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Project Read Project Ready Smile Evaluation Status Report

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          Ready
  Project Ready Smile
  Evaluation Status Report
  July
  Prepared by Kim S Kimminau Ph D Project Evaluator

Project Summary

Project Ready Smile PRS was launched in December                  in five counties in the Kansas
City Metropolitan Area and one additional county Allen County in southeastern Kansas The
project provides oral health screening preventive care services e g fluoride varnish
education referral and dental office care for those who need clinical services to young
children ages birth to    years enrolled in selected early childhood centers that serve low
income minority and under      uninsured families Short term goals for the project include
having a qualified dental hygienist provide on site screening and prevention services along
with assisting families with children that display oral disease to get in to see PRS
participating dentists at their practice sites The long range objective for the project is to
provide oral health education and prevention services so that children enter kindergarten with
healthy mouths and lifelong healthy oral care habits To date PRS has enrolled and
educated over         children and provided over         oral health screenings



Evaluation Objective and Activities

Project Ready Smile provides services to children in selected early childhood ECC settings
in the six targeted counties ECC sites agree to support the project provide access to
children in their care and cooperate by supporting oral health care awareness among
students parents guardians and staff The project’s dental hygienists collect
parental guardian consent forms and provide on site services recording their intervention
work using a common Access® database platform The data are collected and synthesized by
the evaluator to describe the population being served and to profile their oral health status
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Finally periodic surveys of the participating dental providers and the ECC sites are
conducted using an online survey method to collect these partner organizations’ experience
with Project Ready Smile The overall evaluation effort is designed to provide timely feedback
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to program staff to encourage ongoing program improvement and to provide an overarching
framework to assess the effectiveness of the program with regard to its objectives and goals

The primary objective for the project evaluation is to monitor the project’s performance using
a logic model and to provide summary profiles of the children being served by Project
Ready Smile This includes profiling the children by various socio demographic factors and
oral disease status so that the project can improve its effectiveness For example if children
in families that do not speak English as their first language were not able to access care as
efficiently as others the project staff could address this disparity by seeking translation
services or other support services for those children The approach for the evaluation is
rooted in the belief that timely information concerning program operations referral patterns
oral disease prevalence and local childhood center practices will help streamline processes
and identify opportunities for project improvement The evaluation and this approach has
been an integral part of the project from inception and the data produced has been shared
with project staff on an ongoing basis In addition the evaluation is supporting the data
needs of the dental hygienists by assisting in data entry running queries and identifying data
collection solutions based on their practical use of the database system developed for the
project



Child Participant Demographics

Children enrolled in Project Ready Smile share many characteristics but there are some
important differences to note For example children in the Allen County early childhood
center are on average younger than their metropolitan counterparts so it would be expected
that they display lower levels of oral disease see Table     for a complete profile of the
demographic characteristics of the enrolled children     Children in Missouri are more often
African American while those in Wyandotte and Johnson counties are more often Hispanic
These socio demographic differences have a direct impact on the services provided through
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the program Families served will more often need interpreter services or would be more
competently served by providers who have bilingual staff in those early child care centers
with proportionally high Latino family participation




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 Table      Summary Profile of Project Ready Smile by Area of Service Hygienist
  Data through                Percentages reported by county hygienist column variable

County                                      Allen           Cass         Johnson
                                                           Jackson
                                                           Jackson      Wyandotte
                                                           Lafayette

Dental Hygienist                            Percy                                        Total
                                                            Zeigler    Hemberger

DEMOGRAPHICS

Number of Children

Number of Screenings

Mean Age yr

Male

Female

White

Black African American

Asian Pacific Islander

Native American

Decline Other

Hispanic

Non Hispanic

County                                      Allen           Cass         Johnson
                                                           Jackson      Wyandotte
                                                           Lafayette

Dental Hygienist                            Percy                                        Total
                                                            Zeigler    Hemberger
INSURANCE STATUS                      zycnzj.com/http://www.zycnzj.com/
Insured

Uninsured

Report Having a Dental Home


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CLINIC TYPE

Head Start

ORAL HEALTH STATUS

Caries

Right Mandibular Posterior

Left Mandibular Posterior

Mandibular Anterior

Right Maxillary Posterior

Left Maxillary Posterior

Maxillary Anterior

Early Childhood Caries

Rampant Caries

White Spot Lesions

Crown Present

Unsatisfactory Oral Hygiene

Child in Oral Pain

REFERRAL AND FOLLOW UP

Needs Urgent Care

Referral

Second Screenings Completed

Third Screenings Completed

PARENTAL KNOWLEDGE

Brushing should be part of everyday hygiene

                                  Agree
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                                Disagree

                              Don t Know




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County                                              Allen                Cass        Johnson
                                                                        Jackson     Wyandotte
                                                                        Lafayette

Dental Hygienist                                   Percy                                        Total
                                                                         Zeigler    Hemberger
Children should brush as soon as they can hold a toothbrush

                                      Agree

                                  Disagree

                                Don t Know

Cavities are caused by germs

                                      Agree

                                  Disagree

                                Don t Know

Cavities in baby teeth don t matter

                                      Agree

                                  Disagree

                                Don t Know

Bottled water is better for children s oral health than tap water

                                      Agree

                                  Disagree

                                Don t Know

Raisins and cereal are healthy snacks that don t cause cavities

                                      Agree

                                  Disagree
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                                Don t Know

It is OK to put babies and toddlers to bed with a bottle

                                      Agree

                                  Disagree

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                              Don t Know

Babies and toddlers should be allowed to use a pacifier or thumb

                                   Agree

                                Disagree

                              Don t Know




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County                                              Allen         Cass          Johnson
                                                                Jackson        Wyandotte
                                                                Lafayette

Dental Hygienist                                   Percy                                             Total
                                                                 Zeigler       Hemberger
A child s first visit to the dentist should happen by age

                                      Agree

                                  Disagree

                                Don t Know

A person should only go see a dentist if they are in pain

                                      Agree

                                  Disagree

                                Don t Know




       Insurance Status and Dental Home

       Overall           percent of parents report that their child has dental insurance this includes
       public insurance programs such as Medicaid and S CHIP                for the Missouri sites this
       number increases to            percent see Table         These reported levels of insurance are higher
       than expected based on initial estimations No verification of insurance status was done
       among the enrolled children so it is not possible to determine whether this was truly the
       case The fact that Missouri families report a very high level of insurance coverage may be a
       function of the fact that most of the participants             percent are served at Head Start
       centers that are particularly attentive to assuring that eligible children are covered by
       available public insurance options It is remarkable though that there is an inverse
       relationship with parents reporting having dental insurance for their child and reporting having
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       a “dental home” or primary site for dental care As insurance status increases the percent of
       families reporting having a dental home decreases




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Oral Health Status

General Profile

Each time a PRS hygienist screens a child an assessment of their oral health is made The
screening is conducted to assist in triaging children who need urgent emergent care to the
participating dentists’ offices for clinical services Hygienists examine each child to make a
visual assessment of gross defects identify suspected carious lesions and screen for
conditions that are influenced by parental awareness and behavior e g white spot lesions
“baby bottle mouth” etc    that are amenable to educational interventions

There are a limited number of benchmark studies on the prevalence of oral disease in this
age cohort and no local studies of the levels of oral disease among underserved children of
this age birth to     Expectations are that children in the selected early childhood centers
face stiffer challenges in accessing adequate dental care services given insurance language
transportation health literacy and other socioeconomic barriers While the comparison is not
ideal the overall rate of dental caries in this group of children is        percent a rate higher
than the prevalence of untreated dental caries among Kansas               percent and Missouri
      percent third grade students        see Table        It could be argued that these children
disproportionally contribute to the third grade state level statistics on this measure as well as
the measure of children with treated as well as untreated dental decay these children will
go on and age into the population captured through the annual third grade survey

Early childhood caries a condition more frequently observed in poor and minority
populations is caused by the combination of the presence of bacteria and the availability of
readily fermentable carbohydrates such as those found in juice milk formula and soda
Steady contact with these sugars can lead to a distinctive pattern of caries in young children
not only is the condition pathologic it also is associated with greater probability of
subsequent caries in the permanent dentition         The               National Health and Nutrition
Examination Survey NHANES III public use data set was used to measure prevalence of
                           zycnzj.com/http://www.zycnzj.com/ the result of that analysis
early childhood caries among children  to     months of age and
is that early childhood caries is barely detectable at the national level but it was noted to be
more prevalent among Mexican American and economically disadvantaged children               The
overall level of early childhood caries      percent among Project Ready Smile children is


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substantial compared to national data The high level     percent of early childhood caries
in Wyandotte and Johnson Counties is particularly noteworthy



Head Start Compared to Non Head Start Participants
An area of interest of the PRS staff has been to compare and contrast the children
based on the type of early child care center they attend (Table 2). The data are not
fully comparable given that not all of the children have received a second screening,
but the preliminary data indicate the following: Head Start children have higher levels
of reported health insurance, higher levels of observed dental decay and white spot
lesions and subsequently more referrals for dental care (with more observed crowns).
Performance on the parental knowledge does not display any particular deficit or
advantage to being affiliated with the Head Start program. See Table 2 for full
comparative data.




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Table       Comparison of Head Start and Non Head Start Early Child Care Sites

                                                    Head Start         Non Head Start

DEMOGRAPHICS

Number

Mean Age yr

Male

Female

White

Black African American

Asian Pacific Islander

Native American

Decline Other

Hispanic

Non Hispanic

INSURANCE STATUS

Insured

Uninsured

Dental Home

ORAL HEALTH STATUS

Caries

Right Mandibular Posterior

Left Mandibular Posterior

Mandibular Anterior

Right Maxillary Posterior
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Left Maxillary Posterior

Maxillary Anterior

Early Childhood Caries

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Rampant Caries

White Spot Lesions

Crown Present

Unsatisfactory Oral Hygiene

Child in Oral Pain

Needs Urgent Care




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                                                                    Head Start   Non Head Start

REFERRAL AND FOLLOW UP

Referral

Second Screenings Completed

Third Screenings Completed

PARENTAL KNOWLEDGE

Brushing should be part of everyday hygiene

Agree

Disagree

Don t Know

Children should brush as soon as they can hold a toothbrush

Agree

Disagree

Don t Know

Cavities are caused by germs

Agree

Disagree

Don t Know

Cavities in baby teeth don t matter

Agree

Disagree

Don t Know

Bottled water is better for children s oral health than tap water

Agree                              zycnzj.com/http://www.zycnzj.com/
Disagree

Don t Know

Raisins and cereal are healthy snacks that don t cause cavities


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Agree

Disagree

Don t Know

It is OK to put babies and toddlers to bed with a bottle

Agree

Disagree

Don t Know




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                                                                     Head Start          Non Head Start

Babies and toddlers should be allowed to use a pacifier or thumb

Agree

Disagree

Don t Know

A child s first visit to the dentist should happen by age

Agree

Disagree

Don t Know

A person should only go see a dentist if they are in pain

Agree

Disagree

Don t Know




A Comparison of Children With and Without Untreated Dental Caries

One of the best predictors of future oral disease is the presence of oral disease Therefore
if differences between children in PRS with active oral disease and those without caries can
be detected a more targeted set of strategies for prevention and outreach can be developed

Regardless of screening first second or third                    all children noted by the dental hygienist with
at least one tooth surface with active dental decay requiring treatment were grouped together
and compared to children who displayed no active decay Some striking and statistically
significant differences are noted but once again these are preliminary findings based on
incomplete data not all second and many fewer third screens have been completed                           See
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Children in PRS with dental decay as compared to children in PRS without dental decay
are statistically

    •    Almost a year older than their counterparts

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   •   More likely to be Hispanic and less likely to be African American

   •    More likely to be uninsured

   •    More often observed to have unsatisfactory dental hygiene be in oral pain be in need
        of urgent care and in need of referral services

Furthermore parents of children with dental decay are significantly more likely to believe that
“cavities in baby teeth don’t matter” and that “bottled water is better than tap water”




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Table       Comparisons of Project Ready Smile Children With and Without Caries

                                                                Caries Present   No Caries   p value

  Number

  Mean Age yr

  Male

  White

  Black African American

  Asian Pacific Islander

  Native American

  Decline Other

  Hispanic

  Insured

  Dental Home

  Unsatisfactory Oral Hygiene

  Child in Oral Pain

  Needs Urgent Care

  Referral

  Second Screenings Completed

  Third Screenings Completed

  PARENTAL KNOWLEDGE

  Brushing should be part of everyday hygiene

  Agree

  Disagree

  Don t Know

  Children should brush as soon as they can hold a toothbrush
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  Agree

  Disagree

  Don t Know



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Cavities are caused by germs

Agree

Disagree

Don t Know

Cavities in baby teeth don t matter

Agree

Disagree

Don t Know




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                                                                     Caries    No Caries   p value
                                                                     Present

 Bottled water is better for children s oral health than tap water

 Agree

 Disagree

 Don t Know

 Raisins and cereal are healthy snacks that don t cause cavities

 Agree

 Disagree

 Don t Know

 It is OK to put babies and toddlers to bed with a bottle

 Agree

 Disagree

 Don t Know

 Babies and toddlers should be allowed to use a pacifier or thumb

 Agree

 Disagree

 Don t Know

 A child s first visit to the dentist should happen by age

 Agree

 Disagree

 Don t Know

 A person should only go see a dentist if they are in pain

 Agree

 Disagree
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 Don t Know

p value     statistically significant at the    level




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Parental Knowledge

Awareness of oral health and oral health literacy are central goals of the parental education
activities related to Project Ready Smile Because parents provide for their children’s
nutritional needs and they are responsible for their children’s oral hygiene their involvement
in helping to develop healthy oral habits is crucial While the project is aimed at serving the
oral health screening referral and educational needs of children the project is acutely aware
that parents are integral to ensuring that children not only have access to dental care through
insurance coverage a dental home and regular care they are also vital to encouraging a
healthy environment that supports good oral development and healthy nutrition for young
children

Parents or guardians of the children enrolled in the project are requested to complete a form
that includes information about the child their medical history and insurance status followed
by a series of questions about nutrition and oral health Parents are asked the same
questions when children are screened subsequent to enrollment

There are some questions that are significantly different between parents who have children
with active dental decay and those who have children who do not have active decay The two
questions that distinguish these parents are     “cavities in baby teeth don t matter” and
“bottled water is better for children s oral health than tap water ” Table   presents all of the
data that are available to date that compare the total parent population of the children
enrolled in Project Ready Smile to track whether their oral health knowledge has changed
since initial entry into the project

Over time more parents respond correctly that “cavities are caused by germs” and
statistically fewer respond that “cavities in baby teeth don’t matter” However parents
continue to be uninformed about when a child should brush their teeth whether bottled water
is better for a child’s oral health and they mistakenly agree that “raisins and cereal are
healthy snacks that don’t cause cavities ” The value of these findings is that they provide
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opportunities to develop effective education and messaging to PRS families that the project
already has demonstrated effectiveness e g more families understand that caries is an
infectious condition




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Table      Parental Knowledge Comparison Between First and Second Screenings Note
incomplete second screening data available

                                              First                 Second   p value
                                              Screen                Screen

Brushing should be part of everyday hygiene

Agree

Disagree

Don t Know

Children should brush as soon as they can hold a toothbrush

Agree

Disagree

Don t Know

Cavities are caused by germs

Agree

Disagree

Don t Know

Cavities in baby teeth don t matter

Agree

Disagree

Don t Know

                                              First                 Second   p value
                                              Screen                Screen

Bottled water is better for children s oral health than tap water

Agree

Disagree
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Don t Know

Raisins and cereal are healthy snacks that don t cause cavities

Agree



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 Disagree

 Don t Know

 It is OK to put babies and toddlers to bed with a bottle

 Agree

 Disagree

 Don t Know

 Babies and toddlers should be allowed to use a pacifier or thumb

 Agree

 Disagree

 Don t Know

 A child s first visit to the dentist should happen by age

 Agree

 Disagree

 Don t Know

 A person should only go see a dentist if they are in pain

 Agree

 Disagree

 Don t Know




Oral Health Status Comparing First to Second Screening Results

The effectiveness of the project is in part based on whether children screened and found to
have active decay are able to access dental services Table          presents the results of
comparing children at entry and their oral health status at first screening to children seen at a
second screening at their early childhood center site If the project is working as designed
caries detection will continuezycnzj.com/http://www.zycnzj.com/
                                diminish over time and signs of clinical dental care will
increase to meet the needs identified e g children will have restorations crowns and will be
relieved of pain



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The data show that children continue to develop dental disease and that caries continue to
be detected by the dental hygienists caries rate significantly increased from        percent to
      percent from first to second screening events This may seem to be a negative finding
but there are a number of possible explanations The dental hygienists may have been
under recording dental caries during the first screening series for any number of reasons
fear that the most critical care needs children they would see would not be able to receive
care were they to refer every child with slight to moderate decay to the PRS participating
dentists feeling uncomfortable in the project setting and were able to make clearer
assessments at the time of second screening because of mid course calibration correction
and or learning that there are sufficient project resources to pay for children requiring
services which gave them the latitude to include more children over time Alternatively the
pattern of increased dental disease may be related to the fact that the children in the
program are older than when they received their first screening and therefore more likely to
have more observable disease present and or their oral health status may not have been
impacted positively by the project The latter statement is considered unlikely given the
positive clinical outcomes observed to date when comparing the first and second screening
profiles For example there are statistically fewer cases of rampant caries fewer white spot
lesions more crowns are observed a result of dental services provided        better oral hygiene
displayed and fewer children in oral pain see Table



 Table     Oral Health Status Comparisons Between First and Second Screened PRS
 Children note incomplete second screen data available
                                       st                  nd
                                            Screen              Screen          p value

 Caries

 Right Mandibular Posterior

 Left Mandibular Posterior

 Mandibular Anterior          zycnzj.com/http://www.zycnzj.com/

 Right Maxillary Posterior

 Left Maxillary Posterior

 Maxillary Anterior


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 Early Childhood Caries

 Rampant Caries

 White Spot Lesions

 Crown Present

 Unsatisfactory Oral Hygiene

 Child in Oral Pain

 Needs Urgent Care




Dentist Satisfaction Survey

Participating dentists in Project Ready Smile agree to see a certain number of children
referred to them by the PRS dental hygienist Either the child’s care is paid for through their
public insurance coverage Medicaid SCHIP or Project Ready Smile reimburses through a
third party payor for care provided at Medicaid rates

All dentists in the PRS network were contacted by email in July                    to participate in a
satisfaction survey regarding their experiences with Project Ready Smile Among the
network dentists responses were received from                  providers         response rate    While
the participation in the survey is too low to offer a statistically sound profile of the dentists’
experiences their responses are provided in Table

Among those responding              percent accepted Medicaid coverage prior to their involvement
in PRS and            percent reported routinely providing charity care for patients who need
services but cannot afford to pay



 Table      Dentist Satisfaction Survey Results
                very satisfied strongly agree     satisfied agree      neutral
               dissatisfied disagree     very dissatisfied strongly disagree
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 Question

 Patient referral into my practice has been easy for my staff office
 to accommodate

 Patients parent guardian responsive to my clinical care and

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 practice expectations

 PRS staff hygienist has been helpful in assisting with patient
 management

 The billing process for PRS patient reimbursement has been easy
 to manage

 Payment for care provided has been prompt

 Communications from the REACH Foundation about PRS
 activities and progress is useful

 PRS children display levels of dental disease comparable to other
 same aged children I see routinely in my practice

 PRS parents guardians display levels of oral health awareness
 comparable to other parents guardians I see in my practice

 Without PRS the referred children would develop more serious
 oral disease s

 Could not accommodate seeing PRS children without financial
 support of PRS

 Cannot take on more PRS children than I already have committed
 to see

 I find participating in PRS rewarding

 I am willing to contact other dentists and urge them to participate
 in PRS

 Overall my experience with PRS has been positive




Early Childhood Care Center Satisfaction Survey

Seventeen early childhood care center Project Ready Smile coordinators directors were
contacted by email to participate in a satisfaction survey in July     The survey was
designed to identify the ease with which the centers have been able to accommodate the
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project and to collect their impressions of how well the children and parents have adjusted to
the oral health activities conducted through PRS




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Response rate was               percent and the centers responding represent early childhood care
centers that provide services to between                 and         children with an average of   children
among the responding centers



 Table      Early Child Care Center Satisfaction Survey Results
               very satisfied strongly agree       satisfied agree
               neutral     dissatisfied disagree      very dissatisfied strongly
            disagree

 Question

 Children like Project Ready Smile

 It has been easy for families to get referrals to dentists for dental
 care

 Parents like Project Ready Smile

 PRS staff has been helpful in assisting with each child s oral
 health care needs

 I would like to receive more communications from the REACH
 Healthcare Foundation about PRS activities and progress

 The education provided by the PRS hygienist is appropriate for
 the age and needs of the children

 The children like the PRS hygienist

  Goody Bags      gift bags that contain a toothbrush sticker etc
 are enjoyed by the children

 Without PRS the children served at our center would not be able
 to afford dental care

 Our center likes participating in Project Ready Smile

 I am willing to contact other child care centers in my area and
 urge them to participate in PRS
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 Overall my experience with PRS has been positive




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One open ended question was included in the early childhood care centers survey Table
provides the verbatim responses provided by               of the respondents



 Table   Verbatim responses provided to “Would you like to share anything else about PRS ”
          Names included were anonymized by evaluator

    Response     We absolutely love our hygienist

    Response     I have requested copies of activities that the hygienist does with the kids so that I can have
                 evidence for QRS and Accreditation binders so that they can also monitor the success and
                 progress of this program

    Response     A lot of my families enjoy having the extra care for their children s dental care

    Response     The families and the preschool center are very pleased with Project Ready Smile service and
                 Staff

    Response      Our hygienist has done an excellent job conveying the importance of dental care to the
                 children as well as the parents

    Response      The hygienist is so helpful and wonderful with the children She has helped many of our
                 families

    Response     Since our community does not have fluoridated water the children have really needed this
                 service The parents the community and our staff are so proud to have the education and the
                 services brought to our center This makes it so convenient for our families

    Response     This is a great program and is very much needed in urban core centers thanks for your
                 support

    Response     We had an open house and the hygienist came out and talked to our families and family in
                 the community and gave everyone a toothbrush Everyone loved it

   Response      My child really likes the Dental Program He looks forward to seeing the hygienist and he
                 calls her his dentist friend




Performance of Project Ready Smile Logic Model
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At the inception of Project Ready Smile a logic model was constructed for evaluation
purposes Goals were established in eight areas and metrics or targets for each short term
outcome was described The logic model is included in this report as an Appendix with a


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status update column that matches achievement with each of the target measures A color
coded scheme is used for review red shaded metrics represent those not yet achieved
yellow shaded metrics are those showing mixed results and green shaded metrics include
measures achieved or exceeded at this point in the evaluation




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Summary

The Project Ready Smile evaluation includes both process and outcomes evaluation
components The start up and inclusion of the project in early childhood care center
operations have been successful in large part due to the dedicated staff and dental hygienists
who have worked through problems and established positive working relationships with the
centers children and families served Project management and oversight for PRS has been
orchestrated with a single point of contact with dental professional guidance to ensure that
comparable quality oral health screening and care has been provided to all of the children
involved in the project

Areas of improvement could include targeting oral health promoting information to Hispanic
families focusing on children who are screened and observed to have active decay and
developing didactic information to promote healthy behaviors at home while encouraging the
increase of oral health literacy Areas of success include logistical and operational
effectiveness in screening over        children working with a diverse group of early
childhood care centers greater than expected participation by dentists and the continued
engagement of a dental hygiene workforce dedicated to the project




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     Appendix   Project Ready Smile Logic Model with Status Updates




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                                                                                                                                                                         Status July 2009

  Focus / Situation(s)             Inputs             Activities / Strategies     Short-Term Outcomes             Long-Term Outcomes               Impact               Green=Achieved
                                                                                                                                                                      Yellow=Mixed Results
                                                                                                                                                                       Red=Not Achieved
                                                                                                                                             Preschool and
                                                                                                                                             school-based or –
The families of children                                                                                                                     centered PRS
                                                                                                               All children (beyond the
to be served need                                                                                                                            programs will
                                                    CMT will provide on-going   Awareness and knowledge        target child) in the family
education, support and     Care management                                                                                                   increase in number
                                                                                                               will have improved oral
                                                    educational and support     of oral health will increase                                 and reach resulting
resources to meet the      team (CMT)                                                                          health, as will the
                                                    services through PRS        from enrollment                                              in fewer children
oral health needs of                                                                                           parents/guardians who
                                                                                                                                             arriving in
their children                                                                                                 receive the CMT’s services
                                                                                                                                             kindergarten with
                                                                                                                                             active or treated
                                                                                                                                             oral disease
                                                                                METRICS / TARGET                                                                    METRICS / TARGET
                                                                                a. Average pre-program                                                              a. ACHIEVED
                                                                                   knowledge test scores                                                               Pre-post test
                                                                                   will improve by 25% by                                                              significantly improve on
                                                                                   EY1                                                                                 a number of measures
                                                                                                                                                                       (see Table 4 in
                                                                                                                                                                       evaluation report)
                                                                                                                                             Providers will be
                                                                                                                                             willing to sustain
                                                                                                                                             their commitment
Providers are generally                                                                                                                      to serving target
                                                    PRS will provide a
not predisposed to serve   A third party                                                                                                     children; providers
                                                    streamlined billing and     Providers are willing to       Providers continue their
children age 0-5,          administrator will be                                                                                             will encourage
                                                    payment system for target   commit to annual               commitment to serve PRS’
particularly if            responsible for timely                                                                                            colleagues to
                                                    children not                participation in PRS and to    goals and become
reimbursement for          and accurate payment                                                                                              participate;
                                                    enrolled/eligible for       accept Medicaid program        champions for children’s
services rendered is       of costs incurred for                                                                                             providers will
                                                    dental insurance or are     patients                       oral health
complicated or under       eligible children                                                                                                 become vocal
                                                    unable to pay                                                                            advocates for
market value
                                                                                                                                             universal child oral
                                                                                                                                             health service
                                                                                                                                             coverage
                                                                            METRICS / TARGET                                                                        METRICS / TARGET
                                                                            a. 10 dentists will be willing                                                          a. ACHIEVED
                                                                               to see 10 or more                                                                       3 dentists are willing to
                                                                               children by EY1                                                                         see 10 or more children
                                                                            b. 10 dentists will be willing                                                          b. ACHIEVED
                                                                               to see fewer than 5                                                                  c. ACHIEVED
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                                                                               referred children                                                                       Goal of 10 participating
                                                                            c. number of dentists                                                                      dentist surpassed;
                                                                               committed to PRS will                                                                   metric needs
                                                                               increase by 10% by EY1                                                                  recalibration
                                                                            d. number of participating                                                              d. Three dentist who are
                                                                               PRS dentists willing to                                                                 not Medicaid providers

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                                                                                     become Medicaid                                                                      agreed to treat
                                                                                     providers will increase by                                                           uninsured PRS children
                                                                                     5% by EY1                                                                            at Medicaid cost
                                                                                  e. Compared to EY1, there                                                            e. No CEU offered in Y1
                                                                                     will be a 50% increase in                                                         f. Insufficient sample/
                                                                                     the number of dentists                                                               metric not achieved;
                                                                                     attending PRS CEU                                                                    among respondents, 70%
                                                                                     sponsored events by EY2                                                              report being very
                                                                                  f. 85% of dentists surveyed                                                             satisfied or satisfied
                                                                                     at EY1 will be satisfied or                                                          with their participation
                                                                                     very satisfied with PRS                                                              in PRS
                                                                                     operations and staff
The families of children   CMT and participating   CMT will provide routine       Children will receive            All children (beyond the      Fewer children will
to be provided services    dental officers         oral health screenings and     routine preventive care          target child) in the family   arrive in
have poor access/no                                will apply fluoride varnish;   services; among children         will have a stable dental     kindergarten with
access to preventive                               participating dental           needing disease treatment,       home and/or will              active or treated
                                                                                                                   understand, through having    oral disease and
oral health care                                   offices will receive           timely services will be          experienced care, the value   PRS families will
                                                   referred patients and          available                        of a dental home              have a dental
                                                   provide need exams and                                                                        home for each
                                                   care                                                                                          member of the
                                                                                                                                                 family



                                                                            METRICS / TARGET
                                                                            a. 95% of children enrolled
                                                                               will receive screening
                                                                               within 30 days
                                                                            b. 80% of retained enrollees
                                                                               will receive 2nd screening
                                                                               within 7 months
                                                                            c. 95% of children deemed
                                                                               eligible will receive Fl                                                                METRICS / TARGET
                                                                               varnish at each screening                                                                a. ACHIEVED
                                                                            d. 95% of enrollees will                                                                    b. Partially achieved
                                                                               have complete care                                                                       c. ACHIEVED
                                                                               records                                                                                  d. To be audited
                                                                            e. Among enrollees                                                                          e. To be audited
                                                                               requiring care and                                                                       f. To be audited
                                                                               referral, 75% will be                                                                    g. To be audited
                                                                                                                                                                        h. To be audited
                                                                               offered and 50% will                                                                     i. To be audited
                                                                               make an appointment
                                                                               with willing provider
                                                                               within 10 business days
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                                                                            f. Among enrollees
                                                                               requiring referral, 80%
                                                                               will see the provider at
                                                                               scheduled appointment
                                                                            g. Among enrollees


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                                                                                      cancelling or no-show,
                                                                                      100% will receive phone
                                                                                      call from CMT
                                                                                   h. Among no-show
                                                                                      enrollees, 80% will be
                                                                                      assisted in rescheduling
                                                                                      their appointment
                                                                                   i. Among no-show enrollees
                                                                                      who are rescheduled,
                                                                                      50% will see the provider


Families may currently      CMT and dental           Intervention and referral     Awareness of the need for      Fewer ED visits for           Emergency visits
use the emergency           providers                services provided by the      routine preventive care will   avoidable dental emergency    and costs for
department or forego                                 CMT will divert families to   increase among families        care will be needed           emergency dental
emergency care because                               see willing providers         involved in PRS, and oral                                    care among the
                                                                                                                                                community
of inability to pay for                              rather than use the ED        health conditions will                                       hospitals that see
care or inability to find                                                          receive timely medical                                       families enrolled in
a provider willing to see                                                          attention                                                    PRS will decrease
their child




                                                                                   METRICS / TARGET
                                                                                   a. Average pre-program                                                              METRICS / TARGET
                                                                                      knowledge test scores
                                                                                      will improve by 25% by                                                           a.   Varies by question,
                                                                                      EY1                                                                                   three questions
                                                                                   b. Self-report use of                                                                    ACHIEVED (see
                                                                                      emergency care will                                                                   evaluation report)
                                                                                      decrease by 50% by EY1                                                           b.   Data not collected
                                                                                   c. (Medicaid claims pre- and                                                        c.   Medicaid data not
                                                                                                                                                                            requested at this
                                                                                      post will be compared if                                                              time
                                                                                      available)
Unhealthy                   CMT and Early            Healthy behavior and          Fewer families will report     All children (beyond the      Children and
feeding/eating              Childcare Center (ECC)   nutrition education, with     using sweetened beverages      target child) in the family   families served by
behaviors, including                                 particular attention to       at night or routinely          will have less exposure to    PRS will report
providing a throughout                               behaviors that negatively     throughout the day,            unhealthy foods and           improved health
                                                                                                                  beverages that will impact    behaviors and will
the night, prolonged use                             influence oral health will    providing sweetened snacks     their overall health status   have better health
of sippy cups and                                    be provided to PRS            and using sippy cups and                                     profiles than those
pacifiers, and diets high                            families                      pacifiers past                                               not impacted by
in readily fermentable                                                             developmental benchmarks                                     the program
carbohydrates /sugars
characterize target                                                zycnzj.com/http://www.zycnzj.com/
children’s diet




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                                                                    METRICS / TARGET
                                                                    a. The number of families                                                            METRICS / TARGET
                                                                       reporting routinely
                                                                       offering sugar sweetened
                                                                       beverages will decrease                                                           a. Data not collected
                                                                       by 80%                                                                            b. Data not collected
                                                                    b. 50% of targeted enrollees                                                         c. As measured by
                                                                       will decrease their use of                                                           parental survey
                                                                       pacifiers and sippy cups                                                             question #6 (Raisins
                                                                    c. Recognition of impact of                                                             and cereal are healthy
                                                                       sugars, beverages, foods                                                             snacks that don’t cause
                                                                       on oral health will                                                                  cavities) and #7 (It’s
                                                                       improve by 25% by EY1                                                                OK to put babies and
                                                                    d. 80% of ECC offerings of                                                              toddlers to bed with a
                                                                       beverages and snacks will                                                            bottle) , target not
                                                                       be low risk to oral health                                                           achieved
                                                                    e. 100% of ECC post and                                                              d. Data not collected
                                                                       reinforce healthy eating                                                          e. Partially achieved;
                                                                       behaviors                                                                            response varies by
                                                                    f. 50% of ECC will promote                                                              early child care center
                                                                       and provide opportunity                                                           f. ACHIEVED and
                                                                       for daily tooth brushing                                                             exceeded
                                                                       while children are at site
Children do not brush    CMT and ECC   Teaching and ongoing         More families will report       All children (beyond the       Children and
and floss regularly in                 reinforcement of good oral   regular brushing and            target child) in the family    families served by
their home environment                 health habits will be        flossing                        will have better oral health   PRS will report
                                       provided to everyone at                                      status at routine check-up     improved oral
                                                                                                    visits                         health behaviors
                                       the ECC                                                                                     and will have
                                                                                                                                   better oral health
                                                                                                                                   profiles than those
                                                                                                                                   not impacted by
                                                                                                                                   the program
                                                              METRICS / TARGET
                                                              a. 100% of enrollees will
                                                                 receive brush packet
                                                              b. 100% of enrollees will
                                                                 receive demonstration of
                                                                 proper brushing and                                                                     METRICS / TARGET
                                                                 flossing (flossing
                                                                 instruction for
                                                                 parents/guardians and                                                                   a. ACHIEVED
                                                                 age-appropriate children                                                                b. ACHIEVED
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                                                                 in the household of the                                                                 c. Data not collected
                                                                 enrollee)
                                                              c. 100% of enrollees will be
                                                                 provided periodic (at
                                                                 least 2x/yr) take-home
                                                                 information aimed at

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                                                                                 increasing appropriate
                                                                                 oral health behaviors at
                                                                                 home for the entire
                                                                                 family




Participating dental        CMT and oversight     Each participating dental    METRICS / TARGET                 Quality of care for PRS       Effective
offices need to provide     dentists              office will provide PRS      a. 95% of children receiving     children will match that of   treatment and
comprehensive care and                            children’s treatment plans      care will have their          other pediatric patients      preventive care
services for children                             for review                      treatment plans on file                                     will be pervasive
                                                                                                                                              among children in
referred to them for                                                              (and updated in a timely                                    the project’s
care.                                                                             fashion) with PRS                                           communities
                                                                                  (through the CMT)
                                                                               b. Identification of Class I,
                                                                                  II or III will be completed
                                                                                  and recorded for each                                                           METRICS / TARGET
                                                                                  child by PRS oversight
                                                                                  dentist(s)
                                                                               c. Length of time needed to                                                        a. To be audited
                                                                                  complete treatment plan                                                         b. ACHIEVED
                                                                                  will be monitored, by                                                           c. Data being collected
                                                                                  class, for all children by                                                      d. Data being collected
                                                                                  the CMT
                                                                               d. Items of care not
                                                                                  completed but included
                                                                                  in the treatment plan
                                                                                  will be evaluated to
                                                                                  better understand why
                                                                                  the service(s) could not
                                                                                  be delivered by the CMT
                                                                                  and participating dentists
Clinical outcomes           CMT and steering      Untreated decay, number      METRICS / TARGET                 Quality of care for PRS       Effective
associated with the         committee/oversight   of filled teeth/surfaces                                      children will match that of   treatment and
completion of individual    dentists              and pain measures will be    a. level of decay by # and %     other pediatric patients      preventive care
care plans will improve                           monitored                    of involved surfaces will                                      will be pervasive
                                                                               decrease                                                       among children in   METRICS / TARGET
the oral health of                                                                                                                            the project’s
children who are                                                                                                                                                  a. Not achieved
                                                                               b. projected cost of                                           communities         b. Data being collected
provided oral health                                                           treatment plan per child
services in participating                                                                                                                                         c. ACHIEVED
                                                                               (by race/ethnicity and age)                                                           (See Table 3 in
dental offices.                                                                will decrease
                                                                zycnzj.com/http://www.zycnzj.com/                                                                    evaluation report)
                                                                               c. 100% percent of children
                                                                               in pain at first visit will
                                                                               report no pain at last
                                                                               visit/completion of
                                                                               treatment plan

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Reference Cited



   Kimminau KS Greiner KA and Q Hou Smiles Across Kansas                   Update
   http     www oralhealthkansas org pdfs Smiles         Across    KS           pdf

   Center for Health Policy University of Missouri Columbia Missouri Children       Oral
   Health Care
   http     healthpolicy missouri edu docs Pdfs Policy       Briefs ChilrensOralHealth
          pdf

   Li Y and Wang W Predicting Caries in Permanent Teeth from Caries in Primary
   Teeth An Eight year Cohort Study           J Dent Res

   Kaste LM Drury TF Horowitz AM and Beltran E An Evaluation of NHANES III
   Estimates of Early Childhood Caries         J Public Health Dent




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