Based on "Florida's Roadmap for Oral Health" - reviewed and updated annually
The future prosperity of any society depends on its ability to foster the health and well-being of the next generation. When a society invests wisely in children and families, the next generation will pay back through a lifetime of productivity and responsible citizenship.
Since 2010, Florida has received poor ratings on multiple oral health indicators for children including an “F” for meeting policy benchmarks to ensure dental health and access for disadvantaged children and a “D” for the percentage of high need schools with access to sealant programs (less than 25%). The most recent study from the Pew Center on the States found that 75.5% of Florida’s Medicaid enrolled children did not receive dental care in 2011. Florida’s 75.5% places it as the lowest ranking state in the country, falling a full eight points behind the next lowest ranking state at 67%.
In addition, the DentaQuest Foundation-funded, Florida Public Health Institute’s 2014 study, Hospital Emergency Department Use for Preventable Dental Conditions: 2011 & 2012 found that more than 139,000 Floridians were treated in 2012 in hospital emergency departments for oral health conditions considered avoidable with proper preventive and restorative dental care. Charges for these visits exceeded $141 million. The 2012 visits represent a one-year 6.4 percent increase while charges climbed 22 percent yielding a cost increase of over $25 million. Among the reasons Floridians do not receive regular preventive care include lack of dental coverage for adult Medicaid patients, lack of private-practice dentists willing to accept Medicaid’s low payment rates, lack of county health department resources, lack of affordable dental insurance or inability to meet high co-pays, and lack of awareness of the importance of dental health to overall health.
The health status of Floridians through a health equity lens is largely unknown. This is developing, implementing, monitoring, and evaluating work using the definition of health equity described as “the opportunity for everyone to attain her/his full health potential. No one is disadvantaged from achieving this potential because of his or her social position or socially assigned circumstance.”
In response to these troubling trends, between January 2013 and April 2014, with facilitation from the Florida Public Health Institute, the Oral Health Florida Leadership Council developed a results-based strategic plan using the evidence-based Results-Based Accountability™ (RBA) framework, a highly disciplined process developed by Mark Friedman and introduced in his book, Trying Hard is Not Good Enough. This model has been used internationally to help groups move from talk to action in order to achieve measureable results. This plan, Florida’s Roadmap for Oral Health, supports the achievement of the result: “All people in Florida have optimal oral health and well-being” by addressing two areas of focus:
1) Improved access and utilization of quality oral health care
2) Increased access to community water fluoridation.
Headline indicators that will be used to measure success in these areas include:
•Percentage of Medicaid/SCHIP eligible children receiving any dental services
•Total emergency room costs and number of visits due to preventable oral health conditions
•Percentage of Florida schools with school-based sealant programs
•Total eligible receiving a sealant on permanent molar tooth
•Percentage of population on community water systems receiving fluoridated water
Florida’s Roadmap for Oral Health takes into consideration existing Florida oral health plans and initiatives. A living document, it will serve as a blueprint for action by Oral Health Florida over the next three to five years.
From January 2013 through February 2014, during a series of four face to face meetings and numerous conference calls, the Florida Public Health Institute provided the Oral Health Florida Leadership Council with the consultation, facilitation and support needed to develop this roadmap using the framework of Results-Based Accountability™. In January 2013, the Oral Health Florida Leadership Council was introduced to the framework and began its work to develop this strategic plan.
Prior to January 2013, the Oral Health Florida Data Action Team through the development of the Florida Oral Health Surveillance Plan (State Oral Health Improvement Plan, Recommendation 3) performed a scan of all available data to measure the status of Florida’s oral health. The Institute and Oral Health Florida leadership began discussing the need for a revised roadmap and then the Data Action Team identified the best available data and formed trend lines to include a forecast assuming no change in current efforts. In December 2013, during a face to face meeting facilitated by the Results Leadership Group, the Oral Health Florida Leadership Council decided that the plan would remain at the population level in order to maintain focus on the improvement of oral health for the entire state. During this January meeting, the Leadership Council confirmed the roadmap’s result and decided upon three preliminary areas of focus (later consolidated into two).
In August 2013, the Leadership Council used the best available data to identify and rate population-level data indicators according to communication, proxy and data power. In December 2013, the Leadership Council began using a structured data-driven decision making process that included the identification and prioritization of factors that contributed to and restricted progress for the first headline indicator, Percentage of Medicaid/SCHIP eligible children receiving any dental services. They identified partners to engage and listed previously implemented successful interventions. Using this information, the group developed strategies for each prioritized factor and began to list action steps for each of these strategies.
Between December 2013 and February 2014, smaller work groups repeated this process for the indicators of community water fluoridation, emergency department oral health visits and spending and dental sealants. On February 13, 2014, the Leadership Council reconvened to confirm and refine the plan’s strategies and action steps using a formalized proposal-based decision making process. The final first draft was completed in March and presented to the Leadership Council for confirmation in May 2014. Final document was approved in June 2014.
Oral Health Florida and the Florida Public Health Institute aim to present Florida’s Roadmap for Oral Health to the Florida Department of Health and multiple stakeholders in order to garner their support and facilitate strategy implementation.
The Florida Public Health Institute and Oral Health Florida would like to thank Deitre Epps from the Results Leadership Group for her facilitation and guidance as well as the following members of the Leadership Council for hosting face to face meetings throughout this process:
•Palm Beach State College, Nancy Zinser, RDH, MS
•University of Florida College of Dentistry, Frank Catalanotto, DMD
•Special Olympics Florida , Nancy Sawyer, MEd
What is Results-Based Accountability?™
RBA is a disciplined way of thinking and taking action that can be used to improve the quality of life in communities and the performance of programs, agencies and service systems.
Why use it?
How does it work?
RBA starts with the ends (results) and works backwards to the means to achieve the results
What do we mean by “result”?
The quality of life conditions of well-being that we want for the community as a whole.
Friedman, M. (2009). Trying Hard is Not Good Enough:. BookSurge Publishing
Result: All people in Florida have optimal oral health and well-being
Focus area #1: Improved access to and utilization of quality oral health care
Focus area #2: Increased access to community water system fluoridation
Why is this important?
Background and rationale for focusing on the indicator or result.
How will we know the result has been achieved?
The achievement of our result will be measured by progress on 3 – 5 community indicators in each focus area. The goal is to choose indicators that communicate well, are of central importance to the result and for which good data is available.
What critical stakeholders do we need to address the underlying factors?
Innovative states and communities have been able to design programs that connect families with the preventive care needed to stay healthy. These programs have solved problems of health access and shown significant long term improvements for children and families – but many places still don’t have access to these innovations.
A 2000 report by the U.S. Surgeon General called dental disease a “silent epidemic.” Overwhelming numbers of individuals exhibit serious dental diseases , contributing to poor overall health, hospital emergency room visits for preventable dental conditions, missed school and work days and other consequences (1). Access to oral health care services is one of the important determinants of oral health status. The American Dental Association recently presented a data summary (2) that stated: “Utilization of dental care has declined among working age adults, particularly the young and the poor. Dental benefits coverage for adults has steadily eroded the past decade, again particularly for young and poor adults. Not surprisingly, more and more adults in all income groups are experiencing financial barriers to care”. The result of this lack of access to oral health care has been labeled as a “dental crisis in America” by the United States Senate (3). Studies show that patients who are able to access dental care and receive preventive and therapeutic dental services are better able to prevent and control dental diseases such as dental caries (3). We have chosen three indicators to illustrate the level of access to oral health care services for one high risk patient group of children in Florida and one indicator to illustrate the effects of lack of access to oral health services for the general population in Florida.
Past generations have solved many problems of infectious disease for our people. Problems like small pox and measles are a thing of the past. Today, we have the tools to prevent the most common infectious diseases affecting children and families, including tooth decay. Preventing this disease will avoid expensive treatments, missed work, school and missed opportunities later in life.
Background and rationale for focusing on the indicator.
According to the Centers for Disease Control and Prevention (CDC), studies show that water fluoridation reduces tooth decay by about 25 percent over a person's lifetime. Community water fluoridation is safe, effective, economical and available to all consumers of a fluoridated community water supply regardless of age, income, education, or socioeconomic status. Income and the ability to access regular dental care are not barriers to receiving fluoride's protective benefits. In addition, the CDC reports that “every $1 invested in this preventive measure yields approximately $38 savings in dental treatment costs.” The CDC has recognized water fluoridation as one of 10 great public health achievements of the 20th century.
The Centers for Disease Control and Prevention Community Water Fluoridation. (July 2013) Accessed from http://www.cdc.gov/fluoridation/index.htm on May 15, 2014.
Data Development Agenda: Priorities for new or improved data
�Florida Association of Counties
�Local dental groups
�Dental insurance companies
�Florida Department of Health
�Florida Dental Hygiene Association
�University of Florida School of Dentistry
�Nova Southeastern University College of Dentistry
�Florida League of Cities
�Oral Health Florida
�County Health Departments
�American Dental Association
�Centers for Disease Control and Prevention (CDC)
�American Academy of Pediatrics Campaign for Dental Health (ILikeMyTeeth.org)
�Pew's Children's Dental Campaign Project
�Children's Dental Health Project
�Association of State and Territorial Dental Directors
�National Dental Association
�National Hispanic Association
The work of the Florida Head Start State Collaboration Office depends upon both national and state priorities. The Florida Head Start Collaboration Office engages in a number of projects and activities designed to enhance early learning systems and services for children, families, and communities.