Families often don’t understand the connection between oral health and general health; this is not surprising given how differently dental care delivery, financing, and professionals are treated compared to their counterparts in other aspects of health care. Federal agencies are slowly trying to change this situation by co-locating dental and medical clinical services together in community health centers, allowing medical professionals to bill for certain procedures that promote oral health (e.g., fluoride varnish), and encouraging dental practitioners to interface with other community agencies. WIC staff can help dental professionals learn to interact more effectively with low-income families of diverse backgrounds, integrate oral health messages with important nutrition information, and help families set goals that are realistic and attainable.

The on-site preventive oral health services delivered through this program will, more often than not, represent a WIC family’s first professional oral health encounter. WIC provides the family with a familiar, comfortable environment in which they can introduce their child to dental care, without the sometimes overwhelming and frightening features of a dental office. WIC staff can also help refer children for comprehensive dental care in the community and identify supportive services that will assist families in taking advantage of that care.

In Section 2, a number of questions were posed for the WIC staff and dental coordinators and/or providers to consider when planning the program. Review these questions, as well as the following topics.

Oral Health Knowledge and Education

Discuss the oral health-related questions and key messages already incorporated into WIC’s breastfeeding and nutrition counseling. Are they consistent with evidence-based practices that contribute to improved oral health? If not, ask the dental coordinator to provide up-to-date information via in-service training or some other means so all staff are on the same page and not teaching incorrect or conflicting information to caregivers.

Review the risk assessment forms and educational materials the dental team plans to make sure important messages are reinforced and methods and materials are appropriate. WIC staff can give dental providers and educators valuable input about education materials and strategies to ensure they are effective with WIC participants. This is particularly important if your WIC site serves families who speak a variety of languages. Decide which oral health educational messages need to be translated and who will be the most effective educators. Are there staff or volunteers who can help with translation during dental visits or educational sessions? If possible, try to enlist the help of dental providers in the community who speak the languages and are familiar with the cultures of the majority of the participants.

Scheduling and Participant Flow

The success of the oral health program depends heavily on the management of participant flow and the volume of participants treated by the dental team. Core WIC services should not be disrupted, but the dental team will likely require some assistance from WIC staff in generating interest among participants and acquiring participant information. Finding the right balance may take some brainstorming and negotiation. For dental providers to cover their expenses and time, and to make the program sustainable, they need to be able to either bill Medicaid for a certain number of services or document to other funders how productive they have been; therefore, participant volume and access to Medicaid information are critical.

WIC staff know what works best for their participants. The day and time of on-site dental services should be decided jointly by WIC staff and the dental providers, but WIC staff will be able to suggest the most opportune time to see as many families as possible. Once services start, participants begin to expect them on a regular schedule.

The WIC director and staff should consider whether it makes sense to have appointments for the dental visit (generally, this makes sense only if the WIC site sets up appointments for other services) or whether the dental staff, WIC staff, or both will need to market the program to participants in the waiting room. In some circumstances, it may be practical to make appointments and, if there are “no shows,” recruit WIC families from the reception area to fill in the open time slots. If an appointment-based system is chosen, it would be helpful for WIC staff to call participants the day before their appointments as a reminder, if possible. Depending on resources, WIC staff may want to offer more than one kind of appointment reminder to support participant attendance (e.g., a reminder postcard or magnet, or a reminder in the WIC passport, etc.).

The best way to assure effective participant flow is to develop an efficient way to collect and verify Medicaid information and complete the other necessary paperwork needed for the program. Decisions regarding paperwork, including translation into other languages and availability of participant assistance, need to be made well in advance of the program debut. How this is accomplished will vary by WIC site and require WIC staff input and partnership. Although participant flow may be slow and awkward at first, it should grow more efficient as dental providers and WIC staff become more familiar with the program routine.

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 home oral care and professional dental care for their child and 2) the availability of preventive and education services at the WIC site. Refer to Section 6 for examples of materials.

Potential Marketing Strategies

Posters / Flyers

Post well-designed posters and flyers in relevant languages and using appropriate graphics for local populations at WIC sites or other community sites where WIC beneficiaries will see them. This could be a series of posters introducing the importance of oral health and then announcing the services, or one that combines both messages.

Posters should inform caregivers about the new free service available: when, where, and how services will occur, and who will be providing them. Posters should emphasize the relationship between oral health and WIC goals for children and their families. An example (shown here) can be found in Section 6.

Potential venues for poster / flyer distribution:

• Local discount stores
• Grocery stores
• Laundromats
• Bulletin boards in apartment buildings

Participant Handouts

Inexpensive self-designed labels or stickers can be placed on any written materials the participants take home from WIC. The label could advertise the services, remind them to make an appointment, or encourage them to tell their friends and relatives about the services.

Schools

Outreach to state- funded preschools, Early Head Start, and Head Start programs to inform them about the program. Also include such information in any caregiver education classes given through the Health Department. Assure that School Nurses know about the WIC oral health services. They often interface with caregivers of children younger than 5 years old at either Enrollment Centers or in schools when looking for resources for families.

Newspapers

The local Penny Saver (or similar free newspaper) is read by many participants, as well as smaller community newspapers.

PSAs

Public Service Announcements on local radio / TV / cable stations in the most appropriate language for the populations in your community.

Religious Communities

Churches located by the WIC site often attract many families. There may also be “Parish Nurses” who can assist in promoting the program and encourage families to seek services if they already promote WIC.

Other Public Service Programs

Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) and California Child Health and Disability Prevention (CHDP) program participants are always referred to WIC. Remind CHDP Nurses to inform all providers about the oral health program and to counsel caregivers to take advantage of the free preventive dental services.

In California, cultivate a relationship with the Transitional Assistance Department (they enroll participants in Medicaid) to inform them about the program and encourage caregivers to participate.

Partner with Maternal, Child, and Adolescent Health (MCAH) Programs at county or city Departments of Public Health. Inform any Home Visitors about the program so they can encourage new caregivers to attend the WIC services.

Most states have Family Resource Centers for families of children with special health care needs. Make sure they have information about the WIC oral health services as many of these families may also be eligible for WIC.

Dental Providers

Place information and flyers at the clinical site(s) of the dental provider for the program, especially if that site is a community clinic or community health center.

Provide the dental team with a tour of the facility so they know where the various WIC services occur and where the restrooms are located. Refer to Section 2 for determining the best physical location to set up for dental visits. Have the dental providers explain their program needs, particularly in relation to hand washing and infection control. Let them know if there is any secure storage where they can keep supplies or participant paperwork. Typical supplies are listed in Section 3. Decide where paperwork should be kept and how additional copies can be made if needed. The sequence and specifics of what occurs on dental days are found in Section 3 and visually displayed below. Have the dental staff walk through the process of a dental visit so you are familiar with the process and paperwork and so you can answer questions that families may have.

Depending on the referral and case management model chosen, WIC staff responsibilities will vary. One goal of the program is to make families aware of the need for an ongoing dental home where their child can receive comprehensive oral health care. Staff members familiar with dental practitioners in the community can be important links to help families schedule follow-up appointments, complete any additional paperwork, and negotiate any barriers that may interfere with them keeping the appointments. This can also help with communication between dental team members providing on-site services and other practitioners who might be seeing the children.

Dental professionals and WIC staff need to work together to establish successful referrals and to assure that families complete 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. Referrals and outcomes from referrals should be documented for easy retrieval. Specific forms and the Healthy Teeth Toolkit (HTTK) electronic data management system are described in Section 3.

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 would 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 to 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 outcomes (appropriate feeding, home care behaviors), 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.