School-Based Health Center Dental Outreach
- Need: To improve the oral health of children ages 3 to 13 living in underserved rural areas of Louisiana.
- Intervention: Students enrolled in school-based health centers receive oral health assessments, fluoride varnishes, and dental referrals as part of a comprehensive physical exam by nurse practitioners.
- Results: Results from the two most recent grant periods (2015-2016 and 2016-2017) included: 4,000 oral health exams, over 3,000 fluoride varnish applications, and 1500 dental referrals; the last great year seeing 68% of referrals completed, an 11% increase over the prior year.
Evidence-levelPromising (About evidence-level criteria)
In Louisiana, children‘s oral health scored a “D” in The State of Children’s Dental Health: Making Coverage Matter, a 2011 Pew Center on the States report. Poor, rural, and minority populations are especially susceptible to diminished oral health. Evidence-based dental medicine clearly demonstrates that fluoride varnish applications are an effective and safe technique to deter childhood tooth decay.
The School-Based Health Center (SBHC) Dental Outreach program works to improve these measures with integrating oral health assessments by nurse practitioners within the primary medical setting. Innis Community Health Center, Inc. started the program and established a consortium of partners:
- Morehouse Community Medical Centers, Inc.
- Teche Action Clinic
- Central Louisiana Area Health Education Center
- Our Lady of the Lake Pediatric Residency Program
The consortium expanded in 2015 to add three more SBHC sites in six rural parishes (counties) of Louisiana, making a total of five SBHCs. SBHCs, which are Federally Qualified Health Centers (FQHCs), are the primary portals already serving the target population and dental services are available within their organizational structures.
SBHCs are ideal for making timely dental referrals and offering a dental home when one had not been established. Providers acknowledge that the integration of oral health assessments within the comprehensive physical as well as the application of fluoride varnish has added demonstrable quality to their clinical practice.
The program received support from a 2012-2015 Federal Office of Rural Health Policy Rural Health Care Services Outreach grant and a 2015-2018 Federal Office of Rural Health Policy Rural Health Care Services Outreach grant.
The oral health outreach activities include:
- Fluoride varnish application
- Oral exams and risk assessments as part of comprehensive physicals
- Oral health education for children and adults
- Oral health assessment training for primary care providers working at the SBHCs
- Dental case management implementation for oral health referrals
Based on SBHC capacity, the 2012-2015 grant’s goal was to provide 1,250 (40.7% of the possible target population) fluoride varnish applications. By the end of the grant cycle, the project surpassed expectations by completing 2,136 fluoride varnish applications, or 171% of the target goal. In a similar light, caries risk assessments totaled 2,273, or 182% of the target goal. Now the 2015-2016 and 2016-2017 grant periods have accomplished almost 4,000 oral health exams, over 3,000 fluoride varnishes, and 1500+ dental referrals.
A specific activity included in the 2015-2018 grant activity was SBHC Dental Case Management implementation to track follow-up for children with identified dental needs. Compared to the 2015-2016 grant interval, the 2016-2017 interval identified over 1000 individuals needing care, an increase of 130%. To date, the 2016-2017 dental case management improved completed follow-up by 11% over the prior year.
Additional accomplishments in the first grant period included the identification of dental homes, which started slowly, but improved by the end of year three, totals reaching 13.8% of goal target.
One hundred percent of the medical providers (mostly nurse practitioners) have completed required training to perform oral health assessments and fluoride varnish applications. This training is based on the American Academy of Pediatrics training course: AAP Protecting All Children's Teeth (PACT.)
Challenges have remained minimal, since the grantee has experience in achieving grant goals of two prior grants. Committed consortium partners are also in place due to previous grant activities.
However, the key to the program's success, the dental case management function, is a "learning in progress."
In addition, dental home providers continue to be scarce in these rural communities, further adding barriers to access for children needing dental interventions.
This grant program is replicable in SBHCs and primary care facilities throughout the United States. Basic oral health assessment training in a primary care setting is achievable, and the application of fluoride varnish is an evidence-based practice to prevent dental caries. Referral follow-up is a key component impacting a child's overall oral health status.Important replication elements:
- Laws vary across states concerning what types of professionals are allowed to apply fluoride varnish
- Tracking data on the oral health assessments, fluoride varnish applications, and referral follow-up for treatment is essential. Electronic medical records (EMRs) have the capability to integrate the oral health assessment. This EMR capability, along with referral follow-up tracking, are becoming standard practice use.
- Students, parents, and school faculty are realizing that oral health assessments are just as important in the child's overall health status as other assessments such as vision and hearing.
- Collaboration between school systems and SBHCs administrative staff is not only imperative to the program, but impacts future grant proposals and projects.
Contact InformationLinda Matessino, RN, MPH, Grants Project Director
Innis Community Health Center, Inc.
Children and youth
Federally Qualified Health Centers
Racial and ethnic groups
Wellness, health promotion, and disease prevention
November 13, 2015
Date updated or reviewed
January 22, 2018
Please contact the models and innovations contact directly for the most complete and current information about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural community should consider whether a particular project or approach is a good match for their community’s needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep in mind that changes to the program design may impact results.