Best Practices for
State & Local Oral Health Programs
Introduction to Best Practices
Optimal oral health across the lifespan…
ASTDD Best Practices Project
March 2010
Need for Best Practices
Oral Health in America:
A Report of the
Surgeon General
National Call To Action
To Promote Oral Health
A Public-Private Partnership
Under the leadership of
The Office of
the Surgeon General
Building Infrastructure
and Capacity in
State and Territorial
Oral Health Programs
Prepared by: ASTDD
Need for Best Practices
To improve oral health and
general health status
To improve systems of care
Developing Best Practices
What will be
your program’s purpose
for developing best practices?
Association of State & Territorial
State Dental Directors (ASTDD)
Best Practices Project
ASTDD Best Practices Project
Purpose
Build more effective state, territorial
and community oral health programs.
For:
Expand Infrastructure & Capacity
Respond to National Call to Action
Advance Healthy People 2010
ASTDD Best Practices Project
Goal
Promote the development
of best practices by state,
territorial and community
oral health programs to
enhance the oral health of
Americans and reduce
disparities.
Uses of
Best Practice Information

Use as building blocks

Share ideas & lessons learned

Raise awareness of oral health

Promote collaborations

Update guidelines
End-Users of
Best Practice Information
Dental Directors
Government
Officials & Staff
Professional &
Advocacy
Organizations
Best
Practices
Public Health
Programs
Coalitions
Funders
Consumers
Best Practices for
State & Local Oral Health Programs
Using Best Practice Concepts
Optimal oral health across the lifespan…
Best Practice Concepts
1. A best practice is a methodology
that, through experience and
research, has proven to reliably
lead to a desired result.
2. Using best practices is a commitment
to using all the knowledge and technology
at one's disposal to ensure success.
Best Practice Concepts
3. Best practices do not have one
template or form for everyone to
follow.
4. “Best practice” does not commit
people or organizations to one
inflexible, unchanging practice.
Best Practice Concepts
5. Best practices is a philosophical
approach based around continuous
learning & continual improvement.
6. Learning & transfer of best practices
is an interactive, ongoing & dynamic
process that cannot rest on a static
body of knowledge.
Best Practices for
State & Local Oral Health Programs
Best Practice Criteria
Optimal oral health across the lifespan…
“Best Practice”
“Best” from whose perspective
and using what criteria?
Obtain Input from End-Users
for Best Practice Criteria

Build consensus through selection &
ranking of BP criteria
- Early buy-in

Collect additional information to guide
selection of BP criteria
- Types of BP information end-users need
- Public health strategies in use
- Self-reported successful practices
Association of State & Territorial
State Dental Directors (ASTDD)
Best Practices Project
Setting Best Practice Criteria
ASTDD Best Practices Project
Input from States
State surveys:

Developed list of BP criteria

Ranked BP criteria

Identified categories of Best Practices
information states wanted

Obtained listing of states’ reported top
strategies and successful practices
ASTDD Best Practices Project
Best Practice Criteria

Impact / Effectiveness

Efficiency / Cost Effectiveness

Demonstrated Sustainability

Collaboration / Integration

Objectives / Rationale
ASTDD Best Practices Project
Best Practice Criteria

Impact / Effectiveness
Provided benefits to the oral health care and well-being
of certain populations or communities

Efficiency / Cost Effectiveness
Showed costs and expenses are appropriate to benefits
achieved

Demonstrated Sustainability
Demonstrated sustainable benefits and/or
demonstrated that the practice been sustainable within
populations/communities and/or in states/territories
ASTDD Best Practices Project
Best Practice Criteria

Collaboration / Integration
Built effective partnerships/collaborations among
various organizations and integrated oral health with
other health projects and issues

Objectives / Rationale
Addressed HP 2010 objectives, met the National Call
to Action to Promote Oral Health, and/or built basic
infrastructure and capacity for oral health programs
ASTDD Best Practices Project
“Best Practice” Definition
“Best Practice” is a service, function or
process that has been fine-tuned, improved
and implemented to produce superior results
that demonstrate impact/effectiveness, efficiency,
sustainability, and collaboration/integration, with
appropriate objectives/rationale.
Best Practices for
State & Local Oral Health Programs
Best Practices
Applying the Science
Optimal oral health across the lifespan…
Best Practice
Translate Research into Practice
■ Research evidence supporting the
effectiveness & cost-effectiveness
of a dental public health strategy
■ State of the science to design and
implement programs and services
Why evidence?
■ Constant or diminishing resources
require that public health programs
focus on effective and efficient practices
■ “Evidence-based” approaches
incorporate the best available scientific
information into decision-making*
*Based on Sackett et al., BMJ 1996
Systematic Reviews
■ Preferred method for identifying available
knowledge; determining what is “best”;
and summarizing it in a useful manner*
■ Rule-based process reduces bias and
error in reviewing and summarizing
findings
Bader J et al., J Am Dent Assoc 2004;
Mulrow C et al., American College of Physicians 1998
Process in Analyzing a
Best Practice Approach
■ Describe the public health strategy
■ Evaluate the evidence for effectiveness and
cost effectiveness of the strategy
■ Set initial review standards for Best Practice
criteria
■ Learn from state/community practices that
show successful implementation methods
In the Absence of
Research Evidence
■ Realize that the intervention may or may not
be effective
■ Review available information
(e.g., related policies and position statements; theoretical
rationale; consensus of expert opinion; descriptive data)
■ Identify and implement evaluative measures
■ Consider any unintended harms that could
result from the intervention
ASTDD Best Practices Project
Use of Evidence-Based Information
BP Project uses evidence-based information:
■ In analyzing a Best Practice Approach
■ In promoting its use for program development,
implementation, and evaluation
■ In sharing state of the science information on the
ASTDD Website
Best Practice Approach
Evaluation of Evidence
Promising
Proven
Approaches ............................……..........… Approaches
Strength of Evidence
Research
Expert Opinion
Field Lessons
Theoretical Rationale
+
+
+
+++
Research
Expert Opinion
Field Lessons
Theoretical Rationale
+++
+++
+++
+++
A Best Practice Approach Report
Research
Evidence
Summary of Research Evidence
Best Practices for
State & Local Oral Health Programs
Best Practices
Field Lessons & Support Network
Optimal oral health across the lifespan…
Successful Practices
Project’s Database

48 states and 2 territories provided
submissions

230+ successful practices described

An expanding collection
Successful Practice Description
Content

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




History
Justification
Inputs, Activities, Outputs & Outcomes
Budget Estimates
Lessons Learned/Plans for Improvement
Available Information Resources
Best Practice Criteria
Contact Persons for Inquiries
Successful Practice Descriptions
Ongoing and Dynamic
Development of Best Practices
Identify
Best Practices
Science & Art
of Successful
Implementation
Collaboration
Integration
Promote
Best Practices
Supportive
Environment
Cultivate
Best Practices
Project’s Developing Role:
Building a Supportive Environment

A support network

Partners’ support

Building of evidence

State of the science

Capacity building tools

Program & policy evaluation
Best Practices for
State & Local Oral Health Programs
Using Best Practice to
Build Infrastructure & Capacity
Optimal oral health across the lifespan…
Build Infrastructure & Capacity

1999 ASTDD Project

State dental directors
from 43 states
participated

10 essential elements
identified
Build Infrastructure & Capacity
Essential Elements

Surveillance
System


Leadership


State Plan

Policies

Communication
& Education



Linkages /
Partnerships
Population-based
interventions
Community capacity
Health systems
interventions
Leveraging
resources
Best Practice Approach Reports
1.
2.
3.
4.
5.
6.
7.
8.
9.
State Oral Health Surveillance System
State Oral Health Coalitions
State Oral Health Plans
Mandate for a State Oral Health Program
Community Water Fluoridation
School Sealant Programs
School Fluoride Programs
Workforce Development
Oral Health of Individuals with SHCN
Best Practice Approach Reports
(continued)
10. Improving Children’s Oral Health
through Coordinated School Health
Programs (released March 2010)
11. Prevention and Control of
Early Childhood Tooth Decay
(released March 2010)
Building Infrastructure
1999 to 2007 Comparison

State oral health surveillance systems
8 to 30 states

State oral health coalitions
20 to 41 states

State oral health plans
7 to 23 (33) states; 5 in development
Best Practices
The Journey Continues
Optimal oral health across the lifespan…
ASTDD Best Practices Project