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Maternal and Child Health Improving Oral Health Integration Demonstration Projects

Maternal and Child Health—Improving Oral Health Integration Projects

Abstracts

Colorado: Cavity Free Care Network (CFCN)

Organizations: Colorado Department of Public Health & Environment (CDPHE) in collaboration with Denver Health (DH) and the University of Colorado (CU)
Target population: Children ages 1-21

CDPHE, in collaboration with DH and CU, will enhance access to preventive oral health care and reduce oral health inequities among the maternal and child health population ages 1-21 in underserved communities. The project, informed by a network of oral health partners, focuses on strategies to elevate underserved communities, utilize equity-informed data, integrate preventive oral health services and workflows into primary care and other health care settings, and coordinate efforts for oral health literacy. Colorado recognizes the disparities in oral health outcomes, emphasizing the impact of social determinants, geographic, and other community barriers in the development of CFCN, and will prioritize medical-dental integration, oral health literacy, and community engagement to bridge gaps in access to oral health care and oral health awareness.

Colorado is confronted with significant challenges in access to oral health care, particularly among children ages 0-21, as evidenced by state and national data, research outcomes, and community feedback. Escalating rates of untreated decay, especially among communities with inequitable oral health outcomes, are highlighted in the 2022-2023 Colorado Basic Screening Survey. Geographic barriers in rural and dental Health Professional Shortage Areas and lack of affordable dental services, regardless of insurance status, contribute to limited access. Social determinants, insurance status, and language variations further amplify oral health inequities.

The CFCN, led by experts at CDPHE, DH, and CU, will improve access to preventive oral health care (POHC) and address oral health inequities. Activities include:

  • Identify improvement strategies to address policy and practice gaps that cause barriers to the successful implementation of POHC within primary care settings, and, with the CFCN Alliance, engage the Colorado Oral Health Coalition to enact policy change.
  • Establish the CFCN Alliance, composed of key partners, to support the CFCN and provide expertise in health literacy and preventive oral health care. The alliance, comprising experts in medical-dental integration, oral health literacy, policy, and more, will provide ongoing support and contribute to CFCN activities.
  • Develop the Cavity Free Literacy Project, including oral health literacy tools, training, and resources to enhance oral health literacy among health organizations and patients.
  • Utilize the Colorado Priority Community Index to map social determinants of health and oral health access to identify underserved communities.
  • Develop the Beyond Early Smiles: Cavity Free Youth curriculum to expand the existing POHC infrastructure across children ages 1-21, addressing gaps in training, resources, and access to care.
  • Support primary care sites to develop POHC workflows, including using teleORALhealth and supportive health care workers to integrate oral health into medical care.
  • Enhance Colorado’s oral health surveillance system by expanding the Basic Screening Survey’s scale, scope, and timeframe, to increase comprehensive data on oral health in Colorado.
  • Develop and implement an evaluation framework to assess the progress of the CFCN in addressing disparities in access and use of POHC.

Colorado's CFCN project represents a comprehensive effort to advance oral health equity, targeting policy, infrastructure, education, and access barriers. By strategically engaging partners, addressing unmet needs, and leveraging community insights, the project aims to create lasting impact and reduce oral health disparities among underserved populations.

Connecticut: Improving Oral Health for Young Children in Connecticut Through Policy, Practice, Education, and Evaluations

Organizations: Moses-Weitzman Health System (MWHS), MWHS-Weitzman Institute
Target population: Infants and children ages 6 months to 5 years

Connecticut (CT) faces significant challenges in the oral health of young children (ages 6 months to 5 years) from low-income households and minoritized backgrounds, with one in four kindergarteners experiencing tooth decay in 2022. The MWHS’ Weitzman Institute proposes a project in collaboration with key stakeholders to enhance oral health for this demographic. Objectives include policy improvements (state core function [SCF] 1), enhancing oral health literacy at federally qualified health centers (SCF 2), conducting social determinants of health surveillance (SCF 3), testing preventive oral health services introduced through well-child visits in four demonstration sites (local core function [LCF] 1), improving oral health literacy at demonstration sites (LCF 2), and building a data infrastructure (LCF 3). State-level activities include environmental scans and interviews, oral health gap analysis, curriculum development, trainings, and data-driven evaluations. Locally, the focus is on workflow and systems changes to introduce services, refining educational materials with caregivers, and establishing a robust data infrastructure. An alliance of key stakeholders will address challenges collaboratively and includes (in alphabetical order): Community Health Center Association of CT, CT Dental Health Partnership, CT Dental Hygienists’ Association, CT Department of Public Health, CT Department of Social Services, CT Oral Health Initiative, and MWHS’ Community Health Center.

Montana: Montana Oral Health Equity Alliance (MOHEA)

Organization: Montana Department of Public Health and Human Services (MT DPHHS)
Target population: Children ages 1–21 years

Montana is a vast geographic state with just over 1 million population, making it a primarily rural and frontier state. The oral health needs in Montana are pressing. Oral health inequalities are most evident in very rural areas where access to traditional models of dental care is scarce, especially for low-income and minority American Indian and Latino populations. Access, cost, and low oral health literacy contribute to the inequalities. Nearly half of all children in Montana experience tooth decay, and half of women seeking prenatal care do not receive oral health information during that care.

The MOHEA is a collaborative effort with the Montana Department of Health and Human Services’ Oral Health Program (OHP) as the applicant and lead of the project. Partners include the Montana Primary Care Association, the Montana State University’s Mark and Robyn Jones College of Nursing, the Montana Office of Rural Health and Area Health Education Center OneHealth federally qualified health centers (FQHCs), Ag Worker Health & Services FQHCs, Proyecto Salud clinics, and the Northern Cheyenne school-based clinics. MOHEA’s goal is improved access to preventive oral health care and oral health equity among the maternal and child health population, focusing on children ages 1-21 living in Montana’s rural, frontier, and underserved communities. MOHEA’s objectives collectively aim to create a supportive policy environment, enhance organizational capacity, strengthen surveillance mechanisms, and integrate preventive oral health care into primary care settings, ultimately improving oral health outcomes for targeted population.

  • Objective 1: Participating Montana organizations will form a Maternal and Child Health-Improving Oral Health Integration Alliance to accomplish the goals and objectives of the project, MOHEA.
  • Objective 2: The MOHEA will enhance Montana policy and/or scope of practice to increase access to and use of integrated preventive oral health care by June 2028. (SCF 1: Policy and Practice)
  • Objective 3: The MOHEA will increase oral health awareness among 85% of the targeted health organizations and emerging health professions students through oral health literacy training and outreach by June 2028. (SCF 2: Outreach and Education)
  • Objective 4: The MOHEA will implement state-level oral health surveillance enhancements to improve trend analysis by June 2028. Enhancements will measure MOHEA’s community-centered approach to preventive oral health care integration, which considers health determinants and social inequities as barriers to care. (SCF 3: Data, Analysis, and Evaluation)
  • Objective 5: The MOHEA will support the implementation of evidence-based models of care aimed at integrating preventive oral health care and primary care services within 100% of the eight participating primary care settings by June 2028.

MOHEA partners recognize unique opportunities to close oral health equity gaps in Montana communities through new dental technologies, workforce, and delivery models. Dental technologies such as silver diamine fluoride provide non-dentist providers with a tool to arrest the progression of decay and prevent future dental disease using a non-invasive, affordable technique. Creating the MOHEA will be the first time Montana embarks upon a comprehensive, statewide oral health literacy campaign in alignment with established partners that support
integration of oral health.

New York: Transforming Oral Health for Communities (TOHC)

Organization: Health Center Network of New York (HealthEfficient)
Target population: Pregnant women and infants and children from birth to age 40 months

HealthEfficient is requesting Maternal Child Health-Improving Oral Health Integration project funding to support its Transforming Oral Health for Communities (TOHC) proposal. Building on the success of HealthEfficient’s ongoing Health Resources and Services Administration, Maternal and Child Health Bureau-funded Network for Oral Health Integration project (2019-2024), the goal of the proposed TOHC project is to improve access to preventive oral health care and oral health equity for the target population of pregnant women and infants living in communities underserved by oral health care. Access to necessary and appropriate dental care continues to remain a problem in New York. The TOHC project will implement a “Patient-Centered, Team-Based Primary Oral Health Care” model, supported by community health workers (CHWs) and other care team members.

The objectives of the TOHC project are to: 1) enhance state-level policy and/or scopes of practice aimed to increase access and use of integrated preventive oral health care; 2) increase oral health awareness among health organizations across the state, targeted for organizational oral health literacy training and outreach; 3) implement state-level oral health surveillance enhancements aimed to improve trend analysis; and 4) implement at local levels an evidence-based model of care to integrate preventive oral health care and primary care services, including: primary care clinical workflow modifications, provider training, and dental referral tracking.

To accomplish these objectives, HealthEfficient has assembled an alliance of experienced key New York state stakeholders to develop, implement, and continuously evaluate and improve a project model to improve access to oral health services for the target population. The TOHC team, in concert with the alliance, will be responsible for carrying out the project work, including developing models and guiding implementation adhering to the three project core functions: policy and practice; outreach and education; and data, analysis, and evaluation. Using the Institute for Healthcare Improvement’s Breakthrough Series collaborative model, the team will lead three 12-month learning collaborative (LC) cycles inviting alliance members and approximately three community health centers (CHCs) in each cycle (for a total of nine CHC participants during the 4-year project period). The LC cycles will be organized to provide training and improve core competencies of CHWs and CHCs related to 1) evidence-based oral health practices, 2) communication and education, 3) interprofessional collaborative practice, and 4) health information technology integration and optimization of quality improvement data. In addition, the alliance will expand oral health education and outreach to community organizations via CHWs through partnerships between CHCs and other programs in New York state, including the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), Family Home Visiting, and Early Head Start.

By the end of the 4-year demonstration project, HealthEfficient’s TOHC plans to:

  • Establish a state-level policy to increase the scope of practice for CHWs and similar care team members to deliver reimbursable preventive oral health services, including fluoride varnish.
  • Improve oral health awareness among 85% of targeted health organizations within the state.
  • Implement at least one new process and data source for use in oral health surveillance of the target population.
  • Implement an evidence-based model of care to integrate preventive oral health services into primary care in 100% of participating CHCs.

The TOHC project will enhance access to preventive oral health care and promote oral health equity for pregnant women and infants in New York’s communities with barriers to oral health. We are confident that the participating health care organizations implementing this model of patient-centered, team-based primary oral health care will see improved oral health access and outcomes in their communities.

Puerto Rico: Puerto Rico Maternal and Child Health—Improving Oral Health Integration Demonstration Project (MCH-IOHI Project)

Organizations: University of Puerto Rico, Medical Sciences Campus, School of Dental Medicine (SDM)
Pregnant women and infants and children from birth to age 4 years

To address the maternal and child health (MCH) needs of Puerto Rico, the University of Puerto Rico School of Dental Medicine at the Medical Sciences Campus is submitting this proposal to the Health Resources and Services Administration. The main goal of this MCH-IOHI project is to improve access to preventive oral health care and to improve oral health equity among the MCH population living in communities underserved by oral health care in the island. The project’s plan emphasizes evidence-based tools, enhanced state-level policies, and increased oral health awareness through targeted training and outreach. The proposed MCH-IOHI project aims to achieve the following general objectives:

  1. By June 2028, 85% of the MCH-IOHI project teams will report enhanced policy and/or scope of practice aimed to increase access to and use of integrated preventive oral health care
  2. By June 2028, the MCH-IOHI project teams will report increased oral health awareness among 85% of the health organizations across the state targeted for organizational oral health literacy training and outreach
  3. By June 2028, 85% of the MCH-IOHI project teams will implement state-level oral health surveillance enhancements aimed to improve trend analysis
  4. By June 2028, 100% of participating primary care settings will implement an evidence-based model of care aimed to integrate preventive oral health care and primary care services, to include primary care clinic workflow modifications, provider training, and dental referral tracking.

This initiative will actively collaborate as an alliance within the existing oral health coalition with key collaborators, such as the Primary Care Association; Head Start programs; the Department of Health, Division of Maternal Child and Oral Health; and other private and public entities related to the MCH population. The program will focus on strategies and activities in the following core functions at the state and local levels: enhanced policy and scope of practice; outreach and education; and data, analysis, and evaluation. The project will convene a group of experts and agencies in MCH care in Puerto Rico to develop the necessary strategies to optimize oral health care. It will also have representation at the MCH-IOHI learning collaborative, which will develop tools for a standardized implementation of evidence-based preventive oral health care strategies in primary care services for the MCH population. Additionally, it will provide the appropriate structure to monitor and analyze trends in services and availability of provider data, offering the necessary foundation for adequate and timely decision-making and actions.

South Carolina: South Carolina Integration Demonstration (SCID) Project

Organization: South Carolina Department of Health and Environmental Control (DHEC)
Target population: Infants and children from birth to age 11

South Carolina began to address early childhood caries in infants, young children and in children with special health care needs through the Robert Wood Johnson Foundation funding of the More Smiling Faces project (2003-2006). The state’s experience with this More Smiling Faces project provided valuable information and experience in facilitating access to oral health services for vulnerable populations. Oral health integration efforts continued and in 2016 the department of health was the recipient of Health Resources and Services Administration (HRSA) funding for the Perinatal and Infant Oral Health Quality Improvement (PIOHQI) Expansion project that specifically addressed oral health integration for pregnant women and infants from birth to age 3. This opportunity facilitated the integration of oral health statewide through the four DHEC public health regions strengthening the integration of oral health prevention education at the local level through regional partners. The PIOHQI initiative laid the groundwork and provided the foundation needed to conceptualize this current proposal. The SCID project will be expanded and focused on testing models of integrated preventive oral health care  in primary care settings and will aspire to:

  • Inform state policy and practice decisions.
  • Increase oral health literacy across the state using an organizational health literacy approach.
  • Enhance the state’s oral health surveillance capabilities.

A foundational component of the SCID project is to expand the scope and the reach of the existing Public Health Dental Prevention Program for school-based services by constructing policy and guidelines that will allow for the provision of dental services within a primary care setting and expand existing partnerships with several federally qualified health centers across the state. Additionally, the two-tier, state and local, improvement approach will enhance and strengthen the link between state level experts and local frontline staff. The SCID Project proposal is perfectly timed as South Carolina builds upon an established and expanding network of partners and stakeholders. The network analysis work that began with the HRSA funded PIOHQI grant in 2016 and continued with the Medical Dental Integration initiative funded by the Centers for Disease Control and Prevention in 2019-2024 is the foundation that is enabling South Carolina to effectively respond to this proposal with a comprehensive and skilled network of interested and vested partners who are motivated to make improvements that are lasting and impactful. The SCID alliance will support and be organized to implement a two-tier, state and local, improvement approach that addresses the three core functions of the Maternal and Child Health-Improving Oral Health Integration project. This includes policy and practice; education and outreach; and data, analysis, and evaluation. The SCID alliance members that have been invited to participate represent a wide range of knowledge in specific areas and will be expected to take leadership roles within the core function area that falls within their area of expertise. The SCID alliance is filled with individuals who have years of experience executing these types of projects, but more importantly it is a group of individuals who are passionate and stand ready to positively impact the oral health of those in South Carolina who need it the most.

Texas: Preventive Oral Health Care Integration in Texas Initiative (POHCIT)

Organizations: Texas Department of State Health Services, Oral Health Improvement Program (OHIP) in collaboration with the University of Texas Health San Antonio School of Dentistry (UTHSASD), the Texas Tech University Health Sciences Center El Paso (TTUHSC-EP), the Texas Association of Community Health Centers (TAHC), and the Texas Oral Health Coalition (TxOHC)
Target population: Pregnant women

The purpose of POHCIT is to improve maternal and child oral health in underserved populations by integrating preventive oral health care (POHC) into primary care for pregnant women in sustainable and scalable ways that can be replicated throughout Texas. Focusing on underserved populations will reduce health disparities in Texas. The aim of POHCIT is to improve access to POHC by integrating it into primary care settings accessible to pregnant women at increased risk for poor oral health. Funding will support creation of a POHCIT alliance of key stakeholders who will implement a two-tiered, state- and local-level approach to address three core functions: policy and practice; outreach and education; and data, analysis, and evaluation. This results in seven projects overall—formation of the alliance and addressing the three core functions at both the state and local levels. The goal of POHCIT is to improve access to POHC and reduce oral health disparities among the maternal and child health population living in communities underserved by oral health care in four ways:

  • Enhance state-level policy and/or scopes of practice to increase access to and use of integrated POHC (state core function 1).
  • Increase oral health awareness among health organizations selected for oral health literacy training and outreach (state core function 2).
  • Implement state-level oral health surveillance enhancements to improve trend analysis (state core function 3).
  • Implement an evidence-based model of care to integrate POHC and primary care services, including primary care workflow modifications, provider training, and dental referral tracking (local core functions 1-3).

Wisconsin: Wisconsin Maternal and Child Health—Improving Oral Health Integration Demonstration Project

Organization: Children’s Hospital of Wisconsin
Target population: Children ages 1–21 with plans to expand to pregnant women and children and youth with special health care needs

Early access to preventive oral health care (POHC) can improve maternal and child health (MCH) oral health outcomes; however, populations with low socioeconomic status and those from racial/ethnic minority groups often encounter social and structural barriers to care. In Wisconsin (WI), less than half of children enrolled in Medicaid receive preventive dental services. Pregnant women of color and pregnant women on public insurance experience dental disparities and are less likely to receive a dental cleaning during pregnancy. In an effort to reduce the disease burden for young children and prenatal populations, Children’s Health Alliance of Wisconsin and the Medical College of Wisconsin launched the WI Medical Dental Integration project in 2019 to create statewide system change to increase early access to preventive dental care through integration of a dental hygienist into primary care teams. To date, 14 clinics have integrated 18 hygienists across 11 health systems reaching over 17,000 children and pregnant women. While progress has been made, advancement in a multi-pronged integrated POHC approach is needed that considers unique health system and community needs and assesses and addresses barriers that impede advancement toward MCH oral health equity.

A significant opportunity exists to address oral health needs and invest in prevention locally through an integrated POHC model in primary care and through enhancement of the dental knowledge and skillset of medical providers. The integrated POHC approach also necessitates support at the state level, including policy implementation, addressing education requirements, and surveillance. Building on prior efforts and learnings, with this Maternal Child Health-Improving Oral Health Integration (MCH-IOHI) project, through the collaborative leadership of the MCH-IOHI alliance, with input from individuals with lived experience, the MCH-IOHI national consortium and primary care partners, MCH-IOHI key personnel will implement a two-tier, state and local, improvement approach that addresses:

  • Policy and practice: State policy and infrastructure will be assessed to inform implementation of four state level improvement strategies. At the local level, key personnel will assist sites in addressing oral health inequities by implementing an evidence-based integrated POHC model. Efforts will initially focus on children ages 1-21, followed by an expansion to reach pregnant women and other MCH populations such as children and youth with special health care needs. The primary integrated POHC model to be implemented is a dental hygienist added to the primary care team to provide assessment, fluoride, anticipatory guidance, silver diamine fluoride, if applicable, and care coordination during existing medical appointments.
  • Outreach and education: To improve oral health literacy, a state gap analysis will be conducted, and a corresponding health literacy plan will be executed. To improve POHC knowledge and skill among non-dental primary care providers, a gap analysis will be conducted and associated oral health trainings will be developed and implemented.
  • Data, analysis, and evaluation: State surveillance data will be assessed and enhanced to support improved access, better define and monitor MCH population disparities, and identify factors influencing MCH oral health outcomes. A measurable plan to efficiently collect clinic data across primary care sites to assess population impact and areas needing further improvement will be established.

Expanding access to integrated POHC is a crucial approach to improving access and disease prevention for MCH populations. Practice model change, provider skill development, outreach and education, supporting policies, and ongoing data collection and surveillance are necessary to reach the intended project outcome of long term sustainability to reduce the burden of dental disease in the MCH population in WI.

Contact

If you have questions or need additional information about the MCH-IOHI projects, please contact Susan Lorenzo, MCH-IOHI program manager/librarian.