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c/o Oral Health Program 3427 Goni Road, Suite 108 Carson City, NV 89706 Minutes – March 1, 2007
In attendance were: Deborah Aquino, Bureau of Family Health Services, Oral Health Program Marlena Booth, Healthy Smiles Family Dentistry, Inc. Vicky Chandler, Nevada Covering Kids & Families Jean Childs, CSA Head Start Adrina Cohen, Lyon County School District Darla Emm, Cooperative Extension, Medicare Program James Jordan, Bureau of Family Health Services, Oral Health Program Kari Larson, Silver Springs-Stagecoach Hospital District (SSSHD) Michelle Melendy, New Frontier Treatment Center Sharman Plaugher, Community Health Nursing, Zephyr Cove and Virginia City (also temporarily assigned – Dayton) Lori Savoie, Community Health Nursing, Lovelock Sandy Sorani, Community Health Nursing, Lovelock Laura Webb, RDH – LJW Education Services Rebecca Zatarain, CSA Head Start Welcome and Introductions The meeting was called to order at 1:36 pm by Deborah Aquino, with the Oral Health Program. Participants were invited to introduce themselves.

Presentation: New Frontier Treatment Center – Meth Update by Michelle Melendy, Clinic Director - Michelle shared that New Frontier Treatment Center has a 28 bed residential facility in Fallon. Clients stay any where from one to six months in their facility. The first month is intensive treatment and they may choose to stay on for transitional treatment where they get a job and learn daily living skills. Many substance abuse clients have lost those skills or never had the opportunity to gain them. Their residential program covers substance abuse and gambling addiction. They also offer outpatient treatment in Fallon for substance abuse, gambling addiction and mental health. They have drug courts throughout Nevada – one in Lovelock, Winnemucca, Elko, Ely and Pioche. In some of those locations they are beginning to offer outpatient services in addition to the drug court services as their office space expands. Ely offers outpatient services and in Lovelock they are beginning to get some space for outpatients. They treat a lot of clients who seem to have trouble with their teeth. She took an informal survey that morning and out of 14 clients, four had no problems with their teeth, another four had at least one tooth that was a problem, five had “many” teeth with problems (i.e., “all my upper teeth” or “all my molars”) and one client had
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dentures. She also asked the nine clients who said they currently had dental problems if they could pay for dental care. Four had absolutely no resources, insurance or personal or family funds, to pay for their dental care. Marlena Booth of Healthy Smiles Family Dentistry in Yerington offered her office’s services to assist Michelle’s clients. Healthy Smiles accepts Medicaid and Nevada Check Up and also offers a sliding fee scale for uninsured. Occasionally, in urgent situations, they will do work on a pro bono basis. Marlena and Michelle discussed the extra costs associated with the lab fees for dentures. Michelle discussed some of the problems their clients experience overall. By the time they get to residential treatment they have a pretty serious addiction. Approximately 60% of clients are coping with an addiction to meth, as at least one of their addictions. The second most often occurring addiction is alcohol. The “meth mouth” caused by the dry mouth and the typically negative oral hygiene and poor diet of meth users is experienced by many of their clients. She shared that they also have problems that include neglecting their children and not having employment. Many times they have become estranged from their families. The hardest part personally, for her is to see, is the poor parenting of their own children. Their children’s mouths (even without meth) are just as bad. She talked about the high school assemblies and community forums being offered in Lyon County that she is participating in. Upon inquiry the limited availability of preventive oral health care for children in Churchill County was discussed. Give Kids a Smile dates were held there, however the needs are greater than can be addressed in a single day. The average age of clients is 25 to 30. The age range is usually 18 to 40. Usually the addicts don’t live really long lives. The clients they see are very diverse – from business professionals to homeless. They do see more mental health patients and those who have suffered an early trauma. It is estimated that 60% of clients have a co-occurring mental health problem. Self-medication is extremely common. They say that up to 90% of female substance abusers have experience trauma, i.e., child abuse. A question was raised by a participant, “How long does it take meth mouth to develop”. Michelle was unsure; however, another participant stated that it was within six months. The process can work fairly quickly because many of the users have other health conditions and have not had ongoing preventive oral health care. Jim asked Michelle how patients end up at New Frontier. Michelle explained that clients can be self-referred, court referred, or perhaps referred by family members or doctors. The outpatient services are usually used for those who perhaps are still functioning, i.e., may still hold a job. In the later stages many are court ordered. Jim also asked how clients’ expenses are covered. Michelle said they have a sliding fee scale. They also accept insurance and Medicaid. They don’t refuse services to anyone due to an inability to pay, if they can at least agree to a payment plan. Hopefully the family will be able to help pay for at least some food costs while they are there. Sometimes the courts have money set aside for treatment. New Frontier’s website is
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Updates from Participants – Any news for the group? What are you working on? Do you have anything we can help you with? – Marlena is back to work full-time, after her heart attack. She felt lucky to be in the right place at the right time and her best news, as she informed the group, is that she hasn’t smoked a cigarette since. She offered oral health screening at elementary schools that are not being served by existing programs. Adrina Cohen had no new updates. Sharman Plaugher (calling from Zephyr Cove) asked about Marlena’s availability to do screening at the Storey County Schools and the Classroom on Wheels (COW) bus. Sharman and Marlena will get together to work on arranging the screenings. She also asked about the fluoride varnish application training offered by the Oral Health Program. Debbie will check with Laurie Nickles, the Health Educator, and forward the appropriate information to Sharman. Kari Larson from SSSHD shared that they are still working out the final contract with Eastern Sierra Medical Group to operate and staff the Lahontan Dental Clinic in Silver Springs. An attorney has been retained by SSSHD to coordinate the negotiations. Kari and Marlena attended the Safety Net Provider session at the Legislature Building and participated in advocacy to support BDR 311 which would provide $12 million in funding for community clinics and referrals for specialty care. Lori Savoie and Sandy Sorani at the Community Health Nursing office in Lovelock are working on a Wellness Fair where they will be able to provide fluoride varnish. They recently went to a Head Start site and observed the fluoride varnish being applied. Rebecca Zatarain from CSA Head Start shared that she had three Head Start students who were able to obtain dental screenings during the Give Kids a Smile event in Fallon. They all had a clear dental exam with no findings of dental caries. Dr. Guillen’s office (in Fallon) has agreed to see additional Head Start students and bill the Head Start program. She is still negotiating with Eastern Sierra for visits for the students at the Silver Springs office, when opened. Also, she is talking to Dr. Henderson’s office in Fallon about similar arrangements. Jean Childs, also from CSA Head Start, let the participants know that Rebecca’s last day with CSA Head Start is March 9th, and she will be missed. Vicky Chandler, Outreach Coordinator with Nevada Covering Kids & Families has been actively involved in two other oral health coalitions, Washoe County’s Coalition for Underserved Populations and the Carson Douglas Oral Health Coalition. She used to work with the CSA Head Start and one of the issues she saw impacting families was not having health care coverage. Her organization helps assist families in knowing about and applying for Medicaid and Nevada Check Up. Their group is hosting a free training, on March 28th about Medicaid and Nevada Check Up. The audience for the training is anyone who would like to receive updated information about Nevada’s public insurance programs. They will be going over the application. The training will last two hours, 8:30 am to 10:30 am. You may submit questions, with your registration form, so the presenters can be prepared. Welfare and Nevada Check Up are providing the training. Registration applications and information on the training were emailed to CLPS ROHC participants earlier in the day. Vicky offered Sandy and Lori materials for their fair. Darla Emm updated participants on her work to get non-native children seen by the Fallon Tribal Dental Clinic. They still had not hired a dentist. They are interested in opening the doors however, it is a slow process. Members discussed that other tribal locations, Yerington and Schurz, have or are losing their dentists. Jim shared that the results of the 2005-06 Healthy Smile/Happy Child Basic Screening Survey of Third Grade Students has been published to our website. It is available at: Debbie told coalition participants of the invitation received to present a dental themed Page 3 of 4

StoryTime at the Dayton Valley Branch Library on March 21st. This could be a new venue with the potential for educating parents about oral health and distributing information about preventing oral disease and information from additional programs. The Lyon County Community Meth Forums information sheet was sent to participants. These are open to the public. Debbie also invited interested members to attend an advocacy training offered at the next quarterly meeting of the Northern Nevada Chapter of the Nevada Public Health Association (NPHA) on March 8th. Debbie also let participants know that the American Lung Association is asking for donations of old shoes to include in their 1,200 Steps exhibits for Kick Butts Day, March 28, 2007. Donations can be brought to Ike Cress, Nevada State Health Division, Bureau of Community Health, 4150 Technology Way, #101, Carson City before March 15 th. Update – Visioning Team (Marlena Booth, Kari Larson, Lori Savoie, and Laura Webb with Jim Jordan and Debbie Aquino) – Coalition participants discussed the two vision statements submitted for member’s consideration. Coalition participants voted and selected “To provide optimum oral health services to all community members through education, prevention and access to treatment” as the coalition’s Vision Statement. Teleconference participants also voted to accept the submitted Mission Statement and Goals/Priorities as written, with the understanding that future strategic planning could be an opportunity to review and revise them. The Mission Statement adopted is “The Churchill, Lyon, Pershing and Storey Counties’ Regional Oral Health Coalition is a group of healthcare professionals and stakeholders committed to working together to promote oral health education, disease prevention and access to dental treatment with our communities.” The Coalition Goals/Priorities voted in are as follows: 1. Collaboration: Creating linkages and building partnerships. 2. Advocacy: Encouraging new policies and supporting existing policies that promote optimal oral health. 3. Education: Disseminating oral health education materials designed for various audiences; i.e., public, healthcare providers, vulnerable populations and caregivers. 4. Prevention: Implementing new and supporting existing initiatives that prevent oral disease. 5. Access-to-care: Building capacity to meet community members’ oral health needs. Discussion: Action Planning – Where do we go from here? Due to time constraints the following agenda items were tabled for next month’s meeting:  Coalition Introductory Brochure – Sample for review and discussion  Coalition Formalization  Pursuing grant funding and/or donations Next meeting: Our next meeting is scheduled for Thursday, April 5, 2007 from 1:30 pm to 2:30 pm. Please send items for next month’s agenda to Debbie at .

Meeting adjourned at 2:41 pm. Page 4 of 4