Overview
Based on the article "South Dakota Enhances Access to Oral Health Care for Young Children" in the December 2005 issue of the newsletter States in Action.
South Dakota's Partners for Prevention Project seeks to enhance access to dental care for its youngest and poorest children. The project gives medical primary care providers training to detect dental disease and to provide parents with prevention information and tools they need to ensure better oral health for their children. It also trains general dentists in pediatric dental techniques so they can better meet the needs of very young children.
The Issue: Throughout the nation, access to oral health services is frequently limited or unavailable, especially for low-income families. For example, many children in South Dakota are not seen by a dentist until they are more than five years old, even the American Dental Association and the American Academy of Pediatrics, recommend that children now be seen by a dentist by age 1.
In the private sector, many employers and health insurers are looking for ways to constrain escalating health costs, and dental coverage is often one of the first services to be curtailed—through higher cost-sharing for dental services; decreased payments to providers, leading to fewer dentists participating; or elimination of dental benefits entirely. In the public sector, state budget crises have led to significant cuts in state Medicaid programs, with dental care a primary casualty. With the recent improvement in the economy, some states have been able to restore dental services that had been cut or scale back the cost-sharing that affected access to care, and several states have even been able to expand coverage or services in significant ways.
Target Population: Local pediatric and general dentists, children's primary care providers
The Intervention: South Dakota's Partners for Prevention Program is administered by the South Dakota Dental Association (SDDA) on behalf of the South Dakota Oral Health Coalition. It is funded by a five-year, $250,000 grant provided through the Healthy Tomorrows Partnership, a partnership between the Health Resource Services Administration and the American Academy of Pediatrics.
The Partners for Prevention Project began in June 2004. The SDDA formed an advisory committee made up of dentists, medical providers, child advocates, and representatives from social service agencies and state government. David Krol, M.D., M.P.H., a senior policy research consultant at the Children's Dental Health Project in Washington, D.C., and a professor at Columbia University, designed a training curriculum. While similar programs in other parts of the country that have similar goals generally have been initiated by medical or pediatric groups, the Partners for Prevention Program is unique in that it uses local dentists to provide oral health training to medical providers in their community.
South Dakota's Partners for Prevention program seeks to build a network from the community level upward. It tested the program at four pilot sites. In each site, one or two local dentists were recruited to implement the Partners for Prevention Program, reach out to local pediatricians, and present the curriculum to them through the training course. Using the program's inter-professional referral system, doctors made appointments for their patients with dentists, regardless of whether the children have had a regular, or any previous, dental provider. Partners for Prevention is now in place in several communities around the state.
The state's goal is to increase the number of Medicaid-enrolled children ages 1 to 5 that have access to dental services by 25 percent over five years. To achieve this, local dentists train children's primary care providers in how to perform a basic oral health assessment. This includes consideration of clinical factors such as infection, untreated dental decay, and developmental problems as well as risk factors such as lack of a dental home, poor diet, previous tooth decay experience, and poor oral hygiene.
In addition, pediatric dentists will train non-pediatric general dentists in techniques such as making a child comfortable, using new restorative dental treatment techniques for primary teeth, and providing anticipatory guidance to the family. The state aims to train 95 percent of pediatricians, 80 percent of other primary care providers, and 200 general dentists.
The SDDA has begun to evaluate the training sessions and is developing ways to assess outcomes of the program. An evaluation component already in place uses a pre- and post-training test to gauge how well the curriculum communicates information to the providers. Ultimately, an evaluation will examine dental service utilization rates for children with Medicaid coverage before and after the trainings. It also will likely track how many dental referrals are filed and completed and the number of primary care providers performing oral evaluations before and after the training.
For Further Information: Contact Paul Knecht, South Dakota Dental Association, paul@sddental.org.
March 2007