Oral Health Promotion
Plan: Michigan Family
Resources
Jennifer Smits, RDH
University of Michigan E-Learning Program
HYGDCE 485 Sp10
1
Introduction
Head Start (HS) Programs began in 1964 as a federal matching grant program. The focus of HS
programs is to improve the social skills, learning skills, and health status of children who qualify. 1 This
program developed as part of the “War on Poverty,” which over the years, has received great bipartisan
and public support.1 Because this program is federally supported, there are eligibility requirements in
order to be selected to participate in this program. The U.S. Department of Health and Human Services
developed The Head Start Act, which involved income eligibility and poverty guidelines.2 Table 1
outlines the Head Start Family Income Guidelines.2
Table 1
Federal Family Income Guidelines for 2009
2009 Poverty Guidelines for the 48 Contiguous States and the District of Columbia
Persons in Family Poverty Guideline
1
$10,830
2
$14,570
3
$18,310
4
$22,050
5
$25,790
6
$29,530
7
$33,270
8
$37,010
For families with more than 8 persons, add $3,740 for each additional person.
Once it has been determined that the eligibility requirements have been met, it is necessary to file an
application. The program would then contact the individuals who are accepted.
Demographics
Population Trends: Kent County has a wide assortment of races. Figure 1 below illustrates
estimates of the current population.
Figure 1: Kent County Population
Trends
White
Black
Native American
Asian
Pacific Islander
Multiracial
Hispanic
Information taken from www.accesskent.org
2
Kent County comprises 16.4% of the total Michigan population.3 The majority is of Caucasian race
(73.90%) while the next largest group is Hispanic (8.60%), followed by African American (8.48%). Kent
County is the fourth largest in Michigan and is rapidly growing.3 Age distribution is as follows: According
to the U.S. Census Bureau, 7.8% of the population is under the age of 5, 22.3% from 5-10 years of age,
14.1% 20-29, 14.0% 30-39, 15.4% from 40-49, 12.1% 50-59, and finally 14.1% were 59 years of age and
older.3
Education also is an important component of the demographics of a county. The percentage of at
least a high school level of education includes 84.9% of those 25 years of age or older in Kent county.
24.3% of those 25 and older have obtained a bachelors degree. 15.1% of those 25 and older have not
received a high school diploma. Education often determines family income. Kent County’s average
household income is $46,826 with a median income for a family averages $57,288.3 The population
percentage below the standard poverty level is at 12.9% in which of the total poverty population, 36.2%
are under the age of 18 and 6.80% are 65 or older.
Oral Health Status
Michigan continually ranks second highest in the country for oral health disparities and access to
oral health care facilities’. One in nine children who are in the third grade also demonstrate symptoms or
signs on dental infection, swelling, and pain.4 The American Academy of Pediatric Dentistry and
American Association of Pediatrics recommends that children be seen by a oral health professional for
proper assessments and evaluations of children’s’ health during their first year of life. 5 Healthy People
2010 have set objectives to reduce childhood decay through education and prevention. 6
In the U.S., children with dental-related illness lose approximately 51 million school hours a year.6
Untreated dental disease in children can cause pain/dysfunction, problems concentrating, time away from
school, poor appearance--all of which have a big impact on their quality of life and ability to succeed. 7 If
educated, parents may view oral health disease (i.e. tooth decay) as a serious enough phenomena to
impede with every day health, wellness, and ability to attend school; therefore they are more likely to
endorse and attend oral health education programs.8
Barriers to Care
The Center of Disease Control (CDC) is a federal agency responsible for promoting oral health
through constant efforts to reach those most affected by oral health disparitites. 9 The article entitled
Chronic Disease Prevention and Health Promotion from the Center for Disease Control discusses’ how
cost is a major deterrent to being able to access oral health care for many Americans. 9 With 12.9% of
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Kent County being at or below what is considered the average poverty level, dental visits may not be a
top priority.3 Geographic access to oral health care facilities is also a common barrier to care. Kent
County offers the GO! Bus; this is a public transportation route sponsored by Kent Counties community
health care, which could help improve access to health care facilities.3 The Go! Bus information will be
given to the parents with children at MFR during their oral health prevention presentation in the power
point outline.
Vulnerable Population
There are certain populations in communities who are at an increased risk for oral disease and
who experience obstacles in gaining access to oral health care. These populations include: low income
families, the uninsured or underinsured, those with special needs, elderly, and minorities. 6 The Surgeon
General of the United States has spoken of a “silent epidemic” of oral disease which is affecting our most
vulnerable citizens, particularly children living in poverty, and members of racial and ethnic minority
groups.3,10 Those who are uninsured are those particularly suffering from poor oral health.6 Children
who do not have insurance are also 2.5 times more likely to suffer from untreated oral disease than
children who have insurance.6 Nationally, 37% of poor children aged 2 to 9 have one or more untreated
decayed primary teeth, compared to 17% of non-poor children.11 These groups correspond with those
involved in HS/EHS programs.
An increased chance for optimal oral health can be obtained by providing health/nutrition
education and information on access to care through HS Programs. “Most Head Start children are eligible
for dental care through Medicaid and its Early and Periodic Screening, Diagnosis and Treatment program
or the State Children’s Health Insurance program.”12 Once screened, parents/caregivers can find out
what locations in Kent County provide dental care to those with special considerations such as HS/EHS
participants. This information can be found on the Michigan Dental Association website that states who
accepts (or participates with) MIchild, Medicaid, or other state funded programs.13 Bilingual staff is
available to accommodate those at MFR where English is not their primary language (Spanish and
Vietnamese are available). In Kent County alone there are 17 Health/Dental Clinics existing.13
Stressing the importance of the link between oral health and systemic (general) health is crucial.
The correlation is important to educate parents/caregivers so they are informed of the magnitude and
seriousness of oral disease. Too often parents/caregivers are unaware that good oral health is essential
to good overall health, and fail to recognize that oral health problems contribute to other diseases such as
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heart disease, diabetes and stroke, and are associated with serious problems for newborns. Yet, oral
disease is preventable.10
Michigan Family Resources
Michigan Family Resources (MFR) is a Kent County, Michigan based Head Start (ages 3-4) and
Early Head Start (age’s birth-3/pregnant women) Program that focuses on holistic, family-centered
services in a supportive environment for children and low-income families. It is a very welcoming
environment with colorful pictures on the walls and very friendly staff. There are numerous classrooms at
MFR that provide an excellent learning environment for the children with educational toys, videos, etc.
The focus of this program is to provide thorough education/support for a good start in life which includes
comprehensive education systems and health services. Trainings for providing proper/up-to-date
education and information are scheduled periodically throughout the year for staff. 14 These training
sessions would benefit from having new oral and systemic health information that will be provided in the
Oral Health Promotion Plan. Monthly meetings are also open for parents to attend at MFR as well. These
meetings are to engage parents on current issues/information regarding the health and well-being of their
children. These monthly meetings would be a great opportunity to implement preventive dentistry and
tooth healthy nutrition information for parents.
The learning process at MFR revolves around health, education, and parent involvement to
prepare children of low income families for success in school and life. Love et al describes the basic
mission of a Head Start and Early Head Start (EHS) Program as the following: “Mission is to focus on
enhancing children’s development while strengthening families.” 15 The Oral Health Project’s mission is to
increase availability prevention information (i.e. dental decay brochures) for parents, children, and
teachers involved with the HS and EHS program. MFR’s health services program manager stated one of
the main objective that needs to be met is informing parents of effective oral health habits and tooth
friendly nutrition so they can demonstrate this for their children, who are dependent on their care.
Those who participate in MFR are in need of increased access to services and health promotion
activities to assist them in attaining and upholding oral health.14 According to the HS program manager,
many of the staff and their families have limited access to oral health resources and find it challenging to
promote something that they don’t value highly themselves.14 As determined by the Federal
Government, 1,417 of the 1,861 children enrolled in the 2009-10 HS program were at or below the
poverty level.14 Only 37 children’s families at MFR have incomes above the poverty level.
5
Of the 1,861 children enrolled at MFR, 1,357 of them have English as the primary language
spoken at home while 445 children use Spanish as their primary language.14 Finally, race and ethnicity
varies considerably at MFR. Of the total population: 838 are white, 723 are black, 241 are bi-racial, 52
identify as American Indian/Asian, and 5 are Pacific Islander. The parents of children enrolled in our
programs are of similar race and cultural backgrounds. Any information to be shared would need to be
available in English and Spanish. The parents educational levels, for the most part are at a high school
level. They are considered to be living “in poverty.”14 If they have insurance for the children, it is Medicaid
and many of them fail to maintain their Medicaid status (by not supplying needed information to DHS). 14
Vulnerable populations include low income families, uninsured/underinsured, racial/ethnic minority
groups, and children in poverty.6, 10
MFR exhibits the need for oral health education for disease
prevention.
In addition to decay prevention strategies, effective nutrition counseling for the parents and staff
will also be provided. Choosing teeth friendly foods coincides with proper oral hygiene prevention tactics
to help keep the mouth healthy and disease/decay free. MFR has already planted the seed for proper
nutrition by supplying healthy snack choices for the children. The Oral Health Promotion Plan will be the
fertilizer to help this concept expand and grow for more awareness and education on this important topic.
Choosing the right foods in one’s diet is essential for obtaining healthy teeth and a healthy body.
Establishing good nutritional habits in young children can be especially beneficial for good eating patterns
and food choices throughout their life time.
Conclusion
Having a healthy, disease free mouth is imperative to everyday life. A healthy mouth gives
people the ability to: nourish the body (chew/swallow), provide good speech/communication (convey our
feelings through facial expressions), smile, taste, and have confidence in how one perceives him/herself.
Healthy mouths are free from pain/discomfort, therefore allowing a high quality of life. The aim of this oral
health promotion program (early education/prevention) is to provide the skills necessary to avoid
unnecessary pain, suffering, disease, and to help parents prioritize the need for early oral health care for
children in underserved/uninsured populations in order to minimize unnecessary pain and suffering.
Early screening, risk assessment, and preventive programs in WIC, Head Start, and Early Head
Start populations hold a great deal of promise for preventing dental decay in high-risk children.16 This
program will provide children and adults with access to the knowledge and skills to practice a healthy,
productive lifestyle. The Oral Health Promotion Plan will engage in efforts to improve community oral
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health to ensure high quality of life. Statistically, the average attendance percentage is 26% of all parents
whose children attend MFR. Therefore, the program plan will also have gift bags with oral hygiene
products as an incentive for better participation at the monthly meeting.
7
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Program Plan and Narrative
Community Program Plan Goal
To provide information to Head Start staff and parents about the importance of regular preventive dental
visits and tooth healthy nutritional foods for children.
Healthy People 2010: Oral Healthy Objectives
21-1.
Reduce the proportion of children and adolescents who have dental caries experience in their primary or
permanent teeth.
21-2.
Reduce the proportion of children, adolescents, and adults with untreated dental decay.
21-8.
Increase the proportion of children who have received dental sealants on their molar teeth.
21-10.
Increase the proportion of children and adults who use the oral health care system each year.
21-12.
Increase the proportion of low-income children and adolescents who received any preventive dental
service during the past year.
21-13.
(Developmental) Increase the proportion of school-based health centers with an oral health component.
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Program Objectives
Objectives
Evaluation Measures/Outcome
Indicators
Activities/Strategies
By the end of the program, each staff
member and at least 50% of the
parents at MFR will have attended
the Oral Health Promotion Plan
lecture/demonstration.
(Process Objective)
Evaluation Measure:
MFR makes this a requirement for
staff/educators and will have a sign
in sheet for parents.
 There will be an AM and PM
presentation available to be
flexible with work/personal
schedules.
Outcome Indicators: 100% of staff
will attend to gain knowledge and at
least 50% of parents will attend.
 Gift bags will be provided for
those parents who attend for
incentive to participate.
By the end of the program MFR staff
and parents will demonstrate
increase knowledge on oral disease
prevention and tooth healthy nutrition
for a healthier lifestyle for themselves
and the children at MFR.
(Behavioral Objective)
Evaluation measure: Staff and
parents will be given a questionnaire
regarding information on oral health
and nutrition at the beginning and
end of the program.
 Lecture: A lesson plan will be
given with specific oral
health/nutrition information
Outcome Indicators: The
questionnaire collected at the end of
the program will have at least 90%
accuracy.
 Discussion: interaction with both
staff/parents to find causes and
solutions to problems in oral
health/nutrition among MFR’s
participating children

Demonstration: illustrate
effective brushing/flossing
technique so staff/parents are
able to assist children at
home/school.
 Video- Dr. Oz Plaque animation
 Video- Dr. Oz- Attack of the
Plaque
By the end of the program MFR staff
will be provided with tools and
materials that will help them
incorporate the information into their
daily schedules.
Evaluation Measure:
Brochures/information packets given
to staff who will sign a paper upon
receiving this information.
Outcome indicators: 100% of the
staff will receive a packet of
information.
 Print outs will be available of the
power point presentation lecture
given so information is readily
available for review to implement
into daily curriculum.
 Brochures will be given as well
including nutrition information,
oral disease prevention
strategies, etc
- Smilemichigan.com-smilematters
patient fact sheet
- Dr. Oz- Oz Radio-children’s
dental health
- Open wide and Trek Insidechildren’s educational material
FREE from NICDR website.
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Program Plan Narrative
Objective #1:
In order for increased awareness on oral health disease prevention to take place, staff/parents
need to demonstrate they comprehend the information given in the lecture and demonstration. A lecture
will be given on proper oral health and nutrition choices via a power point presentation. The power point
will have a stimulating presentation, which, according to Mason, will have a positive impact on the
learning environment.1 There will be time allotted for discussions in issues that parents and staff feel are
important to address.
Also, a large typodont (an extra large model of human teeth), will be used for demonstration on
proper flossing and brushing techniques for optimal plaque removal; this reinforces proper brushing and
flossing technique which ultimately will prevent accumulation, decay and disease. Another educational
video will be provided from The Dr. Oz Show. This instructional media uses great visual aids and a
demonstration on the effect plaque has on oral health. This visual media emphasizes the learning
objective for increased awareness on oral disease and prevention.
Finally, information will be given on tooth friendly nutrition choices. Healthy food choices are a big
factor in keeping teeth healthy and disease free. Parents and staff will be provided with appropriate
snack/lunch food choices for the children at MFR.
Objective #2
The Healthy People 2010 Tookit emphasizes the importance of engaging partners. It is vital for
the entire staff who works with the children at MFR attend the Oral Health Promotion Plan presentation,
and at least half of the parents to make an impact. Having this participation will establish a sense of
ownership for those involved to change their thought process on the importance of oral health.
Being flexible for the staff and parents is essential for participation. Therefore, providing both AM
and PM presentation times for the parents will accommodate schedules, giving all who is interested the
chance to participate. Electronic communication (such as email, electronic newsletters, etc), website
announcements, and letters given children to take home will publicize the presentation to take place.
Children already take home daily letters to their parents for topics of the day. Having a different color
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(other than the usual white) to grab the attention of parents will be used for the announcement of this
special presentation. This may help grab the attention of parents to reach the goal of 50% participation.
As for the staff, information will be given during the staff training sessions. Oral disease prevention and
healthy, tooth friendly nutritional choices will be described in the special staff training session edition. The
presentation will be in the lecture room for both the parents and staff to have use of multimedia for the
power point presentation.
Many are influenced by incentives. Therefore, for the parents who attend, complementary gift
bags will be given that include various oral hygiene products that will be discussed in the presentation.
Objective #3
One of the Oral Health Promotion Plan’s goals is to inform staff and parents at MFR of the
seriousness and relevance of oral disease and its’ effect on the human body. Emphasizing the
importance on how effective oral hygiene affects one’s general health and well-being at each stage in life
in crucial. For instance, high tooth decay rates can potentially affect children’s well being by not being
able to focus in school due to pain and suffering. This preventable disease can take away from children’s
ability to learn. A brochure on healthy food choices and the decay process will be provided.
Low income, low education, and minority families are at an increased risk for dental disease.
This program will act as an intervention providing scientific based information as guidance to
promote/instill effective preventive habits into the daily lives of the staff/parents and their children. To help
aid staff in accomplishing effective teach strategies, print out of the power point presentation with crucial
information will be provided for each teacher. To help with student involvement, Open Wide and Trek
Inside interactive educational segments will be implemented into daily schedules as well. These
materials are free from the NIDCR website that include: coloring books, DVD’s, and computer based
learning activities.
Factors that increase dental disease can also raise risk for systemic disease/illness. Frequent
snacking on unhealthy food choices (i.e. high fructose corn syrup), increases the chance of dental decay
and obesity. Counseling and education can help to effectively reduce the risk for diseases and provide a
better quality of life. Therefore, once the staff and parents are educated on this topic, they will be able to
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provide this information to the children to reduce their risk of disease. Implementing the food pyramid
guide for tooth friendly food choices will be instilled into the HS program.
Finally, prevention can lessen the economic burden of the cost for restorative dental work.
Discussing the cost savings on prevention will be a great motivator. Being proactive can help prevent a
potential crisis (pain from dental disease, hospitalization from an abscessed tooth, etc) rather than having
to react to them.
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May 2010
Jennifer Smits, RDH
University of Michigan E-Learning Program
M
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Assessment: Recognize Community
Need, Identify Community Program
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F
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Assessment: contact key individuals;
obtain MOU-develop mutual goals
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af
Assessment: Collect information for community profile
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Assessment on-site
agency visit #1
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Assessment on site
agency visit #2
Assessment:
ASSET MAP
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Implementation
27
28
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Send out pre-test
to staff at MFR 30
Assessment: Develop
Community Profile
June 2010
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Plan: Develop Program Plan &
Narrative in relation to HP 2010
Plan: Program goals/objectives/activities
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Plan: Budget (plan funding/contact
possible financial support
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Plan: Provide timeline to stay abreast on dates of completion for
program
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Plan: Obtain
information to be
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included in lesson plans,
power point.
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July 2010
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Plan: Have brochures (in English and Spanish) ordered to
start assembling gift bags
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August 2010
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30
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Plan: Critically analyze target audience for proper layout of power point presentations- i.e. cultural background, dominant language, beliefs
etc.
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Plan: compile info into
power point.
Plan: Submit Power point to MFR for review prior to presentation
and confirm dates of presentations
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September 2010
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Implementation: Send out email/newsletter to inform
parents of presentation. Notify staff.
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7
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Implement:
Give
presentation
for MFR staff
8
9
15
16
Implement:
AM & PM
presentation
for parents
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Implement: After
presentation at
11
12
monthly staff meeting,
give and receive post
test for comparison of
comprehension.
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Give gift bags here!!
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October 2010
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Evaluation: Compare pre/post tests given.
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Evaluation: Discuss with MFR staff if program
met goals/objectives.
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References
1.
Currie J, Thomas D. Does head start make a difference? [Internet]. The American Economic
Review; June 1995. Vol 85, no 3 pg 341-364.
2.
Hhs.gov [Internet] United States Department of Health & Human Services. 2001-2010 [cited 2010
May 13]. Available from: http://www.hhs.gov/
3.
Accesskent.org [Internet} Official website of Kent County, Michigan. 2001-2010. [cited 2010 May
14]. Available from: http://www.accesskent.com/
4.
Michigan.gov [Internet]. Official State of Michigan Website. State of Michigan oral health plan.
2001-2010 [cited 2010 May 11]. Available from: http://www.michigan.gov/som/0,1607,7-19229942-127008--,00.html
5.
Ramos-Gomez FJ. Clinical considerations for an infant oral health program. San Francisco (CA).
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6.
Jones R, Cunningham T, Allukian M, Blahut P, Empey G, Hill L, Sanzi S, Wallace H, Wolpin S.
[Internet] A guide for developing and enhancing community oral health programs. [Internet] [cited
2010 May 14]. Available from: https://ctools.umich.edu/access/content/group/28505313-ada747e8-bc7f-e725600ee119/Reading%20Resources/CommunityGuide.pdf
7.
Centers for Disease Control and Prevention [Web site]. Public Health Resources: State Health
Departments. http://www.cdc.gov/mmwr/international/relres.html
8.
Mason J. Concepts in dental public health. 2nd ed. Philadelphia (PA): Wolters Kluwer/Lippincott
Williams & Wilkins; 2010. p. 71.
9.
Centers for Disease Control and Prevention [Internet} Chronic disease prevention and health
promotion: preventing cavities, gum disease, tooth loss, and oral cancers: a glance at 2010. 2010
Feb. Available from: http://www.cdc.gov/chronicdisease/resources/publications/AAG/doh.htm
10.
Michigan.gov/mdch [Internet]. Michigan Department of Community Health. 2001-2010 [cited 2010
May 11]. Available from: http://www.michigan.gov/mdch
11.
Michigan.gov [Internet] Michigan oral health plan. 2006. [cited 2010 May 13]. Available from:
http://www.michigan.gov/documents/oral_health_work_plan_final_color_140634_7.pdf
12.
Siegal M, Marx M, Cole S. Parent or caregiver, staff, and dentist perspectives on access to dental
care issues for head start children in Ohio. Am J Public Health. 2005 August; 95(8): 1352–1359.
13.
Michigan Dental Association. [Web site]. 2001-2010. Available from: http://smilemichigan.com/
Peck N. Health services program manager. Michigan family resources audit report. 2010 May.
14.
Peck N. (Health services program manager: Michigan family resources audit report, 2009-2010).
Conversation with: Smits J. 2010 May.
15.
Love JM, Kisker EE, Ross C, Raikes H, Constantine J, Boller K, Brooks-Gunn J, Chazan-Cohen
R, Tarullo LB, Brady-Smith C, Fuligni AS, Schochet PZ, Paulsell D, Vogel C. The effectiveness of
early head start for 3-year-old children and their parents. [Internet] Mathematica Policy Research,
Inc., Princeton, NJ; 2005. Vol 41;No 6 pg 885-901.
16.
Kaneilis MJ, Caries risk assessment and prevention: strategies for head start, early head start,
and wic. J Pub Health Dent. 60(3);210-217.
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