During February, we commemorate Children’s Dental Health Month and, in doing so, reflect on the state of oral health for kids in California and what needs to be done to improve it. Tooth decay is the number one childhood chronic disease—two to three times more common than childhood obesity or asthma. Yet it is preventable. Here is some work The Children’s Partnership is doing to promote solutions to the problem.
- Helping families understand their dental benefits and how to use them. Many families in California may not know that if their child is enrolled in health coverage through Medi-Cal or Covered California, he or she also has dental coverage. Schools, businesses, doctors, nurses, and communities all have a role to play in helping families understand how to get the dental care their children need. That’s why we created brand new flyers to help families navigate dental coverage for their children. It will be especially important to educate families whose children may not have had coverage in the past, such as low-income undocumented children who will be newly eligible for Medi-Cal later this year. We will be sharing these flyers through schools, clinics, and other partners. Please help us get them out to families, too!
- Bringing dental care to children where they are in the community. Underserved children, who suffer from poor oral health, face significant obstacles in obtaining dental services. Many low-income families have difficulty getting needed dental services because they lack affordable transportation, lose pay when they miss work, and face other socioeconomic barriers. Bringing care directly to them bypasses these barriers and, for many, may be the only option for getting care. The Virtual Dental Home (VDH) is an innovative and cost-effective system for providing dental care to California’s most vulnerable children in community settings. The VDH model uses technology to connect specially trained dental hygienists and assistants, located at community sites (such as schools and Head Start sites), with dentists in offices or clinics to facilitate comprehensive dental care. We are sponsoring legislation—AB 648 (Low)—which would provide a one-time start-up investment in training, equipment, technical assistance, and other support that providers need to begin implementing the VDH so that it can be brought to underserved communities across the state.
- Encouraging a sustainable system of care for children in Medi-Cal. Now that more kids than ever have health and dental coverage, we need to make sure they can use it. Approximately 5.6 million California children are enrolled in Medi-Cal, but fewer than half of these children are receiving necessary dental care. While progress has been made, Medi-Cal continues to fall short of meeting the dental care needs of the state’s most vulnerable children. We need a sustainable system that brings care to children in community settings, utilizes community health workers to educate and engage families and coordinate care, and provides enough dentists in the right places to address the restorative dental care needs of children. For example, the State should implement a program like the ABCD program in Washington State and a similar program in Alameda County that supports a whole team to address the oral health needs of young children.
- Shaping the State’s oral health plan. This year, TCP is helping to develop the State Department of Public Health’s statewide oral health plan, led by the newly appointed Dental Director, to ensure the plan makes meaningful recommendations for improving children’s oral health and action is taken to begin timely implementation. All of California’s kids deserve the dental care they need to not suffer in pain, do well in school, and avoid costly health problems later on in life.
Please join us in helping families understand their children’s dental coverage and how to get care by promoting these much-needed statewide systems. Contact Jenny Kattlove, Senior Director of Programs, with any questions at jkattlove@childrenspartnership.org.
Today, I had the opportunity to present to the Little Hoover Commission, an independent state oversight agency, on ways to help ensure children enrolled in Medi-Cal get the dental care they need.
The Commission’s review, requested by Senator Richard Pan and Assemblymember Jim Wood, is in response to a recent audit of the State’s Medi-Cal dental care program that found poor access to care and lack of oversight of the program that put the more than five million children enrolled in the program at higher risk for dental disease.
When children’s oral health is neglected, they needlessly suffer and lose the opportunity to realize their full potential. Poor dental health can disrupt normal childhood development and seriously damage overall health. Children with poor oral health end up in the emergency room, and they miss school due to dental problems.
The audit report and the efforts of the Little Hoover Commission—along with the fact that we now have a state dental director to lead statewide efforts to improve the oral health of California’s residents—provide the impetus and tools to finally make real change and put California on the path to ensuring its children have the optimal oral health care they need to stay healthy and succeed in school and life.
The Children’s Partnership’s recommendations to improve children’s oral health are threefold:
1. Bring Care to Where Children Are. If we are truly committed to the oral health of all children, bringing timely dental care to where they are can make a big difference. The Virtual Dental Home brings care to children in schools, Head Start sites, or other community settings. We were pleased to see the enactment of AB 1174 in 2014, and we hope to see enactment of AB 648 in the near future to continue to expand this cost-effective approach to dental care for children.
2. Invest in Preventive Care for Young Children. Young children enrolled in Medi-Cal receive dental services at disproportionately low rates, even though their needs deserve particular attention. Early preventive dental care results in better oral health as well as overall health and well-being over a lifespan. The State needs to address the needs of young children, which could include raising reimbursement rates for providers who see this population or raising rates for particular services that impact this population, such as preventive services.
3. Make the Most of Our Workforce. We can no longer assume that the dentist is the only provider that can address children’s dental care needs. It takes a team to provide the comprehensive oral health education, care management, and treatment families need. Dental hygienists and assistants are helping to bring care to where children are through the Virtual Dental Home. Community health workers can play a vital role in educating families about the importance of good oral health and how to achieve it, as well as connecting families to services. And home visitors can also play a critical role in getting families off to a good start. California should explore how to adopt and support best practices for expanding outreach, education, and services to improve dental care. Improving the oral health of California’s underserved children is a top priority for The Children’s Partnership, but it will take a coordinated effort of the Administration, the Legislature, and stakeholders to truly make a difference. We look forward to continuing to work with the State to ensure that Medi-Cal’s children—more than half of all of California’s children—have the good oral health they need to be healthy and succeed in life.
For most of his childhood, Ethan and his mother often had to drive six hours from their home in Redding, California, to Los Angeles to meet with a psychiatrist for his autism treatment. Today, Ethan, now 19 years old, drives just 10 minutes to a clinic in Redding where he meets with the very same psychiatrist via a live video conferencing system.
Telehealth, using technology to provide health care and support services at a distance, has the potential to improve care for the 1.4 million children in California who, like Ethan, have special health care needs. These children often require multiple specialists, coordinated health care, and related services on an ongoing basis. In both rural and urban areas of the state, Children with Special Health Care Needs (CSHCN) often find their health care needs unmet for a variety of reasons, such as provider shortages, lack of access to specialists, lack of affordable transportation, and a number of other barriers. But with the increased use of video conferencing, remote patient monitoring through smartphones, and other technology applications, we can break down those barriers and make it possible for more children to get care they may otherwise go without, right in their own communities.
Recognizing the potential of telehealth, The Children’s Partnership, the UC Davis Children’s Hospital, and the Center for Connected Health Policy, with support from the Lucile Packard Foundation for Children’s Health, set out to understand how telehealth is currently being used to meet the needs of California’s CSHCN and identify where policy constraints to wider adoption exist. After conducting a literature review, online surveys, and interviews with key stakeholders, including providers and California Children Services (CCS) administrators, we were able to uncover both the best practices of how telehealth is implemented and the difficulties in bringing it to scale.
The majority of providers surveyed, namely pediatric physicians, thought telehealth has potential to bridge gaps in care for CSHCN, but over 50 percent felt that issues of time, reimbursement, and equipment limited its use. Of the 39 CCS program administrator respondents, 32 out of 39 would be interested in state-sponsored training to learn more about telehealth.
It was clear from our interviews and surveys that many are eager for an expansion of telehealth that could help families get their children the care they need in a timely manner and at an affordable cost, regardless of where they live. CSS, health care providers, family advocates, children’s advocates, philanthropists, and other stakeholders all have a role to play to make telehealth for CSHCN a reliable option throughout California. Through expanded outreach to families and providers, and increased incentives for participation, we hope to have more success stories like Ethan’s, so instead of driving hours to multiple doctors’ appointments, children can spend their time reaching their potential.
Read “Realizing the Promise of Telehealth for Children with Special Health Care Needs.”