05HMCHB 20-01-00

INTRA-AGENCY AGREEMENT BETWEEN

THE ADMINISTRATION FOR CHILDREN AND FAMILIES

ADMINISTRATION ON CHILDREN, YOUTH AND FAMILIES

HEAD START BUREAU AND THE PUBLIC HEALTH SERVICE

HEALTH RESOURCES AND SERVICES ADMINISTRATION

MATERNAL AND CHILD HEALTH BUREAU

Fiscal Year 2005

  1. PURPOSE

This Agreement sets forth the terms for the provision of technical expertise in oral health by the Health Resources and Services Administration’s (HRSA)Maternal and Child Health Bureau (MCHB), to the Administration for Children and Families, (ACF), Administration on Children, Youth and Families’ (ACYF) Head Start Bureau (HSB). MCHB will assist the HSB, and the ACF Regional Offices to address the HSB’s oral health priority by assessing oral health program needs, collaboratively developing strategic plans to meet these needs, and designing materials and programs to put these plans into practice. The overall long term goal of this multi-year Agreement is to achieve optimum oral health for all Head Start (HS) and Early Head Start (EHS) children, including American Indian-Alaska Native (AIAN) and Migrant and Seasonal (MS) children.

  1. AUTHORITY

This Agreement is made under the authority of the Economy Act approved June 30, 1932, as amended (31 USC 1535) and under the provisions of general and pertinent regulations of the Comptroller General, Head Start Act, P. L. 105-285 and P.L. 108-447 of the Appropriations Act of 2005 and Title V of the Social Security Act, 42 U.S.C. 701 et seq.

  1. BACKGROUND

From 1966 to the mid-1990’s, HRSA/MCHB and its predecessor dental programs had a close working relationship with the HSB. MCHB dentists provided dental training and technical assistance (T/TA) to Head Start programs across the country, and also assisted the HSB in developing dental program policies and standards. Dental T/TA networks were developed using the infrastructure of established State run dental programs, professional dental organizations and training institutions representing dentists and dental hygienists. Appropriate best practice interventions and training programs were developed to support the dental consultant network assisting grantees to meet these needs. Dental consultant manuals were developed and annual workshops were conducted to train new consultants and to develop standardized interventions to address problems common to several grantees. In 1993, in an effort to consolidate T/TA services and to better meet the needs of HS grantees, the HSB ended its relationship with MCHB and revised its T/TA system to include all health activities, including oral health.

In 1998, the HRSA and the Health Care Financing Administration (HCFA), (which has subsequently been renamed as the Centers for Medicare and Medicaid Services (CMS)), developed a joint Oral Health Initiative to address the oral health needs of children enrolled in Medicaid and the State Child Health Insurance Program (SCHIP). In 1999, representatives from MCHB and the Special Supplemental Nutrition Programs for Women, Infants and Children (WIC) approached the HSB to discuss strategies for improving the oral health status of low-income children. The Head Start and Partners Forum on Oral Health was held in September of that year. The purpose of the Forum was to develop strategies that increase collaboration at the Federal, State, and local levels and to improve oral health services for low-income children and families. Each of the Federal partners contributed funds for the development of three research papers that were presented at the Forum. The papers addressed oral health and nutrition, caries risk assessment and prevention, and access to oral health services which were subsequently published in the summer 2000 issue of the Journal of Public Health Dentistry.

In response to recommendations made at the September 1999 Oral Health Forum, the HSB and the MCHB entered into an Intra-Agency Agreement in October 2001. Both the HSB and the MCHB realized a long-term incremental program was required to implement the recommendations made at the Forum and to accomplish the overall long term goal of this Agreement to achieve optimum oral health for Head Start (HS) and Early Head Start (EHS) children. The first three years of the Agreement focused on strategic plan development and capacity building at the Federal, regional, State, and local level. ACF Regional Offices and States established oral health teams with representatives from other Federal programs serving low income children, such as WIC, Medicaid, and HRSA Regional Office Dental Consultants, State Dental Directors, ACF Regional Office staff, State Head Start Associations, State Collaboration Offices, T/TA providers and Head Start staff to plan and conduct Regional Head Start Forums. Since 2001, 10 Regional Oral Health Forums have been held, 3 Head Start Forums with dental provider professional organizations have been convened, and 48 State and Territorial Oral Health Forums were funded for the purpose of developing Regional, State and professional provider Oral Health Strategic Plans. Current and future years of the IAA will focus on implementing recommendations from these Forums. As follow up to recommendations made at Regional Forums, the incremental provision of oral health expertise to Regional Offices is in process. To date, 10 Regional Offices are currently receiving some oral health expertise through this Agreement.

The first three years of this Agreement also focused on elevating the profile of Head Start within the dental community and beginning the process to rebuild community linkages between HS and EHS programs and dental providers. Assessment of barriers to oral health services for HS and EHS children at the national, regional, State and local levels; and developing strategies and workgroups to remove these barriers has been an ongoing activity. This period has alsoserved to develop strategies and processes to gather and assess education, prevention, early intervention and access to dental care practices.

The Agreement has been very successful in developing national awareness in recognizing the need to increase efforts to build linkages and ultimately develop partnerships and programs between Head Start and the dental provider community. This awareness was acknowledged in fiscal year 2005 Congressional appropriation language when both Houses encouraged the Head Start Bureau to expand its Intra-Agency Agreement with the Maternal and Child Health Bureau to jointly address the unmet dental needs of Head Start children and to build upon the progress made in developing partnerships between Head Start and dental communities at the national, State and local levels.

In 2004, anHSB and MCHB Intra-Agency Workgroup was established to more collaboratively build upon successes made to date to implement and expand oral health activities at the Bureau and Regional Offices to assist local HS and EHS programs in addressing the oral health needs of HS and EHS children and in meeting the oral health requirements of the Head Start Program Performance Standards. The Workgroup will also serve as the principal vehicle in developing policies that maximize the goals of this Agreement.

In early 2005, the Head Start Bureau held the first ever National Hispanic Institute. One of the goals of the Institute was to improve outreach to Hispanic communities. This Intra-Agency Agreement will support follow-up activities to a session at the Institute about oral health and Hispanic families by working with the Hispanic Dental Association to develop regional, State and local partnerships that will result in improved outreach to the Hispanic community.

The HSB and MCHB recognize that activities contained in the Agreement are in various stages of development and implementation. The MCHB will support the HSB in its efforts to share with local grantees, via the on-line Head Start Learning Center (HSLC): evidence based preventive, early intervention and oral health service delivery models; promising practices; and strategic plans developed at the national, regional, state and local levels. Formal agreements and programs will be developed with dental and other health professional organizations to increase local oral systems of care and ensure that all HS and EHS children have a dental home. This Agreement will also support mechanisms to enhance the availability of an appropriately trained and supported dental workforce that will provide services to HS and EHS children.

  1. SCOPE OF WORK AND RESPONSIBILITES

The HSB will:

  1. Designate a person to serve as the MCHB liaison;
  1. Keep MCHB informed of the evolution and approval of pertinent policy and program developments such as the Head Start Innovative Improvement Program Grants;
  1. Provide MCHB with current contact information for ACF Regional Office staff and technical assistance network staff who will support the regional, State and local efforts of this Agreement;
  1. Provide periodic feedback to MCHB on its implementation of the Agreement;
  1. Represent the HSB on the Association of State and Territorial Dental Directors (ASTDD) Head Start Advisory Committee and other committees as established to accomplish the goals of this Agreement;
  1. Maintain an HSB-MCHB Intra-Agency Workgroup to coordinate national efforts to accomplish the goals of this Agreement, including the development of the oral health content of the HSLC. This Workgroup will meet, at a minimum, semi annually;
  1. Provide funds to MCHB for programmatic and administrativeservices as set forth in this Agreement and maintain responsibility for the disbursement of Head Start funds;
  1. The HSB MCHB Liaison will keep HSB and Regional Office staff informed about activities carried out related to this Agreement and progress made in meeting its overall goal of improving the oral health status of HS and EHS children and families.

MCHB will provide these services to the HSB:

  1. Serve as Liaison to all Federal, State and Community Programs and Foundations as it relates to Head Start/Early Head Start, Migrant and Seasonal and American Indian and Alaska Native Branch Oral Health Issues
  • MCHB will provide information regarding the oral health needs of HS and EHS, MS and AI/AN children and their families in its ongoing relationships with private foundations, Federal programs including, the Centers for Disease Control and Prevention, Indian Health Service, HRSA’s Bureau of Primary Health Care (BPHC), the National Institute of Dental and Cranial Facial Research Disparity Centers, and others for integration into their programs. A strategy for outreach to special populations, such as Hispanics and Native Americans, will be developed and shared with the above mentioned Federal programs.
  • MCHB will develop collaborative relationships with CMS, and the National Association of State Oral Health Medicaid Directors to assess State policies and trends surrounding oral health services for Medicaid services to HS and EHS children and pregnant women.
  1. Provision of Oral Health Expertise to the Head Start Bureau
  • MCHB will continue to provide professional advice, consultation and training to HSB staff on all matters of oral health. MCHB will also provide oral health leadership and serve as a liaison to dental and other professional organizations, training institutions, and other Federal and State agencies as it relates to education, prevention, early intervention, research and access to care for HS and EHS children.
  • MCHB will assist the HSB in developing and updating oral health content for the HSLC.
  • MCHB will enhance the HS and EHS capacity of MCHB Oral Resource Center to: 1) gather and assess any prevention, education and service delivery models appropriate for Head Start programs; 2) develop oral health informational and training materials specific to HS and EHS programs; 3) create a central repository for these materials; 4) support communication and informational needs of Regional Office Head Start Oral Health Consultants; and 5) assist the HSB to implement these programs through on-site, Web-based and distance learning modalities.
  • Work with HS and EHS, the ASTDD, the American Academy of Pediatrics, the Maternal and Child Oral Health Policy Center and the American Academy of Pediatric Dentistry (AAPD) and others in the assessment, adaptation, and development and implementation of promising practices, education and service delivery models and T/TA materials for use in HS and EHS programs.
  • MCHB will review and assess oral health policies and data (i.e. SCHIP, EPSDT, and Medicaid) that impact services to HS and EHS children and families and will present pertinent findings and policy implications to the HSB.
  1. Provision of oral health expertise at Regional Office Level

In each ACF-HRSA Regional Office, HRSA, in partnership with ACF, will:

  • Assist ACF staff in implementing recommendations formulated at Regional and/or state HS and EHS Oral Health Forums.
  • Establish and maintain an oral health dental consultant pool that will provide on-site oral health expertise to the ACF Regional Office.
  • Assist the ACF Regional T/TA Liaison, Health Liaison and/or Health Content Expert to develop 1) grantee specific T/TA plans and 2) State-based oral health consultant networks to help implement these plans.
  • Assist the ACF Regional Offices in establishing and maintaining partnerships between the Head Start State Collaboration Offices, MCH State oral health programs and other institutions and agencies that impact oral health of HS and EHS children.
  • Assist the ACF Regional Offices in establishing and maintaining Oral Health Teams consisting of HS, including AI/AN and Migrant and Seasonal Head Start as appropriate, CMS, AAPD, WIC, State Dental Directors and others.
  1. Integration of Head Start and Early Head Start into State Dental Programs and Dental Directors Ongoing Activities

In each State, MCHB will:

  • Assess State Oral Health programs readiness and ability to support HS and EHS programs and locally based HS and EHStechnical assistance specialists and develop a plan for HS and EHS support based on this assessment.
  • Through State Oral Health Forums and other means, develop and implement a strategic plan for State Oral Health programs to assist HS and EHS Programs at the State and community level.
  • Encourage the development of partnerships and agreements between Head Start State Collaboration Offices and State dental programs to support the technical assistance and oral health program needs of HS and EHS programs.
  • Encourage States to conduct oral health needs assessments of HS and EHS children and share this data with ACF Regional Office Oral Health Consultants.
  1. Continue to Raise Public and Professional Awareness of the Oral Health Needs of Head Start and Early Head Start Programs and Develop Collaborative Programs With These Organizations

MCHB will establish a partnership with the American Dental Association, the American Dental Hygiene Association, the Hispanic Dental Association and other dental provider organizations andwill expand and build upon its activities with the American Academy of Pediatric Dentistry and other organizations to:

  • Conduct Professional Organization Forums to assess the organizations willingness and ability to support HS and EHS and MS grantees in meeting their oral health educational and clinical service needs.
  • Develop and implement strategic plans that address the oral health needs of HS and EHS children.
  1. Increase the Number of Pediatric and General Dentists Available to Treat Head Start and Early Head Start Children
  • Develop and implement a program that fosters a dental home and develops systems of dental care at the community level that trains, links and supports general dentists to pediatric dentists, MCHB dental leadership centers and other health care providers to comprehensively meet the oral health needs of HS and EHS children.
  • Provide training for up to three HS Pediatric Oral Health Fellows/Residents at an academic level that will be responsible for training pediatric dentists on working with HS and EHS programs and providing oral health services to HS and EHS children.
  • Initiate programs (i.e. marketing) and campaigns to make the dental, medical, public health and other professions, as well as the general public, more aware of the oral health needs of HS and EHS children.
  • Establish collaborative agreements and service delivery program with the AAPD, American Dental Hygienist Association and others to engage more dental and other health professionals in education, prevention and treatment programs that benefitHS and EHS children.
  1. Offer, in keeping with funding and programmatic requirements, a grant program to community HS and EHS programs.
  • Develop guidance for a community HS and EHS grant program that supports the concept of a "dental home" for HS and EHS children.
  • Administer a community HS and EHS grant program that supports implementation of a service and referral system and ensures early intervention and treatment services for community Head Start programs.
  1. REPORTING REQUIREMENTS

The HSB Project Officer and the MCHB Project Officer will: