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Advancing Oral Health in America (2011) / Chapter Skim
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4 HHS and Oral Health: Past and Present
Pages 141-206

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From page 141...
... . It also describes the current HHS Oral Health Initiative and provides recommendations for the future focus of this effort.
From page 142...
... The work of the Division of Dental Health might be considered the first major oral health "initiative" conducted by the federal government. At this time, programs such as Head Start discovered that oral health care was one of the services most requested by impoverished families (Diefenbach, 1969)
From page 143...
... improved the financial base of existing dental schools, initiated new school construction, and sought to produce nearly 1,000 additional dental graduates within only a few years. In addition, the Health Manpower Act of 1968 provided even more funding to improve and expand training programs under Title VII of the Public Health Service Act.3 At this time, DHEW began to estimate the status of the dental workforce as part of its estimation of the health workforce (NCHS, 1968)
From page 144...
... . In addition, President Nixon signed the Comprehensive Health Manpower Training Act of 1971, which continued the federal government's involvement in the financing of health professions education, including dental education.5 This law strove not just to increase numbers but also "to improve the distribution of such personnel -- both geographically and by medical specialty -- and to promote the more effective use of health manpower" (Woolley and Peters, 2011b)
From page 145...
... Richmond issued Healthy People: The Surgeon General's Report on Health Promotion and Disease Prevention, which highlighted the dramatic impact of public health efforts in fighting communicable diseases and laid out a national agenda for the future role of public health efforts in noninfectious diseases -- that is, health promotion and disease prevention (DHEW, 1979)
From page 146...
... . Healthy People 2010 changed its focus yet again, to concentrate on increasing the quality and years of healthy life and eliminating health disparities.
From page 147...
... As part of the appropriations process for fiscal year 1988, the congressional appropriations committees in both the House and the Senate mandated a study of the oral health activities of HHS (Interim Study Group on Dental Activities, 1989; USPHS, 1989)
From page 148...
... No single entity has been empowered and enabled to coordinate oral health activities.
From page 149...
... . The group also emphasized that all HHS agencies with oral health activities should have a strong, clearly identified oral health presence.
From page 150...
... and Healthy People (HHS, 2000c)
From page 151...
... Longer-term objectives for the HRSA-HCFA initiative had been to "expand funding for dental programs in community health centers, increase the number of grants for sealant programs, expand the number of loans and scholarships for dental students willing to practice in underserved areas, support development of state infrastructures, provide GIS mapping for all states" to enable them to assess oral health care infrastructure at county and subcounty levels, "simplify the designations for Health Professional Shortage Areas, and change federal policies that restrict provider enrollment and access to care" (HHS, 2000c)
From page 152...
... In addition, the report defined goals to reflect those of Healthy People 2010, namely: promote oral health, improve quality of life, and eliminate oral health disparities. Finally, the report specified five necessary actions to improve oral health (see Box 4-2)
From page 153...
... Administration for Children and Families Oral health activities in the Administration for Children and Families center on its Head Start program, which is operated through the Office of Head Start. The Administration for Children and Families requires Head Start programs to determine whether a child has received age-appropriate preventive dental care within 90 days of the child entering the Head Start program.11 If a child has not received appropriate care, the Head Start program must help the parents make arrangements for the child to receive it.12 Ap 11 Code of Federal Regulations, Office of Human Development Services, Department of Health and Human Services, title 45, sec.
From page 154...
... To foster access to oral health for children enrolled in Head Start, in 2006, the Office of Head Start invested $2 million in grants to 52 Head Start, Early Head Start, and Migrant/Seasonal Head Start programs for the Head Start Oral Health Initiative; grantees received supplemental funding for 4 additional years (Del Grosso et al., 2008)
From page 155...
... Preventive Services Task Force is discussed later in this chapter. Centers for Disease Control and Prevention At the CDC, most oral health activities occur in the National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP)
From page 156...
... . dental organizations involved in child health care."14 States are also required to provide dental care to children insured by CHIP.15 In contrast, while states may elect to provide dental coverage to adults insured by Medicaid, they are not required to do so.
From page 157...
... . In addition, CMS will be reviewing state Medicaid dental programs for innovative practices that have increased access to dental care and will be sharing the information about those practices with other states (HHS, 2010g)
From page 158...
... ;18 • Leveraging new CHIPRA quality grants to states to foster the de velopment of additional state-level approaches to ensuring access and quality of oral health care; • Enhancing federal guidance to states on ensuring children's access to preventive and follow-up care through EPSDT, including oral health; • Developing a strategy for oversight and compliance reviews if needed to ensure that particularly those states that have the lowest dental utilization rates are taking steps to come into compliance with EPSDT program requirements, including oral health; and 17 Patient Protection and Affordable Care Act, Public Law 148, 111th Cong., 2nd sess. (March 23, 2010)
From page 159...
... Health Resources and Services Administration Many of HRSA's bureaus and offices provide funding for oral health care activities; Appendix B includes a chart of the key HRSA agencies in 19 Code of Federal Regulations, Food and Drug Administration, Department of Health and Human Services, title 21, sec.
From page 160...
... encompass both federally funded health centers and "look-alike" health centers that meet all of the §330 federal requirements but do not receive federal grants. Preventive dental services are a requirement of all federally funded health centers.20 Health centers provide oral health care services to low-income individuals both directly and through referrals to private professionals.21 BPHC also manages the Service Expansion in Oral Health grants that provided additional funding to FQHCs to expand oral health care services.
From page 161...
... . The OHRC also collects, reviews, and disseminates Head Start oral health technical and programmatic information and materials
From page 162...
... Other goals of the initiative are to increase access to dental care for 0- to 5-year old AI/AN children by 10 percent in FY 2010 and 50 percent by FY 2015; to increase the number of children 0–5 years old who receive a fluoride varnish treatment by 10 percent in FY 2010 and 25 percent by FY 2015; and to increase the number of sealants among children 0–5 years old by 10 percent in FY 2010 and 25 percent by 2015. The IHS is piloting several other projects designed to improve the oral health of AI/AN populations, including using chemotherapeutics to treat ECC, nonsurgical intervention for the treatment of periodontal disease in diabetic and prediabetic patients, and implementing electronic dental re 22 Patient Protection and Affordable Care Act, Public Law 148, 111th Cong., 2nd sess.
From page 163...
... . Using funds from ARRA, the NIDCR funded several developmental projects on oral health disparities, including a study examining gaps in access to dental care for pregnant women, a study that examines how a low dental literacy population interprets dental health prevention information, a study that examines the acceptability and feasibility of a community-based Latino lay health worker, or promotora, and a study that examines the predictors and outcomes of the age of a child at the first preventive dental visit for children enrolled in Medicaid.23 The remainder of NIDCR's budget is used for intramural research and research management and support among its eights branches (NIDCR, 2010e)
From page 164...
... . The NIH offers several loan repayment programs for health professionals (including dentists)
From page 165...
... . It promotes water fluoridation, has established infection control guidelines for practitioners, and has made recommendations for a variety of prevention programs, including school-based dental sealant programs, population-based interventions to prevent and control dental caries and oral and pharyngeal cancers,
From page 166...
... . The CDC also provides grants and technical assistance to states for developing oral health infrastructure, including water fluoridation (CDC, 2010h)
From page 167...
... The federal government has a role to play in improving oral health literacy and has several specific actions that target the general health literacy of both the public and health care professionals. AHRQ Health Literacy Universal Precautions Toolkit AHRQ developed the Health Literacy Universal Precautions Toolkit to help primary care providers improve communication with people of all literacy levels (DeWalt et.
From page 168...
... Because it is often unclear to professionals which patients have low health literacy, the toolkit encourages them to take "universal precautions," in other words, to use the tools with all patients regardless of their perceived literacy level. Healthy People 2010/2020 Health Communications Objectives Recognizing the importance of health communication to improving public health and health care, HHS has included health communications objectives in the last two versions of Healthy People.
From page 169...
... National Standards on Culturally and Linguistically Appropriate Services Recognizing the increasing diversity of the U.S. population and the increasing disparities in health status and access to health care for diverse populations, the HHS Office of Minority Health published National Standards on Culturally and Linguistically Appropriate Services (CLAS standards)
From page 170...
... 6. Increase basic research and the development, implementation, and evaluation of practices and interventions to improve health literacy.
From page 171...
... . In the past, these grants have been used to fund research on a wide variety of health literacy topics, including developing instruments for oral health literacy assessment, assessing the oral health knowledge, opinions, and practices among Latinos, and assessing the health promotion activities in a dental clinic (NIH, 2009c)
From page 172...
... Standard 3: Health care organizations should ensure that staff at all levels and across all disciplines receive ongoing education and training in culturally and linguistically appropriate service delivery. Standard 4: Health care organizations must offer and provide language assistance services, including bilingual staff and interpreter services, at no cost to each patient/consumer with limited English proficiency at all points of contact, in a timely manner during all hours of operation.
From page 173...
... . HRSA provides grants to dental and hygiene schools and residency programs through Title VII and workforce grants to states.
From page 174...
... . This commitment to expanding and diversifying the health workforce continued through the mid-1970s with passage of the Health Professions Educational Assistance Amendments of 1965,27 the Health Manpower Act of 1968,28 and the Comprehensive Health Manpower Training Act of 197129 (Reynolds, 2008)
From page 175...
... Title VII funds are now available for • Dental public health residencies in addition to general and pediatric dentistry; • Dental hygiene programs in general, pediatric, and public health dentistry; • Predoctoral training programs in general, pediatric, and public health dentistry; • Faculty development programs in general, pediatric, and public health dentistry; • Technical assistance to pediatric dentistry training programs; • Financial assistance to dentists who plan to teach or are teaching in general, pediatric, or public health dentistry; and • Faculty loan repayment programs for general, pediatric, and public health dentists who agree to serve as full-time faculty. Previously, training grants for dentistry were grouped together with grants for medicine in Title VII, section 747, of the Public Health Service
From page 176...
... Dental schools with significant enrollment of underrepresented minority students are eligible for Centers of Excellence grants to improve recruitment and training of minority students. Each center must agree to develop a competitive applicant pool; enhance academic performance; support faculty development to train, recruit, and retain underrepresented minority faculty; address minority health issues through clinical education and curriculum; facilitate research in minority health; and train students in community-based settings that provide a significant amount of care to underrepresented minorities.31 Health Careers Opportunity Program grants are available to dental and dental hygiene schools to establish or extend programs to identify, recruit, and support students from disadvantaged backgrounds.32 Scholarships for Disadvantaged Students grants provide funding to dental and dental hygiene schools for financial aid to disadvantaged students.33 Individuals from disadvantaged backgrounds who agree to serve as faculty for at least 2 years at dental and dental hygiene schools are eligible for the Faculty Loan Repayment Program.34 Grants to States for Training HRSA also supports the training of the oral health workforce through grants to states for innovative programs to address the dental workforce needs of designated dental health professional shortage areas.35 States can use these grants a number of ways, including to recruit oral health professionals, to expand dental residencies, to support service expansion, and to establish faculty recruitment programs.
From page 177...
... programs. HRSA's Bureau of Health Professions funds dental public health residency training grants to support approved residencies in dental public health (HRSA, 2010c)
From page 178...
... Some recent and ongoing examples of HHS' efforts to promote interdisciplinary training include: $29.5 million from the ACA and the ARRA to fund interdisciplinary geriatric training (HHS, 2010e) , and the Title VII interdisciplinary, community-based grant programs, which are designed to promote interdisciplinary care and increase access to care for underserved populations and in underserved areas.40 In its most recent report to the secretary and Congress, the Advisory Committee on Training in Primary Care and Dentistry recommended additional funding for training programs that promote interprofessional practice (HHS, 2010b)
From page 179...
... From 2001 to 2008, the Office of Head Start partnered with MCHB and the Association of State and Territorial Dental Directors to foster collaboration between Head Start programs and state oral health programs. During the course of the collaboration, state oral health programs reported becoming more actively involved in Head Start programs and all 50 states developed Head Start oral health action plans (Geurink and Isman, 2009)
From page 180...
... . This will include data from CMS and Healthy People, including data that have not been available to the public in the past.
From page 181...
... The document also provided links to materials from the Kansas Head Start Association regarding appropriate containers (e.g., to avoid baby bottle tooth decay) and included advice on making better food and drink choices.
From page 182...
... . While the materials used in dental restorations have been improving, many still must be replaced because the restoration materials degrade or secondary dental caries develop under the restoration.
From page 183...
... Institutional accreditation is used as one method to protect the public from poorly trained health professionals. IOM's Dental Education at the Crossroads (1995)
From page 184...
... . The DOE currently delegates responsibility for accrediting dental schools and dental programs to the Commission on Dental Accreditation (CODA)
From page 185...
... . Criteria of eligibility for outpatient dental care in the VA differ from the guidelines used for determining other health care benefits and have several different classifications through which the extent of benefits are determined.
From page 186...
... CURRENT REFORM EFFORTS A Revitalized Oral Health Coordinating Committee (2009) In 2009, newly appointed Assistant Secretary for Health Dr.
From page 187...
... 15. Provide a written annual report to the assistant secretary for health as to OHCC activities and progress of oral health initiatives rela tive to national oral health.
From page 188...
... National Oral Health Surveillance Plan Centers for Medicare and Medicaid Services (CMS) Review of Innovative State Medicaid Dental Programs Health Resources and Services Administration (HRSA)
From page 189...
... ARRA investments that affect oral health fall into four major categories: training grants, health information technology, health centers, and research funding from the NIDCR. ARRA invested $500 million in training the health workforce, including dentistry (HRSA, 2009)
From page 190...
... For example, for Goal 1, the plan identifies one objective as ensuring access to quality, culturally competent care for vulnerable populations. A listed strategy is "Increase access to primary oral healthcare services and to oral disease preventive services by expanding access to health centers, school-based health centers, and Indian Health Service-funded health programs that have comprehensive primary oral health care services, and state and communitybased programs that improve oral health, especially for children and pregnant women" (HHS, 2010j)
From page 191...
... 5101 health care workforce; the oral budget requests health workforce is identified $3 million as a high priority area. Training in Expands Title VII training No; the Presi general, grant programs for dentistry, dent's FY 2012 pediatric, and including newly authorized budget requests public health funding for dental schools, an additional dentistry -- financial assistance to dental $19 million Sec.
From page 192...
... 5304 to increase access for rural and underserved populations Primary care Establishes grant program for No; the Presi residency newly established or expand- dent's FY 2012 programs -- ed "teaching health centers," budget requests Sec. 5508 which are community-based $10 million care centers that operate primary care residency pro grams, including general and pediatric dental residencies.
From page 193...
... . There will be four overarching goals for Healthy People 2020: eliminating health disparities; increasing life expectancy and the quality of life for people of all ages; eliminating preventable disease, disability, injury, and premature death; and creating social and physical environments that promote good health for all (Koh, 2010)
From page 194...
... SOURCE: HHS, 2010j. BOX 4-8 Healthy People 2020: Oral Health Proposed Objectives Oral Health of Children and Adolescents • educe the proportion of children and adolescents who have dental R caries experience in their primary or permanent teeth.
From page 195...
... Monitoring and Surveillance Systems • ncrease the number of states and the District of Columbia that I have a system for recording and referring infants and children with cleft lips and cleft palates to craniofacial anomaly rehabilitative teams. • ncrease the number of states and the District of Columbia that I have an oral and craniofacial health surveillance system.
From page 196...
... 2010. Head start dental home initiative.
From page 197...
... Presentation at meeting of the Committee on an Oral Health Initiative, Washington, DC.
From page 198...
... 2008. Strategies for promoting prevention and improving oral health care delivery in Head Start: Findings from the oral health initiative evaluation.
From page 199...
... 2009. Association of State and Territorial Dental Directors Head Start oral health project evaluation report: 2001-2008.
From page 200...
... 1991. Healthy People 2000: National health promotion and disease prevention objectives.
From page 201...
... 2010i. National action plan to improve health literacy.
From page 202...
... 2010. A 2020 vision for Healthy People.
From page 203...
... 2008. The impact of Title VII on general and pediatric dental education and training.
From page 204...
... 2001. Enhancing teacher health literacy in school health promotion: A vision for the new millennium.
From page 205...
... 2011a. The American Presidency Project: Gerald Ford -- state ment on signing the Health Professions Educational Assistance Act of 1976.


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