saa webinar – the relationship between oral health and student per

Smiles Across America Webinar Series

Date: 11/17/2015

The Relationship Between

Oral Health and Student

Performance

/Oral Health America @Smile4Health

Connect with OHA!

/Oral Health America @Smile4Health

HOUSEKEEPING INFORMATION

• Please remember to MUTE your phone.

• Questions are welcome! We’ll allow 10-15 minutes after the presentation for questions.• Questions will be accepted in writing through the control

panel on the upper right hand of your screen.

• Submit questions at any time; we will address them at the end of the presentation.

• Webinar is being recorded; for rebroadcast on OHA’s website – OralHealthAmerica.org

• Your feedback is important to us. Please take our brief webinar evaluation after this session; link will be sent via email.

OUR MISSION

Oral Health America’s mission is to change lives by

connecting communities

with resources to drive access to care, increase

health literacy, and advocate for policies that

improve overall health through better oral health for

all Americans, especially those most vulnerable.

OHA PRIORITIES

ADVOCACYHEALTH

LITERACYACCESS

OHA’s Programs and Campaigns are designed to improve

access to care, oral health literacy and policies that

prioritize the impact of oral health on the overall health of all

Americans – particularly those most vulnerable.

Campaigns for Oral Health Equity

Educate the public, including policy makers, about the importance of oral health for overall health

Emphasize the need to prioritize oral disease alongside other serious health conditions

Advocate for policies that positively impact programs and stakeholders

Current campaigns include:

toothwisdom.org Demonstration

Projects

Professional

Symposia

Advocacy Health Education &

Communications

Technical Assistance

Product Donation

Grant Funding

Terri Chandler, RDHFounder/Executive Director

Email: [email protected]: www.futuresmiles.net

C: (702) 521-4550

School Partnerships: The relationship between oral health and student

performance

1) Participants will learn about Future Smiles and our different school-based oral health delivery models.

2) Participants will learn how the evaluation team determined and analyzed the different “categories of care” within the evaluation design.

3) Participants will learn about our preliminary evaluation of oral health status and student performance.

EDUCATIONAL OBJECTIVES

MEET BELLA~THIS IS WHAT SUCCESS LOOKS LIKE!

OUR MISSION

Increase access to oral health education and services for underserved populations.

Research shows that students who are in poor oral health are more likely to experience dental pain, miss school, and perform poorly in school. It is estimated that 51 million hours per year are missed due to dental related illness.

Most barriers stem from overarching health, family and community issues.

WHY SCHOOL-BASED CARE

OUR FAMILIES

The average family accessing oral health services at our school-based EPOD sites has 4 members and an income of $1,416 per month.

That’s $16,992 per year for a family of 4!

MAP AND LOCATIONS

Future Smiles began providing preventive oral health care at School A through a generous donation from Oral Health America.

FUTURE SMILES OUTCOMES

Outreach efforts since December 29, 2009:

18,745 oral health presentations

5,071 child cleanings

25,719 teeth with dental sealants

10,801 fluoride varnish

51% are uninsured

41% have untreated decay

11% are urgent

2014 Georgetown University’s Center for Children and Families report 9.6% uninsured rate- NV is 1 of the 5 highest in US.

Equals 63,732 children in NV.

AZ is also one of the 5 highest with 10% of its children uninsured.

2011 Quality Report from Medicaid revealed that Nevada has a 37% dental utilization placing Nevada at the bottom quartile for access to dental services.

NEVADA ORAL HEALTH FACTS

2012 Burden of Oral Disease NV 3rd Grade Findings

6 out of 10 (65%) children in Nevada have experienced tooth decay.

Statewide 35% have untreated tooth decay.

In minority children 71% have experienced tooth decay.

11% have urgent dental needs and live with dental pain.

Nevada’s Oral Health Need

DENTAL DISEASE IS PREVENTABLE

Case Management Can Make a Difference

Unmet oral health needs are addressed through case management.

School-Based Health Centers are a cost effective and accessible way to deliver health care to the most vulnerable members of our community.

WE FIND SOLUTIONS

SCHOOL-BASED ORAL HEALTH CARE

FUTURE SMILES EPOD

EPOD~ What does it stand for?

SCHOOL-BASED HEALTH CENTER FOR EDUCATION AND PREVENTION OF ORAL DISEASE

SBHC, Modular or Classroom

Services Include: Screening Education Prophylaxis Fluoride Varnish Sealants Digital X-rays *limited locations Case Management *referral

5 EPOD-Education and Prevention of Oral Disease

Future Smiles Mobile

Sealant Program

16 CCSD Title I Schools

Our Project Evaluated

2 EPODs

1 Mobile

SCHOOL-BASED LOCATIONS

CATEGORIES OF CARE

School SBHC

School-Based

Health Center

Medical

Future

Smiles

EPOD

Future

Smiles

Sealant

Program

Restorative

Dental

Case

Management

Communities

In Schools

Student

Enrichment

A

B

C

School A

792 students with 208 FS participants

79% Free and Reduced Lunch

$1,427 income family of 4

Title I – 3 Star School

School B





School C





2013-2014 Snapshot of Elementary Schools

Medicaid EnrollmentSY’12-’13 SY ‘13-’14

School A 36% 39%School B 52% 55%School C 63% 62%

SCHOOL POPULATION SY 2012-2013

School A Demographics

Caucasian

African American

Indian/Hawaiian/Island

Asian

Hispanic

School B Demographics

Caucasian

African American


Asian

Hispanic

School C Demographics

Caucasian

African American


Asian

Hispanic

SCHOOL POPULATION SY 2013-2014

School A Demographics

Caucasian

African American


Asian

Hispanic

School B Demographics

Caucasian

African American


Asian

Hispanic

School C Demographics

Caucasian

African American


Asian

Hispanic

0%

10%

20%

30%

40%

50%

60%

70%

2009-2010 2010-2011 2012-2013 2013-2014

TRENDS IN UNTREATED DECAY AMONG FS CLIENTS PER

SCHOOL AND BY SCHOOL YEAR

School A School B School C

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

2009-2010 2010-2011 2012-2013 2013-2014

TRENDS IN URGENT DENTAL NEEDS AMONG FS CLIENTS

PER SCHOOL AND BY SCHOOL YEAR



50%

36%42%

58%

31%

22%14% 17%

41%

63%

47%

29%

97% 95% 95% 94%

0%

20%

40%

60%

80%

100%

120%

SY 2010-2011 baseline SY 2011-2012 SY 2012-2013 SY 2013-2014

Figure 1: School A

Untreated Decay Urgent Needs Sealants Present Sealants Post Event

School Intervention School-Based Health Center Future Smiles~EPOD Communities In Schools


49%43%

39%32%

42%

17%13%

7%

20%

37%

60%

29%

100% 100%94%

99%

0%

20%

40%

60%

80%

100%

120%


Figure 2: School B


School Intervention Future Smiles~EPOD


42%

29%

46%

31%

17%11% 13%

8%

26%

70%63%

29%

100% 98% 100% 99%

0%

20%

40%

60%

80%

100%

120%


Figure 3: School C


School Intervention School-Based Health Center Future Smiles~Sealant Program Communities In Schools

SEALANTS

• Sealant application post service event was consistently high in all three sites.

95-100%

• Consistently reaching children who did not yet have sealants.

• We know sealants are a powerful tool in preventing caries.

ORAL HEALTH TRENDS IN CHILDREN AGE 7-11



FIRST MOLAR DFT IN CHILDREN AGE 7-11



FIRST MOLAR DFT BY AGE



PARTICIPATION OVER TIME

24%

76%

School A

Program Participation %

Retained New

37%

63%

School B


Retained New

53%

47%

School C


Retained New

Comparison from SY 2012-2013 to SY 2013-2014

% OF STUDENTS WHO RECEIVED RESTORATIVE DENTAL SERVICES FROM SY ‘12-’13 TO ‘13-’14

18%

82%

School A


Restorative Prevention

87 students with caries

38%

62%

School B




42%

58%

School C




Medicaid Enrollment

SY’12-’13 SY ‘13-’14

School A 36% 40%

School B 52% 55%

School C 63% 62%

HIGHLIGHTS OF PRELIMINARY OUTCOME ANALYSES

Preliminary Analyses Examined:

• Patterns/trends in total preventive care received by school by school year.

• Trends in sealant application rates by school by school year.

• Associations between FS care and student attendance and performance.

METHOD

• Total Care Index Score: Summation of prophylaxis, sealants, and varnish applications per study.

• Repeated Measures ANOVA used to examine changes over time in the Total Care Index Score and Sealants.

• To examine FS student performance and school attendance, we conducted exploratory analyses that assessed for differences in these outcomes by school and over time.

PRELIMINARY FINDINGS

Between school differences in total care and sealant applications existed across study years

Total care index and sealant applications generally decreased over time.

Some school level differences for some study years.

Variation in rates of existing sealants and cohort effects may explain this pattern.

There were no significant patterns in absenteeism related to oral health status

There was no correlation between total # of visits with FS and absenteeism.

PARENT INTERVIEWS

• Feedback on the value of the school-based dental hygiene program provided by Future Smiles.

• Benefits to children—oral health, education.

• Family oral health practices.

• Barriers to oral health care.

• Recommendations for improving FS services.

IN THEIR WORDS….“My son talked about the program and was really interested. To enroll I only had to sign a paper he brought home.”

“Before the program it was hard to get my son to brush his teeth, but because of the lessons they gave him explaining how to do it and how important it is, he does it!”

“Before we got educational materials from the program, I didn’t know we should change our tooth brushes every 3 months. Now we do.”

INTERVIEWS WITH TEACHERS

• Teachers/staff participating in FS activities in 2014-15

Brush at Lunch

5 respondents per school ~ 3 schools

n=15

• Phone interviews

• $25 gift cards incentive

• Future Smiles Evaluation Report

TEACHER/STAFF PERCEPTIONS

• Feedback on the value of the school-based dental hygiene program provided by Future Smiles.

• Benefits to children—oral health, education.

• Benefits to families of participants.

• Facilitators and barriers to FS services in their school.

• Recommendations for improving FS services.

IN THEIR WORDS….“Kids always come back happy from their visits with the hygienist.”

“For parents, anything that benefits the child benefits them. This area is at-risk, low socioeconomic status, money is limited. Saving money on dental care helps put food on the table. Other basic needs will be met if dental care needs are taken care of.”

“Preventative treatment helps kids have good experiences with dental professionals and they will be more willing to continue going. It avoids bad experiences and trauma.”

Student Records from Future Smiles Patients in SY 2010-2014

Attendance Rates

Nevada Criterion Reference Tests (CRTs)

Future Smiles Oral Health Records

Restorative Care

Optimal oral health (visual screening)

Number of sealants, fluoride varnish treatments and prophylaxis

Family demographics

Method for Pilot Study

State Grade-Level Achievement Tests Measures how well a child has mastered the expected

content. Aligned to Nevada State standards.

Annual Reading and Math CRT Given to students from third to eighth grade. Science once in elementary, middle and high school.

Measure How Well a Child has Learned Subject Matter Student only competes against him/herself.

NEVADA CRITERION REFERENCE TESTS (CRT TESTS)

Four Levels of Scoring Emergent/developing Approaches standard Meets standard Exceeds standard

Possible Federal Sanctions Loss of federal funds Providing free tutoring Allowing students to transfer to another schools Complete restructuring of the school

NEVADA CRITERION REFERENCE TESTS (CRT TESTS)

2012-2013 SCHOOL YEAR

0

20

40

60

80

100

120

140

160

Emerging//Developing Approaches Meets Exceeds

CRT Reading Scores- Comparison of Three Schools

School A School B School C p < 0.001

SY’12-’13

CRT Reading Standards

Visual Exam

Caries Present

Visual Exam

No Caries

Emerging 11% 13%

Approaches 9% 12%

Meets 15% 21%

Exceeds 6% 11%


0

20

40

60

80

100

120

140

160

180


CRT Reading Scores – Comparison of Three Schools


SY’13-’14

CRT Reading Standards

Visual Exam

Caries Present

Visual Exam

No Caries

Emerging 12% 13%

Approaches 9% 13%

Meets 15% 22%

Exceeds 6% 8%


0

20

40

60

80

100

120

140

160


CRT Math Scores- Comparison of Three Schools


SY’12-’13

CRT Math Standards

Visual Exam

Caries Present

Visual Exam

No Caries

Emerging 8% 10%

Approaches 11% 15%

Meets 19% 23%

Exceeds 4% 10%


0

20

40

60

80

100

120

140

160

180


CRT Math Scores- Comparison of Three Schools


SY’13-’14

CRT Math Standards

Visual Exam

Caries Present

Visual Exam

No Caries

Emerging 11% 12%

Approaches 10% 16%

Meets 18% 21%

Exceeds 4% 6%

% OF STUDENTS WHO PARTICIPATED WITH CIS

10%

95%

School A


CIS & FS FS Only

0%

100%

School B


CIS & FS FS Only

23%

91%

School C


CIS & FS FS Only

SY 2012-2013 Data

★★★★★

A composite of several performance indicators.

Maximum number of points.

Index score is the sum of all of these factors that is then measured against the star rating criteria.

NEVADA SCHOOL RATINGS

2012-2013 2013-2014

School A

School B

School C

NEVADA SCHOOL RATINGS

Positive Findings - Frequency of Visits

33%

67%

Students Seen Four or More Times by Future Smiles

Untreated Caries Present Visual Screening- No Caries

CONCLUSIONS

Confounding Factors English Language Learners Other Health Factors Family Influences Transient Population

Follow-Up Evaluation Comparative Groups to Include

o Oral Health Statuso Account for Other Health and

Disabilities in Students Comparative Socio-Economic Status

o Low Income o High Income

• Future evaluation will compare school performance between FS vs. non-FS students using a quasi-experimental design Match 3 FS schools to 1 non-FS schools with similar student

characteristics within a low socio-economic schools.

Match 1 high socio-economic school for comparison.

• Conduct a prospective study with 3rd grade students receiving FS in the intervention schools v. matched comparison schools Conduct oral health screening of all youth (FS and non-FS) at baseline.

Validate visual oral health status screening with a full oral exam performed by a dentist to ensure visual screening is a sensitive assessment tool.

FUTURE EVALUATION DESIGN

“We are shifting the focus of our country's health care system from sickness and disease to wellness and prevention.”

President Barack ObamaNational Public Health Week, 2015 Published April 6, 2015

BRIGHTER FUTURE FOR ALL

Terri Chandler, RDHFounder/Executive Director

Email: [email protected]: www.futuresmiles.net

C: (702) 521-4550

Question and Answer Session

• Questions are welcome! This session may last for 10-15 minutes.

• Write your questions in your control panel on the upper right hand of your screen.

• Submit questions at any time.

Contact Information

•Terri Chandler –[email protected]

•Tyler Brown [email protected]

mailto:[email protected]

mailto:[email protected]

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