Oral Health Regional Assessment & Planning Project

(RAPP)

2002-2005

Greater Cincinnati, Northern Kentucky & Southeastern Indiana

October 10, 2000

Cincinnati Enquirer 9/8/00

What was the RAPP?Rising interest in dental issuesSmall funds availableUnited Way looking for initiativesPlanning process needed

RAPP Process CreatedUnited Way and Health Foundation fundingOral Health Council project managementAdvisory Council leadershipBroad community participation by stakeholders

How the Process Worked

Summary ofNeeds/IssuesMade Public

Steering Committee

Advisory Committee Staff Consultants

AdvisoryCommitteeProvides

InitialInput

Implement

Take Plan toCommunity

Implementprogram(s)that can be

enactedimmediately

Begindevelopment

for otherinitiatives

Oral HealthData

Demographics

Literature

Stakeholder &Consumer

Input

BestPractices

Consumer Input

Funding PlanOptions

RealityTesting

AdvisoryCommittee

Review

Stakeholder &Consumer

Input

AdvisoryCommittee

Review& Accept

Internal & External Communications

Preparation for United Way Phase II proposal

5 Months

7 Months

10 Months

Summary ofNeeds/IssuesMade Public

2 Months

ProgramDraft

FinalProgramDesign

DraftImplementation

Plan

FinalImplementation

Plan

Transition Period

What We Found

Economic Culturalconditions norms

Historical Mediatrends messages

Public sectorpractices

Private sector practices

Neighborhood Systemcharacteristics relationships

Family Personalcharacteristics choices

Health caresystem practices

Educationalsystem practices

Families @ 200% of the FPL

Lack Access toDental Care(~450,000)

Multiple factors in the community contribute to poor dental access to care

Multiple factors in the community contribute to poor dental access to care

• Tooth decay is on the rise – more than 45% of inner city children have untreated decay• Emergencies cases have tripled at the Cincinnati Health Dept. Clinics over the past 8 years.• Existing dental clinics are at capacity

• No sliding scale dental clinics in some counties; discounts often insufficient for working poor & others• Some areas have no prevention, education or treatment programs• Families choose rent, food, clothing over dental care

Multiple factors in the community contribute to poor dental access to care

• Impact on employment potential

• Culture of poverty – --postpone treatment--poor appointment compliance

• Perpetuating norms of tooth loss• Dental pain & infection is the #1

one reason why people go to the University Hospital Emergency Room.

Multiple factors in the community contribute to poor dental access to care

RecommendationsWhat should each county have? Treatment for pain & infection Basic restorative care Essential esthetics Effective early prevention Effective educational programs Water fluoridation

Recommendations Improved Preventionsealants, use of pediatricians & ob/gyns, oral cancer exams, mouthguards Increased Educationhealth promotion & education on the importance of oral health community-wide Expanded Access to TreatmentExpand and build, lower fees, Urgent Care Center, dental vans

Regionalized Efforts

Public PolicyProvider EducationHead Start & School SupportMRDD ProgramNursing Home ProgramStrategies for cultural competence/relevance

Public Policy Recommendations

Gain Public/government financing/support

Improving state Medicaid programs

Exploring new systems to provide care

Strategies for addressing cultural needs & disparities

Training for dentists & staffs Training in dental schools Mentoring programs for children from low income/minority families to develop dental careers.

Early AccomplishmentsSealant Program in Northern KentuckyMobile van for Cincinnati Public SchoolsUH GP residency programClermont County Head Start dental projectBabies Milk Fund/Rocking Horse fluoride varnish pilot in pediatric officesOctober 6, 2002 Enquirer articleExpansion of Lincoln Hgts. Clinic2 school-linked dental programsNorthern Ky Clinic expansionFluoride varnish programsCincinnati Dental Society clinic

Cost

One tenth of 1% of the region’s total health care expenditures $13 million

of $13 billion health expenditures per year in the region

Funding PossibilitiesShifts in prioritiesUser taxes(sugar-based drinks, candy)Share of leviesNew levyDental insurance underwriters assessment“Sales Tax” on dental fees

An integrated, collaborative system

with community involvement at the nucleus

Community-developed

CoordinationNucleus

Treatment

Policy

Prevention

Education

Current Status: Rebirth? Internal changes at United Way= end of funding and support 2 year gap prior to publication. Some progress continues Advisory Committee & Oral Health Council intend to continue with

plan implementation.