Unit 1: Essential Elements
Unit 1: Essential Elements

Section 1. Partnerships and Planning

Gathering the Facts

You may wish to divide your oral health data collection into two phases:

  • Phase I. Gather data readily available online or through interviewing local public advocacy/social services organizational representatives as you seek to put together a compelling story to attract the support of other interested parties. These community representatives may introduce you to individuals willing to share their personal stories.
  • Phase II. Refining and building upon the success of your initial data search, pursue more in-depth information, which can further justify support from funders and other oral health stakeholders. This secondary phase often takes more time and effort, as it may involve patient and broad community surveys.

Well-presented Phase I data and a well-chosen selection of compelling anecdotes should get people's attention. Initial data collection may be as simple as calling hospital emergency departments (EDs) to ask how many non-traumatic oral health emergencies presented over a period of time, inquiring about whether children in Head Start met mandatory oral examination requirements with identified prevention and treatment needs completed in a timely manner, or asking area school nurses about the number of children who presented with toothaches during the school year. Which information sources you pursue depends upon the demographics of the underserved population(s) in your area.

Who else is addressing oral health inequities within your area and/or state? Is there a way to partner with them to strengthen your collective efforts? Both quantitative data (measurements) and qualitative data (descriptions) will be helpful. Package statistics and anecdotes so that they tell a compelling story. Once you have gathered your data, prioritize it. All of the information can eventually be shared, but what do you want to highlight in an “elevator speech” as you approach potential partners? The goal is to capture the attention of likely collaborators and motivate them to come and hear more. Choose wisely! Many times, you only get one chance to make your pitch!

These worksheets illustrate a variety of information and data sources, which may help you tell your story:

Information

Data Sources

Local demographics (age, race, poverty)

Census Bureau. Local and state health department websites often have similar information for your particular state.

Resources for determining existing health professionals and/or clinics serving populations with low incomes

  • Number of dentists in an area
  • Ratio of dentists to the population
  • Number of dentists accepting new Medicaid patients
  • Number of existing safety net dental clinics

State dental boards. Ask your personal dentist if the local dental society has this information available.

Find a health center. On the off chance that there is a community health center providing health care in the location that you are investigating, ask if it would share basic patient demographic data with the intent of increasing capacity. This could be beneficial for all involved, especially if an option is to add oral health services to the scope of this health center.

Telephone local dental offices to ask if they accept new Medicaid patients. Calling anonymously as a potential patient may yield surprisingly different responses vs. inquiring in an official capacity.

Contact the city/county health director to identify existing dental safety net clinics and to ask for any pertinent demographic information that this government entity might have.

Ask social service agencies where they refer their patients currently. Are these referral sites sufficient to meet the need? This is important in determining whether a new clinic is warranted or whether enhancing the existing infrastructure could suffice.

Local need indicators

  • Designation as a federal or state dental health professional shortage area (HPSA)
  • Safety net dental clinic capacity
  • Emergency room dental visits
  • Children presenting with toothaches at school

Find shortage areas: HPSAs by state and county. HPSAs can be designated by federal or state government entities.

State primary care offices. In the majority of states, responsibility for gathering the data necessary to recommend HPSA designations (and periodically reviewing them) lies within the State Primary Care Office. Questions about HPSAs should initially be directed here. 3

Contact existing community clinics to find out their capacity to meet their patients’ oral health needs or where they refer those patients whose oral health needs they cannot address. Whether an existing clinic has oral health services on site or not, assess the current situation. Nationally, only one out of five Federally Qualified Health Center (FQHC) patients receive an oral health service annually. What is the situation at this particular clinic? How long is the wait time for a dental appointment? The Health Resources and Services Administration’s Uniform Data System (UDS) Resources information may help.

Local hospital EDs. Increased ED utilization for dental problems is a significant marker for less-than-optimal access to oral health services. Determining the zip code distribution of these ED patients, as well as demographic trends, could be helpful in citing the particular need in your area. The 2015 Association of State and Territorial Dental Directors’ (ASTDD’s) best practice approach report Emergency Department Referral Programs for Non-traumatic Dental Conditions provides significant background on this overall trend as well.

Linking School Nurses to Health and Wellness Resources. School nurses are a frontline resource for documenting need of this significant population. For example, Why School Nurses Are the Ticket to Healthier Communities.

Head Start Collaboration Offices. Head Start Collaboration Offices facilitate partnerships between Head Start agencies and other state entities that provide services to benefit children with low incomes and their families.

State data. State data may include oral health status, resources, care utilization, and prevention programs.

ASTDD: State oral health programs. Government oral health programs in each state are diverse in size, location in the bureaucracy, funding, staffing, and focus. This page provides links to each state.

National Oral Health Surveillance System State Profiles. These oral health data systems monitor the prevalence of oral diseases and the factors influencing oral health, such as risky or protective behaviors, the availability of preventive interventions, and utilization of preventive services. They bring together existing data from multiple national and state sources and present the data in useful and accessible formats for the broad community interested in promoting oral health.

ASTDD: Synopses of State Dental Public Health Programs. This annual report summarizes the oral health status of individual states.

ASTDD’s Data Collection, Assessment, and Surveillance Committee web page offers the latest report and 5-year trend data.

Behavioral Risk Factor Surveillance System. This is a national system of health-related telephone surveys that collect state data about U.S. residents on their health-related risk behaviors, chronic health conditions, and use of preventive services.

American Dental Association’s Health Policy Institute. This research entity has many oral health research briefs that are broken out by state. Dental care utilization and access to care is one of many topics available.                   

National data. Though you will want to concentrate on local data to express your immediate need, it is often beneficial to contrast your situation with state and national data. Are your circumstances and needs better or worse than the bigger picture? Use that information to your advantage.

Oral Health in America: A Report of the Surgeon General. This 2000 report from U.S. Department of Health and Human Services is a foundational reference for bringing oral health into focus.

Centers for Disease Control and Prevention’s (CDC’s) State-Based Programs. CDC supports states in their efforts to reduce oral disease and improve oral health by using effective interventions. CDC provides state health departments with funding, guidance, and technical assistance (TA) to monitor oral disease across populations and to implement and evaluate oral health interventions.

National Oral Health Surveillance System (NOHSS). This system is a collaboration between CDC's Division of Oral Health and ASTDD. It is designed to monitor the burden of oral disease, use of the oral health care delivery system, and the status of community water fluoridation on both a national and a state level.

Oral Health 2020. Since launching a national systems-change strategy in 2011, DentaQuest Foundation investments have helped to build a large, interconnected network of national, state, and community-based change agents dedicated to improving the oral health of all. Today, this network is transforming the national dialogue and re-shaping the landscape of action on behalf of optimal oral health for all.

3 Note that in some states, HPSA information and designation recommendations may be the responsibility of the state primary care association and/or the state office of rural health.


Information

Data Source

Oral health status. Data collected through state or local surveys on different age groups:

  • Dental caries (tooth decay)
  • Periodontal health
  • Oral cancer
  • Oral defects (e.g., clefts, malocclusion)
  • Other oral conditions

Perceived need for oral health care, including perceptions of:

  • Consumers (accessibility, acceptability, affordability)
  • Oral health professionals (e.g., dentists, dental hygienists)
  • School personnel (e.g., teachers, nurses, principals)
  • Health professionals (e.g., pediatricians, nurse practitioners)
  • Key informants (local leaders)

Local or state dental director. Check with local and state entities to see if any pertinent data collection has been done previously. If it has, how recently? Even if outdated, the information should still be relevant for comparison purposes. The National Maternal and Child Oral Health Resource Center has compiled a web page with links to state offices of oral health and a tool to search their library for state reports.

  • ASTDD Seven-Step Model. Needs assessment is not an end in itself but the initial step in the development of a comprehensive oral health program plan. This document was created to make needs assessment simpler and more manageable. It serves as a step-by-step guide that can be adapted to specific community resources and objectives.
  • ASTDD Basic Screening Surveys. There are surveys for both children and adults, as well as a plethora of related reference documents. 

Medicaid and CHIP coverage

  • Utilization of oral health services by individuals enrolled in Medicaid or CHIP
  • Dentist participation in Medicaid and/or CHIP (number of dentists according to number of CHIP claims in the past year)

State Medicaid & CHIP Profiles

  • Medicaid. A treasure trove of current Medicaid facts, trends, and issue briefs from the Kaiser Family Foundation.
  • Kids Count Data Center. A project of the Annie E. Casey Foundation, KIDS COUNT is the premier source for data on child and family well-being in the United States. Access hundreds of indicators, download data, and create reports and graphics on the KIDS COUNT Data Center that support smart decisions about children and families.

Insurance. Percentage of population who are uninsured for oral health care vs. percentage who are uninsured for health care:

  • By age
  • By race or ethnicity
    (This data could be hard to come by, particularly at the local level.)

Uninsured. A plethora of data about uninsured individuals from the Kaiser Family Foundation.

Enroll America. Enroll America is the nation’s leading health-care-enrollment coalition. An independent nonprofit, nonpartisan organization, Enroll America works with more than 6,700 partners in all 50 states and the District of Columbia to create cutting-edge tools, analyze data, inform policy, and share best practices in service of its mission: maximizing the number of Americans who enroll in and retain health coverage under the Affordable Care Act. (This could provide interesting comparison data to your local information.)

Prevention programs. Number and type of public oral disease prevention programs (e.g., fluoride mouth rinse, fluoride varnish, dental sealants); number and age of individuals served.

State health departments. Links to individual state health department sites.

State-Based Oral Health Programs. Oral health information by state from CDC.

US Census: Model-based Small Area Health Insurance Estimates (SAHIE) for Counties and States. The U.S. Census Bureau’s SAHIE program produces timely estimates for all counties and states by detailed demographic and income groups. The SAHIE program produces single-year estimates of health insurance coverage for every county in the United States. The estimates are model-based and consistent with the American Community Survey. They are based on an area-level model that uses survey estimates for domains of interest, rather than individual responses. The estimates are enhanced with administrative data, within a Hierarchical Bayesian framework.

SAHIE data can be used to analyze geographic variation in health insurance coverage, as well as disparities in coverage by race/ethnicity, sex, age, and income levels that reflect thresholds for state and federal assistance programs. Because consistent estimates are available from 2008 to 2014, SAHIE reflects annual changes over time.