Oral Health Forum: Reducing Barriers and Fears

Some of Oral Health Forum’s amazing Case Managers

For 10 years, Heartland Alliance’s Oral Health Forum has been dedicated to improving the dental health of low income Chicagoans. For the last three of those years, OHF Senior Director Alejandra Valencia and her team of case managers have helped develop a program to connect the city’s youngest and most at risk for poor dental health with dentists. A joint operation between CPS’s Health and Wellness office, the Wrigley Foundation, and the CDPH Dental program, the program works to find Chicago’s schools with some of the worst dental health and use in-depth case management and outreach to increase dentists visits.

It has since become a national model, most recently recognized as a Best Practice Program using the “Whole School, Whole Community, and Whole Child Model” at the 2017 National Oral Health Conference in Albuquerque.

In the 2016 school year alone, the outreach program had seen just over 22 thousand students from 49 different schools. Every year, our Oral Health Educators visit these classrooms with interactive educational tools – which are then followed up with a visit from a case manager and, ultimately, a dentist.

Part of the process is reducing stigma and fear. Kimberly and her outreach team show up before a dentist ever comes through the door. They talk about the basics, the importance of brushing, flossing, and diet. Many are surprised at the amount of sugar in their hot chips that they buy at lunch every day.

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“We’re talking to these kids as early as we can. The younger these kids are at intervention, the better chance we have at ensuring good dental health. If we catch them young enough, they won’t need that urgent care later in life.”

Students are sent home with similar education tools and for parents – as well as consent forms allowing the OHF’s case management team to follow through on making dental health connections. If a student is not interested in see the dentist, it’s highly likely that the consent form won’t return signed. This education process also gets children excited to see the dentist. The Oral Health Forum has found that classrooms who receive outreach can increase consent by over 50%.

“You show your face and it changes everything,” says Kimberly Bartolomucci, OHF Program Manager. “We’re developing relationships here, building trust. After these outreach presentations, swaths of students are usually ready to sign up on the spot.”

And it’s at that time of signing up that they begin to work with the case management portion of the program. On a one on one basis, case management helps students determine their dental health needs, find a quality dentist, and make sure connecting issues are being addressed.

With 2 case managers, the team’s ultimate goal is to find a “dental home” for these children. The biggest issue at the moment is the increasing barrier to outreach. Level of dental health, proximity to dentist offices, and access to health insurance are all taken into account at this juncture – with the intent to record all barriers and find solutions to them.

“The whole system has been developed to reduce barriers. We try to find the easiest way to get these kids into a dentist’s chair, and make sure that they have ongoing maintenance.”

With national uncertainty around healthcare, those barriers have been on the rise. A majority of the people served in the program are Medicaid recipients. Illinois ranks 50th in Medicaid dental reimbursement – last place. This means that many dentists will finds reasons not to serve our clients. Combine this with the constant barrage of attacks on healthcare – and in particular, Medicaid – uncertainty is reaching a peak.

Similarly, other national policies have created new barriers. The neighborhoods in Chicago with the worst dental health outcomes are in majority Latino areas. Families were once responsive and open to receiving care, but the current climate has dried up outreach efforts dramatically. In fact, a recent study from the Oral Health Foundation shows that the 2017 schoolyear saw a 25% drop in young people using the program – from 22,000 to 16,000.

In an attempt to reduce the level of fear within OHF’s targeted communities associated with immigration reform, OHF’s case management team is trying to provide both information on dental health AND on the issues most important to them.

“When we go to health fairs or schools we provide basic information on immigrant rights.” Says OHF Case Manager, Brenda Velazquez, “Even though our main goal is to provide dental information, we try to provide resources that are relevant to our communities.”

“The services are there, but bad policy creates a blockade. Honestly, this is what we’ve been training for. When a barrier pops up, we sit down as a team and find the solutions. We’re ready.”

In fall 2017 OHF began expanding its case management efforts to Chicago’s south side neighborhood, Auburn Gresham. OHF will provide case management services to 8 Chicago public schools; identified by CDPH as having the next highest rates of oral disease among children – and will counteract the current fears through honesty, education, and empathy.

“This is about overall health,” Velazquez said. “If your mouth isn’t healthy, it can impact the health of your bones, your heart, everything. We are here to make our communities healthier, and that will not change.”

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