Oral Health Toolkit

Rural Oral Health Toolkit
Welcome to the Rural Oral Health Toolkit. The Toolkit is designed to help you identify and implement an oral health program. It also provides you with resources and best practices. The toolkit is made up of several modules. Each concentrates on different aspects of oral health programs. Modules also include resources for you to use in developing a program for your area. For the most current version of the toolkit, please view the toolkit online: http://www.raconline.org/ communityhealth/oral-health/ If you need assistance with downloading or accessing the resources listed in this toolkit, please contact us: http://www.raconline.org/contact/
About the Community Health Gateway and its Evidence-Based Toolkits The Community Health Gateway showcases program approaches that you can adapt to fit your community and the people you serve, allowing you to: Research approaches to featured community health programs Discover what works and why Learn about common obstacles Connect with program experts Evaluate you program to show impact
This toolkit was developed by the NORC Walsh Center for Rural Health Analysis in collaboration with the Rural Assistance Center. Funding for this toolkit was provided by the Office of Rural Health Policy (ORHP), Health Resources and Services Administration.
TABLE OF CONTENTS
Module 1: Oral Health in Rural Communities An overview of oral health in rural communities. Module 2: Rural Oral Health Program Models Oral health program models and ways to adapt these programs to meet your communitys needs. Module 3: Implementation of Rural Oral Health Programs Resources that support the implementation of oral health programs. Module 4: Planning for Sustainability Strategies to ensure the sustainability of your oral health program. Module 5: Evaluating Rural Oral Health Programs A framework for evaluation, methods and considerations, and metrics for oral health programs. Module 6: Dissemination of Rural Oral Health Resources and Promising Practices Methods for disseminating results from your oral health program. Module 7: Program Clearinghouse Examples of oral health programs that have been implemented in rural communities.
Rural Assistance Center www.raconline.org
MODULE 1: ORAL HEALTH IN RURAL COMMUNITIES

Oral health is a critical component of health and well-being. Poor oral health is related to a range of diseases in adults and children. Routine oral health care examinations and services can help to prevent disease and also identify other conditions. Despite the importance of oral health and developments in knowledge and practice in this area, oral health disparities exist in rural communities related to access to care, utilization of services, and outcomes. This module provides an overview of oral health in rural America. In this module

The State of Oral Health in Rural America Barriers to Oral Health Care in Rural Communities Rural Oral Health Program Partners Other Considerations in Light of the Affordable Care Act
The State of Oral Health in Rural America

Oral health is a critical component of health and well-being. Poor oral health is related to a range of diseases and disorders in adults and children. The Surgeon Generals report on oral health noted that: You cannot be healthy without oral health. Oral health and general health should not be interpreted as separate entities. Oral health is a critical component of health and must be included in the provision of health care and the design of community programs. Despite the importance of oral health and developments in knowledge and practice in this area, oral health disparities exist in rural communities. Disparities are evident in oral health access, utilization, and health outcomes in rural America. To address these disparities, rural communities are developing oral health programs that are responsive to the specific needs of their populations. Rural oral health programs are designed to: Increase access to oral health care Provide oral health care services Increase utilization of services Improve oral health outcomes Improve oral health literacy Reduce barriers to accessing care Raise awareness about oral health Adapt and implement promising and evidence-based approaches Build networks of oral health partners in communities
RESOURCES TO LEARN MORE

Oral Health in America: A Report to the Surgeon General http://www.nidcr.nih.gov/DataStatistics/SurgeonGeneral/sgr/TOC.htm Report Alerts Americans to the full meaning of oral health and its importance to general health and wellbeing. Organization: National Institutes of Health, National Institute of Dental and Craniofacial Research Date: 2000 Advancing Oral Health in America: Summary http://www.nap.edu/catalog.php?record_id=13086 Discusses the challenges facing the current oral health system, the connection between oral health and overall health, and how to improve oral health care. Chapters 2 and 3 discuss the oral health system in rural settings. Report Organization: Institute of Medicine Date: 2011 The State of Rural Oral Health: A Literature Review http://www.srph.tamhsc.edu/centers/rhp2010/10Volume2oralhealth.pdf Literature Review Detailed literature review of rural health issues associated with the Healthy People 2010 focus area on oral health. Organization: Rural Healthy People 2010 Authors: P. Fos and L. Hutchison Date: 2003 Meeting Oral Health Care Needs in America http://www.ruralhealthweb.org/index.cfm?objectid=3FA06195-1185-6B66883263BC28ABA0A4 Policy Brief This policy brief provides background information on rural oral disparities and gives recommendations for how to improve rural oral disparities on a national, state and local level. It also includes a section on suggested dental training programs. Organization: National Rural Health Association Date: 04/2005
Shortage Designation: Health Profession Shortage Areas & Medically Underserved Areas/Populations http://hrsa.gov/shortage/ Website This website includes information about Health Profession Shortage Areas, including dental HPSAs, and Medically Underserved Areas/Populations by County, State, and Zip code. Organization: Health Resources and Services Administration Author: N/A Date: N/A Structural Cavities in Rural Dental Health http://www.dailyyonder.com/silent-epidemic-dentistry/2012/03/22/3824 Article This article describes oral health disparities in rural areas. Organization: Daily Yonder Author: Chuck Shuford Date: 03/2012
Barriers to Oral Health Care in Rural Communities

Rural populations face a range of barriers that affect access to oral health care, including: Low provider-to-population ratios Inadequate number of dentists who accept Medicaid and the Childrens Health Insurance Program or who have discounted fee schedules Insufficient or lack of dental insurance benefits Lack of transportation Lack of child care Insufficient levels or lack of access to water fluoridation Lack of awareness about oral health Geographic barriers to care Poverty Cultural barriers and stigma

Access to Oral Health Services for Low-Income PeoplePolicy Barriers and Opportunities for Intervention for the Robert Wood Johnson Foundation http://www.oralhealthamerica.org/pdf/NCSLReport.pdf Policy Brief This policy brief discusses oral health care policy barriers and solutions. Authors: Shelly Gehshan, Tara Straw Organizations: National Conference of State Legislatures Date: 10/2002 Meeting Oral Health Care Needs in America http://www.ruralhealthweb.org/index.cfm?objectid=3FA06195-1185-6B66883263BC28ABA0A4 Policy Brief This policy brief provides background information on rural oral disparities and gives recommendations for how to improve rural oral disparities on a national, state and local level. It also includes a section on suggested dental training programs. Organization: National Rural Health Association Date: 04/2005 Oral Health among Low-Income Rural Families: Implications for Policy and Programs http://www.csrees.usda.gov/nea/food/pdfs/oral_health.pdf Policy Brief This policy brief discusses barriers to oral health care. Organization: Department of Family Studies at University of Maryland Date: 02/2007 The State of Rural Oral Health: A Literature Review http://www.srph.tamhsc.edu/centers/rhp2010/10Volume2oralhealth.pdf Literature Review This is a literature of rural oral health. Detailed literature review of rural health issues associated with the Healthy People 2010 focus area on oral health. Organization: Rural Healthy People 2010 Authors: Pete Fos and Linnae Hutchison Date: 2003
Rural Oral Health Program Partners

Many rural oral health programs have the support of local health departments, community clinics, social service organizations, and schools, among other organizations. These relationships can help rural oral health programs to: Identify appropriate program partners and volunteers Identify individuals who are in need services and conduct effective outreach
Understand the barriers to oral health care and identify solutions Leverage resources Refer individuals to other providers and social supports

A Guide for Developing and Enhancing Community Oral Health Programs http://www.aacdp.com/guide/ Community Guide This guide is designed to help local public health agencies to develop, integrate, expand or enhance community oral health programs. It provides information on mobilizing community support, assessing needs and existing resources, planning the program, implementing the program, evaluating the program and participating in policy development and research. Organization: American Association for Community Dental Programs (AACDP) Increasing Access to Dental Care in Medicaid: Targeted Programs for Four Populations http://nashp.org/sites/default/files/Dental_Reimbursements.pdf?q=files/Dental_Reimbursements. pdf Policy Briefing This report describes strategies that states have used to address the oral health needs of young children, pregnant women, people with developmental disabilities and people in rural areas. Organization: National Academy for State Health Policy Author: Andrew Snyder Date: 03/2009
Other Considerations in Light of the Affordable Care Act

The Affordable Care Act contains provisions on oral health care coverage and prevention that may affect the design and implementation of future rural oral health programs. Section 1302 of the Affordable Care Act requires pediatric dental benefits to be included in the essential health benefits package. Adult dental benefits are not part of the essential health benefits package. Other activities that have been authorized by the Affordable Care Act include the development of a national strategy to coordinate and promote disease prevention, wellness and public health programs and the development of an evidence-based public education campaign that focuses on early childhood caries, prevention, and oral health care of pregnant women and at-risk populations.

Oral Health and the Affordable Care Act: Only Part Way to the Finish Line http://www.allhealth.org/publications/Oral_Health_Issue_Brief_116.pdf Issue Brief This brief discusses oral health care access for both adults and children in the U.S. within the context of the Affordable Care Act. Organization: Alliance for Health Reform Date: 10/2012 Childrens Oral Health http://www.ncsl.org/issues-research/health/childrens-oral-health-policy-issues-overview.aspx Website This website examines oral health through the Affordable Care Act, Medicaid and CHIP, Access to Services, Workforce Issues, and Prevention and Awareness. Organization: National Conference of State Legislatures Date: 3/2012 Healthcare Reform and Oral Health http://www.oralhealthwatch.org/policy-center/healthcare-reform-and-oral-health/ Fact Sheet This fact sheet summarizes the oral health provisions in the Affordable Care Act. Organization: Oral Health Watch Date: 2010 Prevention Provisions in the Affordable Care Act http://www.apha.org/NR/rdonlyres/763D7507-2CC3-4828-AF841010EA1304A4/0/FinalPreventionACAWeb.pdf Issue Brief This issue brief summarizes the state of public health in the United States and describes the major provisions of the Affordable Care Act that address prevention. Organization: American Public Health Association Author: G. Shearer Date: 10/2010 Patient Protection and Affordable Care Act http://www.gpo.gov/fdsys/pkg/BILLS-111hr3590enr/pdf/BILLS-111hr3590enr.pdf Law Date: 2010
HealthCare.Gov http://www.healthcare.gov/ Website HealthCare.gov is the first central database of health coverage options, combining information about public programs with information on more than 8,000 private insurance products. HealthCare.gov is a federal government website managed by the U.S. Department of Health & Human Services. Organization: U.S. Department of Health and Human Services Office of Intergovernmental and External Affairs Initiatives http://www.hhs.gov/iea/initiatives/index.html Website This website includes news and updates about the work the U.S. Department of Health and Human Services is performing across the country, Affordable Care Act bulletins, and information about how the Affordable Care Act affects your community. Organization: U.S. Department of Health and Human Services Center for Consumer Information and Insurance Oversight http://cciio.cms.gov/index.html Website The Center for Consumer Information and Insurance Oversight (CCIIO) of the Centers for Medicare & Medicaid Services is charged with helping implement many provisions of the Affordable Care Act. CCIIO oversees the implementation of the provisions related to private health insurance. Organization: Center for Consumer Information and Insurance Oversight
MODULE 2: RURAL ORAL HEALTH PROGRAM MODELS

This section provides resources about different rural oral health program models.
Different Models
Rural communities are implementing different oral health program models. The program models are not mutually exclusive. Some programs may apply a combination of these approaches. Workforce Model Workforce models focus on recruiting and retaining dental professionals in rural areas. Allied Health Professional Model The allied health professionals model focuses on the different roles that these professionals provide dental care, education, and referral, screening and support services. Access to Medicaid Model The access to Medicaid model focuses on expanding access to Medicaid through communitybased strategies. Outreach and Education Model Rural communities are developing community-based outreach and education programs to expand access to oral health care. Oral Health Primary Care Integration Model Rural communities are using different strategies to integrate oral health and primary care. School-Based Model Rural communities are implementing school-based oral health programs that provide fluoride varnish and dental sealants. Dental Clinic Model Rural oral health programs are developing dental clinics that provide safety net care to individuals in order to increase access to care and reduce reliance on emergency services. Mobile Dental Services Model The mobile dental services model focuses on providing access to dental care, preventive health care, and chronic disease screening and management services. Dental Home Model Rural communities are designing dental homes for adults and children. The dental home model emphasizes wellness through improved oral health status, increased collaboration among providers, and the promotion of health education. Eligibility and Enrollment Model Rural communities are using eligibility and enrollment models to expand access to oral health services.
Community Fluoridation Model Community water fluoridation is a public health intervention used to prevent tooth decay.
Also in this Module

Guidelines for Rural Oral Health Programs Populations Served Adapting Programs to Serve Your Community
Workforce Model
Recruiting and retaining dentists to practice in rural areas can be challenging because of fewer available local training programs for dental hygienists and assistants, lower private and public health insurance reimbursement rates for services and fewer employment opportunities for the dentists spouse. In order to increase access to care, rural communities are using workforce models to recruit and retain dentists. Rural workforce approaches include: Encouraging students from rural communities to choose dental careers by developing programs that introduce students to the dental profession Offering incentive programs to dental professionals who serve rural populations, including tuition reimbursement and loan forgiveness programs Introducing pediatric residents to area dentists interested in recruiting graduates for their practices Creating linkages between dental schools and rural dental clinics to increase the number of dental student graduates completing a portion of their training in a rural community
IMPLEMENTATION CONSIDERATIONS
The Patient Protection and Affordable Care Act contains oral health workforce and training provisions that may present new opportunities for future rural oral health workforce programs. Specifically, the Affordable Care Act contains provisions to establish:

Programs to train or employ alternative dental health care providers New opportunities for training dentists A dental faculty loan repayment program for faculty engaged in primary care dentistry who train rural dentists New primary care residency programs, including dental programs Funding for graduate dental education

Healthcare Reform and Oral Health http://www.oralhealthwatch.org/policy-center/healthcare-reform-and-oral-health/ Fact Sheet This fact sheet summarizes the oral health provisions in the Affordable Care Act. Organization: Oral Health Watch Date: 2010 Access to Oral Health Care Services: Workforce Development http://www.astdd.org/access-to-oral-health-care-services-workforce-development/ Report This report describes a public health strategy, assesses the strength of evidence on the effectiveness of the strategy, and uses practice examples to illustrate successful implementation. Organization: Association of State & Territorial Dental Directors Date: 5/2011 State and Community Best Practice Approach Examples: Workforce Development http://www.astdd.org/state-and-community-practiceexamples/&bpareport=Access%20to%20Oral%20Health%20Care%20Services:%20Workforce% 20Development Collection of Program Examples The Association of State and Territorial Dental Directors provides state and community best practice approach examples on workforce development. Organization: Association of State and Territorial Dental Directors Oral Health Workforce in Wisconsin http://worh.org/files/OralHealthWorkforce04-10.pdf Power Point Presentation This presentation discusses the disparities in oral health among rural populations in Wisconsin and slide 28 provides recommendations related to the oral health work force. Organization: Rural Health Development Council, Wisconsin Department of Health Services Author: Lisa Bell Date: 04/2010
Allied Health Professional Model

Allied health professionals support rural oral health programs by providing oral health care services, including education, referral, screening and support services. According to the Association of Schools of Allied Health Professions, allied health professionals are individuals who are involved with the delivery of health or related services pertaining to the identification, evaluation and prevention of diseases and disorders. Allied health professionals include dental hygienists, dental assistants, health educators, and dental laboratory technicians. Some states have proposed the creation of a new allied health professional training program for mid-level dental providers called dental therapists to perform certain procedures. Dental
therapists have practiced in countries such as New Zealand, Canada, Hong Kong and Thailand. Dental therapists also practice in the United States. The Alaska Native Tribal Health Consortium introduced dental therapists to care for Alaska Natives in tribal villages in 2005. In 2009, Minnesota authorized the training and practice of dental therapists.
Allied health professionals may support school-based programs (see School Based Model), mobile dental services programs (see Mobile Dental Services Model), dental clinic programs (see Dental Clinic Model), and dental home programs (see Dental Home Model).

Dental Therapists: Background and Updates on Implementation http://www.dentalboard.state.mn.us/Default.aspx?tabid=1165 Website Information and documents related to dental therapist licensure. Organization: Minnesota Board of Dentistry Author: N/A Date: N/A A Review of the Global Literature on Dental Therapists http://www.wkkf.org/~/media/97a0e38a926443bf81491c09dca6a7ea/nash%20dental%20therapis t%20literature%20review.pdf Literature Review This document reviews the different ways that countries around the world use dental therapists in the oral health workforce. Organization: W.K. Kellogg Foundation Author: David Nash, Jay Friedman and Kavita Mathu-Muju Date: 04/2012 American Dental Hygienists Association http://www.adha.org/ This website provides information about the American Dental Hygienists Association and other resources about oral health. Organization: American Dental Hygienists Association American Dental Assistants Association http://www.dentalassistant.org/ This website provides information about the American Dental Assistants Association and the American Dental Assistants Association Foundation. Organization: American Dental Assistants Association
American Dental Education Association http://www.adea.org/ ADEA is the premier association serving the dental education community. Dental education is a broad and varied field that educates individuals as general dentists, specialists, dental hygienists, dental assistants, and dental laboratory technicians. Organization: American Dental Education Association The Association of Schools of Allied Health Professions http://www.asahp.org/ This website provides information about the Association of Schools of Allied Health Professions as well as links to other relevant websites. Organization: The Association of Schools of Allied Health Professions
Access to Medicaid Model

Dental coverage for children has expanded over the years through the Childrens Health Insurance Program, improvements in state Medicaid programs, pediatric dentistry training, and dental management organizations. However, some rural communities do not have adequate access to dentists who accept Medicaid for adults. Rural oral health programs are working to expand access to Medicaid through community-based strategies.
Few rural communities are implementing this model because it is challenging to expand access to Medicaid using community-based strategies.

Medicaid Travel of Pediatric Dental Teams, Alaska Department of Health and Social Services, Department of Public Health http://www.astdd.org/bestpractices/DES02001AKmedicaidtravel.pdf Program Example This is a best practice approach report. Organization: Association of State and Territorial Dental Directors Date: January 2005 Into the Mouth of Babes http://www.ncdhhs.gov/dph/oralhealth/partners/IMB.htm Program Example The Into the Mouths of Babes is a program that reimburses physicians for providing preventive dental services to children 0 to 3 years of age. Organization: North Carolina Department of Health and Human Services
Children and Oral Health: Assessing Needs, Coverage, and Access Describes the current state of children's oral health status and access to dental care. Sponsoring organization: Kaiser Commission on Medicaid and the Uninsured Date: 06/2012 The Current and Future Role and Impact of Medicaid in Rural Health Outlines and describes the current Medicaid program and its importance to rural America. Also discusses rural implications of program expansion, including whether and how states choose to implement changes. Sponsoring organization: Rural Policy Research Institute Rural Health Panel Date: 09/2012 view details Medicaid and Rural America http://files.cfra.org/pdf/Medicaid.pdf Issue brief This issue brief is part of a larger series that examines health care issues in rural America. Organization: Center for Rural Affairs Date: February 2012
Outreach and Education Model

Rural communities are developing outreach and education programs that use curricula, tools, and media to increase community member knowledge and awareness of oral health. Community outreach and education programs may occur in dental clinics as well (see Dental Clinic Model). Rural oral health programs that focus on outreach and education may partner with Area Health Education Centers, local health departments, schools, day care centers, tribes, and Head Start programs. Examples of rural oral health outreach and education activities include: Hosting a dental booth at a community health fair Identifying champions providers in peer groups to increase awareness of oral health care challenges in their communities Working with community health workers to conduct education on oral health selfcare and preventive care in order to reduce emergency department visits Providing teachers with access to ongoing technical assistance on pediatric oral health issues Educating providers about the importance of oral examinations of infants and toddlers Conducting outreach to hard-to-reach populations such as migrant farm workers Working with the Women, Infants, and Children and Head Start programs to include a dental education component
Rural oral health programs use culturally appropriate outreach and education strategies. Educational materials may be translated into different languages. Outreach may occur at churches, stores, and community centers.

The State of Oral Rural Health http://srph.tamhsc.edu/centers/rhp2010/10Volume1oralhealth.pdf Report This document gives an overview of oral health problems in the U.S and highlights five rural health programs and that are using outreach and education models for improving access to dental care for rural populations. Organization: Texas A&M Health and Science Center Author: Pete Fos and Linnae Hutchison Date: 2003 Oral Health Education Materials for Children http://www.dphhs.mt.gov/publichealth/oralhealth/ Resource This website provides oral health education materials for children in first through fifth grade. Click on "Oral Health Education" to display the links to specific materials. Author: Montana Department of Public Health and Human Services Oral Health Program Community Health Access Project Pathways Model http://www.innovations.ahrq.gov/content.aspx?id=2040 Summary The Community Health Access Project implemented the Pathways Model, which employs community health workers who connect at-risk individuals to evidence-based care through the use of individualized care pathways designed to produce healthy outcomes. While this program did not focus on oral health education, it could be adapted to focus on oral health. Author: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services Zero Out Early Childhood Tooth Decay: An Early Head Start Dental Health Initiative http://www.sph.unc.edu/zoe/ Factsheet This project is designed to Zero Out all Early (ZOE) childhood tooth decay in children enrolled in Early Head Start programs in North Carolina. It builds on previous efforts in medical and dental offices to reduce tooth decay and is funded by a 5-year grant (2008 to 2013) from the National Institutes of Health. Organization: University of North Carolina Gillings School of Global Public Health Date: N/A
Smiles for Life: A National Oral Health Curriculum http://www.smilesforlifeoralhealth.org/ Smiles for Life is a national comprehensive oral health curriculum. This curriculum is designed to enhance the role of primary care clinicians in the promotion of oral health for all age groups through the development and dissemination of high-quality educational resources. The curriculum contains educational modules for physicians, nurses, and physician assistants. Organization: Society of Teachers of Family Medicine Group on Oral Health, DentaQuest Foundation, Washington Dental Service Foundation, Connecticut Health Foundation Into the Mouths of Babes Toolkit http://www.ncdhhs.gov/dph/oralhealth/partners/IMB-toolkit.htm Toolkit The Into the Mouths of Babes program trains medical providers to deliver preventive oral health services to high-risk children. Organization: North Carolina Department of Health and Human Services
Oral Health-Primary Care Integration Model

Rural communities are using different strategies to integrate oral health and primary care: Improving communication between dental and primary care providers Creating interdisciplinary teams where mid-level medical and dental hygienists work alongside primary care physicians to provide oral health screenings, guidance, and other services and referrals (See Allied Health Professional Model). Establish referral partnerships between dental clinics and primary care practitioners (See Dental Home Model). Using school-based models for dental assessment that refer children to a source of primary care (see School-Based Model).
The health commons approach has been used to integrate oral health and primary care for uninsured, low-income rural populations. Health commons sites are primary care safety net practices that include medical, dental, behavioral, public health and social services. This approach has been used in New Mexico to pool resources from different public and private stakeholders in the community.
Partnerships play an important role in the implementation of this model.

A Health Commons Approach to Oral Health for Low-Income Populations in a Rural State http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447375/ Peer Reviewed Journal Article This article describes the incorporation of oral health services into a health commons primary care model. Organization: American Journal of Public Health, Vol. 92, No.1 Authors: Stephen Beetstra, Daniel Derksen, Marguerite Ro, Wayne Powell, Donald Fry, Arthur Kaufman Date: January 2002 The State of Rural Oral Health: A Literature Review http://www.srph.tamhsc.edu/centers/rhp2010/10Volume2oralhealth.pdf Literature Review The health commons approach is discussed in the section on proposed solutions. Organization: Rural Healthy People 2010 Authors: Pete Fos and Linnae Hutchison Date: N/A
School-based Model
Rural communities are implementing school-based oral health programs that provide fluoride varnish and dental sealants. In school-based dental programs, dentists, dental hygienists, and community health workers deliver preventive dental services. A rural oral health program in South Dakota utilizes dental hygienists to perform screenings, fluoride varnish, dental sealants, oral health education to students, and if needed, refer patients to local dentists that have agreed to treat more complex cases. Dental hygiene students and their professors travel to rural school sites to deliver services. Another program in rural Montana utilizes a community health advisor to deliver fluoride varnishes to school children during dental screenings. Also, a program in rural Louisiana is educating medical and allied health professionals about how to apply fluoride varnish in schools. School-based programs offer an opportunity to introduce dental hygiene students to the needs of rural populations, and can increase the rural oral health workforce in the long-term (see Workforce Models).
Oral health programs implementing school-based models must obtain the appropriate permissions from parents and school administrators to work with school-aged children. A school nurse or school counselor may serve as an outreach coordinator that can assist the dentist in coordinating the program. Rural oral health programs implementing school-based models may have support from community stakeholders, such as the health department, state office of rural health, universities, and state dental and dental hygienists associations.
RESOURCES TO LEARN MORE ENROLLMENT FORMS AND MANUALS

School Based-Dental Program Information and Enrollment Form http://www.choptankhealth.org/service%20docs/CC-SBDP-enrollment%20form.pdf Form This is a letter template for enrolling in a school-based dental program. Organization: Choptank Community Health System Date: May 2011 School-based Fluoride Varnish Program Manual http://www.oralhealthaccess.org/resources/documents/2010-10-06-Prgrm-Manual-School-BasedFluoride-Varnish.pdf Manual This manual was prepared for the purpose of sharing lessons learned and productive practices arising from development, testing and launching a program of providing school-based oral health preventive services for children. These consisted of providing basic oral health assessments, creating and testing a Community Health Advisor model for fluoride varnish application, and ensuring follow-up referrals and care for children with urgent needs. Author: Anderson Center for Dental Care Date: 2010 Seal America: The Prevention Intervention, Second Edition, Revised http://www.mchoralhealth.org/seal/ Manual Guide for health professionals who want to implement a school-based dental sealant program. Includes step-by-step instructions covering staffing, equipment, funding, program evaluation and more. Author: Nancy Carter, R.D.H., M.P.H. Date: 2011
MORE INFORMATION ABOUT SCHOOL-BASED PROGRAMS

Preventing Dental Caries: School-Based or -Linked Sealant Delivery Programs http://www.thecommunityguide.org/oral/schoolsealants.html Summary of Findings These programs provide direct delivery of dental sealants to children in school-based or schoollinked settings. The Community Preventive Services Task Force recommends school-based and school-linked dental sealant delivery programs based on strong evidence of effectiveness in preventing or reducing tooth decay among children. Community Preventive Services Task Force Date: 2002
School-Based Dental Sealant Programs http://www.cdc.gov/oralhealth/topics/dental_sealant_programs.htm#3 Website Provides information about the evidence supporting school-based sealant programs, as well as recommendations for implementation. Organization: Centers for Disease Control and Prevention Use of Fluoride: School-based Fluoride Mouthrinse and Supplement Programs http://www.astdd.org/use-of-fluoride-school-based-fluoride-mouthrinse-and-supplementprograms-introduction/ Report Organization: Association of State and Territorial Dental Directors This Best Practice Approach Report describes a public health strategy, assesses the strength of evidence on the effectiveness of the strategy, and uses practice examples to illustrate successful implementation. Date: June 2011 Eastern Plains Oral Health Initiative http://www.cahec.org/community/oral_health.php Program Example The Eastern Plains Oral Health Initiative promotes the health of school children in seven frontier areas of Colorado by employing a school-based dental sealant program and educating parents/caregivers about the importance of preventive oral health practices for their children. Organization: Centennial Area Health Education Center
MORE INFORMATION ABOUT CLINICAL RECOMMENDATIONS FOR FLUORIDE VARNISH

Professionally Applied Topical Fluoride: Evidence-Based Clinical Recommendations http://jada.ada.org/content/137/8/1151.full Evidence review This is a summary of evidence-based clinical recommendations developed by an expert panel established by the American Dental Association Council on Scientific Affairs that evaluated the collective body of scientific evidence on the effectiveness of professionally applied topical fluoride for caries prevention. Author: American Dental Association Council on Scientific Affairs Date: 2006 Recommendations for Using Fluoride to Prevent and Control Dental Caries in the United States http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5014a1.htm Report The recommendations in this report guide dental and other health-care providers, public health officials, policy makers, and the public in the use of fluoride to achieve maximum protection against dental caries while using resources efficiently and reducing the likelihood of enamel fluorosis. Author: Centers for Disease Control and Prevention Date: August 2001
Fluoride Varnish for Preventing Dental Caries in Children and Adolescents http://summaries.cochrane.org/CD002279/fluoride-varnishes-for-preventing-dental-caries-inchildren-and-adolescents Summary The review of trials found that fluoride varnish can substantially reduce tooth decay in both milk teeth and permanent teeth. Organization: Cochrane Database of Systematic Reviews Authors: Marinho VCC, Higgins JPT, Logan S, Sheiham A Date: January 2009
Dental Clinic Model

Rural oral health programs are developing dental clinics that provide safety net care to individuals. Some rural communities are leveraging existing dental clinics, while others are seeking funds to build new free-standing clinics or open clinics within a local medical center. In one rural program that participates in an oral health consortium, four dental clinics operate in a partners building at no cost. Rural oral health programs offer preventive, restorative, surgical and rehabilitation services to patients, such as: Dental hygiene (cleaning, scaling, polishing) Oral cancer screening Dental X-rays Dental sealants Fluoride varnish Fillings Root canal therapy Crowns Tooth extraction Dentures Treatment of gum disease
In addition to these services, dental clinics may offer education on oral hygiene, self-care and wellness maintenance. Rural dental clinics may also provide services for expecting mothers and mothers with infants, such as information about newborn hygiene and bottle-feeding, sample dental products, dental wipes, and treatment schedules. In some dental clinics, dentists or dental students offer their services free of charge. Other dental clinics may accept Medicaid or use a sliding fee scale. Some dental clinics offer only emergency dental services, and such services are offered at reduced rates.
Rural dental clinics are staffed in different ways. Some programs recruit dentists to provide dental care to patients on a rotational schedule, sharing the responsibility across providers. Other programs work with dental residents to provide free dental care. Programs also offer multi-day portable clinic events staffed by dental and medical professionals and community member volunteers. Rural oral health programs have established patient advisory groups to guide their projects in order to identify and understand the needs of their priority population. In some cases, food, transportation and modest compensation are offered to advisory group members to improve participation.

American Dental Association Center for Evidence-based Dentistry http://ebd.ada.org/about.aspx Website The Center for Evidence-based Dentistry provides a database of systematic reviews on all oral health topics, synopses of the key elements of systematic reviews, clinical recommendations and guidelines, and links to other many outside resources including tutorials, glossaries, and databases. Organization: American Dental Association Dental Support Center http://www.usetinc.org/programs/uset-thps/DentalSupportCenter.aspx The purpose of the Dental Support Center (DSC) is to improve access to quality clinical and preventative services for the Indian Health Service Beneficiaries. The website contains patient educational resources and templates that could be used in other clinics. Organization: United South and Eastern Tribes, Inc. Mission of Mercy https://www.amissionofmercy.org/aboutus/ Program Example Since 1994, Mission of Mercy has been providing free healthcare, free dental care and free prescription medications to the uninsured and underinsured. Organization: Mission of Mercy The Calhoun County Dentists Partnership: A Hands-Up, Not a Hand-Out http://www.smilemichigan.com/Portals/pro/Journals/March%202012/index.html?pageNumber=4 0 Journal Article This article describes the Calhoun County Dentists Partnership that provides dental care to patients in exchange for community service at local nonprofit organizations. Citation: Journal of the Michigan Dental Association, Issue 94, Vol. 3, p. 38-41 Author: Sharon Emery Date: March 2012
School-based Oral Health Screening Materials http://www.dphhs.mt.gov/publichealth/oralhealth/ Resource This website provides oral health screening resources including basic screening survey manuals and video, screening form, parental consent letter, among other resources. Author: Montana Department of Public Health and Human Services Oral Health Program How to Start a Dental Clinic http://www.nnoha.org/practicemanagement/startclinic.html Resource This is a resource that provides information on starting a dental clinic. Organization: National Network for Oral Health Access Date: N/A Dental Forms Library http://www.nnoha.org/dentallibrary.html Forms The National Network for Oral Health Access Dental Forms Library is a collection of forms in use by safety-net oral health programs across the country. These sites are sharing their forms to allow other programs to have a reference in developing their own material. Organization: National Network for Oral Health Access 2011-12 Definitions, Oral Health Policies, Clinical Guidelines http://www.aapd.org/policies/ The American Academy of Pediatric Dentistry (AAPD) Reference Manual is divided into five sections: (1) definitions; (2) oral health policies; (3) clinical guidelines; (4) endorsements; and (5) resources. Oral health policies are statements relating to AAPD positions on various public health issues. Clinical guidelines are practice recommendations designed to assist the dental provider in making decisions concerning direct patient care. Organization: American Academy of Pediatric Dentistry Date: 2011 Oral Health Disparities Collaborative Implementation Manual http://www.nnoha.org/goopages/pages_downloadgallery/download.php?filename=20606.pdf&or ig_name=oral_health_implementation_manual.pdf&cdpath=/oral_health_implementation_manu al.pdf%C2%A0 Shares experiences and lessons learned from health centers that participated in the 2005 HRSA Oral Health Disparities Collaborative Pilot. Organization: The Health Resources and Services Administration, U.S. Department of Health and Human Services Date: June 2008
Mobile Dental Services Model

Rural communities deliver dental services through mobile dental vans or portable dental clinics in population centers, schools, or hard-to-reach areas. A mobile dental van may include dental operatories; X-ray facilities; a sterilization system; and computer for processing claims, updating medical records, and scheduling appointments. The mobile dental services model focuses on providing access to dental care, preventive health care, and chronic disease screening and management services for underserved residents of isolated communities. Mobile dental services models offer access to care for residents that would otherwise have to travel a long distance to reach a dentist. Services offered by mobile dental programs may include providing dental exams, providing education, and delivering dental sealants. Root canals and oral surgery are two services not often provided by a mobile program. Mobile dental programs may also transport dental equipment to Head Start centers, schools, and nursing facilities to enable providers to provide care on site. The mobile dental program may submit claims to Medicaid and third party insurances. The Tioga Mobile Dental Services program, sponsored by the Tioga County Health Department, is one model that has been adapted by rural communities.
Relationships with community stakeholders are imperative to the success of the mobile dental services model. Rural programs have worked with schools and government agencies that are vested in the program to provide the electronic, water and septic hook-ups. While the van is on site, local dental professionals donate supplies and equipment. Community stakeholders may also help program staff by referring clients. The mobile program may refer patients for more specialized care to private dental practices. Mobile dental services programs have different staff needs than other programs. For example, programs typically hire or work with a coordinator who is responsible for scheduling appointments, determining eligibility, billing, reporting, and community outreach. Some programs have a policy that van staff must be able to lift at least 50 pounds of portable equipment. Finally, it is important for this program model to maintain diverse funding streams from patient fees, in-kind support from local organizations or foundations, and fundraising events. Maintenance of the van can be expensive, given the costs associated with obtaining appropriate licenses and winterizing the van in harsh climates.

Medicaid Travel of Pediatric Dental Teams, Alaska Department of Health and Social Services, Department of Public Health http://www.astdd.org/bestpractices/DES02001AKmedicaidtravel.pdf Report A best practice approach report that describes a program in Alaska that reimburses travel and per diem expenses for pediatric dental teams in order to improve access to dental care services. Organization: Association of State and Territorial Dental Directors Date: January 2005 Tioga Mobile Dental Services, Tioga County Health Department http://naccho.org/topics/modelpractices/database/practice.cfm?practiceID=315 Report This program is highlighted as a model practice in the National Association of County and City Health Officials best practice database. Organization: National Association of County and City Health Officials Medicaid Travel of Pediatric Dental Teams, Alaska Department of Health and Social Services, Department of Public Health http://www.astdd.org/bestpractices/DES02001AKmedicaidtravel.pdf Program Example This is a best practice approach report. Organization: Association of State and Territorial Dental Directors Date: January 2005
Dental Home Model

The dental home model of care is a comprehensive approach to improving oral health access for vulnerable populations by providing a regular source of care. The American Academy of Pediatric Dentistry adopted the dental home as a policy in 2001 and defined it as the ongoing relationship between the dentist and the patient, inclusive of all aspects of oral health care delivered in a comprehensive, continuously accessible, coordinated, and family-centered way. The dental home model emphasizes overall wellness through improved oral health status, increased collaboration among providers, and the promotion of health education. Rural communities are designing dental homes for both adults and children. The Carolina Dental Home Program in North Carolina has been replicated in rural communities. This program brings physicians and dentists together to provide dental care for children on Medicaid from birth to three years old. Rural communities have adapted the Carolina Dental Home Program by targeting children outside of the primary care setting, such as at child care centers and community events, and expanding the targeted age group. Rural communities have also adapted the Michigan Community Dental Clinic program. This network of public health clinics serves adults and children on Medicaid as well as low income,
uninsured individuals. This program is striving to expand the clinic system to establish dental homes for persons unable to obtain care in private sector settings.
The dental home model emphasizes wellness, prevention and disease management. Dental hygienists, dental assistants, nutritionists, and health educators can play an important role in supporting dental home programs. Some dental home programs may include an outreach component to identify people who are at greatest risk of oral disease. Dental home programs may also offer screenings and referrals for other services and supports. Therefore, dental home requires collaboration across other providers, agencies and organizations in the community.

Policy on the Dental Home http://www.aapd.org/media/Policies_Guidelines/P_DentalHome.pdf Policy The American Academy of Pediatric Dentistry supports the concept of a dental home for all infants, children, adolescents, and persons with special health care needs. Organization: American Academy of Pediatric Dentistry Date: 2010 Policy on Workforce Issues and Delivery of Oral Health Services in a Dental Home http://www.aapd.org/media/Policies_Guidelines/P_WorkforceIssues.pdf This is the American Academy of Pediatric Dentistrys policy that focuses on the benefits of dental services delivered within a dentist-directed dental home. Organization: American Academy of Pediatric Dentistry Date: 2011 Carolina Dental Home Program http://www.ncdhhs.gov/dph/oralhealth/partners/CarolinaDentalHome.htm Program Example The N.C. Oral Health Section, partnering with the UNC-CH Gillings School of Global Public Health, designed this pilot program to improve access to dental care for young children. The objective of the Carolina Dental Home program is to identify best practices for treating and preventing tooth decay in young children. This pilot program has been funded by Health Resources and Services Administration (HRSA). Michigan Community Dental Clinics http://midental.org/about-us/ Website This program helps local health departments in Michigan establish dental clinics, based on the successful Dental Clinics North model. Date: N/A
Eligibility and Enrollment Model

Rural communities are using eligibility and enrollment models to expand access to oral health services. The eligibility and enrollment model is often a component of a school-based model, dental clinic model, or dental home model. Some programs provide insurance counseling and enrollment assistance. For example, one rural community works with Medicaid outreach workers to enroll eligible individuals into Medicaid. The Medicaid outreach worker also coordinates with local offices to secure applications and renewal forms ahead of dental visits. Another rural oral health program works with the county health department to refer individuals to a dental home. This program has an arrangement with local dentists to provide dental services at a reduced cost. Programs may also provide information and referrals to help families to access other social services that are available in the community as well as transportation assistance.
Eligibility and enrollment models require strong partnerships in the community where patients can be referred for services. Partners include colleges, health and social service agencies, schools, dental societies, churches, Area Health Education Centers, and legal services organizations.

The State of Oral Rural Health http://srph.tamhsc.edu/centers/rhp2010/10Volume1oralhealth.pdf Report This document gives an overview of oral health problems in the U.S. and highlights five rural health programs and their models for improving access to dental care for rural populations. Programs that incorporate eligibility and enrollment components include Miles for Smiles and Choptank Community Health Systems Oral Health Prevention Program. Organization: Texas A&M Health and Science Center Author: Pete Fos and Linnae Hutchison Date: 2003 Access to Baby and Child Dentistry http://abcd-dental.org/ Program Example Works to increase the number of Medicaid-enrolled babies, toddlers and preschoolers who receive dental care in Washington state. One study evaluated the program in a rural county. Organization: A public-private partnership managed by Washington Dental Service Foundation
Community Water Fluoridation Model

Community water fluoridation is a public health intervention to prevent tooth decay. One of the Healthy People 2020 oral health objectives is to increase the proportion of the U.S. population served by community water systems with optimally fluoridated water. Water fluoridation prevents tooth decay by ensuring that teeth have frequent contact with low levels of fluoride. While there are other available sources of fluoride, studies have shown that water fluoridation can reduce tooth decay by 25 percent over a persons lifetime. Rural populations are less likely to have access to adequately fluoridated drinking water. Few rural oral health programs have focused on community water fluoridation.
The local community can become the driving force to promote fluoridation and oral health. Successful program shave active participation from professionals responsible for water policy as well as oral health professionals. Water fluoridation programs may encounter policy, technical and logistical challenges.

Fluoride Legislative User Information Database (FLUID) http://fluidlaw.org/ The Fluoride Legislative User Information Database (FLUID) is a comprehensive database containing historical information on legal cases decided by U.S. courts and current information on federal and state policies regarding community water fluoridation. Local policies that affect significant U.S. population bases are added over time. Water Fluoridation and Dental Health Indicators in Rural and Urban Areas of the United States http://publichealth.hsc.wvu.edu/wvrhrc/docs/2011_fluoridation_final_report.pdf Report Findings from this report suggest the need to improve access to adequately fluoridated public water for rural populations. Organization: West Virginia Rural Health Research Center Author: Michael Hendryx, PhD, R. Constance Weiner, DMD, Matthew Gurka, PhD Date: November 2011 Preventing Dental Caries: Community Water Fluoridation http://www.thecommunityguide.org/oral/fluoridation.html Summary of Findings The Community Preventive Services Task Force recommends community water fluoridation based on strong evidence of effectiveness in reducing tooth decay. Organization: Community Preventive Services Task Force Date: 2002
Recommendations for Using Fluoride to Prevent and Control Dental Caries in the United States http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5014a1.htm Report The recommendations in this report guide dental and other health-care providers, public health officials, policy makers, and the public in the use of fluoride to achieve maximum protection against dental caries while using resources efficiently and reducing the likelihood of enamel fluorosis. Organization: The Centers for Disease Control and Prevention, U.S. Department of Health and Human Services Date: 2001 State and Community Best Practice Approach Examples: Community Water Fluoridation http://www.astdd.org/state-and-community-practiceexamples/?bpareport=Use%20of%20Fluoride:%20Community%20Water%20Fluoridation Collection of Program Examples The Association of State and Territorial Dental Directors provides state and community best practice approach examples on community water fluoridation. Organization: Association of State and Territorial Dental Directors Resource Highlights: Focus on Fluoridated Community Water http://www.mchoralhealth.org/highlights/water.html Collection of Resources This collection of selected resources offers information about fluoridated community water. Organization: National Maternal and Child Health Oral Health Resource Center Date: September 2011
Guidelines for Rural Oral Health Programs

Rural communities are using evidence-based practices and guidelines to develop rural oral health programs. For example, rural oral health programs that target infants and children are incorporating the American Academy of Pediatric Dentistrys recommendations and guidelines related to treatment options for early childhood caries, perinatal oral health care, infant oral health care, oral health care for the pregnant adolescent, and management of the dental patient with special health care needs. The American Dental Association Center for Evidence-based Dentistry website may also be helpful to rural communities that are identifying clinical recommendations and guidelines for their oral health programs.

American Dental Association Center for Evidence-based Dentistry http://ebd.ada.org/ClinicalRecommendations.aspx Website The Center for Evidence-based Dentistry provides a database of systematic reviews on all oral health topics, synopses of the key elements of systematic reviews, clinical recommendations and guidelines, and links to other many outside resources including tutorials, glossaries, and databases. Organization: American Dental Association Dental Guidelines http://www.usetinc.org/programs/uset-thps/DentalSupportCenter/Guidlines.aspx Guideline This website provides an overview of the recommendations for using fluoride and dental sealants. Organization: United South & Eastern Tribes, Inc. 2011-12 Definitions, Oral Health Policies, Clinical Guidelines http://www.aapd.org/policies/ The American Academy of Pediatric Dentistry (AAPD) Reference Manual is divided into five sections: (1) definitions; (2) oral health policies; (3) clinical guidelines; (4) endorsements; and (5) resources. Oral health policies are statements relating to AAPD positions on various public health issues. Clinical guidelines are practice recommendations designed to assist the dental provider in making decisions concerning direct patient care. Organization: American Academy of Pediatric Dentistry Date: 2011
Populations Served
Rural oral health programs serve a range of different populations: Uninsured and underinsured individuals School-age children Mothers and pregnant women Medicaid recipients Minority populations The homeless
Some rural oral health programs have conducted community health needs assessment to identify their priority populations.

Hard to Reach: Rural Homelessness & Health Care http://www.nhchc.org/wp-content/uploads/2011/10/Rural-Homelessness.pdf Project Report This report discusses homelessness in rural areas and compares its impact on health care access and outcomes in rural areas versus urban areas. Author: Patricia A. Post Date: 01/2002
Adapting Programs to Serve Your Community

Rural communities may also take guidance and direction for oral health programs from promising programs. One rural community developed a program that combines treatment and education services in a dental clinic by adapting a dental disease management initiative focused on risk-based treatment and patient education, Caries Management by Risk Assessment (CAMBRA). Another community used the Health Resources and Services Administrations Health Disparities Collaborative as the basis for their rural oral health program. The United South and Eastern Tribes Dental Support Center provides an organizational model and guidelines that can be adapted to rural community attributes. In addition to implementing promising programs, rural communities are also adapting their program activities to best serve their populations. For example, when providing mobile dental services in rural areas, a dental van can be rotated to various locations on a weekly basis rather than a daily basis to accommodate for the longer travel distances. Additionally, a mobile dental services program may incorporate a teledentistry component to prescreen and diagnose patients before the van arrives in a particular community. To accommodate patients schedules, some programs provide two-to-three day portable clinic access events at Federally Qualified Health Centers (FQHCs) and health departments. These events are staffed by dental and medical professionals and community member volunteers, and offer opportunities for people to access care without an appointment.

Oral Health Disparities Collaborative Implementation Manual http://www.nnoha.org/goopages/pages_downloadgallery/download.php?filename=20606.pdf&or ig_name=oral_health_implementation_manual.pdf&cdpath=/oral_health_implementation_manu al.pdf%C2%A0 Shares experiences and lessons learned from health centers that participated in the 2005 HRSA Oral Health Disparities Collaborative Pilot. Organization: The Health Resources and Services Administration, U.S. Department of Health and Human Services Date: June 2008
Implementing CAMBRA Protocols into Practice http://www.cda.org/Portals/0/journal/journal_112011.pdf#page=25 Compilation of articles This journal provides a compilation of articles on CAMBRA in practice. Citation: California Dental Association Journal Date: November 2011 Caries Management by Risk Assessment http://www.cda.org/Portals/0/journal/journal_112007.pdf#page=13 Article This article discusses application practices of Caries Management by Risk Assessment (CAMBRA) by dental providers, financially sustainable models for using CAMBRA. Citation: CDA Journal, 35(11), p.777-785. Organization: California Dental Association Author(s): Dr. Douglas Young, Dr. John Featherstone and Jon Roth Date: 11/2007 State of Alaska, Oral Health http://dhss.alaska.gov/dph/wcfh/Pages/oralhealth/default.aspx Overview This webpage provides a general overview of Alaskas oral health surveillance program, state oral health plan, oral health coalition, school-based oral health program and water fluoridation program. Organization: Alaska Department of Health and Social Services Division of Public Health Kentucky Oral Health Program http://chfs.ky.gov/NR/rdonlyres/23F37CEA-0B78-4F07-9D16CFFF43483B17/0/beigebrochureoralhealth80107.pdf Brochure The Kentucky Department for Public Health coordinates an oral health program that employs water fluoridation, dental sealant and fluoride varnish initiatives to address rural and non-rural oral health needs in Kentucky. Organization: Kentucky Cabinet for Health and Family Services Department for Public Health Eastern Plains Oral Health Initiative http://www.cahec.org/community/oral_health.php Program Example The Eastern Plains Oral Health Initiative promotes the health of school children in seven frontier areas of Colorado by employing a school-based dental sealant program and educating parents/caregivers about the importance of preventive oral health practices for their children. Organization: Centennial Area Health Education Center
MODULE 3: IMPLEMENTATION OF RURAL ORAL HEALTH PROGRAMS

When implementing an oral health program, it is important to have the appropriate staff, partners, and resources. Each programs needs will differ depending on the goals, program model, and target population. This module focuses on the implementation of oral health programs, including facilitators of success and common challenges.
In this module
Staff Needed to Support Programs Other Resources Needed to Support Programs Possible Partners Implementation Considerations Facilitators of Successful Programs Common Implementation Challenges
Staff Needed to Support Programs

Talented staff plays an important role in the success of any rural oral health program. Rural oral health programs require different types of staff. Staff needs depend on the goals of the program, program model, and target population. For example, programs that aim to deliver oral health services in a dental clinic model must have access to dental professionals. If it is not feasible to hire a full-time dentist, programs may ask dentists in the area to donate time or work with dental students from local dentistry schools. Programs with an outreach component may need to hire an outreach coordinator. Programs with a school-based education component work may work with a health educator. For example, one school-based program model retained the services of a health educator in a tooth fairy costume to educate children about oral health. Common types of program staff are listed below. There may be overlap in roles across staff members. Programs may hire full or part-time staff and work with volunteers and students. Many programs work with bilingual providers and staff. Director Program manager Coordinator Dentist Dental hygienist Dental assistant Receptionist
Case manager Billing manager Outreach worker Educator Evaluator Community liaison Grant writer

Recruitment and Retention Tips for Human Resources and Dental Directors http://www.nnoha.org/goopages/pages_downloadgallery/download.php?filename=16972.pdf&or ig_name=dental_recruitment_tips_final_0811.pdf&cdpath=/workforce/dental_recruitment_tips_final_08-11.pdf%C2%A0 Tip sheet The National Network for Oral Health Access has compiled recruitment and retention tips for programs attempting to build a strong, high-quality, dental workforce. It also contains links to recruitment tools that dental practices can use in their efforts to recruit dental professionals. Organization: National Network for Oral Health Access Date: 08/2011 Safety Net Dental Clinic Manual- Facilities and Staffing http://www.dentalclinicmanual.com/chapt2/3_0.html Manual This chapter in the Safety Net Dental Clinic Manual provides information about staffing size and mix, alternative practice for dental hygienists, and the expanded function of dental assistants. Organization: National Maternal and Child Oral Health Resource Center
Other Resources Needed to Support Programs

Rural oral health programs require different resources. The types of resources needed depend on the goals of the program and the program model. Education and outreach programs require culturally appropriate curricula and education materials. Mobile dental van programs require a reliable vehicle that can hold portable dental equipment and supplies. Clinic-based programs require space and supplies, among other resources. General categories of resources include: Community support Programs have developed advisory committees to gain community support. Advisory committees may include dentists and dental hygienists, administrative personnel from the hospital and dental school in the community, and staff from Area Health Education Centers (AHECs).
Training materials Programs require materials and curricula that can help staff to provide services to the target population. If the program has an educational component, it is important to use culturally appropriate education and outreach materials. Supplies Dental clinic programs or outreach programs may distribute brochures, toothbrushes, toothpaste, and floss to individuals. Space Some programs rely on schools and other organizations to donate space for education or dental clinic activities. For example, a local hospital may house a dental clinic. Transportation Mobile dental van programs require a reliable vehicle that can hold portable dental equipment and other supplies. Permissions Programs that provide sealants or fluoride varnish to children in schools need to secure permission from the school and from parents. Insurance Programs may need to purchase insurance for some of their programs. For example, in order to serve patients in a mobile dental van, programs will need to buy auto insurance.

Practice Management: How to Start a Dental Clinic http://www.nnoha.org/?site_id=1213&page_id=46074&id_sub=46074Manual This chapter in the Safety Net Dental Clinic Manual provides information about resources that are useful in setting up a dental clinic. It includes links to a sample budget and an Oral Health Start-Up Tool Kit. Organization: National Maternal and Child Oral Health Resource Center Safety Net Dental Clinic Manual Manual http://www.dentalclinicmanual.com/index.html The manual is presented in an easy-to-use format, and includes tools and resources like clinic policies, efficiency tips, professional standards, supply lists, floor plans, design tips, photos of equipment, customizable budget worksheets, funding strategies, quality improvement plans, fact sheets, and Web sites. Organization: National Maternal and Child Oral Health Resource Center
Dental Forms Library http://www.nnoha.org/dentallibrary.html Forms The National Network for Oral Health Access Dental Forms Library is a collection of forms in use by safety-net oral health programs across the country. These sites are sharing their forms to allow other programs to have a reference in developing their own material. Organization: National Network for Oral Health Access A Guide for Developing and Enhancing Community Oral Health Programs http://www.aacdp.com/guide/ Community Guide This guide is designed to help local public health agencies to develop, integrate, expand or enhance community oral health programs. It provides information on mobilizing community support, assessing needs and existing resources, planning the program, implementing the program, evaluating the program and participating in policy development and research. Organization: American Association for Community Dental Programs (AACDP)
Possible Partners
Rural oral health programs often have established relationships with providers, community organizations, and Area Health Education Centers (AHECs), and consider these relationships to be important to their success. Partners may serve as funders for programs and provide guidance for the program. For example, one rural oral health program worked with a local AHEC to help with education and outreach efforts. Other programs have worked with local colleges and universities, WIC, and Head Start programs. Another program worked with a grant writer from a nearby federally qualified health center to write new proposals for funding. Project partners helped another program by posting job openings in job banks at their organizations. Potential partners include:

Area Health Education Centers Public health organizations Universities and colleges Foundations Government organizations Community service organizations Volunteer groups Multicultural alliances and associations Hospitals State and local health departments
Head Start programs Federal Qualified Health Centers Area clinics and medical centers Philanthropic funds and charities WIC programs
Implementation Considerations
Each rural oral health program is different and there is no one-size-fits-all implementation strategy. Several implementation considerations are described for each program model [See Program Models]. Additionally, there are several cross-cutting issues to consider prior to implementing a rural oral health program: Program demand While oral health programs can help to fill unmet needs in rural communities, it is critical to consider the demand for the program or service that will be provided. In some rural communities, it may be necessary to advertise and promote the available services. For example, a mobile dental services program advertises its services on the radio and on the side of the van itself. In other communities, the need for care may outpace the programs ability to serve the population with the available resources. The program should consider these issues carefully and identify a strategy in the event that the program cannot provide required services (e.g., referral network of providers). Priority population It is essential to identify and understand the priority population before implementing a rural oral health program. Programs serving schoolchildren may require a different set of strategies than programs serving migrant farm workers. A dental clinic program may need to provide on-site child care for patients with young children. With an understanding of the priority population, it is possible to determine the program model, size, scope, and resource needs. Partnerships Successful rural oral health programs attribute their success to the strong collaborations that they have with community partners, such as clinics and local organizations. Partners and allies can help to increase awareness of the program in the community, play a role in program activities, and participate in sustainability planning and evaluation. Sustainability It is critical to consider and plan for short and long-term sustainability of the program. Sustainability planning may include identifying funding sources for the future. Sustainability planning may also include thinking about how to continue to develop staff, for example, by providing ongoing staff trainings about the current issues facing the target population.
Evaluation Evaluation presents an opportunity to assess program results and identify ways to improve program performance. Developing an evaluation plan and building evaluation instruments at the outset will make it easier to measure the outcomes of the program. Some rural oral health programs have noted that they did not spend enough time on evaluation when they implemented their projects, and they would have benefited from earlier planning.
Facilitators of Successful Programs

There are several facilitators of successful oral health programs in rural communities: Relationships Collaboration across different organizations allows for the development of new ideas and resources that benefit oral health programs. Some oral health programs work with a consortium of partners to identify and resolve program challenges. Program staff Successful oral health programs have dedicated and experienced staff, such as dentists and program administrators who believe in the program. Reputation Having a strong foothold in the community is a major advantage for any organization leading or collaborating in a rural oral health program. People may be more receptive to educational or outreach activities conducted by an organization that they already know of and trust. Flexibility It is more challenging to access oral health care in a rural community. People may need to travel multiple hours to see a dentist. In order to break down access barriers, it is important for oral health programs to offer some flexibility, in the event that an individual is late or misses an appointment. Commitment When developing direct service rural oral health programs, it is important to work with providers and staff that are committed to working in an underserved area. Training Rural programs often train providers and other staff about poverty and other similar issues, with the belief that an understanding of these issues will improve their relationships with the populations they serve. One particular resource that has been used in rural programs is the Ruby Payne Framework for Understanding Poverty.
Common Implementation Challenges

Rural oral health projects may experience implementation challenges or require mid-course corrections. Below are a few challenges that existing rural oral health projects have encountered.
Recruiting dental staff Rural programs that are implementing a dental clinic model have faced barriers to recruiting a dentist. Some programs are working with volunteer or retired dentists or students. Hard-to-reach populations The priority population may be highly mobile. For example, one rural oral health program was striving to provide care to two hard-to-reach populations: Hispanic poultry workers and migrant farm workers. These populations travel from camp to camp during different times each year, making it challenging to reach them. Providing services in mobile units Several rural oral health programs use mobile dental vans to provide oral health services. Dental vans are limited in the types of services they can provide (e.g., root canals, surgeries). Programs that employ mobile dental units often partner with dental clinics to refer patients who need more extensive dental care. Start-up costs Rural oral health programs may have start-up costs that are higher than the revenue that the program can generate. Language Several existing rural oral health programs target communities with a large Hispanic or immigrant population. Such programs need to ensure that their staff understands the importance of providing services or public health education in a culturally appropriate manner. In addition, programs may need to either employ staff proficient in Spanish or other languages. Culture Rural oral health programs face cultural challenges related to stigma. Individuals may not want to go to a free dental clinic because of the stigma associated with receiving charity care. To address this challenge, some programs provide services at hospitals or medical offices.
MODULE 4: PLANNING FOR SUSTAINABILITY

It is important to think about sustainability early. This model discusses the key issues in planning for sustainability of oral health programs in rural communities, describes different payment models, and lists funders of oral health programs.
In this module

What to Think About When Planning for Sustainability Importance of Sustainability Planning Sustainable Payment Models Funders of Rural Oral Health Programs
What to Think About When Planning for Sustainability

Three critical issues are linked to the sustainability of rural oral health programs: Funding and Resources Partnerships Evaluation
FUNDING AND RESOURCES

Ongoing funding and resources, such as staff time, are important to sustaining rural oral health programs. It may take years before the revenue generated from the program offsets the associated costs, so identifying funding and resources early is critical. Programs may be able to secure grants from foundations or other organizations [See Organizations that have funded rural oral health programs and research]. If dental services are provided, it may be possible to bill Medicaid or other insurers for services and/or use a sliding fee scale. Regardless of the financing mechanism, it is critical to monitor trends in Medicaid and insurance payment policy in the event that changes occur.
PARTNERSHIPS
Rural oral health programs have collaborated with schools, Federally Qualified Health Centers (FQHCs), Area Health Education Centers (AHECs), WIC sites, and other state and local agencies to develop partnerships. Some programs have established an oral health consortium or steering committee in the community as a vehicle for sustainability. By developing a consortium or committee, organizations have an opportunity to meet regularly, identify resources and capacity, and build sustainable relationships that can improve oral health in the community. These gatherings are an opportunity for the program to acknowledge and thank partners for their
continued support. Additionally, it is important to be aware of any staff changes in partner organizations, as such changes can affect the viability of partnerships in the long term.
EVALUATION
Rural oral health programs are using evaluation information to convey the impact of their programs. Evaluation is also a critical tool to demonstrate the return on investment (ROI) of the program. Some rural oral health programs are calculating ROI using RAC's Economic Impact Analysis Tool. Additional information is available in Evaluation.

Healthy Kentucky Smiles: A Lifetime of Oral Health. Statewide Oral Health Strategic Plan: The Commonwealth of Kentucky2006 http://chfs.ky.gov/NR/rdonlyres/67ED0872-8504-43A0-81658739F320CAC9/0/StrategicPlan.pdf Report The document outlines the strategic plan for oral health for the state of Kentucky, including sustainability and collaboration activities. Organization: Kentucky Department for Public Health Date: 05/2006 Sustainability Toolkit: 10 Steps to Maintaining Your Community Improvements, 2nd Edition Brief overview and ordering information: http://www.civicpartnerships.org/docs/tools_resources/sustainability.htm Guide This document provides a ten step process for collaborative and organizations to sustain their community improvements. Organization: Public Health Institute Date: 2011 Developing a Plan for Financial Sustainability http://ctb.ku.edu/en/tablecontents/sub_section_main_1297.aspx Guide This document discusses financial sustainability for non-profit organizations. Organization: Community Tool Box Author: Jenette Nagy Date: 2012
Importance of Sustainability Planning

A sustainability plan documents strategies to continue the program, activities, and partnerships including:
Obtaining input and buy-in from coalition members and key external decision makers Defining short-term and long-term financing strategies Creating an organizational plan to attract and make the best use of human, financial, and in-kind resources
Any program will need to develop a sustainability plan tailored to its specific needs. As a starting point, there are several sample sustainability plans available publicly that can serve as useful reference points. These plans are not tailored to rural oral health programs, but their components can be adapted. In addition to sustainability plans, rural oral health programs may also need a risk management plan. A risk management plan can help the program to plan for unexpected events, such as the loss of a partner or changes in federal and state policies.

Creating an Effective Plan for Your Sustainability Efforts http://www.axisperformance.com/S29SustPlan.html Guide This website provides a guide for sustainability planning. Organization: Axis Advisory Author: Marsha Willard Date: 12/2007 Planning for Sustainability http://www.raconline.org/sustainability/ Tools to help rural communities consider the sustainability of programs that address community needs and to engage partners and stakeholders in this planning process. Organization: Georgia Health Policy Center A Sustainability Planning Guide for Healthy Communities http://www.cdc.gov/healthycommunitiesprogram/pdf/sustainability_guide.pdf Guide This document provides a comprehensive plan for sustaining public health efforts in communities. Organization: Centers for Disease Control and Preventions (CDC) Healthy Communities Program Rural Health Care Pilot Program Sustainability Plans Website:http://www.usac.org/rhcp/participants/sustainability-plans.aspx Guide This website provides an overview of what is required in a sustainability plan. Organization: Universal Service Administrative Company
Toolkit for Program Sustainability, Capacity Building and Volunteer Recruitment/Management http://www.nationalserviceresources.org/filemanager/download/online/sustainability_toolkit.pdf Toolkit This toolkit focuses on program sustainability and can be used to plan for the sustainability of different types of programs Organization: Corporation for National & Community Service Sample Sustainability Action Plan http://www.ilj.org/publications/docs/Sample_Sustainability_Action_Plan.pdf This document provides an example of a sustainability action plan. Organization: Consulting Services for Community Solutions Author: Michelle Voll
Sustainable Payment Models

Few rural oral health programs have funding to finance all of the dental services their patients need. Programs are using different payment models to sustain their programs: 50-50 payment model One rural oral health program uses a 50-50 model. This program works with local dentists who would not ordinarily see Medicaid patients. The program has a grant that pays for a cleaning and personalized dental care plan. Any services needed after that are offered at a reduced rate, where the patient pays 50 percent and the program pays 50 percent of the services. Volunteer hours One rural program in Michigan that has been successful in providing dental care to patients in a rural community is the Calhoun County Dentists Partnership. In this program, community dentists offer dental care to individuals who are residents in the county, do not have dental coverage, and meet income limits. Individuals who receive care are asked to donate their time at one of more than 60 local nonprofit organizations. Donated services Rural oral health programs host dental clinics where student dentists provide services at no cost. One rural program collaborates with a hospitals pediatric dentistry residency project. In this project, two pediatric residents complete rotations of 4 days per month at a rural dental clinic that serves low-income and uninsured populations.

The Calhoun County Dentists Partnership: A Hands-Up, Not a Hand-Out http://www.smilemichigan.com/Portals/pro/Journals/March%202012/index.html?pageNumber=4 0 Journal article This article describes the Calhoun County Dentists Partnership that provides dental care to patients in exchange for community service at local nonprofit organizations. Organization: Journal of the Michigan Dental Association, Issue 94, Vol. 3, p. 38-41 Author: Sharon Emery Date: March 2012 The Community Dental Access Initiative http://www.cjaonline.net/events/SustSeries/Calls/Toolbox/CHP%20Brochure%20%20Dentists%27%20Partnership.pdf Brochure This brochure highlights the dental care services that are available to patients without insurance in Calhoun County, Michigan, through the Dentists Partnership. Organization: Dentists Partnerships
Funders of Rural Oral Health Programs

A variety of government agencies, foundations, and organizations have funded rural oral health programs and research. The organizations listed below are examples.
FEDERAL AGENCIES
Office of Rural Health Policy, Health Resources and Services Administration http://www.hrsa.gov/ruralhealth/ State Offices of Rural Health http://www.hrsa.gov/ruralhealth/about/hospitalstate/stateoffices.html Indian Health Service http://www.ihs.gov/ The Denali Commission http://www.denali.gov/
PROFESSIONAL ASSOCIATIONS
American Dental Association http://www.ada.org American Dental Hygienists Association http://www.adha.org
American Association for Community Dental Programs http://www.aacdp.com/ American Association of Public Health Dentistry http://www.aaphd.org/
OTHER ASSOCIATIONS
National Association of Counties http://www.naco.org/ National Association of Community Health Centers http://www.nachc.com/ Association of State and Territorial Dental Directors http://www.astdd.org/
ACADEMIES
Academy of General Dentistry http://www.agd.org/splash/ American College of Dentists
http://www.acd.org/
FOUNDATIONS AND CHARITABLE ORGANIZATIONS

RAC information specialists can conduct a custom funding search to find additional options. For more information, contact 800-270-1898 or info@raconline.org. Anthem Blue Cross Blue Shield https://www.anthem.com/health-insurance/about-us/charity-guidelines Areas served: National Otto Bremer Foundation http://www.ottobremer.org Areas served: 80 communities located in Minnesota, North Dakota and western Wisconsin Kate B. Reynolds Charitable Trust http://www.kbr.org/ Area served: North Carolina Childrens Miracle Network http://childrensmiraclenetworkhospitals.org/ Areas served: Makes donations to local hospitals
Delta Dental http://www.deltadental.com/Public/CommunityBenefits/CommunityBenefits.jsp?DView=Comm unityBenefitsHome Areas served: National Aetna Foundation http://www.aetna-foundation.org/foundation/index.html
HOSPITAL FOUNDATIONS
A Profile of Foundations Created from Health Care Conversions http://gih.org/files/usrdoc/2009_Conversion_Report.pdf Lists health foundations formed from transactions involving hospitals, health plans, or health systems. Organization: Grantmakers in Health Date: 06/2009
NETWORKS
3RNet, Rural Recruitment and Retention Network https://www.3rnet.org/ National Network for Oral Health Access http://www.nnoha.org/
MODULE 5: EVALUATING RURAL ORAL HEALTH PROGRAMS

Program evaluations can be used to demonstrate program outcomes, gain buy-in from stakeholders, and share best practices. Evaluation can also help to elevate oral health as a community priority. This module discusses methods and considerations for program evaluation and presents common evaluation metrics for rural oral health programs.
In this module

Evaluation Framework Evaluation Methods and Considerations Evaluation Questions Types of Metrics Commonly Used in Evaluations
Evaluation Framework
Evaluation presents an opportunity to assess program results and identify ways to improve program performance. The steps of undertaking an evaluation are: 1. Identifying goals. Think about whether you are interested in assessing program processes (e.g., what is happening in the program) or exploring program outcomes (e.g., the impact of the program). 2. With the goal of the evaluation in mind, it is possible to design research questions and select an evaluation design. 3. Generally, the next phase is instrument design and data collection. 4. Then comes analysis of the information collected. 5. Based on this analysis, identify findings and lessons learned and disseminate the results. The Centers for Disease Control and Preventions Framework for Program Evaluation can be tailored to oral health programs. The steps in this framework include: Engaging stakeholders Describing the program Focusing the evaluation design Gathering credible evidence Justifying conclusions Ensuring the use and sharing of lessons learned The CDC Framework for Program Evaluation also discusses common evaluation concerns that are relevant to rural oral health programs:
Cost Time Technical demands
This information may be helpful, as rural oral health programs must balance the need for evaluation information with available resources and expertise.
Evaluation Methods and Considerations

There are many evaluation methods available for rural oral health. Programs may collect primary qualitative and quantitative data through in-person interviews, surveys, and focus groups. In some instances, programs may use secondary data to understand how their population compares to populations at the local, state and national levels. It is important to choose the evaluation methods that work best for each program. Special considerations for evaluating rural oral health programs include: Designing data collection instruments that are sensitive to the cultural practices and beliefs, language, and literacy level of the population. Bearing in mind the mobility of the population, especially when collecting data from migrant farm workers or populations served by a mobile oral health program. Is it possible to collect data on the same people over time? Planning evaluation logistics, including the travel time and distance required to collect data, number of participating sites, and number of evaluation staff required. Securing any needed approvals. Some evaluation approaches may involve collecting protected health information that can be linked to a specific individual. The U.S. Department of Health and Human Services provides more information on the Health Insurance Portability and Accountability Act.

A Framework for Program Evaluation http://www.cdc.gov/eval/framework/index.htm Website The CDC highlights a practical and non-prescriptive toolthe evaluation frameworkwhich summarizes and organizes the steps and standards for effective program evaluation Organization: Centers for Disease Control and Prevention Other Evaluation Resources http://www.cdc.gov/eval/resources/ Website The CDC offers links to other evaluation resources, including manuals, toolkits, websites, and professional associations. Organization: Centers for Disease Control and Prevention
Health Information Privacy http://www.hhs.gov/ocr/privacy/ Website The Office for Civil Rights enforces the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule, which protects the privacy of individually identifiable health information; the HIPAA Security Rule, which sets national standards for the security of electronic protected health information; and the confidentiality provisions of the Patient Safety Rule, which protect identifiable information being used to analyze patient safety events and improve patient safety. Organization: U.S. Department of Health and Human Services
Evaluation Questions
It is important to develop evaluation questions and indicators in the planning stages of the project. It is also never too late to begin thinking about evaluation questions, metrics, and outcomes. To develop evaluation questions, it may be helpful to consider the following: 1. What are the desired outcomes of this program? 2. How will we get there? What activities will enable us to reach our outcomes? 3. How will we know that we are making progress toward the desired outcomes?
Types of Metrics Commonly Used in Evaluations

The specific goals of the rural oral health program should be considered when determining the metrics for program evaluation. Rural oral health programs collect qualitative and quantitative information on program processes, outputs and outcomes. Common metrics include:
DEMOGRAPHIC INFORMATION ON PARTICIPANTS OR PRACTICES

The participant's: Age Gender Type of health insurance Socio-economic status Language spoken The practice's: Gross annual operating expenses Revenue and revenue per encounter Average length of time that a dental clinic is fully scheduled Payer mix
PROCESS MEASURES
Number of encounters for oral health services per month or year Number of dental professionals trained to use an evidence-based curricula Number of dental professionals providing oral health care services Number and level of participation of organizations involved in the program Number of preventive procedures provided Number of referrals to other providers Number of participants who express awareness of the existence of oral health programs in their communities
OUTCOME MEASURES
Frequency of tooth brushing Time spent brushing teeth Reasons for not brushing teeth Time since the last visit to the dentist Preventive services received during the past two years Health outcomes (oral health improvements)
IMPACT MEASURES
Percentage increase in patients served Percentage increase in oral health exams given by dental clinics Amount of additional revenue available to health centers/ dental clinics

Thinking About How to Evaluate Your Program? These Strategies Will Get You Started http://pareonline.net/getvn.asp?v=9&n=8 Journal Article Citation: Practical Assessment, Research & Evaluation, 9(8) In this article common evaluation, terminology is introduced and explained, and a series of strategies is presented to help those delivering direct services and programs to begin the program evaluation process. Organization: University of Vermont Authors: Rebecca Gajda and Jennifer Jewiss Date: 03/2004 The Educators Guide to Service-Learning Program Evaluation http://www.servicelearning.org/filemanager/download/37/EvaluationToolkit.pdf Guide This guide provides information on the outcome measures of program evaluation and the process used to design them. Organization(s): Learn and Serve Clearinghouse and RMC Research
Guidelines for Measuring the Performance of the Environmental Protection Agency Partnership Programs http://www.epa.gov/evaluate/pdf/tools/guidelines-measuring-epa-partnership-program.pdf Guide This EPA guide discusses the strategies for measuring program performance. Organization(s): Environmental Protection Agency and National Center for Environmental Innovation Date: 06/2006 Pediatric Oral Health Quality and Performance Measures Concept Set: Achieving Standardization and Alignment http://ada.org/sections/professionalResources/pdfs/dqa_draft_starter_measure_concept_set.pdf Organization: American Dental Association, Dental Quality Alliance Pediatric Oral Health Quality and Performance Measures: Environmental Scan http://ada.org/sections/professionalResources/pdfs/dqa_environmental_scan.pdf Organization: American Dental Association, Dental Quality Alliance
MODULE 6: DISSEMINATION OF RURAL ORAL HEALTH RESOURCES AND PROMISING PRACTICES

Disseminating results is an important step in building and maintaining relationships with project partners and funders. It is also important to gain local support and buy-in from the community. Rural oral health programs are disseminating their projects in different waysfrom participating in meetings at regional and national conferences to crafting annual reports and issue briefs. Programs are reporting their results to stakeholders including county public health departments, county commissioners, state government staff, and other regional and local entities.
In this module

Methods of Dissemination Sharing Successes
Methods of Dissemination
Common methods of dissemination include: Publishing project findings in national dental journals, statewide publications, and local newspapers Presenting results at national conferences and local and state-level press conferences Creating and distributing program materials, such as flyers, guides, pamphlets and DVDs Summarizing findings in progress reports for funders Disseminating information on an organizations website Discussing project activities on the local radio Publishing information in the local newspaper Hosting health promotion events at health fairs and school functions Using the 2-1-1 system to publicize available services and resources
Sharing Successes
Various dissemination methods and vehicles may be used to share the successes of oral health programs. Rural oral health programs disseminate project findings and lessons learned at the local, state and national level in order to reach as many people as possible. When sharing successes, it is important to highlight the following: Effectiveness of the program Acceptability in the community Sustainability Program mission
To share results, rural oral health programs should:

Identify their target audience, Establish strategic partnerships, Develop messages that highlight key aspects of their program, and Select communication and dissemination mediums
Also, for more information about sharing successes, please visit RACs Success Stories and Lessons Learned: http://www.raconline.org/success/success.php.

Healthy Communities Program Success Stories http://apps.nccd.cdc.gov/dchsuccessstories/ Website/ tool A tool that can help communities to tell the story of their program and showcase program activities. Organization: Centers for Disease Control and Prevention How to Develop a Success Story http://www.cdc.gov/healthyyouth/stories/pdf/howto_create_success_story.pdf Guide This document describes the important steps needed in order to create and communicate success stories. Organization: Centers for Disease Control and Prevention (CDC) Date: 12/2008 Documentation and Knowledge Sharing Tool http://www.pedaids.org/Publications/Toolkits/Phase-1-Toolkit-%282010%29/Step5_Documenting-and-Knowledge-Sharing Toolkit This toolkit provides strategies for effective sharing and documentation of program success and best practices. Organization: Elizabeth Glaser Pediatric AIDS Foundation Date: 2010 Elements of a Strategic Communications Plan http://www.wkkf.org/~/media/aa22ede1aae64236b3114060e60137f4/5000009.pdf This guide provides a template for creating an effective communications plan. Organization: W.K. Kellogg Foundation
MODULE 7: PROGRAM CLEARINGHOUSE

The HRSA Office of Rural Health Policy funded rural communities to implement oral health programs as part of the 330A Outreach Authority program. This program focuses on reducing oral health care disparities and expanding health care services in rural areas. Examples of current 330A Outreach Authority grantees that developed an oral health care program in a rural community are provided below. Oral health program model information is available in Module 2. Delta Dental Plan of South Dakota Project Title: Dakota Smiles Mobile Dental Program Synopsis: Improve access to dental care and increase prevention and screening. Eastern Shore Area Health Education Center Project title: Eastern Shore Childrens Regional Oral Health Consortium (CROC) Synopsis: Increase availability and access to comprehensive oral health care services in order to prevent and control oral disease in children and adolescents and eliminate oral health disparities. Innis Community Health Center Project title: Building Tomorrows Smiles Synopsis: Provides early intervention in the form of oral screening exams and fluoride varnish applications for infants and toddlers and develops professional education for health care providers. Mississippi Headwaters Area Dental Health Center Project title: Ensuring Patient Success with Outreach and Support Synopsis: Provide patient outreach and support services at a new community dental clinic. Rice Regional Dental Clinic Project title: Pediatric Dentistry Residency Project Synopsis: Increase access to dental care for underserved children in the 17-county service area of West Central and Southwest Minnesota. Thumb Rural Health Network (TRHN) Project title: Partnering For Health-Thumb Access to Care Project Synopsis: Increase access to primary care, dental care, and vision care for low-income, uninsured residents of rural Michigan counties. West Central District Health Department (WCDHD) Project title: West Central Smiles Clinic Synopsis: Expand dental services for underserved children through a portable dental clinic.
Delta Dental Plan of South Dakota

Project title: Dakota Smiles Mobile Dental Program Grant period: 05/01/2009 04/30/2011 Contact name: Connie Halverson, Public Benefit Coordinator Location: Pierre, South Dakota Website:http://www.deltadentalsd.com/communityinvolvement/dakotasmilesmobiledent alprogram/ Program Overview: The goal of this program is to reduce barriers to dental care access. The Delta Smiles Mobile Dental Program used two mobile vans to provide dental care services to low-income residents. Delta Dental partnered with schools in order to provide dental care to children. Services included restorative oral health treatment and preventive care such as cleanings and screenings.
Models Represented by this Program: Oral Health- Primary Care Integration Mobile Dental Services Outreach and Education
Eastern Shore Area Health Education Center

Project title: Eastern Shore Childrens Regional Oral Health Consortium (CROC) Grant period: 05/01/2009 04/30/2011 Contact name: Jacob F. Frego, Executive Director Location: Cambridge, Maryland Website: http://esahec.org/services/croc/ Program Overview: This program developed a comprehensive dental center in Dorchester County, a regional hospital-based pediatric dental program for the six mid and lower shore counties, and a community-based outreach and education program. The goal of the program is to improve the availability of and access to preventative, restorative, and rehabilitative oral health care for low-income children on the Eastern Shore of Maryland.
Models Represented by this Program: Oral Health Primary Care Integration Outreach and Education Dental Home Workforce
Innis Community Health Center

Project title: Building Tomorrows Smiles Grant period: 05/01/2009 04/30/2012 Contact name: Linda Matessino, Executive Director Location: Innis, Louisiana Program Overview: This program strives to enhance oral health for Medicaid infants and toddlers in rural Louisiana. The program provides early intervention, such as oral exams and fluoride varnish applications, to children between the ages of six months and three years and educates parents about the importance of oral health care. The program also provides educational services to dentists practicing in Federally Qualified Health Centers.
Models Represented by this Program: Oral Health Primary Care Integration Outreach and Education School-based
Mississippi Headwaters Area Dental Health Center

Project title: Ensuring Patient Success with Outreach and Support Grant period: 6/01/2009-5/30/2012 Contact name: Ms. Jeanne M Larson, Executive Director Location: Bemidji, Minnesota Website: http://www.northerndentalaccess.org/ Program Overview: This program addresses barriers to oral health care for low income individuals who are eligible for subsidized care programs and who live within several rural Minnesota counties. The program established a patient support center within a new dental access clinic. The centers services include a treatment coordinator to advise patients of their recommended treatment plan, insurance counseling, child care, transportation assistance, and referrals to social and private agencies.
Models Represented by this Program: Outreach and Education Dental Clinic
Rice Regional Dental Clinic

Project title: Pediatric Dentistry Residency Project Grant period: 05/01/2009 04/30/2012 Contact name: Linda Jackson, DDS, Dental Director Location: West Central and Southwest Minnesota(clinic is located in Willmar, MN)
Website: http://www.ricehospital.com/dental/
Program Overview: The goal of the Rice Memorial Hospitals Pediatric Dentistry Residency Project is to expand services at the dental clinic through pediatric residents. The programs objectives are to provide dental care to underserved children and youth; promote oral health among people living in the area through education and public service; and increase the number of pediatric dentists choosing to practice in the service area.
Models Represented by this Program: Dental Clinic Outreach and Education Workforce Model
Thumb Rural Health Network (TRHN)

Project title: Partnering For Health-Thumb Access to Care Project Grant period: 05/01/2009 04/30/2012 Contact name: Ed Gamache, Chair; CEO, Harbor Beach Community Hospital Location: Harbor Beach, Michigan Website: http://www.trhn.org/ Program Overview: The Partnering for Health program aims to address disparities in medical, dental and vision care in the Thumb area counties of Huron, Sanilac, and Tuscola, Michigan. The programs objectives are to increase the number of low income uninsured individuals that have an ongoing source of care or medical home, and offers free or low cost oral health services.
Models Represented by this Program: Oral Health Primary Care Integration Dental Clinic Dental Home Outreach and Education
West Central District Health Department

Project title: West Central District Health Department Tooth Tour Grant period: 05/01/2009 04/30/2012 Contact name: Shannon Vanderheiden, Health Director Location: North Platte, Nebraska Website: http://www.wcdhd.org/dentalservices/toothtour.html Program Overview: This program established a mobile dental clinic to reach underserved elementary school-aged children. The mobile dental clinic travels to participating elementary schools within a three service area. Services provided by the clinic include dental examinations, screenings, cleanings, x-rays and fluoride varnish applications. In addition, dental hygienists travel to schools to provide oral health education to students.
Models Represented by this Program: Mobile Dental Services School-based Outreach and Education Dental Clinic

Oral Health Toolkit

Загружено:

Сведения о документе

Авторское право

Доступные форматы

Поделиться этим документом

Поделиться или встроить документ

Параметры публикации

Этот документ был вам полезен?

Это неприемлемый материал?

Авторское право:

Доступные форматы

Oral Health Toolkit

Загружено:

Авторское право:

Доступные форматы

Rural Oral Health Toolkit

Rural Assistance Center www.raconline.org

MODULE 1: ORAL HEALTH IN RURAL COMMUNITIES

The State of Oral Health in Rural America

Rural Assistance Center www.raconline.org

RESOURCES TO LEARN MORE

Rural Assistance Center www.raconline.org

Barriers to Oral Health Care in Rural Communities

Rural Assistance Center www.raconline.org

RESOURCES TO LEARN MORE

Rural Oral Health Program Partners

Rural Assistance Center www.raconline.org

RESOURCES TO LEARN MORE

Other Considerations in Light of the Affordable Care Act

Rural Assistance Center www.raconline.org

RESOURCES TO LEARN MORE

Rural Assistance Center www.raconline.org

Rural Assistance Center www.raconline.org

MODULE 2: RURAL ORAL HEALTH PROGRAM MODELS

Rural Assistance Center www.raconline.org

Also in this Module

Rural Assistance Center www.raconline.org

RESOURCES TO LEARN MORE

Allied Health Professional Model

Rural Assistance Center www.raconline.org

RESOURCES TO LEARN MORE

Rural Assistance Center www.raconline.org

Access to Medicaid Model

RESOURCES TO LEARN MORE

Rural Assistance Center www.raconline.org

Outreach and Education Model

Rural Assistance Center www.raconline.org

RESOURCES TO LEARN MORE

Rural Assistance Center www.raconline.org

Oral Health-Primary Care Integration Model

Rural Assistance Center www.raconline.org

RESOURCES TO LEARN MORE

Rural Assistance Center www.raconline.org

RESOURCES TO LEARN MORE ENROLLMENT FORMS AND MANUALS

MORE INFORMATION ABOUT SCHOOL-BASED PROGRAMS

Rural Assistance Center www.raconline.org

MORE INFORMATION ABOUT CLINICAL RECOMMENDATIONS FOR FLUORIDE VARNISH

Rural Assistance Center www.raconline.org

Dental Clinic Model

Rural Assistance Center www.raconline.org

RESOURCES TO LEARN MORE

Rural Assistance Center www.raconline.org

Rural Assistance Center www.raconline.org

Mobile Dental Services Model

Rural Assistance Center www.raconline.org

RESOURCES TO LEARN MORE

Dental Home Model

Rural Assistance Center www.raconline.org

RESOURCES TO LEARN MORE

Rural Assistance Center www.raconline.org

Eligibility and Enrollment Model

RESOURCES TO LEARN MORE

Rural Assistance Center www.raconline.org

Community Water Fluoridation Model

RESOURCES TO LEARN MORE

Rural Assistance Center www.raconline.org

Guidelines for Rural Oral Health Programs

Rural Assistance Center www.raconline.org

RESOURCES TO LEARN MORE