Oral Health Care Access Issues for Head Start's Indian Programs

By Tracy Finlayson

Access to oral health care is a major issue that continues to challenge staff in Indian Head Start Programs nationwide. At the Oral Health Forum, participants from different areas of the United States and different perspectives came together to identify barriers to access and develop action plans to fix the problem. Participants "spoke from the heart and echoed each other," according to W. J. Strickland, Head Start Bureau's Indian Branch Program Specialist. Although there were no identified cultural barriers, participants saw many universal problems affecting all Indian families.

A large problem is a lack of training and consistent information available to staff, dental care providers, and parents. Overall, programs reported feeling isolated, and unable to provide access to oral health care or preventive practice training and education. There is a lack of knowledge available to individual American Indian Head Start programs about the level of water fluoridation in their communities. This impairs their ability to assess whether children need fluoride supplements. The need to gain support for screening and follow-up efforts was also discussed and participants suggested that one way to address the issues of isolation would be for American Indian Programs Branch (AIPB) grantees to form coalitions. The coalition could start a dialogue with local dental hygiene schools, since they exist in almost all the states and can become involved with the Indian Head Start programs. Participants also felt that the needed information and support could come from the T/TA networks. T/TA providers could increase the training and up-to-date information sessions they offer to educate parents and staff.

For some families that are able to access care and schedule an appointment, there remains the issue of following through and keeping their appointments. Lack of transportation sometimes arises as another barrier to accessing care. Also, while Head Start children have Medicaid to cover the cost of dental treatments, too few dentists accept this form of payment. The dentists who do accept Medicaid and work with Head Start children need to be better recognized and appreciated by programs.

Indian Head Start programs are the link to continuing strong relationships between Head Start children and dental providers in their communities. At the Oral Health Forum, the following strategies for action to increase oral health care access were also discussed–

• Encourage oral health care providers and dentists to become members of the Health Services Advisory Committee (HSAC)
  
• Encourage parents to take children to dentists by age one
  
• Obtain information about foundations that might support improved dental health
  
• Obtain information about Title V services and support for dental health
  
• Ask for federal support to encourage people to become involved in pediatric dentistry
  
• Offer more frequent screenings of children, and screen mothers
  
• Offer updated training materials to WIC, nutritionists, parents, and AIPB staff
  
• Include all key players in discussions, work holistically, and get together with partners to develop timelines and plans
  
• Identify and implement prevention strategies such as gum swabbing, good nutrition, and tooth brushing
  
• Ask the Quality Improvement Centers (QICs) to develop tip sheets and other educational information

These action plan ideas were generated from the participants representing the Indian Head Start programs. Participants had a positive experience and left the Forum with a "glimmer of hope that there would be action on the horizon," says W. J. Strickland. He expressed the importance of their input and emphasized that the "next time the Head Start Bureau has a forum, people [should] be encouraged to attend and have their voices heard. We have a commitment to the programs to work in partnership." The Oral Health Forum provided an occasion to share ideas and experiences. It created a great deal of enthusiasm for addressing oral health issues and making positive changes in Indian Head Start Programs. The message is clear in their slogan: "Beautiful smiles for wholeness and wellness in the new millennium."

Tracy Finlayson was an Intern, Head Start Bureau