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Activity 8Activity 9By 2011, provide technical assistance andtraining to 27 community health centersstatewide to help them establish fluoridevarnish programs for their clients,reflecting the community-specific andcultural needs of clients.By 2011, expand BSB trainings to privatemedical providers (physicians and nurses)with the collaboration and support of theVirginia Chapter of the AAP, byconducting at least six private sectortrainings annually.Activity 10By 2008, collaborate with the VirginiaCommonwealth University (VCU) Schoolof Dentistry and the Virginia DentalAssociation (VDA) to conduct in-depthtraining to at least six dentists annuallyregarding care of young children.Activity 11By 2011, continue working with the otherpartners initiated during the State OralHealth Collaborative Systems (SOHCS)grant (e.g., Resource Mothers and RegionalPerinatal Council Programs) to educatewomen about the importance of oral healththroughout pregnancy and early oral healthcare for their children and expand theseservices into selected hospitals that servelow-income families.Virginia Department of Health5To date, seven community health centers have received BSBfluoride varnish training. Technical assistance is ongoing to thosecenters that have been trained.Trainings were conducted in three private medical offices and onechildren’s hospital, with a total participation of 43 medicalproviders. The trainings included information about oral screening,varnish application, parent education, and the importance ofestablishing a dental home by aged 1. Training in the VDH BSBmodel is recommended (but not required) for Medicaidreimbursement of medical providers in Virginia.In FY11, DHP contracted with a pediatric dentist, Dr. MathewCooke, Assistant Professor, University of Pittsburg Department ofDental Anesthesiology (and previously with VCU School ofDentistry), to conduct dentist trainings in five locations across thestate. Sixty-nine dentists attended these lecture and hands-ontrainings, bringing the total number of dentists trained to almost 140.The training increases skills in providing services for young childrenand CSHCN.Partnering continues with Healthy Start and Resource MothersPrograms, providing trainings and technical assistance upon request.Through partnership with the Virginia Department of SocialServices, regional oral health training was held for 41 child day careworkers as part of their provider training and development. Thethree-hour training focused on infant and early child oral health andincorporated state competencies in the classroom related to oralhealth. The Comprehensive Health Investment Project (CHIP) ofVirginia remains a strong partner for the provision of preventiveservices during home visitation by CHIP nurses. A conference callwas held to update nurses on new forms and recommendations.H47MC08656

Activity 12By 2011, conduct a statewide educationalcampaign regarding the importance of earlyoral health, targeting pregnant women andparents by developing educationalmaterials, media releases, and a video forhealth department patient waiting rooms.Pilot materials with appropriate focusgroups to ensure that they are culturallyand language appropriate.Activity 13By 2011, expand the “Adopt a Head Start”program throughout the state to 14adoptions, a collaborative project betweenVDH and the 10 components of theVirginia Dental Hygienists’ Association(VDHA). The goal is for each componentto adopt at least one Head Start. Volunteerdental hygienists from the private sectorare being trained in the BSB curriculum toprovide oral screenings, fluoride varnishapplications, and anticipatory guidance.Virginia Department of Health6In FY11, plans were developed and a script was written for aneducational DVD for WIC clinic waiting rooms. Topics include theimportance of baby teeth, causes of tooth decay, preventing toothdecay, and the importance of timely professional dental care. Scriptapproval is currently pending. Through collaboration with WIC,oral health messages have been developed for use in Virginia’s“Health Bites,” an electronic educational system for WIC clients thatcan be accessed online. Information will target pregnant women,infants, toddlers, and preschoolers and is offered in a question andanswer format.One additional VDHA local component was trained for the “Adopt aHead Start” initiative, bringing the total to nine of the ten activecomponents having received the training. Currently, sevencomponents, including three dental hygiene schools, have “adopted”a Head Start program. Volunteers provided seven staff trainings,nine parent trainings, and attended five advisory committeemeetings. Support and technical assistance is ongoing for the“Adopt a Head Start” program. In April 2011, DHP exhibited at theVDHA Annual Session to highlight new resources and updatedtoolkits. A strategic plan status update was reported to the VDHAExecutive Board. The Board expressed strong interest in continuingto support the initiative. A new round of trainings has beendeveloped to be presented in November 2011 to components for theupcoming year focusing on the age one dental visit and specifictechnical assistance for adopting a local Head Start program. Thetrainings will be offered to dentists through promotion from theVDA and through hygienists inviting their employers. VDHA hasrepresentation on the Virginia Head Start Health Services AdvisoryCommittee.H47MC08656

Activity 14By 2011, work with eight dental hygieneprograms statewide to incorporate earlychild preventive measures in theircurriculums and to provide training incommunity settings for their students.Activity 15In 2011, administer and analyze theAssociation of State and Territorial DentalDirectors Basic Screening Survey (BSS) toobtain baseline information about the oralhealth of children (aged birth - 5 years) inWIC programs in 11 health districts. In2011, conduct a follow-up cross-sectionalstudy of the same programs.Activity 16By 2011, begin measuring the impact ofincreased referrals and training of publichealth dentists in local departments bymodifying and utilizing the existingrequired monthly activity reporting form(DH 1214) to track visits in 0 - 3 year olds.In 2011, utilize WIC programs in the 11chosen health districts to obtain baselinedata regarding parental knowledge andaccess to dental care for children aged 1 3. Conduct a follow-up study in the sameprograms in 2011.Activity 17Virginia Department of Health7No significant progress to report. Curriculum content is mostlydriven by accreditation standards set by the American DentalAssociation’s Commission on Dental Accreditation. Old DominionUniversity, Virginia Commonwealth University, and GermannaCommunity College have provided Head Start classroom programsand some fluoride varnish activities this year. Lord FairfaxCommunity College has “adopted” a local Head Start programwhere students will be active in education efforts.Baseline BSS survey data have been collected in all targeted districtsover the four-year grant period, including FY11. The survey formused to collect the screening data is included as Attachment A.Baseline data for nearly 10,000 WIC enrolled children are includedas Attachment B. Follow-up data collection will be completed infall of 2011.From July 1, 2010, to June 30, 2011, 3,910 (11%) of visits were forchildren aged birth to 4 years in local health departments.From August 2008 through August 2011, the WIC caregiverquestionnaires were administered to parents in all districts that haveimplemented the varnish program. The survey form used forcaregivers is included as Attachment A. Baseline data for more than11,000 caregivers are included as Attachment B. Follow-up surveyswill be completed in fall 2011.H47MC08656

OBJECTIVE 2By 2011, extend the oral health screening, education, andfluoride varnish program (Bright Smiles for Babies) thatwas initiated under the SOCHS grant to CSHCN.Activity 1By 2011, develop training and educationalmaterials specific for CSHCN for the BSBmanual. All materials will be age-specific,developmentally and culturally appropriate,and translated as needed.Activity 2Activity 3By 2011, continue to provide training andeducation regarding early oral health toprofessionals employed by statewideprograms that provide evaluations andcare-coordination for CSHCN (e.g., CareConnection for Children programs, ChildDevelopment Clinics, hospitals, and PartC) and to healthcare professionals in theprivate sector.By 2011, continue to work with statewideparent groups such as The Arc of VirginiaFamily Involvement Project to provideeducation about early oral health care toparents of children who qualify for thestate-administered Part C.Virginia Department of Health8Accomplishments in FY 2011 (Grant Year 4)Training materials, including power point presentations andeducational information packets, are regularly updated to reflectcurrent knowledge and audience needs. The DHP website regardingCSHCN was updated throughout the year as new providers joined orexisting providers sent changes to their information. A separatesection of the BSB manual was added specifically for CSHCN.From September 2010 through August 2011, “Oral Health Care forCSHCN” presentations, informational sessions, and exhibit boothone-on-one educational opportunities were provided to 256 healthcare providers, case managers, care coordinators, home visitors,school nurses, parent resource managers, lay health workers, andparents/caregivers. This figure includes 11 nurses at CarilionCommunity Hospital who were trained to provide oral healthscreenings and fluoride varnish applications in addition to theCSHCN training.During FY11, contacts included Children’s Hospital, The Arc ofVirginia, Down Syndrome Association, Virginia Department ofEducation Office of Special Education, Partnership for People withDisabilities, and Health Promotion for People with Disabilities TaskForce that have led to invitations to present information regardingoral health for CSHCN for families and caregivers. Severalorganizations have included website links to VDH’s dental webpageso that parents can access information more readily. VDH staffassisted with planning the Central Virginia CCC ConnectionsResource Fair held in 2011 for CSHCN and their families. This fairwas attended by close to 500 people. In collaboration with the VCUPediatric Dental Program, parents/caregivers and healthprofessionals were educated and 71 oral screenings and fluoridevarnish applications were provided for CSHCN.H47MC08656

Activity 4By 2011, design, administer, and analyzesurvey of parents of children enrolled in atleast four of the six Care Connection forChildren (CCC) centers to assess level ofparental knowledge and ability to accesscare for their child. Conduct a follow-upstudy in the same programs in 2011.OBJECTIVE 3By 2011, improve access to care for CSHCN throughcollaborative projects.Activity 1By 2011, explore innovative ways ofdeveloping dental referral systems forCSHCN such as through the standardizedscreening being promoted for referringchildren to state programs like Part C,working with DMAS, VDH Title VCSHCN program, and the Virginia Chapterof AAP.Virginia Department of Health9In January 2009, a dental health survey was developed to assess theoral health care needs of CSHCN, the oral health knowledge of thefamilies, and their ability to access care for their child. BetweenJune and December 2009, a total of 198 surveys were completed byparents attending CCC centers, the Children’s Hospital of RichmondEarly Intervention/Infant Services, Arc of Virginia in Richmond, andother appropriate venues. The results showed that the majority (67%- 92% depending on topic) of parents were knowledgeable regardingthe age one dental visit and other basic oral health topics. However,less than half (43%) were aware of the transmission of cariescausing bacteria. Surprisingly, only 16% reported a difficultyfinding a dentist for their child. It was concluded that additionalparent surveys would not lend more useful information, andtherefore, the follow-up survey was not conducted in 2011(Attachment C).Accomplishments in FY 2011 (Grant Year 4)Using funding from the Oral Health Workforce grant, in FY 2011,the dental home visiting program was extended to include a total ofeight health districts in the state. Fifty family support workers(home visitors) were trained to provide targeted oral healtheducation to families of CSHCN and to assist with making dentalappointments upon referral by the public health dental hygienistsemployed in these districts. Since the inception of the program, 111home visitors have been trained in all eight districts. In addition,DHP dental hygienists working under remote supervision inSouthwest Virginia began providing oral screenings, anticipatoryguidance, fluoride varnish, and dental referrals to children of all agespresenting to CCC pediatric specialty clinics in three cities inSouthwest Virginia. In FY11, 236 CSHCN received fluoridevarnish and/or oral screenings in the CCC clinics.H47MC08656

Activity 2By 2011, develop a statewide directory ofdental providers who treat CSHCN so thatchildren may be referred to a dental home.Activity 3By 2011, collaborate with the VCU Schoolof Dentistry and the Virginia DentalAssociation to conduct in-depth training toat least six dentists annually regarding careof CSHCN.Virginia Department of Health10Effective June 2009, this objective was ectory/. In January 2010, afollow-up survey was sent to dentists to update information andincrease participation. To date, about 2,400 dentists have beenincluded on the website, which is about half of the licensed dentistsin Virginia.In FY11, through a contract with the Virginia Dental Association,DHP worked with Dr. Matthew Cooke, Associate Professor at theUniversity of Pittsburgh and adjunct faculty at VCU, to expandtraining to dentists across the state. The course was offered in fivedifferent areas of the state to broaden the scope of the training. Atotal of 69 dentists and 31 auxiliaries were trained in the care ofCSHCN and very young children, for a total of 137 dentists and 31auxiliaries since grant inception. The expansion included an activehands-on component with 109 patients provided with dental care invarious host clinics.H47MC08656

II.SECTION TWO: GRANT SUMMARYThe Virginia Targeted Oral Health Service Systems (TOHSS) grant project had twoprimary goals. The first was to increase age one dental visits for high-risk children. This wasaccomplished primarily by working with local health department Special Supplemental NutritionProgram for Women, Infants and Children (WIC). The second goal was to improve access tooral health services for children with special health care needs (CSHCN). This summarypresents the outcomes and accomplishments, the impact on the system of care, and the lessonslearned for each objective of the original TOHSS grant application.OBJECTIVE 1By 2011, integrate dental visits for one-year-old children into existing systems thatcurrently serve high-risk children.a) Accomplishments and OutcomesThe major accomplishments of this grant project were the statewide expansion of BrightSmiles for Babies, developed under the State Oral Health Collaborative Systems Grant, and theresultant increase in the number of very young children receiving oral health preventive servicesin Virginia. Under the TOHSS grant, the Virginia Department of Health (VDH) Dental HealthProgram (DHP) collaborated with the WIC program at the state and local levels to provide directservices to local health department patients, thus helping to fill a void for dental services withinthe agency. As a result, an increasing number of low-income children in WIC programs arereceiving oral health preventive services and referrals for dental treatment as needed.During the first year of the TOHSS grant, DHP began targeting children in WICprograms as a means of expanding and sustaining the Virginia Bright Smiles for Babies (BSB)initiative. This program includes oral screening and risk assessment, fluoride varnishapplication, parental education, and referrals for local dentists. During the past four years, thenumber of oral health preventive services to infants and young children enrolled in the WICprogram has steadily increased. Data have been collected over the grant period regarding healthstatus and caregiver knowledge. Survey forms and baseline data are included as Attachments Aand B, respectively.In addition to TOHSS grant, funds from the Title V Maternal and Child Health (MCH)block grant and the Preventive Health and Health Services (PHHS) block grant have supportedstaff positions. Staff members in the BSB program currently include full- and part-time dentalhygienists working in nine health districts. The program is supervised by a full-time programsupervisor who has been with the program since its inception. A part-time dental hygienist nowalso currently oversees the CSHCN program efforts. During the past one to two years, eightadditional health districts hired full-time dental hygienists through the Health Resources andServices Administration (HRSA) Oral Health Workforce Activities grant and seven have begunproviding the BSB program in their district as part of their job duties. Hygienists in three ofthese districts practice under a pilot protocol of remote supervision, which has the potential forVirginia Department of Health11H47MC08656

greatly broadening the statewide impact of the projects initiated in the TOHSS grant. (Note:Data from the Oral Workforce Activity programs are not included in this report.)In 2010, VDH approved a new policy providing automatic eligibility for WIC clients toreceive BSB services regardless of insurance status. This has enabled DHP to bill Medicaid forapplication of dental varnish for WIC participants aged 6 months to 3 years. Prior to this policychange, billing was impeded because financial eligibility screening would have been required foreach child before they received oral health preventive services. As a result of this policy change,DHP has been billing Medicaid since July 2010 and uses this funding source to help sustain staffand other program costs, including travel and supplies. All oral health services, includingvarnish, continue to be offered free of charge to WIC clients who do not have Medicaid.Medicaid revenues will help to sustain the program long term.Another significant result is that dental and medical providers are starting to receive themessage about the importance of early oral health preventive services. The efforts of VDH, incollaboration with organizations—such as the Virginia Chapter of the American Academy ofPediatrics (AAP), Virginia Dental Association (VDA), Virginia Dental Hygienists’ Association(VDHA), and Virginia Commonwealth University (VCU)—have played a role in the steadilyincreasing number of private and public dental and medical providers providing oral healthpreventive services to high-risk children. According to state Medicaid data, the number ofmedical providers billing for fluoride varnish application for children under aged 3 has increasedfrom 24 to 118 since 2006. Since 2007, the number of children in this age group who havereceived an oral assessment by a dentist has increased ten-fold , from 453 to over 4,300 childrenin FY11. While there is still a long way to go before a significant number of high-risk childrenreceive these services, if this trend continues, real impact on the oral health of children should beseen through venues other than dental

Virginia Targeted State Maternal and Child Health Oral Health Service Systems Grant Program CFDA # 93.110 Submitted by: Karen C. Day, DDS, MS, MPH Dental Health Programs (DHP) Manager Virginia Department of Health Grant Number H47MC08656 Table of Contents 1. Section One: Accomplishments of FY11 Final Grant Year page 1