Oral Health Equity Project

State: MA Type: Model Practice Year: 2005

The mission of the Oral Health Equity Project (OHEP) is to increase access to preventative services and dental care for economically disadvantaged elders living in Boston’s public housing. OHEP provides free oral health screening for 60+ elders, low-cost follow-up appointments and treatment, and raises awareness about oral cancer prevention, denture care, smoking, nutrition, and overall oral hygiene. The goal of the three-year project is to provide oral health screening to 1000 low-income elders.
BHA housing was initially chosen as a way to reach vulnerable populations who are unlikely to have dental insurance or regular access to a dentist. While most screenings take place at public elderly/disabled housing, OHEP includes private elderly housing within the City of Boston after discovering a need within those facilities as well. The collaboration between the schools and the systems to provide comprehensive oral health care to elders has been an effective way to reach an otherwise marginalized population. The on-site screenings reach elders that have not seen a dentist for years. Community based outreach is not entirely new, but coupled as it is with the partner schools, OHEP has created an innovative and effective method for providing elder health services.
Agency Community RolesWith the official creation of OHEP, BPHC took the lead, centralizing data collection, referrals, and purchasing dental supplies for the project, including toothbrushes, denture kits, gloves, mirrors, and more. As part of the responsibility for overall management of the project, BPHC developed the screening and referral tools and designed and implemented the data collection and analysis. The Schools: Boston University School of Dental Medicine, Delta Dental of Massachusetts, Harvard University School of Dental Medicine, The Mass College of Pharmacy and Allied Health Science’s Forsyth School of Dental Hygiene, and Tufts University of Dental Medicine all have shown a commitment to providing access to oral health services for the low-income, uninsured and underinsured residents of Boston. Among the participating dentists in the OHEP are the director of Geriatric Dentistry at Tufts, the Director of Community Public Health Programs at Boston University, a Professor of Public Health Dentistry at Harvard, and a director of Community Dentistry at Delta Dental. Each of the schools has made additional staff, fourth year dental students, and first year students available for the oral health screenings. Boston Housing Authority and the Elderly Commission: In order to reach the goal of 1000 elders screened in three years, the OHEP needed to find community-based settings that were accessible to low-income elders. Boston Housing Authority has numerous elderly and disabled housing developments. BHA identified several sites with a high percentage of elders and invited OHEP to use the community room in those sites for the screenings. BHA also shared race and ethnicity data, so that the OHEP could provide materials and interpreters in the appropriate languages. In addition to these public housing sites, the Boston Elderly Commission provided OHEP with the various private elder housing facilities within the City of Boston that also had great need of dental services within their communities. Conducting oral health screenings on site in elderly housing had many advantages when reaching a relatively non-mobile population: elders were able to simply come into the room on their way to or from home; signs were posted well in advance and flyers were in every mail box; materials were available in the languages appropriate to the area; and all housing sites had a site coordinator who had regular contact with the residents. In most cases, the site coordinator was responsible for the outreach of the event. Nutritious food was always provided as an additional incentive to the elders. Relationships have also been developed with medical interpreters who speak Haitian Creole, French, Spanish, Vietnamese and Chinese. These medical interpreters attend screenings to provide the clients with comprehensive and culturally competent oral health screening.  Costs and ExpendituresFor the three-year project, OHEP purchased the materials needed for use during the screening, including paper plates (to place dentures on during the screening), disposable hand mirrors, flashlights, and gloves were provided by the schools of dental medicine and other materials, including denture kits, fluoride varnish, denture labeling kits, and a model tooth set for each school, with a cost of approximately $3,500. Boston is culturally and ethnically diverse. Based on the data from the pilot screenings and from information provided by the BHA, it was determined that educational materials were needed in the following languages: Chinese (Traditional and Simplified), English, Haitian Creole, Portuguese, Spanish, Russian, and Vietnamese. Elder-specific materials were created on following topics: Denture Care, Dry Mouth, Fluoride, Oral Cancer, and local resources. The cost of printing complete sets of 4,000 folders and 500 English only, 500 English/Spanish, 500 English/Haitian Creole, 500 English Portuguese, 500 English/Russian, 500 English/Vietnamese, and 500 traditional Chinese/simplified Chinese printed materials was $12,000.00. Canvas bags were also designed, and 2,000 of them were printed at a cost of $2,800. These represent one-time costs at the start of the project. Staff time was provided both in-kind from BPHC, Boston University, Harvard, Delta Dental of Massachusetts, Forsyth, and Tufts, and Ms. Turnier was hired at 30 hours/week to provide oversight, case management, and data entry/analysis. Boston, Harvard and Tufts Universities divided the 42 screenings between them, and provided a dentist at each location, along with graduate-level dental students. Medical interpreters were hired for many of the screenings, with an average cost of $19-25/hour for three to four hour screening periods. Currently Delta Dental of Massachusetts funds OHEP for a three-year period, with an average of approximately $110,000/ year in funding. As for sustainability, the project can be continued with minimal expenditures but with significant staff time. Each screening takes four and a half hours, including set-up and breakdown time; and each client requires approximately 20 minutes on site for informed consent, the screening, and then education. Following the screening, data entry and analysis, and then follow-up letters are sent to each patient that scheduled an appointment at the screening. With an estimated cost of $100/hour to include the food, materials, time of the BPHC staff, the dental schools, and the cost of interpreters, a screening that serves between 10 and 40 clients costs approximately $600. Because the number of clients served changes at each screening, there is some variation in average cost per client. Based on the average number of clients seen, the cost per client would be $24.  ImplementationWorking with site coordinators at each housing development, the agency provided sixteen screenings from June - November 2004, and has an additional sixteen screenings scheduled for January - May 2005. Prior to those screenings, twenty six screenings were conducted from September 2003- March 2004 and screened 426 individuals. OHEP has appointments at each of the schools that can be assigned to patients at each screening. A new digital data collection system streamlines the paper-based system. Bi-monthly meetings to report on the program's progress to partners, and see them at each of the screenings they have committed to. The program is in the second year of a three year grant, and is on target with all the goals and objectives.
Long term follow-up of the clients will be our next step, as the clients who were seen at the screenings begin to use the systems, and as the program continues to provide community-based screening to elders in their areas. The social work graduate student has begun to establish linkages with community health centers and with private dentists to create referral systems for elders. Connecting elders to their neighborhood dental providers will create a more comprehensive care system. These linkages will also ease the burden on the schools of dentistry, and will allow for a more sustainable oral health system than the one that currently exists.