Getting a Head Start on Oral Health:
An Overview of Oral Health Requirements
and Programs
The National Center on Health
Reg Louie, DDS, MPH
Harry Goodman, DMD, MPH
Bev Isman, RDH, MPH, ELS (facilitator)
UCSF Dental Public Health Seminar
October 15, 2013
What is Head Start
•
Head Start (HS) is a federal program that promotes the school
readiness of children ages birth to five from low-income families
(living at 100% or below the federal poverty level) .
•
HS programs provide a learning environment that supports
children's growth in the following domains:





Language and literacy
Cognition and general knowledge
Physical development and health
Social and emotional development
Approaches to learning
Source: Copied from ECLKC website: http://eclkc.ohs.acf.hhs.gov/hslc/hs/about
History of Head Start
•
HS began as a summer demonstration project in 1965 as part of
Lyndon Johnson’s War on Poverty.
•
Since 1965, HS has served nearly 30 million children. Currently,
HS is administered by the Admin. for Children and Families (ACF)
within the Dept. of Health and Human Services (HHS) and serves
over 1 million children annually in all 50 states, US territories,
and AI/AN and Migrant communities.
•
HS was reauthorized in 2007 with several provisions to
strengthen HS quality. The HS training and technical assistance
system was redesigned to support programs through six National
Centers and a state-based system to ensure success.
Source: Copied from ECLKC website: http://eclkc.ohs.acf.hhs.gov/hslc/hs/about/history
Head Start Services
•
HS programs provide comprehensive services to enrolled
children and their families, which include:
 Education and cognitive development services
 Health, nutrition, social, and other services
•
HS emphasizes the role of parents as teachers, and
programs build relationships with families that support:



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Family well-being and positive parent-child relationships
Families as learners and lifelong educators
Family engagement in transitions
Family connections to peers and community
Families as advocates and leaders
Source: Copied from ECLKC website: http://eclkc.ohs.acf.hhs.gov/hslc/hs/about
Head Start Service Models
• HS serves preschool-age children (3 – 5 years) and their
families. Early Head Start (EHS) serves infants, toddlers
(up to 36 months), pregnant women, and their families.
• HS programs offer a variety of service models.
Programs may be based in:
 Centers or schools that children attend for part-day or
full-day services
 Family child care homes
 Children's own homes (home-based model), where a HS
staff person visits once a week and provides services
Source: Copied from ECLKC website: http://eclkc.ohs.acf.hhs.gov/hslc/hs/about
HS Program Performance Standards
•
•
The HS Program Performance Standards provide a standard
definition of quality services that all EHS and HS grantees are
required to follow.
HS performance standards related to oral health include:
 Within the first 90 days of enrollment, HS must determine
whether each child has an ongoing source of continuous,
accessible care (“dental home”)

HS staff should ask the parents the following in order to determine if
children have a “dental home”
 Name of dental provider?
 Date of last dental visit?
 How often does the child visit the dentist?
HS Program Performance Standards
 Within the first 90 days of enrollment, a health
care professional must determine if a child is up to
date on preventive and primary oral health care
according to state Early and Periodic Screening,
Diagnostic, and Treatment (EPSDT or Medicaid)
schedule
 Health care professionals and HS staff access their
state's EPSDT schedule to ensure children's health and
dental needs are met
 http://eclkc.ohs.acf.hhs.gov/hslc/states/epsdt
HS Program Performance Standards
 Dental follow-up and treatment must include
topical fluoride treatments as recommended by
a dental professional
 Head Start must establish ongoing
communication with parents of children with
identified dental needs to facilitate the
implementation of the plan
 Education of HS staff, case management
systems, and documentation are vital to this
process
HS Program Performance Standards
 If a child is not up to date on age-appropriate
preventive and primary care (EPSDT), HS must
help parents bring the child up to date within the
first 90 days of enrollment
 e.g., Assists with Medicaid/CHIP application,
transportation, finding a dental provider, etc.
 Head Start must obtain or arrange further
diagnostic testing, examination, and treatment for
each child with health/dental problem
 Dental follow-up remains one of the biggest challenges
for Head Start parents and staff
YES
NO
YES
ACTIO
N
 Toothbrushing
 Gum Wiping
 Healthy Drinks
 Healthy Food
 Healthy Snacks
 Lift the Lip
 Other
Reinforce or choose
new goal:
ACTIO
N
 Toothbrushing
 Gum Wiping
 Healthy Drinks
 Healthy Food
 Healthy Snacks
 Lift the Lip
 Other
Reinforce or choose
new goal:
Home visit 
Dental visit 
Parent conference 
Informal contact 
School meeting 
Home visit 
Dental visit 
Parent conference 
Informal contact 
School meeting 
Home visit 
Dental visit 
Parent conference 
Informal contact 
School meeting 
Home visit 
Dental visit 
Parent conference 
Informal contact 
School meeting 
DATE
DATE
DATE
DATE
Give Parent
Form to be
Signed by
Dentist
MEETING ORAL
HEALTH
REQUIREMENTS
Family Oral
Health
Educat ion
Toothbrushing 
Gum Wiping 
Healthy Drinks 
Healthy Food 
Healthy Snacks 
Lift the Lip 
Other

Reinforce or choose
new goal:
NO
Keep
Appointment
Get Signed
Form
Prevent ive
Ser vices
NO
Secure
Services in:
 Dental home
 Classroom
DATE
YES
Reinforce or choose
new goal:
Toothbrushing 
Gum Wiping 
Healthy Drinks 
Healthy Food 
Healthy Snacks 
Lift the Lip 
Other

Make
Appointment
ACTIO
N
Document
Dental
Home
Time






Fluoride Treatment
Toothbrushing
Gum Wiping
Sealants
Parent Education
Professional Dental
Cleaning
 Other
Date
CHILD’S NAME
 Fluoride Treatment
 Toothbrushing
 Gum Wiping
 Sealants
 Parent Education
 Professional Dental
Cleaning
 Other
Date
 Fluoride Treatment
 Toothbrushing
 Gum Wiping
 Sealants
 Parent Education
 Professional Dental
Cleaning
 Other
ACTIO
N
ACTIO
N
NO
ACTIO
N
ACTIO
N
Parent
to Secure
Dental Home
YES
Oral Exam
ACTIO
N
ACTIO
N
Dental
Home
Provide
Dentist List
(see I-Smile)
CONGRATULATIONS!
ACTIO
N
ACTIO
N
Enroll in
Medicaid/
Hawk-i/CHIP
Appointment Date
ACTIO
N
Insurance Provider
ACTIO
N
ACTIO
N
Determine
Insurance
Status
ACTIO
N
FOLLOW UP
TREATMENT
REQUIRED?
Phone
ACTIO
N
Dentist Name
Date
US Children: Decay Trends for Primary (Baby) Teeth
Caries in children aged 2 to 5 years increased
from 24 percent to 28 percent between 19881994 and 1999-2004
(CDC - 2007)
HS Program Information Reports (PIR)
 The PIR provides comprehensive data on the
services, staff, children, and families served by
EHS / HS programs nationwide. All grantees and
delegates are required to submit PIR reports to
the HHS OHS annually.
Self-reported data
 The PIR data is compiled for use at the federal,
regional, state, and local levels.
http://eclkc.ohs.acf.hhs.gov/hslc/mr/pir
HS Program Information Reports (PIR)
Oral Health PIR data requirements:
 Number of children age 3 and older who
received preventive oral health care
 Number of children age 3 and older who need
dental treatment
Of those, how many children received or are
receiving dental treatment
Reason children did not receive dental treatment
Program Information Reports (PIR)
Oral Health PIR data requirements:
Number of children age 3 and older up-to-date
on preventive and primary oral health care based
on state EPSDT schedule (age varies by state)
Number of pregnant women who received an
oral exam or treatment (EHS)
Program Information Reports (PIR)
2012 Statistics (Self-Reported Data)
 91% have a dental home
 87% receive dental exams
 20% are diagnosed as needing treatment
 81% are receiving or have received care
 85% receive preventive care
 79% children 0-2 Up-to-Date on Dental EPSDT
Schedule
 40% pregnant women completed dental exam
Head Start and Oral Health
Head Start directors, staff, and
parents report oral health issues as
one of their biggest challenges
 Finding dentists that
 See young children
 Accept Medicaid
 Have extended hours
 Following up on needed treatment
Photo Credit: Jane September |
Stock Free Images & Dreamstime
Stock
Head Start and Oral Health
Dentists and their staff report the following issues:
 Don’t feel comfortable treating young children
May not have received adequate education
 Parents canceling or not keeping appointments
 Inadequate Medicaid reimbursement to cover
services
 Believing that oral health is not important to
parents
Head Start and Oral Health
Parents report the following issues:
 Dental office staff are not friendly or welcoming
 Explanations and instructions are hard to
understand
Too technical
Not in the language they speak
 Transportation is difficult or impossible
 Difficult to miss work for dental appointments
 Oral health care is too expensive
Challenges
 Maintaining open and clear communication
between Head Start staff, oral health
professionals, and parents
 Debunking myths and misperceptions
 Reducing barriers to accessing oral health care
for children
 Engaging parents in their child’s oral health,
and increasing their confidence and skills
 Preventing oral diseases and injuries
Dental Office Factors
 Attitudes toward and experiences with Medicaid
 Ability of dentists and dental office staff to
effectively work with infants and young children
 Compliance with Head Start oral-health-related
program performance standards, including
documentation
 Communication with parents (e.g., explaining
how to be a good oral health consumer)
Dental Home and the PIR
 A dental home is defined as a continuous and
accessible source of dental care. Families need to
know where they would take their child if they had a
dental emergency and also where they will take their
child for dental services after they graduate from
Head Start.
 What if you provide dental exams
at the center and some children
don’t have to go to the dentist?
Mobile Dental Programs
 Is a mobile dental program a dental
home?
 A few cautions…
Dental Exams:
Different ways to get there
 Work with families to schedule appointments and
take their children individually to the dentist.
 Provide dental exams onsite by inviting the
local dental staff to the center
 Arrange to take the children in groups to the
dental clinic for their exams.
Preventive Care
Different Ways to Get There
 Daily brushing with fluoride
toothpaste in the center
 Fluoride Varnish
applications 3-4 times a
year
www.ihs.gov/headstart
www.ihs.gov/doh/ecc
Dental Treatment:
Different Ways to Get There
 Have families schedule treatment appointments and
take their children to the dentist individually.
 Work with families to obtain informed consent and then
Head Start can transport children to the dental clinic for
routine treatment.
OR…thinking outside of the box
 Discuss less invasive treatment options with your local
dental staff so that more children can be treated quicker,
avoiding referrals to pediatric dentists.
Effective Family Engagement
 Most health education
is overwhelming and
endless information
that may not be
understood or
remembered.
Programs
Technical Assistance
Office of
Head
Start
Training & Resources
Monitoring
Research and Evaluation
Training and Technical Assistance
Indirect Support
Direct Support
National T/TA Funding
Regional T/TA Funding
National
Centers
Other
Initiatives
Early
Childhood
Education
Specialists
Grantee
Specialists
Office of Head Start National Centers
• Program
Management and
Fiscal Operations
• Quality Teaching
and Learning
• Cultural and
Linguistic
Responsiveness
• Early Head Start
PMFO
CLR
QTL
EHS
• Parent, Family,
and Community
Engagement
PFCE
• Health
NCH
National Center on Health
OHS Priority Health Issues
 Healthy active living
 Developmental and behavioral health
 Safety and injury prevention
 Health literacy
 Oral health and dental homes
 Asthma prevention with special emphasis
on tobacco exposure prevention
National Center on Health Partners
 American Academy of Pediatrics
 Education Development Center, Inc.
 Center for Child and Human Development at Georgetown
University
 UCLA Health Care Institute at the UCLA Anderson School of
Management
 National Training Institute for Child Care Health Consultants at
The University of North Carolina at Chapel Hill
 National Maternal and Child Oral Health Resource Center at
Georgetown University (OHRC)
 Association of State and Territorial Dental Directors (ASTDD)
Association of State and Territorial
Dental Directors (ASTDD)
 National non-profit organization representing SOHPs and
other partners
 Assistance to state oral health programs (SOHP) in
improving the oral health of all residents through:
 Community focused disease prevention programs
 Improved access to care
 Development of competent dental public health infrastructure
 Worked with Head Start programs from 2002-2008 through
the OHS/HRSA IAA
 Subcontractor to OHRC for Head Start Oral Health Project
State Oral Health Programs (SOHPs)
 A unit of state government usually in the health dept.
 Assess and track dental disease rates
 Promote and support education, prevention and access to
care services
 Use evidence-based strategies to promote best oral health
practices and policies
 Build public and private partnerships to promote and
support state and local programs and policies
 Assure adequate & competent oral health workforce
What SOHPs and HS Programs Give Each Other
 Best practices
 Education of families, HS teachers/staff, dental and
other health professionals
 Workforce development
 Data and surveillance
 Insurance and access (Medicaid/SCHIP)
 Coordination, collaboration, and leadership
 Funding
 Linkage to dental professionals and HS personnel
Oral Health Project Activities
1. Use a three-pronged approach targeting parents,
programs, and providers within a framework for oral
health activities that includes disease prevention and
management, access to care, and systems integration.
2. Focus on the oral health needs of infants, children, and
pregnant women enrolled in Head Start.
Oral Health Project Activities (continued)
3. Establish and maintain a communication network at the
national, regional, and state levels to share information
with national organizations, regional offices, Head Start
state collaboration offices, state Head Start
associations, state oral health programs, health
professionals, and others about Head Start oral health
issues.
4. Collaborate with the American Dental Hygienists’
Association to use volunteer dental hygienist contacts in
each state to serve as primary information conduits
between NCH and state contacts.
What is the Role of the Head StartDental Hygienist Liaison?
 Dental hygienists in every state
are serving in volunteer roles to:
 Provide a communication link
between NCH and Head Start oral
health activities and programs.
 Collaborate with state organizations
and ongoing networks (e.g., Dental
Home Initiatives), including state
dental directors and Head State
state collaboration office directors,
to address prevention and accessto-care issues.
What is the Role of the Head StartDental Hygienist Liaison?
 Dental hygienists in every state
are serving in volunteer roles
to:
 Assist in promoting evidencebased preventive and
educational services to Head
Start statewide.
 Share links to resources with
Head Start and other partners
to improve consistent
messaging on oral health.
Oral Health Project Activities (continued)
5. Seek guidance about ways to
accomplish oral health program
activities, with particular
attention to the unique needs of
American Indian and Alaska
Native Head Start programs,
Seasonal and Migrant
Farmworker Head Start programs,
and children with special health
care needs.
Disease Prevention and Management
 Collaborate with organizations to widely distribute
NCH evidenced informed information and
materials.
 Assist in locating policy statements, guidelines,
training materials, and new research, and
disseminate these.
 Present at national and regional trainings.
Access to Care
 Contact key individuals in each state to
determine their ability to assist with T/TA,
linking programs to dental homes, and other
Head Start activities.
 Collaborate with organizations to increase the
involvement of federally qualified health
centers with Head Start programs.
Access to Care (continued)
 Continue to gather input from the Office of Head
Start, national organizations, and key informants
on strategies to develop a system of oral health
care and oral health services for Head Start, as well
as methods of tracking outcomes.
 Continue to collect, review, and share promising
and successful state and local models and practices
via the Early Childhood Learning & Knowledge
Center, newsletters, and presentations.
Access to Care (continued)
 Continue to collaborate with state Medicaid and
Children’s Health Insurance Programs (CHIPs), state
oral health programs, state dental associations, and
others to support the Centers for Medicare &
Medicaid’s Oral Health Initiative to increase the
number of Head Start participants enrolled in Medicaid
or CHIP who receive preventive oral health services.
 Promote work force, case management, and
reimbursement models that increase access
to/completion of care.
Systems Integration
 Summarize and analyze Head Start program
information report oral health service data to
identify national/regional trends, successful
programs, and programs needing TA.
 Promote T/TA on valid tools to collect data on the
oral health of children enrolled in Head Start that
will allow for comparisons across states and can be
submitted to the National Oral Health Surveillance
System.
Cross-Cutting Issues
 Share links to resources, and promote
inclusion of Head Start and perinatal/early
childhood oral health information in learning
modules for students and residents.
 Encourage dental manufacturers, insurers,
grantmakers, and others to contribute or
leverage resources for Head Start activities.
Resources for Head Start Staff, Health Professionals, and Families

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



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Resource guide
Curricula
Tip sheets
Newsletter
Booklet and poster
Orientation guides
Brochures
Website
Oral Health in Head Start: A Resource Guide
 Journal articles
 Material descriptions and
contact information
 National initiative and programs
 Policy
 Professionals education, tools, and
training
 Public education
 Surveillance
 Organization descriptions
and contact information
National Center on Health
Contact Information
Toll-Free: 888-227-5125
Email: nchinfo@aap.org
Website: http://eclkc.ohs.acf.hhs.gov/hslc/ttasystem/health/center
Dental Public Health Competencies
I.
II.
III.
IV.
V.
VI.
VII.
VIII.
IX.
X.
Plan OH Programs for populations
Select interventions and strategies for the prevention and control of
oral diseases and promotion of oral health
Develop resources, implement and manage oral health programs for
populations
Incorporate ethical OH standards in oral health programs and
activities
Evaluate and monitor dental care delivery systems
Design and understand the importance the use of surveillance
systems to monitor OH
Communicate and collaborate with groups and individuals on oral
health issues
Advocate for, implement, and evaluate public health policy,
legislation, and regulations to protect and promote the public's oral
health
Critique and synthesize scientific literature
Design and conduct population-based studies to answer oral and
public health questions
Still Have Questions?
 Contact Information:
Dr. Reg Louie
reglouie@sbcglobal.net
Dr. Harry Goodman
harry.goodman@maryland.gov