Head Start and Partners Forum on Oral Health

During much of the 1990s, Head Start directors, staff and parents, as well as the Administration on Children, Youth and Families (ACYF) program specialists, reported that the number one health issue affecting Head Start programs nationwide was access to oral health services. Programs and parents alike told us about children suffering in pain, children who could not eat, or children who had speech and language delays because they were unable to get needed dental treatment. Even if parents were able to find a dentist who would accept Medicaid patients, they would have to wait months for an appointment, or travel over thirty miles to keep the appointment.

In March 1999, representatives from the Head Start Bureau, Health Resources and Services Administration (HRSA), Health Care Financing Administration (HCFA), and the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) met to discuss an oral health initiative that was being developed by HCFA and HRSA. The Head Start Bureau shared its concerns about the lack of Medicaid providers and listened to HRSA express its concern that low-income children experience a disproportionate share of dental disease. After much discussion, it was decided that while the most pressing need was to get children necessary dental treatment, a long-term strategy would be to prevent dental disease from occurring in the first place. This would require that all the federal partners, as well as Head Start staff and parents, work together to improve the oral health of young children.

On September 16 and 17, 1999, the "Head Start and Partners Forum on Oral Health" was held in Washington, D.C. Head Start staff and parents, training and technical assistance providers, pediatric dentists, representatives from local and state WIC programs, Medicaid, Maternal and Child Health and Child Care, and regional ACYF, HRSA, and HCFA staff met to learn about oral health. The purpose of the Forum was to convene a group of representatives from Head Start and other federal agencies, researchers, scientists, practitioners, parents, and advocates to discuss the latest research and evidence-based oral health practices, and to develop strategies to implement these practices.

The Forum was unique to Head Start for two reasons. First, three scientific papers specifically written for the Forum were sent to participants prior to the Forum. At the Forum, each paper was presented and participants were given an opportunity to comment on the papers during breakout sessions. Second, researchers, practitioners, and parents met face to face to discuss the feasibility of integrating the research findings into daily practice. (Summaries of these papers can be found on pp. 10–15.)

Partnerships with other federal programs serving children and families are not new to Head Start. However, the partnership between Head Start, HRSA, HCFA, and WIC is unique because it supports the larger DHHS Oral Health Initiative and efforts to address oral health issues with constituencies at a regional, state, and local level. Furthermore, each partner made a financial contribution to the development of one of the scientific papers, and committed to disseminating consistent messages from the papers to their respective communities.

The Forum had three objectives–

1. To develop strategies to increase collaboration at the federal, state, and local levels and to develop and implement strategies to improve oral health services to children and families.

2. To present three scientific papers to participants about–

• current evidence-based oral health practices and recommended guidelines related to nutrition
• access to preventive and treatment services
• the prevention, management, and suppression of caries

3. To assess participant's reactions to the scientific papers and the feasibility and cultural appropriateness of implementing recommendations on local, state, and national levels

For each paper, Forum participants were asked the following questions–

• What did you learn that was new and different?
  
• Are the recommendations feasible?
  
• What will you do with this information?
  
• What partnerships will you form to address these issues?
  
• What other comments do you have for the authors?

Participants also had an opportunity to address concerns related to special populations such as infants, toddlers, pregnant women, and children with disabilities. They also addressed the cultural implications of the recommendations. On the second day, they met in regional groups to develop action plans to implement after they returned home.

After the Forum, comments on each paper were compiled and sent back to the authors for revision. The final papers were published in the summer edition of The American Journal of Public Health Dentistry. (See back page on how to get copies of the journal or of individual papers).

In this issue of the Bulletin, you will find general information that was presented at the Forum, summaries of each of the three papers, participants' reactions to the experience, descriptions of follow-up activities that have taken place throughout the country since the Forum, and oral health resources. Enjoy reading about this unique and exciting effort to improve the oral health status of children and families throughout the country.

Robin Brocato is a Head Start Health Specialist, Head Start Bureau, T: 202-205-9903; E: rbrocato@acf.dhhs.gov.