Delivering oral health services at WIC sites is an excellent opportunity to become more involved in the local community and provide a much needed service to low-income families. Integrating oral health services into WIC programs, however, requires preparation, organization, efficiency, and flexibility; especially for dental professionals who are used to providing comprehensive clinical services in dental operatories with a full complement of staff. The dental team also needs to develop a public health mindset that values population-based approaches in multidisciplinary community-based settings. Valuing and understanding the job responsibilities of community health professionals and WIC staff is crucial to successful integration of oral health messages and services.
The oral health services provided at WIC sites focus on important components of preventive oral health care, but do not represent complete diagnostic and comprehensive care. One of the goals of these services is to link children to a dental home. For infants and toddlers to have the best chance of enjoying a childhood free of dental disease, it is crucial to reach caregivers with preventive messages and services before a child is one year of age. This is best done in a comfortable environment where families can receive other services at the same time. For low-income families, many of whom receive a variety of supportive services, places such as WIC sites, health center clinics, and public health departments provide opportunities to make the most of limited time and resources. Most of these families do not have enough money to pay for the child care or transportation required to make multiple appointments during a week, or even the time to make them if they are working, attending classes, or taking care of other family members. Making preventive oral health services available where caregivers can realistically and easily access them will help reduce potential barriers to care as well as frustration by dental providers due to missed appointments.
Oral examinations and fluoride varnish applications for young children do not require much equipment; things like high intensity dental lights, dental chairs, air/water syringes, and suction are not needed. Additionally, the few necessary supplies (listed later in this section) are almost all disposable.
The best position for performing the exam and preventive services is with the dental provider and caregiver each sitting in a chair and facing each other in the knee-to-knee position. The child can sit in the caregiver’s lap facing her/him and recline into the provider’s lap. This puts the child in the same position used in pediatric dental practices with dental chairs and allows direct eye contact between provider and child, while still allowing the child to see and touch the caregiver. A table next to the chairs can hold all supplies and paperwork, and a garbage bin can be placed within reach.
A dental assistant (or another second person) can help with paperwork, set up and dispose of used supplies, and continue to educate the family after the clinical procedures. This model is efficient: the provider can accomplish an oral inspection, review oral care recommendations, apply fluoride varnish, and involve the caregiver in discussion at the same time. It allows the caregiver to be an integral part of the process, to see what the child’s needs are, and learn how to manage them.
Marketing is crucial for any program. Although there are many strategies for marketing this program, one critical strategy is for WIC staff to inform families early of 1) the importance of both home and professional oral health care for their child and 2) the availability of preventive and educational services at the WIC site. Dental providers will need to educate WIC staff on the importance of good oral health and the relationship to the other services WIC provides so WIC staff can then market these services to families.
One way to involve WIC staff early on is to offer to demonstrate the services on their own young children as a free service. This places them in the caregiver role and gives them the perspective they need to best explain the process to their participants. In most sites, on dental visit days, the WIC staff or the dental team will need to go into the WIC waiting room to promote the oral health services directly to families. “Selling” the services and their benefits requires excellent communication skills, and knowledge of motivational interviewing techniques is as important in this early encounter as it is for the actual dental visit. WIC staff are often more effective at this; they have an established, trusting relationship with their participants, and many are already trained in motivational interviewing. Thus, marketing to WIC staff is necessary on an ongoing basis. WIC staff’s priorities are the core functions of their organization, so they may need periodic reminders and motivation to educate WIC participants about dental days and the importance of the services. Refer to Section 4 for specific suggestions on marketing dental days and to Section 6 for examples of materials.
Information on each state’s status regarding Medicaid reimbursement to medical primary care providers for providing dental caries prevention services can be found in this document, published by the American Academy of Pediatrics. Relevant oral health coding information can be found here.
Typical staffing model for California sites
1 Clinician (Dentist in FQHC; Registered Dental Hygienist in Alternative Practice [RDHAP] for fee-for-service in CA, due to billing issues)
Risk assessment
Clinical assessment
Fluoride varnish
Toothbrush prophy
Anticipatory guidance
Goal setting
1 administrative person/educator (could be a dental assistant, public health educator, or dental hygienist)
Assist caregivers in completing forms (listed later in this section)
Caregiver education
Referrals and planning for follow up
Data entry
Translation to other languages, if necessary
In large, busy WICs, a third person may be needed to help with participant flow and paperwork.
Public Health Nurses
Note that the Humboldt County model (see Section 5 for more on this model) uses Public Health Nurses, rather than dental professionals, to provide oral health services. Some programs may want to involve PH nurses or other medical professionals if they can bill for oral health services or if other funding will support their employment.
FQHC Staffing
Some FQHCs have on-site WIC programs; this is ideal, as it allows for a more seamless provision of preventive services and a dental home. FQHCs without on-site WIC programs will likely still be able to implement this program, but there are additional considerations regarding collaboration with WIC programs outside the walls of the health center. FQHC dental directors need to discuss long-term commitment for any collaboration with WIC with their CEOs and get assurance that appropriate staff will be available. They will also need to determine whether providing oral health services at WIC is in their scope of project and which WIC sites are within their geographic service area. WIC sites are considered “portal” dental sites, so certain requirements must be met if services are to be provided at these locations. If FQHCs do not have a WIC program, they can locate a local WIC agency and negotiate a scope of service change in order to bill for services. See Section 6 for FQHC resources.
Skills Training
Working with diverse populations of caregivers and young children requires good listening and communication skills, as well as excellent time management. This applies to both clinicians and dental assistants/educators. Additional skills in risk assessment and motivational interviewing are also needed. In many ways, some of the skills for interacting with families resemble those of community health workers or promotoras. One example is being conscious to speak at a low volume; WIC is a public space so care must be taken to protect the privacy of participants. If you have not had much experience working with families and young children in your professional education or practice and would like to improve your confidence and skills, contact the Center for Oral Health for additional assistance (
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).
Cultural Competency
Particularly in ethnically diverse areas, cultural competency among dental staff is critical. People from different cultures have different attitudes toward subtle behaviors that others may not be aware of, and dental staff should be trained and educated about common concerns among local populations. These may include diet, gender roles, attitude toward eye contact, personal space and sensitivity to physical contact, expectations of the relationship between a participant and a professional, and the amount of time spent at the visit, among others.
Assemble a WIC site resource kit that can be easily transported and restocked. There are many ways to do this. Plastic rolling carts or bins tend to be the easiest solution as they are lightweight, inexpensive, and can be labeled and stacked.
If resources permit, small incentives are always appreciated by families. Toothbrushes specifically designed for infants and toddlers are available at reasonable bulk prices. Children love stickers. Adult toothbrushes and small tubes of toothpaste are always appreciated by adults, as well as any other items that will help them maintain their or their child’s oral health.
In the Alameda County model (see Section 5 for more on this model), the dental team also gives out a Dora the Explorer book titled Show Me Your Smile!: A Visit to the Dentist (see Section 6 for bibliographical information). According to the team, it is the best children’s book available on the subject and it often dramatically improves children’s anxieties about the dental visit.
The paperwork used for gathering information, assuring consent, facilitating follow-up, and tracking program outcomes is important. All paperwork used to gather information or educate caregivers should be written in the most common languages used by the majority of participants (usually English and Spanish, in California); WIC staff can determine whether other languages should be considered. A small, lockable file folder should be used to secure HIPAA-protected information and to transport the forms at the end of the day. Permission forms and screening forms should never be placed where others might accidentally view them. Suggested forms are listed below.
Alternatively, there is a paperless option available—the Healthy Teeth Toolkit (HTTK), available through COH. The HTTK will be described later in this Section.
Suggested Forms
See Section 6, Participant Forms for templates and samples of these forms.
Caregiver Commitment Form
This worksheet allows the dental provider to negotiate with the caregiver to set reasonable goals and follow-up care plans. It includes pictures and descriptions of several measures the caregiver can circle and commit to take to improve her / his child’s oral health.
Caregiver Permission and History Form
This form is used to elicit informed consent from caregivers plus gather personal information and some health and dental history. Information from this form is used for tracking and case management so it must be easy to read and to complete.
Caregiver Summary
This take-home form should summarize, in easy-to-understand words and in the participant’s own language, the results and recommendations from the oral health visit. It could also include information about local low-cost or free dental resources and / or specific referral information.
Caries Risk Assessment Form
The questions on this form can be used to determine if a child has moderate or high risk factors or specific protective factors. The form used in this manual is the most recent one adopted by the American Academy of Pediatric Dentistry (AAPD).
Dental Assessment / Preventive Services Form
Transfer some of the information from the caregiver permission and history form, record the results of the oral inspection (screening) and the services provided. This form may be designed to contain as much information as desired, including Medicaid billing information.
WIC Attendance Sheet
This caregiver sign-in sheet lets the program know at a glance how many caregivers and how many children were seen each working day. This assists with record keeping and preliminary accounting.
Referral / Case Management Information
Before implementing the program, identify dental practices, public health clinics, and/or community health centers that 1) are geographically close, 2) have agreed to provide care to children of WIC participants, and 3) are enrolled as Medicaid providers. Provide a short list of those resources to families.
Without referral arrangements, you will be providing preventive services but not addressing additional diagnostic or dental treatment needs. If available, case managers can be used to facilitate referrals and follow-up. Case managers work with families to assess dental insurance eligibility, assist in overcoming barriers to seeking care, link families to dental professionals who can provide care for their child, and follow-up to ensure that dental care was acquired.
Regardless of whether you use a case manager model, someone will need to determine how referrals will be made for dental treatment and the extent of assistance that participants will need in order to obtain necessary services. InsureKidsNow.gov lists dentists who are Medicaid dental providers by state, but keep in mind that this may not be an all-inclusive list.
Educational Handouts
Caregiver Brochures
Brochures can be distributed to families to help retain the knowledge taught during the visit and teach other family members at home about oral health care. The First Smiles Healthy Teeth Begin at Birth pamphlet is available in nine different languages; contact the Center for Oral Health for more information.
Fluoride Varnish Handout
These should explain what fluoride varnish is and does and include directions on what to do/not do during the few hours directly after application and into the next morning. See Section 6, Educational Materials for a sample handout.
Caregiver Satisfaction
It is important to acquire feedback about the visit from caregivers in order to determine the degree of satisfaction and learning and initiate improvements to the program. If the WIC site uses family satisfaction forms, then you might want to create one for the oral health services. Caregivers could then be encouraged to complete the form and place it in a box for later review by WIC staff and the dental team. Assure them their feedback will remain confidential and that they are not required to include their names unless they want someone to follow up with them. If the WIC site does not use such forms, encourage families to give you immediate feedback or to provide feedback to the WIC staff. If there are any concerns, caregivers are usually more comfortable discussing them with WIC staff, who can then follow-up to resolve any issues and improve the program. Satisfied families are more apt to recommend services to other families.
It is critical that adequate infection control be maintained while providing dental services at WIC sites. The goal of infection control is to prevent or reduce the risk of transmitting microorganisms that could cause disease. Assessing the WIC site prior to selecting a place to provide services is the first step in infection control.
The Organization for Safety and Asepsis Prevention (OSAP) has developed a Site Assessment Checklist and an Infection Control Checklist (both found here) for use in alternative sites using either mobile vans or portable equipment. Although you will not be using portable equipment per se, both checklists include items that may be useful in developing an infection control plan for WIC sites.
The following table outlines the four principles of infection control recommended by the U.S. Centers for Disease Control and Prevention (CDC) and gives tips for providing oral health assessments and fluoride varnish for young children.
Become familiar with the physical site before the initiation of the program. Locate entrances and exits, the waiting area, restrooms, water sources for hand washing, and the WIC teaching and interviewing areas. Locate where WIC staff conduct participant intake and where oral health services will be provided. Inspect the space carefully with WIC staff to decide what materials must be removed at the end of the day and what can be stored neatly and safely and with HIPAA consideration. If WIC has agreed to confirm Medicaid enrollment, know where that will take place. Discuss how participants proceed through the facility and identify any potential bottlenecks when dental services are added. Review respective responsibilities of participating WIC staff and the dental team.
Plan to spend 4-5 hours at the WIC site each dental day. Try to arrive at least 15 minutes before the scheduled first visit to set up supplies, get paperwork ready, and review participant flow with the WIC staff. Cover the top of any workspace with a plastic table cover that can be wiped before and after use to prevent contamination. Clipboards or writing surfaces and pens should be readily available for completion of forms.
Although total time for a dental visit can be 15-25 minutes, clinicians should plan on seeing participants every 15 minutes if patient flow allows, as a caregiver’s time will be split between the assistant and the clinician.
Establish rapport and have participants complete paperwork
Depending on the model used, the oral health team may need to meet and greet caregivers in the WIC waiting area and solicit their participation in the program. If marketing efforts have been effective (marketing strategies can be found in Section 4), then less time will be needed to describe the program to families. Determine what languages participants speak so that translation can be arranged if needed and language-appropriate forms will be used. Initial communication is crucial for caregivers to establish trust and to understand the benefits of the oral health visit to themselves and their children. A warm welcome and a brief session playing with the child will help establish rapport. Introductions might include that the dental team is made up of professionals (team members might mention where they normally work), the team is working in partnership with the WIC staff, and the service is covered by their Medicaid dental benefits (or another funding source, if they are not on Medicaid). This initial stage of establishing rapport is crucial for generating an adequate participant flow and for families to have a successful visit.
Use the Attendance or Sign-in Sheet to document the names of participating caregivers and their children. This level of detail has been found to be important as caregivers may arrive with 2 or 3 children with different last names. A Sign-in Sheet provides a quick tally of the number of caregivers and children seen for dental services each day. Names can be cross-checked with permission forms.
Even in very busy WIC offices, choices can be made to facilitate the completion of paperwork so the flow of participants is smooth and bottlenecks do not occur. One option is to assist caregivers in completing the initial Permission and History Form in the waiting area just after they sign in. The clip board and paperwork could be made available to pick up and complete, WIC staff may assist with the paperwork, or the dental team may assist in completing forms. Since forms can be confusing and caregivers will vary in their literacy levels, offering assistance with forms is strongly recommended.
If the caregiver does not have time to complete the forms in the waiting area, then dental staff should be available to guide them through any questions as they wait to receive the service. This is the time to discuss and record insurance information and check Medicaid status. This may be achieved with an on-site point of sale (POS) device, the telephone, or via a computer with the correct database. Medicaid status can also be supplied by WIC staff if that was arranged during planning meetings. Since this step can be time consuming, the process should be thoroughly understood by all staff prior to beginning the program.
Provide the educational session (10 minutes)
Caregivers will benefit more from the clinical session if they receive some initial education about key oral health issues. A few different models exist for accomplishing this. This session may be conducted in a classroom or with individual families while they are waiting for the clinical portion of the visit. Some programs hold multiple short classes throughout the day so that families are automatically routed to the class and then to the dental visit. The following is one suggested format and sequence for presenting the information during an individual session. See Section 6 for an example of ways to convey the information and engage families in a group session.
Step 1: Establish the goal
Discuss what tooth decay is, what causes it, and what roles caregivers can play in preventing it. All caregivers want their children to be healthy. Reinforce the concept that oral health is an important part of total health!
Step 2: Tell a story
Tell a story from your life or ask the caregiver to relate an example of how they changed a particular behavior based on new information, e.g., use of seatbelts, eating habits. Acknowledge how difficult it is to change some behaviors and that knowledge alone isn’t effective without motivation and knowing what goal you want to reach. During the educational part of the visit, assess what knowledge is already known and what new information will help the child to have a healthy mouth.
Step 3: Teach key oral health messages
Consider using the Preventing the Spread of Tooth Decay in Babies and Young Children flip-book (available through the Center for Oral Health) and other educational materials listed in Section 6. This is the opportunity to share the four key messages noted in the box. Determine if this is new information or not, and how the caregiver feels about each message. Do they agree or disagree with the messages? What home oral care do they already perform and how often? Have they encountered any problems or do they have specific questions that will make home oral care easier for them? Is there anything they would especially like more information on or a particular behavior they want to be able to change? A specific plan can be discussed during the anticipatory guidance portion of the clinical encounter.
Clinical Encounter (10 minutes)
After the educational session, the child(ren) will be treated by the clinician.
Step 1: Conduct a risk assessment
Use the items on the Caries Risk Assessment Form to further engage the caregiver in conversation about home oral care habits and feeding practices. Motivational interviewing is used to elicit the caregiver’s perceptions about certain behaviors, including ability to perform behaviors considered “protective factors” and changing any behaviors that serve as “risk factors” for dental decay. For additional information on motivational interviewing, see Section 6.
Step 2: Conduct a knee to knee assessment to determine the oral health status of the child
Use a toothbrush prophylaxis (“prophy”) to clear any oral debris and plaque and to assess the caregiver’s brushing techniques and demonstrate any adaptations that would be more effective. Be sure to compliment the caregiver’s efforts to clean the child’s mouth. Note that some states do not reimburse for a toothbrush prophy, and use of a rubber cup prophy is not recommended by the American Academy of Pediatric Dentistry (AAPD) for young children; it also entails use of a dental cart with a hand piece and suction.
Perform a quick visual assessment to count the teeth and determine if there are any white spot lesions on teeth that can be remineralized, if there are any obvious areas of decay, and if the child has previously received any restorative treatment. Determine if tooth eruption is on schedule and check occlusion. Note if there are any soft tissue lesions, inflammation or indications of oral trauma. Show the caregiver if there are areas of concern and how to recognize when there are problems.
Apply fluoride varnish quickly to cover all the teeth, giving the caregiver instructions about the child’s eating and toothbrushing for the next day. Then let the child sit up in the caregiver’s lap. To review the procedures for applying fluoride varnish and caregiver instructions, consult Section 6.
Use the Dental Assessment Form to record the results of the oral assessment. Although the findings would certainly be a part of the discussion and anticipatory guidance, they also need to be transferred to the Caregiver Summary Form. This form serves as a reminder about what services are needed and that the child should be seen on a regular basis for dental checkups.
Step 3: Provide counseling to the caregiver based on the risk assessment and the oral health status of the child
Counseling should be selective and based on the results of the interview and the oral screening. It should address any concerns and questions the caregiver may have, as well as clinical observations. If transmission of bacteria from caregiver to child is a problem, then discuss ways to change the behaviors that are putting the child at risk. Discuss any recommendations for use of fluoride toothpaste and any feeding or dietary practices that are of concern. Help caregivers understand what to expect in their child’s oral growth and development in the upcoming months and how to prevent or minimize problems. This is a time-sensitive opportunity for the caregiver to reflect on goal setting and be engaged in possible behavior changes. It is also an opportunity to emphasize key oral health messages.
Consider using the Goal Setting Form to help the caregiver set one or two realistic and attainable goals. This form is easy to read and allows caregivers to simply circle some changes they plan to make based on what they have learned. Try to discuss what occurs during a typical day in the family’s life and set goals that are realistic. The form serves as a reminder when they get home and a tracking form to note progress when the child returns for another WIC visit. Negotiate an appropriate interval of time for the child to have established a dental home in the community or to have another dental visit at WIC based on risk factors, usually 3-6 months.
Reinforce the educational messages and the caregiver’s commitment with additional educational materials if they have not been given out earlier, and provide an incentive for the caregiver as well as the child (toothbrush, stickers, coupons, etc.).
The Ten Most Successful Strategies
Encourage WIC staff to promote the program and engage caregivers about the importance of oral health and the “free” oral health services.
Assure that the dental visit team and WIC staff are well organized and ready to go!
Suggest to caregivers that it is their “LUCKY DAY” because they are at WIC on a Dental Day!
Assure that the whole dental visit team and WIC staff are adequately trained to perform the best possible service in the shortest period of time.
Use Risk Assessment and Anticipatory Guidance wisely. Small steps with only a few key messages work best.
Don’t be afraid to go to the waiting room to sell the benefits of the program yourselves! Sitting around waiting for families to elect to participate in the dental visit is not productive.
Empathize with families. Point out that by preventing dental problems now, caregivers can reduce the number of expensive dental procedures their children will need and save them from a great deal of pain and discomfort later in life.
Have toys or books available for children who may have to wait for siblings.
Provide at least one non-dental incentive for caregivers, such as discount coupons.
WIC staff are your new best friends. Teamwork yields the most success! Help WIC staff to understand and value the program.
Recommendations for referrals and any specific follow-up considerations should be recorded on the appropriate form or in an electronic management system. This information is given to whomever has been assigned to do referrals and case management and is discussed with the caregivers. Dental professionals and WIC staff need to work together to establish a successful referral system and to assure that families complete any follow-up appointments.
Programs that provide preventive services but do not initiate successful referrals or keep track of a child’s progress will not be able to document outcomes that are attributable to the program. If you are unable to motivate caregivers to establish a dental home in the community right away, then it is advisable to recall them at an appropriate interval to check on progress, provide another fluoride varnish application, and continue to emphasize the importance of a dental home.
To determine how preventive services such as fluoride varnish are billed and reimbursed by Medicaid, check with each state’s Medicaid Dental Contact (list available here) or the State Oral Health Program Director (list available here).
Billing is different for FQHCs that provide services at WIC facilities. For billing purposes, only a dentist can provide the services. There are multiple ways that FQHCs can receive reimbursement:
If the WIC clinic is co- located in one of your facilities that is not under your scope of services, you can walk the WIC participants into your dental or medical space and charge encounter rates.
If you have a dental van, you can make arrangements to provide preventive and restorative dental services in the WIC parking lot and charge encounter rates.
If the WIC clinic is within your service area, but not any of the above, you can apply to the HRSA Bureau of Primary Health Care for a change in scope of services (but check with State laws first). Once this is received, you can charge the encounter rate. Until you receive the change in scope, there is no reimbursement mechanism through Medicaid.
Billing is for codes D9430 & D1206 Office Visit/Fluoride Varnish, billable at the FQHCs core rate. Work with the state’s Medicaid program to ensure the ability to bill the core rate as this may differ between states. Procedure code D9430 Office Visit (without the fluoride varnish) is not billable.
FQHCs can bill PPS if they perform one or more of the following services: dental exam, prophy, or fluoride varnish application.
Detailed information for FQHCs can be found in Section 6.
During the initial planning stages of the program, a management and evaluation plan should be jointly established by the dental providers and WIC staff. This should include 1) what data will be collected and how often to measure progress, 2) who will collect the data, 3) who will analyze the data, and 4) how the data will be shared and used to document successes and initiate improvements.
During program implementation, make sure that the forms and procedures being used are actually collecting the necessary data. Make sure successful processes (paperwork, participant flow, etc.) are documented, as well as clinical (better oral hygiene, prevention of caries) and educational (appropriate feeding, home care behaviors) outcomes, with both quantitative (numbers of children seen and how often, percentages of caregivers who follow up on referral, etc.) and qualitative (caregiver satisfaction or success stories, marketing successes, etc.) data.
Successful relationships between WIC staff, community programs, and dental providers are also important to document. This kind of information is critical for program sustainability, leveraging additional funding, and/or expanding the program to other sites.
The Healthy Teeth Toolkit (HTTK) is a data management tool developed by the Center for Oral Health specifically for managing the delivery of preventive dental services in community-based settings like WIC centers and schools. Designed to track preventive dental services over time, it gives community oral health programs the ability to measure the efficacy of their protocols and intervention strategies.
Note:The HTTK is currently used by several community oral health organizations as part of a beta-test of the HTTK system. These organizations provide real-world environments to test the features and functions of the HTTK. The Center for Oral Health plans to release a new version of the HTTK in 2012 which will be available to any community oral health program. Until then, please contact COH if you interested in becoming a beta-test site.
HTTK tracks oral health screenings and preventive dental services including application of fluorides and sealants, prophylaxis (tooth cleaning), oral health education, and risk assessment. It uses well-established public health standards, such as the ASTDD Basic Screening Survey and the AAPD Risk Assessment. It is customizable and can be adapted to record data specific to any oral health program.
HTTK’s case management tools allow community dental providers to document progress through their manage-to-care process, matching children to needed therapeutic services. It documents contacts with participants (who, what, when) and with third parties on behalf of participants. The tools can be adapted to model virtually any protocol, documenting the process as a series of predefined tasks and outcomes. This allows case management, typically a dynamic and loosely documented process, to be analyzed with some degree of rigor.
Structure
The HTTK is web-based. Data is stored on a secure server accessible over the Internet. Users of the HTTK access the system through the HTTK website, www.healthyteethtoolkit.com, using a login name and password.
Data
Data stored in the HTTK is organized in three primary participant records categories:
Child Records (Personal and family information)
Children (participants) are typically entered in the system by name and date of birth. Additional information can be entered including demographics, insurance status, parent/guardian names, and contact information.
Service Records (Dental service information)
Children can have multiple service encounters, each documented by date, provider, and services rendered.
Case Records (Logs of contacts with/on-behalf of participant)
Case management encounters, whether direct to participant family or to third parties on their behalf, are documented by date/time, case manager, and encounter notes.
A schematic of how data is organized in the HTTK is shown below:
HTTK User Interface
The user interface used to view / add / maintain these data records is straightforward and participant-centric. The primary data view is the “Child Record List.” This list can be all-inclusive, showing all children entered in the system, or filtered to show a select few.
Child Record List
Filtering is accomplished by setting matching-criteria for one or more data fields of the Child, Case, and Service records using the built in “Search” function. Search is a powerful feature that can be used to quickly determine if a child is in the system (helps prevent duplicate records) or get a count of children for a particular profile or condition (valuable for data analysis).
Service Records
The Service Record documents up to six preventive services commonly performed by community oral health programs:
Oral Health Evaluation (based on the ASTDD Basic Screening Survey)
Caries Risk Assessment (based on the AAPD developed survey)
Fluoride varnish application
Dental sealant application,
Prophylaxis (tooth cleaning)
Oral health education
Case Records
Case management contact records document interaction with participants or with others on their behalf. An organization’s protocols define the case management goal and the steps to achieve it. Typically, for community oral health programs, the objective of case management is to connect children identified in need of therapeutic services with providers of those services.
Healthy Teeth Toolkit Version 2
The new release of the HTTK, version 2, is anticipated to be available by mid-year of 2012. This version refines and extends the current feature set.
Clinical / Practice Management New Features
More efficient methods for data entry in community-based care environments
Prevention/resolution of duplicate records
Support for tablet computer (e.g. iPad) based data entry at point of service
Input Templates – predefined sets of default values to reduce data entry overhead
Bulk data import
Billing for services
Support for CDT coding
Electronic and paper based submission
Tracking of billing status
Optimized for Medicaid
Audit trail recording
Tiered, privilege-based data entry
Report generator
Documentation of analytic results
Support for COHP forms and correspondence
Support for customized report output formats
Interoperability with other software systems
Data transfer with other software systems (e.g. practice management systems)
Data security
HIPAA compliance
Encrypted data entry and transmission
Regular data backup
Case Management New Features
Coordinates with third party therapeutic providers
Automatic confirmation of received care via third party practice management systems
Manual confirmation of received care via special third party user login accounts
For a program to be “sustainable,” the resources needed to operate it must be sufficient and available when needed. Sustainability also means that the purpose, spirit, and ideals of the program stay intact even when there are changes in personnel, sponsors, or funders. Sustainability should be addressed during the planning stages and throughout the program; otherwise important decisions may be subsumed by day to day operations and re-emerge when a crisis occurs.
Assuring that the resources are available to operate a program over time also requires the development of a shared vision among those who can manifest the necessary financial, personnel and material resources. This means that shared resources can come from a variety of agencies, like WIC, dental providers, clinics, the local health department, Maternal and Child Health Programs, and other local programs (e.g. county First 5 programs, in California).
Tips to promote sustainability
Work with the local health department and other State and local agencies to access Title XIX Federal Financial Participation (FFP) matching funds for non-clinical services. These include case management, program organization, quality assurance, interagency coordination, planning, and other non-clinical services designed to increase access to Medicaid services for eligible participants. These federal funds can be accessed through matching with local or state non-federal dollars. Note that there is a process in place for acquiring these funds; it is not automatic and will require setup. See Section 6 for more on FFP.
Work with WIC to develop a system to maximize the number of Medicaid-eligible children who are scheduled for dental visits. This will also maximize FFP funding toward reimbursement.
Promote ownership and celebrate accomplishments among all of the key players:
WIC staff
Dental providers
Participants
Other community programs
Program managers and policy makers
Work closely with other community-based organizations or funders to create additional support for the program.
