Oral Health: Integrating New Science into Daily Practice: Perspectives from the Field

By Dorothy Allbritten

How do we integrate new scientific findings into what we do and how we do things at our Head Start centers? This is a common question for participants at research conferences as they return to their Head Start programs armed with new knowledge as well as the desire, hope, and enthusiasm to share the information they know will be helpful to children and families.

Many participants left the September 1999 Oral Health Forum with that very question in mind. The Head Start Bureau and its partners had provided summary recommendations in three areas of research–nutrition and oral health, prevention, and access to dental care (summary papers can be found on pages 10 to 14 of this Bulletin). The far-reaching recommendations outlined strategies for incorporating the new science discussed at the Forum into daily practice.

The Challenges
When Head Start staff returned to their centers, some common challenges were echoed from Maine to California: What are these new findings? How can we get the word out? People will not understand why they should change the way they do things. How can we show people how these activities can benefit expectant parents, children, and ultimately families? Folks will not want to change what they do, since their parents did it the same way. Medicaid will never increase reimbursement so providers can cover their costs. Is it really possible to integrate medical and dental systems to provide continuity of care?

Addressing the Challenges
At a minimum, it will take four steps to address the challenges of integrating new science into the daily
practice of oral health at Head Start centers–

1. Identify the challenges to implementing the new science as a priority for your center.

2. Plan two or three approaches to addressing the specific challenges. Prioritize them.

3. Implement your priority plan of action using all appropriate strategies.

4. Evaluate the outcome of your implemented plan. Determine if the new science is being practiced as intended.

Implementing the Change
The details of a sound plan are what make it successful. Therefore, it is important to consider the following when implementing the plan–

• Assess the audience for whom the new science is intended. Is it Head Start staff, expectant women, children, parents, or oral health providers you want to inform about the new science? Clearly articulate how the new science will benefit the audience.
• Plan the approach based on where the audience "is." Include representatives of the audience in the planning process. Consider the following questions–
  
  • What practices do the audience currently use?
    
  • What change will be necessary to incorporate the new science into daily practice?
    
  • How will the audience receive and integrate the proposed change today, tomorrow, and from now on?
    
• Deliver only one change in practice at a time. For example, introduce only one new food to a toddler at a time. Be sure to provide the change in an acceptable–or "bite size"–dose.
• Assist people in replacing old ways with new ones by providing strategies for incorporating the change into the way daily practices have been conducted in the past.
• As change is implemented, provide positive feedback and encouragement to those who have begun to use a piece of the new science on a routine basis.

The Outcomes
When implemented, the recommendations from all three scientific sections of the 1999 Oral Health Forum will fuel a high quality, comprehensive, coordinated, culturally competent American system of oral health care. The only challenge remaining in this future utopia will be where to find a carious tooth as an example for dentists in training!

Dorothy Allbritten is a Pediatric Nurse Practitioner and Health Services Manager, Fairfax County Head Start, T: 703-324-8124.