Seal America, The Prevention Invention
Seal America, The Prevention Invention

Step 6
Developing Forms and Records, Tracking Students, and Collecting and Analyzing Data

Developing forms and records, tracking students, and collecting and analyzing data are necessary activities for monitoring the impact of school-based dental sealant programs. Data can provide information about staff productivity, program costs, oral disease burden, quality of care provided, treatment needs, and need for referrals and follow-up.

Planning for Information Management

As part of the process of planning a school-based dental sealant program, program administrators should determine the information needs of the program and how information will be monitored and retrieved. Administrators need to identify required data and then to plan for collecting and analyzing it. Funders and school districts or school systems in which the program operates may require specific information to ensure accountability and to demonstrate success. It is therefore extremely important for program administrators to talk to key stakeholders to identify all of their information needs before developing an information-management plan. Consent forms, student records, and follow-up letters to parents all should be designed with the program’s data-collection needs in mind.

Printing Forms and Records

Although it is less expensive to order rather than print forms and records (e.g., consent forms, student records, other documents) in large quantities during the early stages of a program, it may be preferable to print small quantities, in case changes need to be made later. Even with good planning, additional data-collection needs may become evident after the program is under way.

Collecting Data

Collecting information about the targeted population’s characteristics (demographic data), participation rates, number of students assessed, number of students receiving dental sealants, sealant-retention rates, and presence of dental caries and sealants is important for all school-based dental sealant programs. Programs need this information to maintain or increase funding and to establish a rationale for maintaining or expanding the program. If all school-based dental sealant programs collect this basic information, program administrators will be able to compare student profiles, sealants placed, and program costs with those of other sealant programs.

Most school-based dental sealant program data are derived from returned consent forms and student records, which are discussed later. Methods used to collect these data vary among programs and depend upon the size of the program, available resources, and the purposes for which the data will be used. Methods range from hand tabulation to direct computer data entry with computer-generated reports.

In programs where data entry is done on site, laptop computers are taken to schools, and all assessment results and treatment information is entered directly into the computer. However, because staff members’ ability to accurately enter data varies, it is sometimes preferable to record data manually while in the school and to have a staff member skilled in data entry enter it later.

As program administrators make decisions about data-collection methods, they may wish to seek the advice of existing school-based dental sealant program administrators, individuals with training in statistical analysis, and individuals familiar with Medicaid billing and collections.

School-based dental sealant programs administered by agencies may have access to computers, billing systems, and individuals with expertise in data collection, analysis, and billing. If the agency administering the program offers other clinical services, it is likely that a billing system is in place that collects demographic and treatment information. The system may be modified to accommodate the school-based dental sealant program’s data-collection needs.

Consent Forms

A consent form is used to request the parent’s permission for their child to participate in the school-based dental sealant program. Consent forms should state that the child’s teeth will be assessed and, if indicated, that dental sealants will be placed on the child’s teeth. Some forms also request the parent’s permission for the child to be re-assessed during the next school year and for missing or partially missing sealants to be replaced and for dental sealants to be placed on newly erupted teeth, if needed.

Demographic data are most commonly collected from consent forms. When completing consent forms, parents provide information on the child’s age, race and ethnicity, grade, sex, and dental insurance status. Some consent forms ask for information about the child’s health history and whether the child has a regular dentist. Requests for Medicaid, CHIP, or other insurance policy identification numbers can also be included on the consent form. A wide variety of consent forms have been developed by numerous school- and community-based dental sealant programs. Sample consent forms include the following: Future Smiles School Sealant Program, Dental Program at School, Dental Sealants at School, Free Dental Decay Prevention Program.

When developing consent forms, program administrators may wish to seek legal advice. They may also wish to consider having the forms translated into non-English languages, especially in areas where many families speak English as a second language. It is desirable to print forms on colored paper, so that they are easier to identify when it is time to collect them.

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Student Records

A school-based dental sealant program must prepare and maintain a record for each student that participates in the program. At a minimum, each student record should include a signed consent form (or signed forms) and documentation on dental-sealant-assessment results, sealant placement, referrals for follow-up care, retention-check results, and any other information that is pertinent to the student’s oral health. Before finalizing the student record, program administrators should make sure it conforms to patient-record requirements dictated by their state dental practice act.

Cincinnati Ohio’s school-based dental sealant program student record has been used successfully for a number of years. An electronic student record, Sealant Efficiency Assessment for Locals and States (SEALS), developed by the Centers for Disease Control and Prevention (CDC), has also been used successfully in a series of pilot tests. Both records are described in the following sections.

Cincinnati, Ohio’s, Student Record

Cincinnati, Ohio’s, school-based dental sealant program provides an example of a student record designed to capture basic information necessary to provide dental sealants, track students (e.g., identify what classroom the student is in, whether all appropriate forms have been signed and collected, whether the student’s teeth have been assessed, assessment results, which teeth need to be sealed, which teeth were sealed, whether the student needs follow-up care, whether a referral was made, whether needed follow-up care was provided), and make comparisons among school-based dental sealant programs. From this form, the following information can be tabulated:

  • Number of students assessed
  • Demographic profile of students assessed
  • Number of students with a history of dental caries
  • Number of students with untreated caries
  • Number of students with at least one sealant present
  • Number of students receiving sealants
  • Number of sealants applied
  • Retention-check information

The form may be used as a starting point and modified to meet an individual program’s needs.

The demographic information collected on this sample form allows program staff to compile a sex and race breakdown of the population served. Some programs want information related to individual socioeconomic status (SES). A question about the student’s eligibility for the National School Lunch Program can be added to the form.

In instances where programs bill for services, program administrators have found that including billing information in the student record makes data entry and billing convenient. The information included in the section of the form labeled “Billing Information varies among programs. The sample form shows what kind of information is necessary to bill Medicaid or CHIP. Other forms of reimbursement, such as private insurance and Medicaid managed care, should also be considered when modifying this section of the form.

The “Initial Assessment” section of the form is completed as the student is being assessed for dental sealants. A key accompanies the form to explain the information that should be recorded in each box. Generally, the form allows for collection of the following information:

  • Assessment date
  • Presence of decayed, missing, or filled permanent or primary teeth
  • Existence of active dental caries
  • Dentist code
  • Signature of the dentist
  • Presence of any sealants
  • Need for sealants on each permanent posterior tooth
  • General comments

The “Treatment” section of the form is completed to show the care provided to the student:

  • Number of teeth sealed
  • Number of surfaces sealed
  • Provider code
  • Treatment codes
  • Date the sealants were applied
  • Signature of dental hygienist who applied the sealants
  • Referral information
  • General comments

The “Retention Check” section of the form is designed for collection of 1-year retention results and allows for collection of the following information:

  • Date of the retention assessment
  • Number and types of teeth needing to be re-sealed
  • Dentist code
  • Provider code
  • Signature of the dentist

The “Tooth Charting” section of the form is identical to the initial assessment section and is intended for recording the condition of previously applied sealants. There are also spaces for totals of completely and partially lost sealants, teeth that need sealants applied because they were incompletely sealed initially, teeth that need new sealants, total sealants re-applied, the date upon which they were applied, and the signature of the dentist.

The “New Assessment—Subsequent Year(s)” section of the form is intended for any assessments that occur after the 1-year retention check. Most programs use this section for sixth-, seventh-, or eighth-grade students who return new consent forms but who participated in the program earlier, as first- or second-grade students. This section is intended to be used like the initial assessment section. In addition to repeating the initial assessment information, it allows for recording lost sealants, teeth that previously were partially sealed and need to have sealant material added, and teeth that have erupted since the first assessment and need sealants.

SEALS: Sealant Efficiency Assessment for Locals and States

SEALS is a student record and system of data collection and analysis designed to capture data at the child-, individual-, school-, and school-district level in a format that allows the generation of summary reports. CDC has also developed software to enter the data to generate reports and to be exported for additional analysis, if desired. It is anticipated that it will be possible to send these data to states to generate statewide summary reports, as well. Program evaluation (see Step 10, Program Evaluation) can be conducted using these data.

The SEALS child-level data-collection form (student record), available in electronic or paper format, is made up of four parts: demographic information, screening and assessment results, preventive services, and follow-up.

  • Demographic data include the student’s name, gender, date of birth, age, race or ethnicity, special health care needs status, and Medicaid or CHIP status.
  • Screening data are entered when the student is assessed for dental sealant placement. The form includes a table identifying all teeth that could be sealed (premolars and first, second, and third molars). Each available tooth is assessed according to whether it is decayed, filled, or sealed and whether an occlusal, lingual, and/or buccal sealant is prescribed. The assessment data are signed and dated by the dentist. Space is available for written comments.

    A second table identifies whether (1) untreated tooth decay is present, (2) the student has had any caries experience, (3) dental sealants are present, (4) treatment (urgent or non-urgent) is needed, and (5) the student is referred for treatment.
  • Preventive services data identify each tooth and tooth surface that has been sealed. The dental hygienist signs and dates the form on the day the sealants were applied. Space is available for written comments.

    A second table asks for a tabulated number of sealed surfaces by first molars, second molars, and other. For programs that offer topical fluoride treatments, information can be entered as to whether the student was treated with a varnish or a gel, foam, or rinse.
  • Follow-up data identify teeth or tooth surfaces where dental sealants are retained. As with the other sections, the dentist’s signature and date are required. Summary data on the number of surfaces retained and whether the student received follow-up care for untreated oral disease is requested.

Analyzing Data

The analysis of data collected during the planning and implementation of a school-based dental sealant program provides valuable information on the program’s overall performance and offers insight into areas needing improvement. Data analysis answers questions about the quality, cost-effectivenes,s and significance of the program. These issues are addressed in more detail in Step 10, Program Evaluation.

Data analysis can generate information on

  • General demographics (e.g., age, sex, race and ethnicity, SES)
  • The program’s effectiveness in reaching populations at high risk for oral disease that lack access to care (e.g., populations with high level of untreated tooth decay, urgent oral health needs, emergent oral health needs, and presence of dental sealants and restorations)
  • The program’s effectiveness in targeting teeth that would benefit from sealants (e.g., grade levels targeted)
  • The program’s effectiveness in reaching the target population (e.g., percentages of returned consent forms, students assessed, and dental sealants placed)
  • Services delivered (e.g., assessments, sealants placed, surfaces sealed, sealant retention, referrals, and delivery of oral health education)
  • Quality of services delivered (e.g., referrals that result in dental visits, retention rates)
  • Costs (e.g., total cost, cost per assessment, cost per student who received dental sealants)

How the analysis is conducted depends on the way in which the data were collected. Data recorded in electronic format are more easily analyzed than paper-based data. SEALS software provides an interface for inputting data and automatically generates reports in many of the areas listed above.

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