDevelopment

Sharon Rose,MPH, UniversityofCalifornia, SanFrancisco

James Rouse Iniguez, MA,UniversityofCalifornia, SanFrancisco

Amor Santiago, DPM,MPH,ED,AsianPacificIslandersHealthParityCoalition

Carol Schulte, MSW,LCSW, SanFranciscoDepartmentof Public Health

Steven Silverstein,DMD,MPH,UniversityofCalifornia, SanFrancisco

Claire Sit, RDH, SanFranciscoDepartmentof Public Health

Jodi Stookey,PhD, SanFranciscoDepartmentof Public Health

Joel Streiker, PhD,CARECEN

Marianne Szeto, MPH, SanFranciscoDepartmentof Public Health

Kenneth Tai,MD,NorthEastMedicalServices

Sharine Thenard, DDS,MS,AlamedaPediatricDentistry

Gloria Thornton, AnthemBlueCross

Roberto Vargas,MPH,UniversityofCalifornia, SanFrancisco

Linda Wilson, MPA KaiMingHeadStart

Allen Wong, DDS, SFDS

Yuaner Wu,RN,PHN,PhDN,UniversityofCalifornia, SanFrancisco

Simona Zompi, MD,MPH,Immunology&GlobalHealthConsulting

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Glossary of Terms Affordable Care Act (ACA):Legislation,includingthePatientProtectionandAffordableCareAct(P.L.111-148)andtheHealthCareandEducationReconciliationActof2010(P.L.111-152),thatexpandsMedicaidcoveragetomillionsoflow-incomeAmericansandmakesnumerousimprovementstobothMedicaidandtheChildren’sHealthInsuranceProgram(CHIP).

Best Practice:Thebestclinicaloradministrativepracticeorapproachatthemoment,giventhesituation,thepatient’sorcommunity’sneedsanddesires,theevidenceaboutwhatworksforthissituation/need/desire,andtheresourcesavailable.

Caries (tooth decay or cavities): Amultifactorialinfectiousdiseasethatresultsinthedestructionofthetoothstructurebydemineralizationandultimatelycavitationofthetoothsurfaceifleftuntreated.Itisthemostcommonchronicchildhooddisease,andyethighlypreventable.

Caries experience:anycurrentorpastdentalcariesasdefinedbyhavingatleastonedecayed,extracted,orfilledtoothduetocaries.

Case Management: Acollaborativeprocessofassessment,planning,facilitation,carecoordination,evaluation,andadvocacyforoptionsandservicestomeetanindividual’sandfamily’scomprehensivehealthneedsthroughcommunicationandavailableresourcestopromotequality,cost-effectiveoutcomes.

Certified Medical Assistants (CMA):Multi-skilledpractitionerswhoassumeawiderangeofadministrativeandclinicaldutiesinphysicians’officesandotherhealthcaresettings.

Certified Nurse Midwife (CNM):Registerednursewithatleastamaster’sdegreeinnursingandadvancededucationinthemanagementoftheentirematernitycycle

Early Childhood Caries (ECC): Anyprimarytoothinachildunder6yearsoldthatisaffected by caries

Federally Qualified Health Centers (FQHCs): AllorganizationsreceivinggrantsunderSection330ofthePublicHealthServiceAct(PHS).FQHCsqualifyforenhancedreimbursementfromMedicareandMedicaid,aswellasotherbenefits.FQHCsmustserveanunderservedareaorpopulation,offeraslidingfeescale,providecomprehensiveservices,haveanongoingqualityassuranceprogram,andhaveagoverningboardofdirectors.

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S

S

S

S

S

S

S

S

S

Fluoride varnish (FV): Athincoatingoffluoridethatisappliedtotoothsurfacesinordertopreventorstopdecay.Ithasbeenproveneffectiveininfantsandchildrenwithhighriskofdecay.

Healthy People 2020: Thefederalgovernment’spreventionagendaforbuildingahealthiernation.Itisastatementofnationalhealthobjectivesdesignedtoidentifythemostsignificantpreventablethreatstohealthandtoestablishnationalgoalstoreducethesethreats.TheoverarchinggoalsofHealthyPeople2020areto:attainhigh-quality,longerlivesfreeofpreventabledisease,disability,injury,andprematuredeath;achievehealthequity,eliminatedisparities,andimprovethehealthofallgroups;createsocialandphysicalenvironmentsthatpromotegoodhealthforall;andpromotequalityoflife,healthydevelopment,andhealthybehaviorsacrossalllifestages.

Head Start:HeadStartisafederalprogramthatpromotestheschoolreadinessofchildrenagesbirthto5fromlow-incomefamiliesbyenhancingtheircognitive,socialandemotionaldevelopment.Inadditiontoeducationservices,programsprovidechildrenandtheirfamilieswithhealth,nutrition,social,andotherservices.

Indicator: aquantitativeorqualitativeexpressionofaprogramorpolicythatoffersaconsistentwaytomeasureprogresstowardthestatedtargetsandgoals.Thedatawewillmeasuretodetermineifwehaveachievedourresult

Managed Care Plans: Managedcareplansareatypeofhealthinsurance.Theyhavecontractswithhealthcareprovidersandmedicalfacilitiestoprovidecareformembersatreducedcosts.

National School Lunch Program (NSLP): afederallyassistedmealprogramoperatinginpublicandnonprofitprivateschoolsandresidentialchildcareinstitutions.Itprovidesnutritionallybalanced,low-costorfreelunchestoeligiblechildreneachschoolday.Becauseincomeeligibilityisarequirement,thepercentageofchildrenwhoqualifyforNSLPor“freeand/orreduced”lunchprogramservesasaproxyforincomelevelofaschool.

Obstetrics & Gynecology (OB/GYN): OBforobstetricsorforanobstetrician,aphysicianwhodeliversbabies.GYNforgynecologyorforagynecologist,aphysicianwhospecializesintreatingdiseasesofthefemalereproductiveorgans.

Outcomes: Theresultsofimplementingtheplan,asexperiencedbythepopulation.

Public Health Nurse (PHN): Publichealthnursesintegratecommunityinvolvementandknowledgeabouttheentirepopulationwithpersonal,clinicalunderstandingsofthehealthandillnessexperiencesofindividualsandfamilieswithinthepopulation.

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S

S

S

S

S

S

S

S

S

Safety Net: Individualsandorganizationsthatprovidehealthcaretolow-incomeandothervulnerablepopulations,includingtheuninsuredandthosecoveredbypublicinsurancesuchasMedicaid.

Sealants:Aresinmaterialappliedtothechewingsurfacesofmolarandpremolarteethtopreventcaries.

Strategy: Acarefullydesignedoralhealthplanofactionforobtainingaspecificgoaloroutcome. Tactic:Anactionimplementedasoneormorespecifictasksforcarryingoutastrategy

Women, Infants and Children (WIC):TheSpecialSupplementalNutritionProgramforWomen,Infants,andChildren(WIC)providesFederalgrantstoStatesforsupplementalfoods,healthcarereferrals,andnutritioneducationforlow-incomepregnant,breastfeeding,andnon-breastfeedingpostpartumwomen,andtoinfantsandchildrenuptoagefivewhoarefoundtobeatnutritionalrisk.

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S

S

S

S

S

References Ahovou-Saloranta,A.,Forss,H.,Walsh,T.,Hiiri,A.Nordblad,A.Makela,M.&Worhtington,H.v.(2013).Sealantsforpreventingdentaldecayinthepermanentteeth.CochraneDatabaseofSystematicReviews.

CaliforniaHealthcareFoundation.(2009).EmergencyDepartmentvisitsforPreventableDentalConditionsinCalifornia.Oakland,CA:CaliforniaHealthcareFoundation.Retrievedfrom http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/D/PDF%20DentalCountySupplement.pdf.

CaliforniaMedi-CalDental.(2013,August).RestorationofSomeAdultDentalServicesin2014. Denti-CalBulletin.

CentersforDiseaseControlandPrevention(CDC).DivisionofOralHealth,NationalCenterforChronicDiseasePreventionandHealthPromotion.(2013).PreventingDentalCarieswithCommunityProgramsFactSheet.Atlanta,GA.Retrievedfrom http://www.cdc.gov/oralhealth/publications/factsheets/dental_caries.htm.

CentersforDiseaseControlandPrevention(CDC).NationalCenterforHealthStatistics(NCHS).(2010).NationalHealthandNutritionExaminationSurveyData,2009-2010.Hyattsville,MD:U.S.DepartmentofHealthandHumanServices,CDC.Retrievedfrom http://wwwn.cdc.gov/nchs/nhanes/search/nhanes09_10.aspx.

ChildrenNow.(2013)[Infographic,interactivemapofmixed2013data].Denti-CaldentistsbyCACounties.Retrievedfromhttp://www.childrennow.org/index.php/learn/infographic-counties-denti-cal.

Glassman,P.&Harrington,M.(2013)ThevirtualDentalHome:Improvingtheoralhealthofvulnerableandunderservedpopulationsusinggeographicallydistributedtelehealth-enabledteams.SanFrancisco,CA:UniversityofthePacific,ArthurA.DugoniSchoolofDentistry.

HiltonIv,StephenS,BarkerJC,Weintraub.(2007).Culturalfactorsandchildren’soralhealthcare:aqualitativestudyofcarersofyoungchildren.CommunityDentistryandOralEpidemiology.35:429–438

Kelly,S.E.,Binkley,C.J.,Neace,W.P.,&Gale,B.S.(2005).BarrierstoCare-SeekingforChildren’sOralHealthAmongLow-IncomeCaregivers.AmericanJournalofPublicHealth,95(8):1345-1351.

Marinhov.C.,Higgins,J.P.,Logan,S.,&Sheiham,A.(2002).Fluoridevarnishesforpreventingdentalcariesinchildrenandadolescents.CochraneDatabaseofSystematicReviews.(3).

Mofidi,M.,Rozier,R.G.,&King,R.S.(2002)ProblemswithaccesstodentalcareforMedicaid-insuredchildren:Whatcaregiversthink.AmericanJournalofPublicHealth,92(1),53-58.

Pourat,N.&Nicholson,G.(2009).Unaffordabledentalcareislinkedtofrequentschoolabsences. HealthPolicyResearchBrief.LosAngeles,CA:UCLA.

Revels,M.&Holland,K.(2013).SystematicScreeningandAssessmentofWorkforceInnovationsintheProvisionofPreventiveOralHealthServices.Anniston,AL:SarrellDentalProgram.

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SanFranciscoUnifiedSchoolDistrict.(2013).DentalEncounters,Aug-Oct2013.SanFrancisco,CA:SFUSD.SFDPH-SFUSD-SFDSSanFranciscoKindergartenScreening,[SanFrancisco,2005-11](2013). PreparedbySFDPHMCAHEpidemiology.

Sierawan,H.,Faust,S.&Mulligan,R.(2012).Theimpactoforalhealthontheacademicperformanceofdisadvantagedchildren.AmericanJournalofPublicHealth.102(9):1729-34.

Terpak,C.H.,Yu,Z.Martin,K.Curtis,M.(2010,April).AmbulatorySurgeryofEarlyChildhoodCariesinCalifornia,2005.PosterpresentedatNationalOralHealthConference,Dallas,TX. http://www.cdph.ca.gov/programs/MCAHOralHealth/Documents/MO-OralHealthP-AmbulatorySurgery.pdf

ThomsonWM,PoultonR,MilneBJ,CaspiA,BroughtonJR,AyersKM.Socioeconomicinequalitiesinoralhealthinchildhoodandadulthoodinabirthcohort.CommunityDentistryandOralEpidemiology.2004;32(5):345-53.

U.S.DepartmentofHealthandHumanServices.(2013)KeepKidsSmiling:PromotingOralHealthThroughtheMedicaidBenefitforChildren&Adolescents.Washington,D.C.:USDHSS.

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Acknowledgments Writing and EditingMiriamAbramsLisaChungMargaretFisherKaraLugtuSharon RoseJodiStookey Publication AdvisorsStrategicPlanningSteeringCommittee Strategic Planning ConsultantMiriamAbrams,MiriamAbramsandAssociates Copy EditingJoshuaNossiterSanFranciscoDepartmentofPublicHealthMaternalChildandAdolescentHealthSection Graphic Design MikeOrtizCity&CountyofSanFrancisco ReproMail Funding for the Strategic Planning ProcessCalifornia Department of Public Health MettaFundTheUnitedWay

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Comments, questions, and requests for information can be directed to:

Lisa Chung, DDS,MPHDivisionofOralEpidemiology&DentalPublicHealthUniversityofCalifornia,SanFrancisco3333CaliforniaStreet,Suite495SanFrancisco,CA94143-1361lisa.chung@ucsf.edu

Margaret Fisher, RDHAP,BSChildHealth&DisabilityPrevention(CHDP)ProgramCityandCountyofSanFrancisco–DepartmentofPublicHealth30vanNessAvenue,Suite210SanFrancisco,CA94102Margaret.fisher@sfdph.org