Dental Care for Children and Youth with Special Health Care Needs

AAPD ConferenceAAPD ConferenceChildren and Adults with Special Health Children and Adults with Special Health Care NeedsCare NeedsNovember 17-18, 2006, ChicagoNovember 17-18, 2006, Chicago

Betsy Anderson, Family Voices

• National Network of Families & Friendshttp://www.familyvoices.org

• Family to Family Health Information Centers (35!)

• Meetings and Workshops

• Research and Data

• Networking and Partnerships

FAMILY OICESV

Bright Futures Materials:

The Family Pocket Guide is a quick reference that contains:

How to choose and work with your health care provider

What to expect as your child grows

What will happen at health visits from birth to age 21

Color-coded by age

Various tip sheets in the appendix for all ages

Complements the Bright Futures Guidelines for Health Supervision of Infants, Children and Adolescents

Dental Health Issues for Children

Thoughts for families Dental health is more than teeth – it also includes

mouth, face, nutrition, speech, chewing, swallow- ing, appearance, well being, and confidence.

Ideas about dental health and what can be done may be different from when you were growing up. New dental procedures such as sealants, cosmetic treatments, and pain man- agement have been added and improved.

Experiences and beliefs about dental care vary from country to country.

Cost and coverage can be barriers to good dental care High costs of care Lack of information about how to get services covered Families with coverage may face red tape and delays in determining

what is covered, pre-approvals, and co-pays.

Providers may be hard to find, especially for those with Medicaid or certain dental plans.

Family-centered care exists in some, but not all, dental practices. Needed is:

Understanding of families’ roles in day to day care and special situations

Information especially for families and children Support for children and families

Communication and coordination among child health providers - dentists, pediatricians, and other caregivers – is needed.

Dental care is not typically part of regular health insurance, conveying a confusing message.

www.brightfuturesforfamilies.org

________________ ________________________________________________________________________

2340 Alamo SE, Suite 102, Albuquerque, NM 87106 Telephone 505-872-4774 Fax 505-872-4780 Toll Free: 1-888-835-5669 E- mail: kidshealth@familyvoices.org Internet: http://www.familyvoices.org

Dental Health Issues for Children

Dental Health Issues for Children with Special Health Care Needs

Thoughts for families

All of the issues mentioned on the previous page may also apply for children with special needs. These issues may be “heightened.” Additional concerns may include: Need for accessibility, modification, accommodation. Dental offices and

practices should comply with Americans’ with Disabilities Act standards. Staff attitudes and comfort caring for children with special needs Staff training to address information, support, and specific treatments for

children with special needs. Medications a child is taking may cause increases in cavities and plaque. Appropriate recommendations for anesthesia. Some children may need

anesthesia for treatments and procedures that others do not. In other cases, children with special needs may be inappropriately anesthetized. Consideration that costs for treatment, equipment and supplies will likely be in

addition to other health care costs families face. Under managed care, some procedures may be denied, thus requiring families to appeal in order for children to receive needed services. Families will need to coordinate dental appointments and care with other

health care services and therapies children receive. Communication and coordination with children’s other health care professionals in order to provide quality, family-centered care. Children and families benefit from dental health professionals who act as

advocates for children’s dental and other health care and services!

Note that for some children with special needs, there are no special dental health issues!

Our thanks to Bright Futures at Georgetown University for graphics

Supported by G97MCO 4453 from the Maternal and Child Health Bureau, Division of Child, Adolescent and Family Health

Health Resources and Services Administration, Department of Health and Human Services

Dental Health Issues for Children with Special Healthcare Needs

Family Roles and Partnerships:

Families are their children’s first and best advocates, providing and

overseeing

their children’s health and development.

• Initially - no where to go but up – families were not seen as partners or providers

• Roles for families at many levels• MCHB and other champions!• Concept of family-centered, community-

based, coordinated, culturally competent care• Concepts now selling points• Partnerships at many levels

Family Roles and Partnerships:

Obstacles

Successes

Care and Services

Raising children is important, hard work –24 hours a day.

• Few services, giant gaps in service• Lack of parent presence• From limited care to fragmented care• Care in specialty settings – primary care not comfortable or confident in their roles

• Innovation, technology, techniques• Success in education (IDEA) prompted changes• Each specialty “bloomed”• Family roles have become more diverse• Family roles are recognized and supported

Care and Services: Obstacles

Successes

Information and Data

Children’s health happens in many settings –

home, school, community.

Families are the links between caregivers and settings.

Information and Data:

• limited to non-existent

• not family friendly

• not matched to family roles

Obstacles

Successes• Tremendous progress• Internet dissemination • Oral Health Data

- Nat’l Survey CSHCN (2001)- Nat’l Survey of Children’s Health (2003)- Family Voices: provision of oral health info has doubled, 2005-2006

• MCHB Performance Measures National and State Measures

Information and Data:

Financing

Your child’s health care providers want to help you raise healthy children.

Children’s regular health and dental visits are excellent times to get this help.

• Early on - seldom mentioned • Soon after and ongoing - major health

and economic consequence for the entire country

• Katie Beckett waivers (1982); children assisted

by technology• SCHIP (1997 – being reauthorized ‘07)• Increase in understanding of issues• Increase in advocates

ObstaclesFinancing:

Successes

Recommendations & Resources

There are lots of right and good

ways to raise healthy children.

6 Critical Indicators of Progress• Medical Home• Insurance Coverage• Screening• Organization of Services• Family Roles• Transition to Adulthood

Promoting the Oral Health of CSHCN• In Support of the National Agenda

Maternal and Child Health Bureau

Important Initiatives Advancing the Agenda

• National Maternal and Child

Oral Health Resource Center

• ASTDD – State forums and plans

• Children’s Dental Health Project

• AAP – PROHD Project

• And others!

Family-Centered Care

• Be intentional – extend FCC to oral health practitioners

• Recognize families as primary care providers and models for their children

• Involve families in program, policy, and practice areas – work with families to define roles

Recommendations

Care and Services

• Create “virtual teams” to bring together those involved in a child’s care

• Emphasize health and wellness for CSHCN• Build on Dental/Medical Homes and

Bright Futures• Quality Care - define & discuss with

families

Recommendations

Information and Data:

• Participate in and help shape national, state and local initiatives

• Provide more specific and accessible data on

– insured/uninsured

– co-pays

– out-of-pocket expenses for families

Recommendations

Financing:

• Express and define financing needs that partners can support

• Put teeth and gums back into the child! Integrate health and dental health

• Work broadly for good health for all

Recommendations

• Family-to-Family Health Information Centers

• FV topical call on oral health (June ’07)

• Work w/partners to identify best oral health info for families (spring ’07)

• Family Voices Health and Wellness Survey (current) http://go.tufts.edu/familymatters

Resources & Initiatives

FAMILY OICESV

• Build a community of champions for dental health

Be advocates! Be out there! Be visible!

• Recent APHA Conference

Finally

If you find your life’s passion,

you’ll never work again.

Health promotion works!

Families matter!

Raising healthy children is everybody’s business!