School-Based Dental Program – Addressing Oral Health Needs:
A How-To Guide

School-based dental programs are often one of the most efficient ways to reach children. These programs can provide access to oral health services and education. Access to dental care can be via mobile dental services or by establishing onsite dental clinics linked with a school health clinic. The University of Rochester Eastman Dental Center’s Collaborative School-Based Dental Program is one of the many effective school-based dental programs in the nation.
ROCHESTER’S COLLABORATIVE SCHOOL-BASED DENTAL PROGRAM

Administrator
University of Rochester Eastman Dental Center
Division of Community Dentistry
Community Collaboration
Rochester/New York State Oral Health Coalition
Rochester Primary Care Network

Program Description
Collaborative school-based outreach dental program targeting Inner City and neighboring rural communities. Established a network of both school-based and non-school-based outreach dental programs, which consisted of year-round part-time satellite clinics, mobile dental trailers (Smilemobiles) and on-site portable school dental clinics. A new full-time school-linked community outreach dental center (under construction) is expected to be operational by May 2002.

 

Program Location
Rochester, New York

 

Brief History

  • The first Smilemobile school dental program was initiated by Eastman Dental Center, in 1970.
  • In 1993 a Monroe County Health Department sponsored school dental health survey revealed pockets of children at high risk of dental caries, especially among recent immigrant children, in Rochester schools. In response to this and because of serious lack of dental services for underserved children, the current collaborative outreach dental program began in 1994, under the leadership of Dr. Buddhi Shrestha. The program was developed primarily to provide preventive and primary dental care to Medicaid and other underserved school children that have no dentist of their own. In 1999 Rochester Oral Health Coalition (ROHC), a consortium of health care and community organizations was established to address the unmet dental care needs in Rochester area urban/rural communities. Rochester Primary Care Network serves as lead agency for the coalition.

Demographics

 

  • Rochester, Monroe County, and its six neighboring rural counties in western New York
  • The target population is school-aged, underserved urban and rural child recipients of Medicaid and Child Health Plus who have no access to dental care
  • Seven to twelve-year old children were treated, specifically targeting schools identified by a “Dental Care Needs Acuity Index” as “Most Needed”

Administration of Program

 

  • Originally 11 service sites serving a total of 2200 underserved school children in 1994 has grown to 37 sites serving over 10,000 children in year 2000.
  • Services are currently administered at 24 urban and 13 rural service sites, which include two permanent “Hub” satellite clinics (one urban and one rural) for providing basic dental care to both children and adult underserved populations, including homeless populations.
  • Pediatric/general dentists, post-graduate dental residents and dental hygienists provide all preventive and basic dental treatment including dental prophylaxis, fluoride, sealant and restorative treatment at the site. More comprehensive dental work is referred to the University of Rochester Eastman Dental Center Main Clinics.
  • All necessary treatments are completed within one month with minimum loss of class-time, and children receive follow-up dental care each year
  • There are no missed appointments or waiting list
  • The inner-city program consists of three Smilemobiles (2 full-time and one part-time mobile dental clinics) each serving five or six schools. In addition, seven year-round, part-time satellite clinics and one permanent “Hub” clinic have been established.
  • The rural program consists of two portable dental programs (part-time school based clinics), each serving four to five different sites. This is coupled with one year round part-time satellite clinic and one “Hub” clinic and three Smilemobile clinics used in the summertime.

Community support

 

  • The school district provides clinic space, utility and custodial services for 6-12 weeks each year at no cost to the program, and assists with enrollment and scheduling of appointments.
  • County/State health and social service departments assist with necessary permits/waivers, regulatory inspections, etc. for opening clinics in schools. They also help with the enrollment of Medicaid-eligible school children for dental treatments. Also, the New York State Bureau of Dental Health provides Maternal and Child Health block grant funding for the sealant program.
  • The Rochester Primary Care Network provides funding through federal grants to subsidize sliding fee scales for providing dental care to uninsured children. The RPCN also provided a three-year grant funding for the expansion of the school program to four neighboring rural counties.
  • The Daisy Marquis Jones Foundation awarded $250,000 in year 2000 to fund the purchase of a new fully-equipped third Smilemobile and $350,000 in year 2001 to build a 3000 square feet outreach dental facility at one Rochester’s elementary school campus.
  • Other community partners includes: Unity Health St. Mary’s Hospital, Corning Hospital, BOCES Geneseo Migrant Center, rural county health departments and school districts, and 3 rural county Departments of Social Service
  • Parents appreciate the program, beside its clear health benefit to their children, because it costs no money for transportation, and requires no loss of the parents’ work time.

Annual Budget
Over $2 million per year
Financial support

  • The primary source of funding is Medicaid and Child Health Plus reimbursements. Secondary sources include sliding fee scale reimbursements from federal grants through Rochester Primary Care Network, New York State Bureau of Dental Health, Maternal and Child Health Block Grant, Monroe County Health Department and grants from local foundations including Daisy Marquis Jones Foundation who provided $600,000, during the past two year.
  • Currently, the program is self-supporting through per diem-based Medicaid reimbursements, Child Health Plus and other third-party reimbursements.

Assessment:

The program has developed its own assessment technique known as the Dental Care Needs Acuity Index (DCNAI). The schools with school-based dental programs generally scored better than schools without these programs in such DCNAI parameters as tooth decay, percent of children with active caries, presence of sealants, and enamel fluorosis.

Statistics

 

  • Rochester’s current school based outreach dental program has provided preventive and primary dental care to over 10,000 “difficult to reach” underserved Medicaid and Child Health Plus school children, over 90% of whom would otherwise not have received care
  • Free screening and referral services have been given to over 2500 non-Medicaid school children annually.
  • A recent study by Dr. Buddhi Shrestha and co-worker, which was reported at the International Association for Dental Research meeting ( J. Dent Res 79 Special Issue, 503, 2000), showed that on a long-term basis school-based dental delivery system was more cost-effective than traditional delivery system.

Other comments

 

  • There exist a number of regulatory barriers, which make establishment of a “stand-alone” full-time school-based dental program rather difficult. A new statewide oral health initiative is currently underway, which includes efforts to remove these barriers.
  • Local dentists have occasionally opposed the program because of a fear of losing patients.
  • The program would not be able to self-sustain if it were not for the per diem-based Medicaid reimbursements that New York State provides to all Article 28 health institutions such as hospitals, community health centers, diagnostic center, etc. The rates, however, vary from one institution to other, based on their costs for delivering the services.

Contact Person

Dr. Buddhi Shrestha, D.D.S., M.S., Ph.D.
Chair, Rochester/New York State Oral Health Coalition
Rochester Primary Care Network
Associate Professor, Division of Community Dentistry
University of Rochester Eastman Dental Center
Elmwood Avenue, Box 683
Rochester, NY 14620
Tel: 716.275-0128
Fax: 716.756.5577

E-mail: Buddhi_Shrestha@URMC.Rochester.edu