ile t programs m 12 al-A-Sntal sealan 20 Se sed de to school-ba ring consin e rtn ccess of Wis Pa rt po A re he on t su Partnering to Seal-A-Smile 2012 This report was developed by Children’s Health Alliance of Wisconsin and made possible through a partnership and funding from Delta Dental of Wisconsin Delta Dental of Wisconsin is a not-for-profit dental service corporation that administers and underwrites easy-to-use, cost-effective dental plans for employers and individuals throughout Wisconsin Delta Dental of Wisconsin is the largest dental benefits provider in the state, covering more than million employees and family members Delta Dental supports a significant number of charitable oral health initiatives focused on improving access to dental care and raising awareness of the importance of proper oral health The following individuals contributed to the preparation of this report: • Matt Crespin, MPH, RDH, Children’s Health Alliance of Wisconsin • Alex Eichenbaum, Children’s Health Alliance of Wisconsin • Caroline Madormo, BSN, RN, CPN, Medical College of Wisconsin Graphic design and layout, Tara Goris, Children’s Health Alliance of Wisconsin Table of contents Executive summary Background Methods Key findings 10 Conclusion/recommendations 18 Sealant program profiles 20 • Adams County 20 • Ashland County 52 • Barron County 21 • Bayfield County 22 • Brown County 23 • Buffalo County 24 • Burnett County 21 • Calumet County 50 • Chippewa County 21, 25 • Clark County 26 • Columbia County 27 • Crawford County 33 • Dane County 28 • Dodge County n/a • Door County 29 • Douglas County 30 • Dunn County 21, 25 • Eau Claire County 25, 31 • Florence County 60 • Fond du Lac County 32 • Forest County 60 • Grant County 33 • Green County 34 • Green Lake County n/a • Iowa County 33, 35 • Iron County 52 • Jackson County n/a • Jefferson County 36 • Juneau County 37 • Kenosha County 38 • Kewaunee County 29 • La Crosse County 39 • Lafayette County n/a • Langlade County 40 Partnering to Seal-A-Smile 2012 • Lincoln County 41 • Manitowoc County 42 • Marathon County n/a • Marinette County 43 • Marquette County 20 • Menominee County n/a • Milwaukee County 44, 45, 46, 47, 53 • Monroe County 48 • Oconto County 49 • Oneida County 60 • Outagamie County 50 • Ozaukee County n/a • Pepin County n/a • Pierce County n/a • Polk County 21 • Portage County 51 • Price County 52 • Racine County 53 • Richland County n/a • Rock County 54, 55 • Rusk County 25 • St Croix County 21 • Sauk County 56 • Sawyer County n/a • Shawano County 57 • Sheboygan County 58 • Taylor County 25 • Trempealeau County 59 • Vernon County n/a • Vilas County 60 • Walworth County 61 • Washburn County 21 • Washington County 53 • Waukesha County 62 • Waupaca County 63 • Waushara County 64 • Winnebago County 50, 65, 66 • Wood County 67 2011-12 county breakdown of schools (grades 1-8) 68 Seal-A-Smile map 69 Seal-A-Smile logic model 70 Partnering to Seal-A-Smile 2012 Executive summary This report provides a comprehensive overview of the Wisconsin Seal-A-Smile (SAS) program The information highlights the program’s expansion and key findings identified through analysis of annual data from 2005-10 Continued expansion of programs will help reach populations without access to regular preventive care This report highlights the tremendous work being accomplished throughout Wisconsin despite limited resources, and builds on the previous report released in 2009 After the release of the previous report, additional federal and private funding for Wisconsin SAS was secured These findings demonstrate how additional funding can make a significant difference The findings in this report substantiate the need for continued state and private funding for school-based oral health prevention programs What you will find in the this report This report provides an overview of the success school-based oral health prevention programs have had since 2005 Key findings focus on caries rates, children served, sealant retention rates and other efficiency measures Data was collected from current and past Wisconsin SAS programs, in addition to other school-based programs not funded through SAS Please note, instead of using both years to denote school year, we reference the year of the fall semester For example, 2010-11 is referred to as the 2010 school year Key findings from the 2005-10 school years: • The number of schools served by Wisconsin SAS increased from 135 to 406 • The number of schools served by Wisconsin SAS with free and reduced lunch (FRL) rates of greater than 50 percent increased from 48 to 229 • The number of children and youth with special health care needs (CYSHCN) served by Wisconsin SAS increased from 261 to 3,248 • The overall average cost to deliver sealants increased from $89.37/child to $110.49/child • The average amount of Medicaid reimbursement received by programs increased from $17.40/child to $59.94/child due in part, to the ability of dental hygienists to become Medicaid providers • The number of children screened and sealed increased significantly • The percentage of children screened with untreated dental decay decreased from 40.8 percent to 35.4 percent • The number of children who received fluoride treatments in addition to dental sealants increased from 3,304 to 23,499 • The proportion of children with either Medicaid or SCHIP (BadgerCare Plus) insurance coverage participating in Wisconsin SAS increased from 53.4 percent to 69.5 percent • The number of children who received oral health education quadrupled from 9,404 to 37,599 • Sealant retention rates increased from 76.1 to 92.9 percent Partnering to Seal-A-Smile 2012 Testimonial "The value of Just Kids Dental (Douglas County) program is difficult to express We have many children in our school district who have never been to a dentist Without this great program and their ability to work with community resources, many of the children who have received quality services would have never received oral health care The dental staff have a wonderful way of making our students feel comfortable so each student remains positive about dental care Our younger students even tease about who gets to go first in the dental chair!" Nancy Smith Director of Health Services School District of Superior Partnering to Seal-A-Smile 2012 Background Children’s Health Alliance of Wisconsin (Alliance) is the statewide voice for children’s health The Alliance raises awareness, mobilizes leaders, impacts public health and implements programs proven to work Since 1994, the Alliance has led efforts to improve access to oral health care for underserved children in Wisconsin Efforts include coalition building, policy development activities and program management In 2005, the Partnering to Seal-A-Smile grant was awarded to the Alliance by Delta Dental of Wisconsin to evaluate the effectiveness of the Wisconsin Seal-A-Smile (SAS) program and bring attention to the need for increased school-based oral health programs Since 2000, the Alliance has administered the Wisconsin SAS program in collaboration with the Wisconsin Department of Health Services (DHS), Oral Health Program The Alliance provides program oversight, technical assistance and data collection for approximately 42 school-based dental sealant programs annually The SAS program targets low-income, uninsured children who attend schools with high FRL rates Wisconsin SAS defines high-risk schools as those with FRL rates 35 percent and greater In addition to sealant application, all children receive topical fluoride applications and oral health education A select number of programs also provide dental cleanings and restorative services Medicaid billing is utilized by all programs to help ensure sustainability Volunteer time and match dollars account for nearly 75 percent of the true costs to run Wisconsin SAS programs Sealant application is considered an evidence-based, preventive strategy for children and commonly used in private practice dentistry Low-income, uninsured children have difficulty accessing private practice dentistry and are denied the benefits of regular dental preventive strategies, including sealants The Wisconsin SAS program is helping Wisconsin achieve its Healthiest Wisconsin 2020 oral health objectives The first objective states that by 2020, the state will “assure access to ongoing oral health education and comprehensive prevention, screening and early intervention, and treatment of dental disease in order to promote healthy behaviors and improve and maintain oral health.” According to the Wisconsin 2008 Make Your Smile Count survey, the percentage of Wisconsin’s third grade children with untreated decay decreased from 31 to 20 percent between 2001 and 2007 The second Healthiest Wisconsin 2020 objective states that by 2020, the state will “assure appropriate access to effective and adequate oral health delivery systems, utilizing a diverse and adequate workforce, for populations of differing races, ethnicities, sexual identities and orientations, gender identities, and educational or economic status and those with disabilities.” This objective can partially be measured by the percentage of Wisconsin schools with a dental sealant program Nationally, Healthy People 2020 calls for the number of school-based dental sealant programs to increase Oral health objective number eight states the country will strive to “increase the proportion of low-income children and adolescents who received any preventive dental service during the past year.” Oral health objective number 12 calls for the “increase in the proportion of children and adolecents who have received dental sealants.” The Wisconsin SAS program has increased both the number of high-risk schools served, as well as the number of children receiving Medicaid or SCHIP (BadgerCare Plus) assistance served Partnering to Seal-A-Smile 2012 The Alliance manages state general purpose revenue (GPR) targeted to fund school-based sealant programs The dollars are subcontracted to the Alliance through DHS and subsequently awarded to communities through a request for proposal process released each spring Beginning in 2000, $60,000 of GPR was allocated annually from the state budget In 2005 this amount doubled to $120,000, as a result of Governor Jim Doyle’s Kids First Initiative However, due to budget cuts, GPR funding in 2011 was reduced to $106,720 In the 2006 school year, SAS funding again increased to approximately $200,000 due to Wisconsin receiving a Health Resources and Services Administration (HRSA) three-year oral health workforce grant In 2009, HRSA funding increased to $241,000, which Delta Dental has matched annually Beginning in the 2012 school year, HRSA funding will end and GPR funding will be increased by $250,000 to fill the void Delta Dental has agreed to match this funding for the 2012 school year Annual Wisconsin SAS funding $700,000 $600,000 $500,000 Delta Dental funding $400,000 HRSA funding $300,000 GPR funding $200,000 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 $0 2000 $100,000 School year Awards to community programs, as determined by a review committee, have ranged annually from $1,000 to $75,000 depending on the needs of the individual program The number of community programs funded each year has increased from 12 to 42 with requests for dollars surpassing those available As part of the Partnering to Seal-A-Smile grant, Delta Dental generously provided annual funding for 500 uninsured children in urban Milwaukee schools to receive dental sealants This funding allowed the Smart Smiles program, operated by Columbia St Mary’s - St Elizabeth Ann Seton Dental Clinic, to increase the number of children served and expand their scope of service Over the five years of funding, Smart Smiles treated over 3,000 uninsured children Individual program profiles, beginning on page 20, highlight program accomplishments and best practices While there are common elements to all school-based dental sealant programs, each is uniquely designed based on individual community needs and resources Partnering to Seal-A-Smile 2012 Methods The SAS logic model found on page 70 shows funding sources, activities, outputs and outcomes that have assisted with the design of this report The following outcomes were evaluated: • Number of schools served and the FRL rates of those schools • Number of CYSHCN served • Number of students screened and sealed • Number of children with untreated decay and severity of disease • Insurance status of children participating • Proportion of children retaining sealants placed by Wisconsin SAS programs • Number of students receiving oral health education In 2003-04, the Centers for Disease Control and Prevention (CDC) developed the Sealant Efficiency Assessment for Locals and States (SEALS) electronic data collection tool Wisconsin programs were used as a model for the creation of SEALS Wisconsin DHS, the Alliance and nine community programs worked intensely to retroactively collect data from the previous three years of the SAS program SEALS software has been marketed as a user-friendly tool to standardize sealant data collection throughout the nation SEALS calculates cost-effectiveness, efficiency measures, disease burden and demographic information Wisconsin communities collect this information and forward it electronically to the Alliance The data assists in policy development and evaluation of programming SEALS data was used to evaluate the outcomes identified for this report Data from non-funded programs also was collected through self-reporting by individual program managers The Alliance continues to work with non-funded programs, in an attempt to integrate SEALS into their programs Some non-funded programs have agreed to utilize SEALS, allowing continuity in data collection statewide Partnering to Seal-A-Smile 2012 Testimonial “The day we had our school-based dental program dream fulfilled was amazing! The registered dental hygienists were so professional, friendly, wonderful with the children and incredibly efficient! The very best thing of all was that about one third of our student body took advantage of this program and received treatment they otherwise may not have gotten The teacher who helped coordinate the program made a personal contact with the parent(s)/guardian(s) of those students at higher risk, explaining the importance of receiving care We were so impressed that the providers came back six weeks later to follow through with a few additional treatments that needed to be administered Taking on that kind of responsibility of follow-up care is admirable On that day, one of the hygienists identified a situation happening with one of our student's front teeth and suggested his guardian be contacted right away This was done by the teacher coordinator Part of the challenge is it was taking so long for the guardian to get an appointment for the student, a common problem in our area of the city The guardian called the dentist again and was able to get in sooner due to this urgent need being identified We are so grateful that we will be able to work with Preferred Dentistry (Milwaukee/Racine/Washington Counties) next school year This has truly been one of the most positive programs we have ever participated in and we are forever thankful to everyone who does their part to help make it possible We hope that this program will continue in the future God bless you for all of your efforts to help take care of our students' dental needs through this very unique and important program.” Katie Foxe Remedial and Resource Teacher / Coordinator of Special Services Christ Memorial Lutheran School Partnering to Seal-A-Smile 2012 Shawano County Program title Shawano County Healthy Smiles Program inception 2009 Fiscal agent Shawano County Health Department Children served 200 180 160 140 120 100 80 60 40 20 Schools served (2010-11) FRL status Oral exams Sealants 50% 2009 No FRL 57 2010 School year Children served (2010-11) Findings (2010-11) Oral exams 176 Sealants 91 Fluoride treatment 164 Oral health education 338 Untreated decay 31.3% Urgent needs 4.0% Retention rate 84.3% Program notes The program is coordinated by a program manager at the local public health department A dental hygienist provides oral exams, sealants, fluoride varnish applications and oral health education The program targets all children in second grade at area schools Collaborating partners include local dentists who provide follow-up care for children with restorative needs Partnering to Seal-A-Smile 2012 Sheboygan County Program title Sheboygan Schools Seal Students’ Smiles Program inception 2005 Fiscal agent Sheboygan County Health and Human Services Children served 1,200 Schools served (2010-11) 1,000 FRL status 800 Oral exams 600 50% 200 58 No FRL 2005 2006 2007 2008 2009 2010 School year Children served (2010-11) Oral exams Sealants 1,027 847 Fluoride treatment 1,012 Oral health education 1,026 Findings (2010-11) Untreated decay 34.0% Urgent needs 4.0% Retention rate 91.7% Program notes The program is coordinated by nurses at the local public health department and school district A dental hygienist provides oral exams, sealants, fluoride varnish applications and oral health education A program coordinator works closely with school administration and staff to maximize student participation The program targets all children in second and fifth grade at area schools The program has become very efficient in service delivery and Medicaid billing, which has significantly reduced the amount of SAS funding requested annually Partnering to Seal-A-Smile 2012 Trempealeau County Program title Health Smiles for Trempealeau County Program inception 2010 Fiscal agent Trempealeau County Health Department Children served 180 160 140 120 100 80 60 40 20 Schools served (2010-11) Oral exams FRL status 50% No FRL 2009 59 2010 School year Children served (2010-11) Findings (2010-11) Oral exams 156 Sealants 123 Fluoride treatment 134 Oral health education 108 Untreated decay 31.4% Urgent needs 10.3% Retention rate n/a Program notes The program is coordinated by a dental hygienist contracted by the local public health department The coordinator provides oral exams, sealants, fluoride varnish applications and oral health education The program targets all children in second and fifth grade at area schools The program has expanded since its inception in 2010, and anticipates providing sealants to more than 175 children in the current school year Buffalo County Health Department contracts with Trempealeau County to provide services at one school Partnering to Seal-A-Smile 2012 Vilas, Florence, Forest and Oneida Counties Program title Northwoods Dental Project Program inception 2007 Fiscal agent Vilas County Health Department Children served 60 800 700 600 500 400 300 200 100 Schools served (2010-11) FRL status Oral exams 50% 2005 2006 2007 2008 2009 2010 No FRL School year Children served (2010-11) Findings (2010-11) Oral exams 729 Sealants 598 Fluoride treatment 459 Oral health education 1,240 Untreated decay 13.0% Urgent needs 2.8% Retention rate 94.7% Program notes The program is coordinated by a dental hygienist at Vilas County Health Department Dental hygienists provide oral exams, sealants, fluoride varnish applications and oral health education The program has expanded since its inception in 2007, adding Florence and Forest Counties to their service area The program targets all children in second and sixth grade at area schools In addition to the SAS program, the health department offers oral health services to Head Start children, pregnant women and seniors Collaborating partners include all area public health departments and local dental providers Partnering to Seal-A-Smile 2012 Walworth County Program title Walworth Seal-A-Smile Program Program inception 2009 Fiscal agent Walworth County Health and Human Services Children served 700 Schools served (2010-11) 600 500 400 300 FRL status Oral exams Sealants 35-50% 200 50% 100 No FRL 2009 61 2010 School year Children served (2010-11) Findings (2010-11) Oral exams 590 Sealants 509 Fluoride treatment 588 Oral health education 1,199 Untreated decay 36.4% Urgent needs 2.0% Retention rate n/a Program notes The program is coordinated by a dental hygienist at the local public health department Dental hygienists provide oral exams, sealants, fluoride varnish applications and oral health education The program targets all children in second and fifth grade at area schools The program has expanded since its inception in 2007, and anticipates providing sealants to 900 children in the current school year Collaborating partners include school nurses at all area schools Partnering to Seal-A-Smile 2012 Waukesha County Program title Waukesha In Schools Sealant Program Program inception 2007 Fiscal agent Waukesha County Community Dental Clinic Children served 120 Schools served (2010-11) 100 80 Oral exams 60 FRL status 50% No FRL 2007 2008 2009 2010 School year Children served (2010-11) Findings (2010-11) Oral exams 75 Sealants 63 Fluoride treatment 74 Oral health education 79 Untreated decay 70.7% Urgent needs 16.0% Retention rate n/a Program notes The program is coordinated by a dental hygienist at Waukesha County Community Dental Clinic Dentists, dental hygienists and dental hygiene students from Waukesha County Technical College provide oral exams, sealants, fluoride varnish applications and oral health education The program targets all children in second and fifth grade at area schools The program transitioned from a school-linked to a school-based program, and anticipates providing sealants to nearly 200 children in the current school year Partnering to Seal-A-Smile 2012 Waupaca County Program title Healthy Smiles for Waupaca County Program inception 2010 Fiscal agent Waupaca County Department of Health and Human Services Children served 450 400 350 300 250 200 150 100 50 Schools served (2010-11) Oral exams FRL status 50% No FRL 2009 2010 63 School year Children served (2010-11) Findings (2010-11) Oral exams 406 Sealants 173 Fluoride treatment 234 Oral health education 752 Untreated decay 15.0% Urgent needs 1.7% Retention rate n/a Program notes The program is coordinated by a dental hygienist contracted by the local public health department The coordinator provides oral exams, sealants, fluoride varnish applications and oral health education The program targets all children in second through fifth grade at area schools The program has expanded since its inception in 2010, and anticipates providing sealants to 250 children in the current school year Alternative funding has been secured by the program to provide services at non-qualifying SAS schools in the county Partnering to Seal-A-Smile 2012 Waushara County Program title Shara Smile Program inception 2007 Fiscal agent Waushara County Health Department Children served 350 Schools served (2010-11) 300 250 200 150 FRL status Oral exams Sealants 35-50% 100 >50% 50 64