2012 Partnering to Seal-A-Smile A report on the success of Wisconsin school-based dental sealant programs. pot

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Partnering to Seal-A-Smile2012A report on the success of Wisconsin school-based dental sealant programs.Partnering to Seal-A-Smile 2012This report was developed by Children’s Health Alliance of Wisconsin and made possiblethrough a partnership and funding from Delta Dental of Wisconsin. Delta Dental of Wisconsin is a not-for-profit dental service corporation that administersand underwrites easy-to-use, cost-effective dental plans for employers and individualsthroughout Wisconsin. Delta Dental of Wisconsin is the largest dental benefits providerin the state, covering more than 1 million employees and family members.Delta Dental supports a significant number of charitable oral health initiatives focusedon improving access to dental care and raising awareness of the importance of properoral health.The following individuals contributed to the preparation of this report:• Matt Crespin, MPH, RDH, Children’s Health Alliance of Wisconsin• Alex Eichenbaum, Children’s Health Alliance of Wisconsin• Caroline Madormo, BSN, RN, CPN, Medical College of WisconsinGraphic design and layout, Tara Goris, Children’s Health Alliance of Wisconsin2Table of contentsExecutive summary 4Background 6Methods 8Key findings 10Conclusion/recommendations 18Sealant program profiles 20• Adams County 20• Ashland County 52• Barron County 21• Bayfield County 22• Brown County 23• Buffalo County 24• Burnett County 21• Calumet County 50• Chippewa County 21, 25• Clark County 26• Columbia County 27• Crawford County 33• Dane County 28• Dodge County n/a• Door County 29• Douglas County 30• Dunn County 21, 25• Eau Claire County 25, 31• Florence County 60• Fond du Lac County 32• Forest County 60• Grant County 33• Green County 34• Green Lake County n/a• Iowa County 33, 35• Iron County 52• Jackson County n/a• Jefferson County 36• Juneau County 37• Kenosha County 38• Kewaunee County 29• La Crosse County 39• Lafayette County n/a• Langlade County 40Partnering to Seal-A-Smile 2012Partnering to Seal-A-Smile 2012• Lincoln County 41• Manitowoc County 42• Marathon County n/a• Marinette County 43• Marquette County 20• Menominee County n/a• Milwaukee County 44, 45, 46, 47, 53• Monroe County 48• Oconto County 49• Oneida County 60• Outagamie County 50• Ozaukee County n/a• Pepin County n/a• Pierce County n/a• Polk County 21• Portage County 51• Price County 52• Racine County 53• Richland County n/a• Rock County 54, 55• Rusk County 25• St. Croix County 21• Sauk County 56• Sawyer County n/a• Shawano County 57• Sheboygan County 58• Taylor County 25• Trempealeau County 59• Vernon County n/a• Vilas County 60• Walworth County 61• Washburn County 21• Washington County 53• Waukesha County 62• Waupaca County 63• Waushara County 64• Winnebago County 50, 65, 66• Wood County 672011-12 county breakdown of schools (grades 1-8) 68Seal-A-Smile map 69Seal-A-Smile logic model 7034Executive summaryThis report provides a comprehensive overview of the Wisconsin Seal-A-Smile (SAS) program. Theinformation highlights the program’s expansion and key findings identified through analysis ofannual data from 2005-10. Continued expansion of programs will help reach populations withoutaccess to regular preventive care.This report highlights the tremendous work being accomplished throughout Wisconsin despitelimited resources, and builds on the previous report released in 2009. After the release of theprevious report, additional federal and private funding for Wisconsin SAS was secured. Thesefindings demonstrate how additional funding can make a significant difference. The findings in thisreport substantiate the need for continued state and private funding for school-based oral healthprevention programs.What you will find in the this reportThis report provides an overview of the success school-based oral health prevention programs havehad since 2005. Key findings focus on caries rates, children served, sealant retention rates and otherefficiency measures. Data was collected from current and past Wisconsin SAS programs, in additionto other school-based programs not funded through SAS. Please note, instead of using both years todenote school year, we reference the year of the fall semester. For example, 2010-11 is referred to asthe 2010 school year. Key findings from the 2005-10 school years:• The number of schools served by Wisconsin SAS increased from 135 to 406.• The number of schools served by Wisconsin SAS with free and reduced lunch (FRL) rates ofgreater than 50 percent increased from 48 to 229. • The number of children and youth with special health care needs (CYSHCN) served byWisconsin SAS increased from 261 to 3,248.• The overall average cost to deliver sealants increased from $89.37/child to $110.49/child. • The average amount of Medicaid reimbursement received by programs increased from$17.40/child to $59.94/child due in part, to the ability of dental hygienists to becomeMedicaid providers.• The number of children screened and sealed increased significantly.• The percentage of children screened with untreated dental decay decreased from 40.8percent to 35.4 percent.• The number of children who received fluoride treatments in addition to dental sealantsincreased from 3,304 to 23,499.• The proportion of children with either Medicaid or SCHIP (BadgerCare Plus) insurancecoverage participating in Wisconsin SAS increased from 53.4 percent to 69.5 percent.• The number of children who received oral health education quadrupled from 9,404 to 37,599.• Sealant retention rates increased from 76.1 to 92.9 percent.Partnering to Seal-A-Smile 2012Partnering to Seal-A-Smile 2012Testimonial"The value of Just Kids Dental (Douglas County) program is difficult to express. Wehave many children in our school district who have never been to a dentist. Withoutthis great program and their ability to work with community resources, many of thechildren who have received quality services would have never received oral healthcare. The dental staff have a wonderful way of making our students feel comfortableso each student remains positive about dental care. Our younger students even teaseabout who gets to go first in the dental chair!"Nancy SmithDirector of Health ServicesSchool District of Superior56BackgroundChildren’s Health Alliance of Wisconsin (Alliance) is the statewide voice for children’s health. The Allianceraises awareness, mobilizes leaders, impacts public health and implements programs proven to work.Since 1994, the Alliance has led efforts to improve access to oral health care for underserved children inWisconsin. Efforts include coalition building, policy development activities and program management. In2005, the Partnering to Seal-A-Smile grant was awarded to the Alliance by Delta Dental of Wisconsin toevaluate the effectiveness of the Wisconsin Seal-A-Smile (SAS) program and bring attention to the needfor increased school-based oral health programs.Since 2000, the Alliance has administered the Wisconsin SAS program in collaboration with the WisconsinDepartment of Health Services (DHS), Oral Health Program. The Alliance provides program oversight,technical assistance and data collection for approximately 42 school-based dental sealant programsannually. The SAS program targets low-income, uninsured children who attend schools with high FRLrates. Wisconsin SAS defines high-risk schools as those with FRL rates 35 percent and greater. In additionto sealant application, all children receive topical fluoride applications and oral health education. Aselect number of programs also provide dental cleanings and restorative services. Medicaid billing isutilized by all programs to help ensure sustainability. Volunteer time and match dollars account fornearly 75 percent of the true costs to run Wisconsin SAS programs.Sealant application is considered an evidence-based, preventive strategy for children and commonlyused in private practice dentistry. Low-income, uninsured children have difficulty accessing privatepractice dentistry and are denied the benefits of regular dental preventive strategies, including sealants.The Wisconsin SAS program is helping Wisconsin achieve its Healthiest Wisconsin 2020 oral healthobjectives. The first objective states that by 2020, the state will “assure access to ongoing oral healtheducation and comprehensive prevention, screening and early intervention, and treatment of dentaldisease in order to promote healthy behaviors and improve and maintain oral health.” According to theWisconsin 2008 Make Your Smile Count survey, the percentage of Wisconsin’s third grade children withuntreated decay decreased from 31 to 20 percent between 2001 and 2007.The second Healthiest Wisconsin 2020 objective states that by 2020, the state will “assure appropriateaccess to effective and adequate oral health delivery systems, utilizing a diverse and adequate workforce,for populations of differing races, ethnicities, sexual identities and orientations, gender identities, andeducational or economic status and those with disabilities.” This objective can partially be measured bythe percentage of Wisconsin schools with a dental sealant program. Nationally, Healthy People 2020 calls for the number of school-based dental sealant programs toincrease. Oral health objective number eight states the country will strive to “increase the proportion oflow-income children and adolescents who received any preventive dental service during the past year.”Oral health objective number 12 calls for the “increase in the proportion of children and adolecents whohave received dental sealants.” The Wisconsin SAS program has increased both the number of high-riskschools served, as well as the number of children receiving Medicaid or SCHIP (BadgerCare Plus)assistance served. Partnering to Seal-A-Smile 2012Partnering to Seal-A-Smile 2012The Alliance manages state general purpose revenue (GPR) targeted to fund school-based sealantprograms. The dollars are subcontracted to the Alliance through DHS and subsequently awarded tocommunities through a request for proposal process released each spring. Beginning in 2000, $60,000 ofGPR was allocated annually from the state budget. In 2005 this amount doubled to $120,000, as a resultof Governor Jim Doyle’s Kids First Initiative. However, due to budget cuts, GPR funding in 2011 wasreduced to $106,720. In the 2006 school year, SAS funding again increased to approximately $200,000 due to Wisconsinreceiving a Health Resources and Services Administration (HRSA) three-year oral health workforce grant.In 2009, HRSA funding increased to $241,000, which Delta Dental has matched annually. Beginning in the2012 school year, HRSA funding will end and GPR funding will be increased by $250,000 to fill the void.Delta Dental has agreed to match this funding for the 2012 school year. Awards to community programs, as determined by a review committee, have ranged annually from$1,000 to $75,000 depending on the needs of the individual program. The number of communityprograms funded each year has increased from 12 to 42 with requests for dollars surpassing thoseavailable.As part of the Partnering to Seal-A-Smile grant, Delta Dental generously provided annual funding for 500uninsured children in urban Milwaukee schools to receive dental sealants. This funding allowed theSmart Smiles program, operated by Columbia St. Mary’s - St. Elizabeth Ann Seton Dental Clinic, toincrease the number of children served and expand their scope of service. Over the five years of funding,Smart Smiles treated over 3,000 uninsured children.Individual program profiles, beginning on page 20, highlight program accomplishments and bestpractices. While there are common elements to all school-based dental sealant programs, each isuniquely designed based on individual community needs and resources.7$0 $100,000 $200,000 $300,000 $400,000 $500,000 $600,000 $700,000 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 Annual Wisconsin SAS funding HRSA funding Delta Dental funding GPR funding School year 8MethodsThe SAS logic model found on page 70 shows funding sources, activities, outputs and outcomes thathave assisted with the design of this report. The following outcomes were evaluated:• Number of schools served and the FRL rates of those schools.• Number of CYSHCN served.• Number of students screened and sealed.• Number of children with untreated decay and severity of disease.• Insurance status of children participating.• Proportion of children retaining sealants placed by Wisconsin SAS programs. • Number of students receiving oral health education.In 2003-04, the Centers for Disease Control and Prevention (CDC) developed the Sealant EfficiencyAssessment for Locals and States (SEALS) electronic data collection tool. Wisconsin programs wereused as a model for the creation of SEALS. Wisconsin DHS, the Alliance and nine communityprograms worked intensely to retroactively collect data from the previous three years of the SASprogram. SEALS software has been marketed as a user-friendly tool to standardize sealant datacollection throughout the nation.SEALS calculates cost-effectiveness, efficiency measures, disease burden and demographicinformation. Wisconsin communities collect this information and forward it electronically to theAlliance. The data assists in policy development and evaluation of programming.SEALS data was used to evaluate the outcomes identified for this report. Data from non-fundedprograms also was collected through self-reporting by individual program managers. The Alliancecontinues to work with non-funded programs, in an attempt to integrate SEALS into their programs.Some non-funded programs have agreed to utilize SEALS, allowing continuity in data collectionstatewide.Partnering to Seal-A-Smile 2012Partnering to Seal-A-Smile 2012Testimonial“The day we had our school-based dental program dream fulfilled was amazing! Theregistered dental hygienists were so professional, friendly, wonderful with thechildren and incredibly efficient! The very best thing of all was that about one third ofour student body took advantage of this program and received treatment theyotherwise may not have gotten. The teacher who helped coordinate the programmade a personal contact with the parent(s)/guardian(s) of those students at higherrisk, explaining the importance of receiving care. We were so impressed that the providers came back six weeks later to follow throughwith a few additional treatments that needed to be administered. Taking on that kindof responsibility of follow-up care is admirable. On that day, one of the hygienistsidentified a situation happening with one of our student's front teeth and suggestedhis guardian be contacted right away. This was done by the teacher coordinator. Partof the challenge is it was taking so long for the guardian to get an appointment for thestudent, a common problem in our area of the city. The guardian called the dentistagain and was able to get in sooner due to this urgent need being identified.We are so grateful that we will be able to work with Preferred Dentistry(Milwaukee/Racine/Washington Counties) next school year. This has truly been one ofthe most positive programs we have ever participated in and we are forever thankfulto everyone who does their part to help make it possible. We hope that this programwill continue in the future. God bless you for all of your efforts to help take care of ourstudents' dental needs through this very unique and important program.”Katie FoxeRemedial and Resource Teacher / Coordinator of Special ServicesChrist Memorial Lutheran School9[...]... education n /a Untreated decay n /a Urgent needs n /a Retention rate n /a Program notes The program is coordinated by a dental hygienist at the local public health department The coordinator provides oral exams, sealants, fluoride varnish applications and oral health education The program targets all children at area schools Separate funding was secured by the county to fund the delivery of restorative care by... rate n /a Program notes The program is coordinated by a dental hygienist contracted by the local public health department The coordinator and volunteer dental hygienists provide oral exams, sealants, fluoride varnish applications and oral health education The program targets all children in second and fifth grade at area schools In 2010, the program did not require SAS funding, as other inkind donations,... provides oral exams, sealants, fluoride varnish applications and oral health education The program targets all children in second and fifth grade at area schools The program has expanded since its inception in 2009, and anticipates providing sealants to 120 children in the current school year Collaborating partners include local schools, dentists and several of the Marshfield Clinic Dental Centers Partnering. .. American Dental Association and CDC recommendations for school-based sealant programs Programs are no longer able to use self-etch products and have implemented tooth selection and material selection protocols based on the new recommendations These are possible contributing factors to the improved retention rates being observed in SAS programs statewide In 2009, Wisconsin SAS implemented a policy to improve... Oral health education 56 Untreated decay 23.1% Urgent needs 15.4% Retention rate 92.7% Program notes The program is coordinated by a dental hygienist contracted by the local public health department The coordinator provides oral exams, sealants, fluoride varnish applications and oral health education The program targets all children in second and fifth grade at one area school The Buffalo County SAS program... Fluoride treatment 113 Oral health education 234 Untreated decay 29.2% Urgent needs 0.0% Retention rate n /a Program notes The program is coordinated by a dental hygienist contracted by the local public health department The coordinator provides oral exams, cleanings, sealants, fluoride varnish applications and oral health education The program targets all children in second through sixth grade at area schools... funding has increased by $250,000 to replace HRSA funding ending July 2012 Delta Dental will again match this increase in 2012, allowing for nearly $600,000 in funding to be awarded to local programs Many • • • • of the recommendations in the 2009 Partnering to Seal -A- Smile report have been achieved An increase in GPR funding will take place in the 2012 state fiscal year All programs are now required to. .. donations, grant funding and Medicaid billing sustained the program The SAS program provided funding to collect data using SEALS to ensure statewide data is collected uniformly The program receives ongoing technical assistance through this collaboration with the SAS program Collaborating partners include area dental providers, Head Start, United Way and local schools Partnering to Seal -A- Smile 2012 Fond... used to provide dental services across northwestern Wisconsin The program targets all children at area schools The SAS program is a portion of RHDC’s overall oral health program that also serves Head Start children, pregnant women and other low-income adults and seniors in rural Wisconsin Collaborating partners include local dental clinics, schools and public health departments Partnering to Seal -A- Smile. .. Crawford and Iowa Counties The coordinator provides oral exams, sealants, fluoride varnish applications and oral health education The program targets all children in second and fifth grade at area schools The program has expanded since its inception in 2009, and anticipates providing sealants to 175 children in the current school year Collaborating partners include local schools and public health departments . Partnering to Seal -A- Smile 2012 A report on the success of Wisconsin school-based dental sealant programs. Partnering to Seal -A- Smile 2012 This report. awarded to the Alliance by Delta Dental of Wisconsin to evaluate the effectiveness of the Wisconsin Seal -A- Smile (SAS) program and bring attention to the
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