The delivery of oral health care to children from families with low incomes was an important component of the Children and Youth Projects.
Reproduced with permission from the Journal of the History of Dentistry.
- Children and Youth Projects created
During the 1960s, there was a growing realization that children and adolescents, particularly those from families with low incomes, needed comprehensive health care. In 1965, Congress amended Title V of the Social Security Act (P.L. Law 89-97) to promote child and adolescent health, particularly in areas in which families with low incomes were highly concentrated. This amendment authorized Children and Youth Projects (C&Y Projects) to provide support for comprehensive health care for children and adolescents.
Through the mid-1970s, C&Y Projects provided accessible and appropriate comprehensive health supervision services to children and adolescents, including prevention, case finding, diagnosis, treatment, correction of defects, and follow-up care. All projects were required to include oral health care.
Maternal and Child Health Bureau. 2000. Understanding Title V of the Social Security Act: A Guide to the Provision of the Federal Maternal and Child Health Block Grant. Rockville, MD: Maternal and Child Health Bureau.
Maternal and Child Health Service. 1970. First Project Dental Directors National Conference for Children and Youth. Rockville, MD: Maternal and Child Health Service.
Lady Bird Johnson, the First Lady, reading to children enrolled in Project Head Start at Kemper School in Washington, DC.
- Head Start Program established
In January 1964, President Lyndon B. Johnson unveiled an ambitious legislative program known as the "War on Poverty" to address poverty and unemployment. He appointed Sargent Shriver, director of the Peace Corps, as the program's leader.
Later in 1964, President Johnson and Sargent Shriver assembled a committee of academic and civil rights activists, among them Robert Cooke, a pediatrician at John Hopkins University. Sargent Shriver asked Robert Cooke to put together a committee of the best specialists in all fields related to children.
In 1965, the committee issued a report with recommendations that served as the foundation for Head Start's comprehensive health care approach, with its focus on prevention and parental involvement. The report put forward the idea that environment, and not just biology, play a large role in children's intellectual development—especially during early childhood. That same year, Project Head Start was launched as an 8-week summer program to help communities meet the needs of young children from families with low incomes. The following year, Congress authorized legislation to create the Head Start Program of the U.S. Department of Health and Human Services as a year–round program that provides early education and health services for children ages 3 to 5 from families with low incomes.
In 1994, Early Head Start was established to serve pregnant women with low incomes. The program focused on promoting positive birth outcomes and on healthy physical and cognitive development in infants and children from birth to age 3 from families with low incomes.
Both Early Head Start and Head Start provide education and health services in the context of family and community.
Head Start teacher brushing a child's teeth in the classroom.
Head Start has a long history of providing comprehensive health services to young children and families. The program has served more than 30 million infants and children from birth to age 5 and their families. Each year, Head Start serves nearly 1 million infants, children, and pregnant women in centers, family homes, and family child care homes in urban, suburban, and rural communities throughout the nation.
Head Start services are based on the premise that a child must be healthy to be ready to learn and that good oral health is essential to a child's behavioral, speech, language, and overall growth and development. Head Start program performance standards require that staff track the provision of oral health care (i.e., that an infant or child has a dental home and is up to date according to the state's dental Early and Periodic Screening, Diagnostic, and Treatment program periodicity schedule) and help parents obtain oral health care for their child. Head Start programs also promote good oral hygiene in the classroom. In addition, Head Start programs track whether pregnant women enrolled in the program received an oral examination and follow-up care, if needed.
Administration for Children and Families, Early Childhood Learning & Knowledge Center. 2015. Head Start Program Facts: Fiscal Year 2014.
Administration for Children and Families, Early Childhood Learning & Knowledge Center. 2015. Program Information Report (PIR).
Holt K. 2011. Dentists and Head Start: What You Should Know and How You Can Help (2nd ed.) Washington, DC: National Maternal and Child Oral Health Resource Center.
National Head Start Training and Technical Assistance Resource Center. 2006. Physically Healthy and Ready to Learn. Washington, DC: National Head Start Training and Technical Assistance Resource Center.
Vinovskis MA. 2005. The Birth of Head Start: Preschool Education Policies in the Kennedy and Johnson Administrations. Chicago, IL: University of Chicago Press.
Weber B. February 10, 2014. Robert E. Cooke, a creator of Head Start, dies at 93. New York Times.
Child receiving oral health care. Reproduced with permission from the American Dental Association. All rights reserved.
- MCH Pediatric Dentistry Training Program established
In 1965, the Children’s Bureau, now the Maternal and Child Health Bureau (MCHB), initiated the MCH Pediatric Dentistry Training Program to address the lack of oral health professionals who had been specially trained to serve a pediatric population in general and children with special health care needs (CSHCN) and other populations at high risk for dental caries (tooth decay) in particular and to serve as a regional and national resource for other pediatric dentistry programs.
Through the MCH Pediatric Dentistry Training Program (later named Leadership Education in Pediatric Dentistry), dentists receive specialized training in prevention and treatment services for the pediatric population and in dental public health and leadership. The purpose of the program is to facilitate a national focus on leadership in the field:
- Postdoctoral training of dentists in the primary care specialty of pediatric dentistry for leadership roles in education, service, research, administration, and advocacy related to oral health programs for the maternal and child health (MCH) population.
- Development and dissemination of curricula, teaching models, and other educational resources to enhance the MCH content of dentistry training programs.
- Regional and national continuing education, consultation, and technical assistance in pediatric oral health.
Trainees and faculty provide services to the general pediatric population, as well as to CSHCN, including children with behavioral problems. Clinical services include comprehensive oral treatment and are provided in a variety of settings, including university-based dental clinics, group homes, local community health clinics, and school-based centers. Populations at high risk are targeted for the provision of clinical services; these populations include children with developmental disabilities, children of migrant farm workers, Native American children, and children from families with low incomes.
Maternal and Child Health Bureau, Division of Research, Education, and Training. MCH Training Program: Pediatric Dentistry. Rockville, MD: Maternal and Child Health Bureau, Division of Research, Education, and Training [website].
President Lyndon Johnson signing Medicare and Medicaid bill.
- Title XIX (Medicaid) established
In the mid-1960s, federal involvement in the financing of health services expanded dramatically. A series of major programs provided federal support for oral health services. The most far-reaching of these programs, the Social Security Amendments of 1965, established Title XVIII (Medicare) and Title XIX (Medicaid).
Medicaid established a sliding scale of payment to states for medical services to individuals who qualified for public assistance programs for the blind, aged, disabled, and families with dependent children. Fourteen services were authorized under Medicaid, of which five were mandatory: inpatient hospital services, outpatient hospital services, laboratory and X-ray services, skilled nursing home care for adults, and physician services. Oral health care, including dentures, was listed as optional. By 1984, all states participated in Medicaid, and between 30 and 32 states provided some oral health care to adults eligible for the program, although the scope of care varied substantially from state to state.
Albertini TF, Hillsman JT, Crawford BL. 1984. Federal financing of dental services. Journal of Dental Education 48(11):606–615.