Early Childhood Cavities Prevention (ECCP) in Multnomah County

Multnomah County's "Baby Days — Urban Managed Care Partnership Model" reported that between December 2003 and the end of May 2004, 384 babies received risk assessments and fluoride varnish. Of these babies, 53 were referred for further dental treatment and, by the reporting deadline, 42 (79.2%) had completed that dental visit. The parent(s) who brought their child to the clinic were 86% Spanish speaking, 8% English, 3% Russian and 3% other languages. In addition, 58 babies seen by primary health providers through Maternal and Child Health Division of Multnomah County also received fluoride varnish. Eighty-seven percent of the parents were Spanish speaking, and 13% were English native speakers. All parents were invited to learn more about oral health and best practices.

A comparison of the numbers of babies seen at clinics over the past two years, reveals the large increase since the implementation of the Robert Wood Johnson Foundation, Early Childhood Cavities Prevention grant. In 2002 and 2003, 640 babies were seen for risk assessment and fluoride varnishes and for their parent to receive best practice oral health educational training. From July 2003 (shortly after the implementation of the contract) to May 2004, 879 babies were seen. This is an increase of 37%.

Dental referrals for babies were slightly down even though more babies were seen. Over summer, the team will be setting up a means for tracking all babies who are referred for dental treatment to either hospital, an outside pedodontist or a MultiCare dentist. The pilot project will look back over two years, to ascertain whether Baby Days is making a difference in the number of referrals required.

During this reporting period, there were 435 pregnant women enrolled in the Oregon Health Plan through MultiCare Dental. Educational mailings in English, Spanish and Russian were sent to 212 newly pregnant women. In response, 64 women scheduled a dental visit and 51 (79.7% of those scheduled) completed a dental visit. Of all the enrolled pregnant women 79 (18.2% of the total) have had at least one dental visit during the last year.

The team reports that insufficient staff time was available to solicit as many pregnant women for treatment as had been hoped. Phone contact was difficult during both daytime and evening hours. Educational material continues to be mailed and these ask pregnant women to make appointments. Periodic requests keep coming in for additional educational material for pregnant women from the dental hygienists providing preventive services in dental clinics, so it is inferred that more women are attending than have been reported; tracking preventive treatment with pregnant women across several clinics is proving more difficult than anticipated.

The MultiCare/Multnomah County Health Department Early Childhood Cavities Prevention program continues to provide risk assessments, education and fluoride varnish applications for three Early Head Start Programs in Multnomah County. The involvement of some Baby Days personnel in these partnerships may help to develop a more secure base for sustainability. During the current reporting period four Early Head Start staff received training, 149 parents were given educational materials and training, 69 new children had a risk assessment, 231 varnishes were placed, 50 children were referred for further dental treatment (so far 22 are confirmed as having received treatment) and twelve pregnant women parents of Early Head Start children attended a dental screening with four being referred for further treatment.

The home-based portion of the Early Head Start proved more of a challenge to get parents to bring children to risk assessments and fluoride varnish even though the assessments were scheduled during the hours that parents brought children for a required 'socialization' time. Baby Days staff met several times with the health coordinators at two of the Early Head Start. Each is partnering to seek solutions for the low turnout for the home-based children. The third Early Head Start will be adding 16 additional center based babies and 100 families for whom they will provide education only.

The Multnomah County "Baby Days" team offered early childhood oral health training in preventive care for children up to 24 months of age to primary care providers in six sites where they treat CareOregon patients, (the Medicaid-funded Oregon Health Plan), in addition to uninsured and other insured patients. These six sites provided training to 41 of approximately 100 primary providers contracting with Care Oregon. The plan is to return to two of these sites to give a full staff training that includes protocols for fluoride varnishes. A pre and three month post survey on clinical practices was sent to one site intending to target pediatric and family practice providers. To date, no post surveys have been returned. During the reporting period, 94 fluoride varnish applications were applied by the same primary care providers. A scheduled training for Multi-Care Dental providers, in collaboration with the Early Childhood Cavities Prevention Coalition and “Bugs, Bottles and Babies” was cancelled due to low registration. However, twelve dental hygienists were trained from Linn-Benton Dental Hygiene Association. (Linn and Benton are two counties in the Mid-Willamette Valley). The Baby Days team also participated in the training and educational booth sponsored by the Early Childhood Cavities Prevention Coalition at the April conference of the Oregon Dental Association.

MOVING TOWARD SUSTAINABILITY. Although funding for the School Dental program of Multnomah County was cut by almost half this did not directly affect the Baby Days program however it eliminated one dental team serving school children. But dental treatment for Medicaid eligible individuals will continue under the Oregon Health Plan Plus for children and pregnant women. The State Oral Health Program Resource Development Coordinator has been helping the County make use of Medicaid Administrative Claiming. They also have the intention of applying for an Innovative Grant from Head Start when that is re-opened for applications later this year.

Baby Days will have dental students participating in service learning in the Baby Days Program at two of the Baby Days sites in the fall of 2004. Dr. Gagneja, Acting Chair of the Department of Pediatric Dentistry and the pilot project director will finalize expectations and available dates. Not only will it keep the baby visits up, but it also will provide an opportunity for dental students to learn about a public health approach to prevention and early intervention and the oral health needs of people with low income.

The Baby Days team has been assisting a Foundation which works with the Latino community by training eleven of their promotoras (health promoters) of Early Childhood Cavities prevention. They also staffed an educational table at a family health fair put on by the Foundation which highlighted ECCP, but included other areas of oral health as well. There were 75-100 interested contacts.

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