Amber Burks

Danielle Chelette

Special Needs Oral Health Program- Part 1

Needs Assessment

A. General data

1. Description of Site

Groves Elementary is located at 3901 Cleveland Groves, Texas 77619. Groves

Elementary was built in 1948 as a junior high school and it originally served

students grades 7-9. In the 1970’s this school was changed from a Jr. High school

to an elementary school currently serving students in the 4th and 5th grades. The

2008-2009 school years marked the sixtieth anniversary of the building. This

school is within the Port Neches-Groves Independent school district, and is

governed by the elected members of the school board. The function and role of

this site is to provide education to 4th and 5th grade students. The mission of

Groves Elementary is “we believe that all students can learn, the mission of the

staff of Groves Elementary is to provide continuity of the teaching process, a

challenge for all students to excel academically, a positive school climate for

learning, and a caring atmosphere through which we can offer the best possible

educational opportunities”(1). This school is funded by the state government.

The life skills classroom they do have a fundraiser once a month selling baked

potatoes to the teachers at Groves Elementary. The money from the fundraiser

is used by the students in the class to do community based instructional

activities such as going to a restaurant or to the movies. (1, 2)

2. Description of Target Population

The target population consists of twelve students’, 6 students in the life skills

classroom and 6 students in the adaptive behavior unit. The ages range from

nine to twelve. These students may have an intellectual and developmental

disability and/or emotionally disturbed. In the adaptive behavior unit, all of the

students live in a single parent home. The enrollment requirements are based on

the doctor’s diagnosis, and could include Down’s syndrome, mental retardation,

and autism. (2, 3, 4)

3. Description of Staff Population

The teacher over the life skills department has 2 paraprofessionals to help assist

with the students. In a separate classroom is the director of the adaptive

behavior unit and has 1 paraprofessional to help assist with the students. The

responsibilities of the instructors in the life skills department are to conduct

academic lessons, develop independent living skills, and socially appropriate

behavior. The responsibilities of the instructors in the adaptive behavior unit are

very similar to the life skills department but, they also work on anger

management. The teacher of the life skills department has a bachelor’s degree in

education with some graduate hours, and has been teaching for thirteen years.

The director of the adaptive behavior unit has a bachelor’s degree in education

and in math. This instructor also has an EC/EC certification with some graduate

hours, and has been teaching for twenty-three years. (2, 3)

4. Description of Services Provided

The principal of Groves Elementary and the teachers in both life skills

department and the adaptive behavior unit all have the capability to coordinate

activities. For the life skills department, the teacher likes to bring the students

out to eat, to the grocery store, and to the bank. Part of the students’ curriculum

is to learn how to order food, and how to act in a social setting. The activities are

designed and implemented for the students. The students go to class from 8:30

a.m. to 3:30 p.m., Monday through Friday. The life skills department coordinates

a potato sale the last Thursday of every month. They also take a trip the Tuesday

before the potato sale to the grocery store to gather supplies for the sale. The

adaptive behavior unit uses an incentives program, they work to reach a certain

amount of Accelerated Reader (AR) points, and they are rewarded with a

bowling trip. In the future, the life skills department plans to attend the Young

Men’s Business League (YMBL) rodeo youth day next month. This is a community

event for the students and the events coordinator reserves a day for special

needs students to attend. The life skills classroom schedule is as follows:

breakfast, restroom, office jobs, work (math, spelling), snack, restroom, PE/work,

recess, lunch, restroom, quiet time, work, snack, restroom, and to prepare for

dismissal. The adaptive behavior schedule is as follows: 8:30-9:15 reading, 9:15-

11:00 math, 11:00-11:30 lunch, 11:30-12:00 language arts, 12:00-1:15 science

(inclusion with other students), 1:15-2:15 PE/music (alternates), and 2:15-3:30

history/writing. (2, 3, 4) At this location the water is fluoridated at 0.80 mg/L. (5)

B. Information Related to Dental Health

There have been no previous dental services provided to this target group in the

past. The director of adaptive behavior unit was involved with an oral health

program before being hired on at Groves Elementary, but is unaware of the

results of the program. As part of a preventative measure, the life skills

department incorporates brushing in their daily schedule, either in the morning

or after lunch. They also make this part of their learning curriculum. At the

beginning of the school year the life skills department sends out a school supply

list which does include toothbrushes and toothpaste. The staff has great

knowledge and awareness of dental health. (2, 3, 4)

C. Dental Health Status

1. Dental Caries- The dental caries rate of Texas children in the 3rd grade was

seventy-three point three percent out of three thousand eight hundred sixty-

four students. The children in our target group are at a higher risk for caries

because of their cognitive, sensory, or physical conditions. Also, this target

population has more untreated caries. (6,7)

2. Periodontal Disease- This target group has a poorer periodontal status and has

fewer remaining teeth due to their condition and lack of oral hygiene routine. (7)

3. Oral Hygiene- Because of their disabilities, they have great limitations when it

comes to their oral hygiene and lack of skills. Oral hygiene is difficult for this

group of students and their oral hygiene status is general, moderate to low

grade. (7)

4. Malocclusion- Certain conditions do cause malocclusion such as Down’s

syndrome and cerebral palsy. (7)

5. Oral Cancer- Not relevant

6. Utilization of Dental Services- In the Oral Health Needs Survey of 2009 from the

Michigan Department of Community Health, the utilization of dental services of

special needs children was listed from that state. Dentists were asked to

estimate how many special needs patients were treated in their office. In a year

eighteen point eight three percent were treated. Forty point six two percent of

the dentists in the survey stated that they treated less than five children with

disabilities in 2009. Only about ten percent of the dentist surveyed stated that

they treated more than thirty children in a year with disabilities. (10)

7. Additional information- Out of the 6 students in the special needs class the

majority is white with 1 Hispanic, 2 students have a reduced lunch, 1 student

has a free lunch, and 2 students live in a single parent home. In the adaptive

behavior unit the majority is white with one Hispanic, 4 out of the 6 students

have free or reduced lunch, and all of the students live in a single parent home.

Some special needs students eat non-food items, and occasionally you can smell

it on their breath. The director of the adaptive behavioral unit explains the

students are not consistent with brushing, and you can smell it on their breath in

the morning. (2,3)

Goal-Improve the oral health of the 4th and 5th grade special needs children at Groves

elementary through an educational program.

Objective - Increase the dental health knowledge of the students by 15% using the pre

and post-test

Objective - Decrease plaque and oral debris by 15% using plaque score

Objective - Increase their oral health and skills by passing a toothbrush evaluation

Objective : Increase their knowledge of healthy foods by getting 50% correct matches on

the nutrition game board

Rational

Oral Health Services for Children and Adolescents with Special Health Care Needs is a

second edition resource guide. This resource guide starts off with an introduction describing the

purpose of this guide and the need for oral health care among children and adolescents with

special needs. The National Maternal and Child Oral Health Resource Center (OHCR) developed

this resource guide. The first part of this guide provides peer reviewed articles over specific

diseases such as barriers to dental care for children with Autism, access to dental care needs for

children with special needs, and nutrition and oral health considerations in children with special

needs. The second part includes guides, brochures, reports, and fact sheets. The third and last

section includes lists for professional associations that are used for resources. Our target group

is composed of several different developmental disabilities and this resource guide gives us

information on each condition. This resource guide also provides past national, state, and local

special needs oral health programs and how they were conducted. (8)

Promoting the Oral Health of Children with Special Health Care Needs- In Support of the

National Agenda covers several different topics such as medical home, insurance coverage,

screening, organization of services, family involvement, and transition to adulthood. The

medical home is where families and health care providers work together to recognize special

health care needs, provide continuous care, and coordinate with other services and other

health care professionals. For families who cannot afford dental care, this article wants to

increase access to care for special needs patients by programs such as Medicaid to provide

reimbursement opportunities. They strive for insurance companies to support special needs

clinics. Screenings are intended for infants and young children to be identified with special

needs conditions early to ensure they receive the correct care to prevent oral health diseases.

They provide organizational services and they try to make them family-centered and easily

reachable. This article states that family members of special needs patients play a major role in

the child’s health care needs. Overall, this article is stating the need for development of special

needs oral health care programs. The national goal that was stated in Healthy People 2010:

National Health Promotion and Disease Prevention Objectives is to “increase the proportion of

states and territories that have service systems for children with or at risk for chronic and

disabling conditions as required by Public Law 101-239”(9). (9)

In 2009, the state of Michigan designed an Oral Health Needs Survey stating a need for

dentists to provide more dental care to special needs patients. This survey suggested that

dentist do not want to provide care for special needs patients because of their low insurance

rates and how they are time consuming and not bringing in a profit when these particular

patients are seen in the dental office. This survey wants to develop new ideas to enable more

dentists to provide care to this target group. Surveys were sent out to different dentists to

provide information about what facility they work in and what insurances they accept. Overall,

this study proved that dental health care professionals need to dedicate more time and training

to these special needs patients giving them more opportunities for dental treatment. (10)

Program Design

A. Activities

This project is aimed at educating 4th and 5th grade special needs students at Groves

Elementary. Throughout the program we will provide oral health education, instruction,

and emphasize the importance of oral health. We will have a total of 4 sessions, with

one session each week. The sessions will be as follows:

1. Session 1 (week 1)

a. The role of the dental hygienists and teeth

Introduction of general information related to the anatomy of the oral cavity and

the importance of keeping your natural teeth

1. Pre-test- Overall class discussion

2. Discuss how many teeth are in a deciduous dentition

3. Discuss how many teeth are in permanent dentition

4. Discuss the importance of keeping natural teeth

5. Discuss the role of an RDH

6. Read The Tooth Book by Dr. Seuss

7. Students will create a mouth model made out of construction paper, glue,

and marshmallows

2. Session 2 (week 2)

a. Plaque

Introduction of plaque and the effects it has on the oral cavity

1. Discuss plaque, what it is composed of (bacteria, germs)

2. Discuss how it is the cause of cavities

3. Discuss the importance of brushing

4. Discuss a proper brushing technique (Fones Method)

5. Hand out toothbrushes to each student

6. Demonstrate proper brushing technique

7. Have students practice brushing in their own mouth

8. Help students and modify brushing methods

9. Apply disclosing solution to students

10. Show students spots missed in mouth

11. Coloring activity

3. Session 3 (week 3)

a. Caries and Fluoride

Introduction of the caries process and ways to prevent them from forming

1. Discuss the caries process

2. Discuss the role of fluoride in preventing caries

3. Demonstration with eggs, fluoride, and vinegar

4. Coloring activity

4. Session 4 (week 4)

a. Nutrition

1. Discuss healthy snacks for the oral cavity

2. Discuss unhealthy snacks for the oral cavity

3. Reiterate sugars role in the caries process from the foods mentioned

4. Magnet game involving identifying healthy foods vs. unhealthy foods

5. Enjoy healthy snack time with the students

6. Hand out post-test to each student- Overall class discussion

B. Constraints and Alternative Strategies

1. Constraint: There may be a short attention span from the students in the classroom

due to their intellectual disabilities and their knowledge towards oral health.

Alternative: 1. Keep the presentation short, clear, and concise. 2. The presentation

needs to be enjoyable and include all senses including hearing, seeing, touching, and

tasting to keep their attention. 3. Involve the students in the presentation and keep

their interest.

2. Constraint: The students may have difficulty understanding information presented

due to their intellectual disabilities.

Alternative: 1. We need to provide the most basic form of oral hygiene education

and instruction. 2. Make sure the students are aware they can ask questions

throughout the presentation.

3. Constraint: School attendance may be an issue in this department because

occasionally they are absent from school.

Alternative: 1. Send a letter home advertising our oral health program including the

dates of each lesson to encourage the students to attend school on those particular

dates. 2. Ask the teachers to remind the students the day before and encourage

their presence.

4. Constraint: There may be a lack of parental involvement due to their busy lifestyle

and work schedule.

Alternative: 1. Send a letter home requesting their attendance to one or all of the

program dates. 2. Inform the parents/guardians’ of their role in their child’s oral

health, and stress that their involvement is crucial to the success of our program.

C. Resources

The following resources will be required for implementation of the program:

1. Personnel: Program planners (Amber and Danielle)

2. Supplies:

a. Youth toothbrushes (15), toothpaste (15)- provided by LIT DH

b. Gloves, disclosing solution, cotton swabs, paper napkins, cups, tongue

depressors- provided by program planners

c. Glue, scissors, crayons, pencils-provided by the students at Groves Elementary

3. Audiovisual aids: illustrations:

a. The Tooth Book by Dr. Seuss, typodont, pink and red construction paper,

marshmallows, eggs, anti-cavity mouth rinse with fluoride, 3 containers, vinegar,

healthy snacks-provided by program planners

b. magnet game- provided by LIT DH

4. Evaluation material:

a. Pre-test-T/F Overall class discussion

b. Post-test- T/F Overall class discussion

c. Plaque index sheets

d. Director evaluation

5. Supplements

a. Program plan written lesson plan- provided by program planners

D. Budget:

The estimated cost for the dental health program is as follows:

1. Toothbrush and toothpaste 0.00

2. Paper napkins and cups 0.00

3. Gloves 9.00

4. Cotton swabs and tongue depressors 9.00

5. Disclosing solution 5.00

6. Construction paper 3.00

7. Eggs 4.00

8. Fluoride mouth rinse 5.00

9. Vinegar 3.00

10. Containers 7.00

11. Healthy snacks 8.00

12. Marshmallows 4.00

Total $57.00

E. Timetable

There will be 4 sessions spanning a 4 week period of time. The projected weeks of

implementation will be scheduled as follows:

Session 1: Tuesday March 18, 2014 from 2:15-2:45

Session 2: Friday April 4, 2014 from 2:15-3

Session 3: Tuesday April 8, 2014 from 2:15-2:45

Session 4: Tuesday April 15, 2014 from 2:15-2:15

Evaluation

A. Formative evaluation:

1. For week 1, we will evaluate their dental knowledge over teeth and the role of a

dental hygienist.

2. For week 2, we will evaluate each student’s effectiveness of removing plaque by

taking a plaque score. Also, review the students’ knowledge of teeth and the role

of a dental hygienist that was discussed in the previous lesson.

3. For week 3, we will evaluate their knowledge of caries and fluoride. Also, we will

review each student’s effectiveness of removing plaque by taking a plaque score.

4. For week 4, we will evaluate their knowledge of healthy snacks. Also, we will

review their knowledge of caries and fluoride and any material that they may be

struggling with. After results of the post test, we will review any subject matter

they struggled with.

b. Summative evaluation:

1. Increase the dental health knowledge of the students by 15% using the pre

and post-test.

2. Decrease plaque and oral debris by 15% using plaque score.

3. Increase their oral health and skills by passing a toothbrush evaluation at the

end of the oral health program.

4. Increase their knowledge of healthy foods by getting 50% correct matches on

the nutrition game board.

References

1. Port Neches-Groves Independent School District. (2014). Our Schools Mission Statement and History. Retrieved from http://png.groveses.schoolfusion.us/?sessionid=9cf2a1d0438b7d67c4033449b1474e4b&t

2. (J. Fecowycz, personal communication, February 11, 2014).3. (D. Windhorst, personal communication, February 11, 2014).4. (B. Chelette, personal communication, February 11, 2014).5. Centers for Disease Control and Prevention. (2008). My Water’s Fluoride. Retrieved

from http://apps.nccd.cdc.gov/MWF/PWSDetailV.asp?PWSID=1230012&State=TX&StartPg=1&EndPg=20&County=Jefferson&PWSName=&Filter=0&PWS_ID=&State_ID=TX&SortBy=1&StateName=Texas

6. Centers for Disease Control and Prevention. (2007-2008). Caries Experience. Retrieved from http://apps.nccd.cdc.gov/nohss/IndicatorV.asp?Indicator=2

7. Boyce, R., & Shah, B. (2012). Trends in Periodontal Status and Dental Caries Among Specific Treatment Populations. The Brooklyn Hospital Center Journal of Health Sciences, 3. Retrieved from http://www.tbh.org/journal/story_print.php?story_id=214

8. Bertness J, Holt K, eds. 2011. Oral Health Services for Children and Adolescents with Special Health Care Needs: A Resource Guide (2nd ed.). Washington, DC: National Maternal and Child Oral Health Resource Center.

9. Maternal and Child Health Bureau, Health Resources and Services Administration. Achieving and Measuring Success: A National Agenda for Children with Special Health Care Needs. [Website]http://mchb.hrsa.gov/programs/specialneeds/measuresuccess.htm.

10. Michigan Department of Community health/ Michigan Oral Health Coalition. (2009). Oral Health Needs Survey 2009 Technical Report. Retrieved from www.mohc.org

11. (R. Tornwall, personal communication, March 4, 2014).

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