Indian Health Service Oral Health Program Guide

Appendix IV

EVALUATION OF COMMUNITY INVOLVEMENT IN ORAL HEALTH PROGRAMS

Evaluation of Community Involvement in Oral Health Programs

Introduction

The Evaluation of Community Involvement may be conducted concurrently with the review of other dental program aspects or reviewed separately. The community and management evaluation documents, while professionally conceived, are not limited exclusively to use by dental professionals. They may be assessed by non-dental persons with general background knowledge in these areas. Uses for the documents also include orientation of new staff, self-evaluation by individual professionals, establishment of program standards, and assessment of program activities which impact on oral health.

The following criteria address many in the community-basedactivities
that are known to have a positive influence on oral health:

  1. An ongoing fluoridation program is established at the community level. At a minimum this program consists of the following components:

a.A Service Unit* Fluoridation Committee/Team or similar work group that regularly meets to develop a strategy for increasing the percentage of community water system[1](CWS) users with fluoridated water to 75%[2] or to maintain the percentage at or above that level.

Method to assess: Review Fluoridation Committee/Team/Work Group meeting minutes and current and past CWS inventories (See b.).

* Any reference to Service Unit fluoridation committees/teams could also refer to Tribal or Urban health committees/teams or Area-wide initiatives.

b. A current plan for promoting fluoridation according to the recommendations outlined in the Centers for Disease Control and Prevention Engineering and Administrative Recommendations for Water Fluoridation, 1995[3]. This plan should include a Service Unit CWS inventory of fluoridating, non-fluoridating, and naturally fluoridated systems; indicate each CWS user population; establish criteria to prioritize and target CWSs where fluoridation could be implemented or resumed; and specify activities planned to promote implementation at targeted sites.

Method to assess: Evaluatethe fluoridation plan and outcomes.

c.Resources for fluoride analysis of drinking water, including samples from private wells serving American Indian/Alaska Native households. These resources should include state or Environmental Protection Agency-certified laboratories, and the availability of approved and properly calibrated, operated, and maintained field test kits (colorimetric, or ion specific electrode) at the Service Unit level.

Method to assess: Determine if a current listing of certified laboratories exists, and if agency-sponsored water testing services are available at the Service Unit. Review the availability of field test kits.

  1. Cooperatively established criteria that define optimal fluoridation status for tribally-owned and operated CWSs at the Service Unit. At a minimum, the criteria should include the optimal fluoride level and control range; define the frequency of monitoring and split sampling by the CWS; the percentage of monitoring results that must fall within the control range, and split sample tolerance.

Method to assess: Review the current optimal fluoridation criteria.

  1. Schools with at least 30 percent American Indian/Alaska Native (AI/AN) enrollment promote school topical fluoride (mouthrinse, varnish, etc) and/or toothbrushing (with a fluoridated dentifrice) programs for reducing the incidence of dental caries, unless unwarranted due to documented low caries rates.

Method to assess: Survey dental staff and/or school administrators to determine how many schools have fluoride mouthrinse and/or toothbrushing programs and how many more could be implemented.

  1. A sealant program exists for those schools with at least 30 percent AI/AN enrollment. These programs provide pit and fissure sealants on permanent molars for at least 80 percent of all AI/AN school children six to eight years and 12 to 15 years. An evaluation method for retention of sealants should also be conducted.

Method to assess: Review dental data and participate in discussions with dental staff and/or school administrators. Conduct random chart reviews to determine if 80 percent compliance is being met. Review any available retention studies.

  1. Oral health education curricula are provided for schools with at least 30 percent
    AI/AN enrollment.

Method to assess: Survey dental staff and/or school administrators to determine how many schools have oral health education curricula and how many more schools could be included.

  1. Programs have been established to make oral health services available to individuals/families, and target groups at high risk for oral disease. These groups may include diabetics, tobacco users, Head Start children, and other special population groups as identified in the PL 94-437 oral health objectives.

Method to assess: Review community health plan and perform chart reviews to determine whether needs of high-risk individuals are addressed. The Community-Based Activity Reporting System (CBARS) can be used to measure preventive activities by target groups.

  1. The dental program has provided oral health in-service training to non-dental health professionals in the past 12 months. An evaluation of the training should be conducted.

Method to assess: Review annually the number of presentations to non-dental health professionals and the number of participants. CBARS should be used to provide documentation. An evaluation method to assess appropriateness and effectiveness should also be reviewed.

  1. The dental program participates in community health activities and promotes community-based oral health promotion/disease prevention programs based on the needs of the community. An evaluation is conducted on these programs.

Method to assess: Review dental program participation in school-based programs, health fairs, health professions recruitment, community meetings, Head Start functions, etc. CBARS should be used to document these activities. These activities should support the oral health objectives specified in each Service Unit/Tribal/Urban preventive plan.

  1. Dental clinic staff have identified and participated in effective primary health care education or services delivery programs, e.g., diabetes, tobacco education, Well Baby, and WIC programs.

Method to assess: Review policies and procedures of dental program to assess involvement with other primary health care programs. Ask primary health care program directors if dental program could improve role in education or services delivery. Review any program evaluations.

  1. Local Tribal administration is involved in planning, implementation, and evaluation of oral health promotion/disease prevention programs. Opportunities for local Tribal participation have been presented and explored.

Method to assess: Review documents (Tribal health committee meeting minutes and/or correspondence from the dental program) to the Tribe to determine what efforts have been undertaken. Determine that dental program staff have met at least once in the past year with the Tribal health leaders, e.g., Tribal health director, Tribal council, Tribal chairman, or council members.

  1. Community satisfaction assessments have been conducted during the preceding year. Findings have been incorporated into changes in programs and policies.

Method to assess: Review data from any available community satisfaction assessments and actions which have resulted from this process.

  1. The Dental Program develops and routinely monitors and evaluates a community-based BBTD/rampant caries prevention program.

Method to assess: Review dental prevention plans to assess appropriateness and effectiveness of collaborative efforts. Review annual dental data reports or other surveys to assess the incidence of disease in target population (0-3 years). An annual evaluation method should also be in place. Knowledge, skill, and attitude surveys should be developed with evaluation at regular intervals to assess program progress.

  1. An annual evaluation process should be implemented for a select number of the criteria.

Method to assess: Review evaluation methods and analysis. Discuss findings and how changes have been incorporated into programs.

Evaluation of Community Involvement in Oral Health Programs

CRITERIA

/ Yes / No / N/A / Comments
  1. Community Water Fluoridation

  1. Service Unit Plan

  1. Fluoridation team has met

  1. Team assesses compliance

  1. Reliable mechanism for testing

  1. School fluoride program

  1. School sealant program

  1. School oral health curriculum

  1. Oral health services available to high risk groups

  1. Oral health in-service provided

  1. Community health activities

  1. Participation in health ed or primary services delivery

  1. Tribal involvement

  1. Community satisfaction assessment

  1. Community-based ECC prevention program

  1. Annual evaluation for selected criteria

Community Feedback Form

Describe strengths of the community component of the dental program:

Describe any weaknesses of the community component of the dental program:

Recommendations for improving the community component of the dental program:

Signatures: ______

EvaluatorEvaluateeDate

cc: Service Unit/Tribal Health Administrator

Chapter 7, Appendix IV, page 1

Quality Assessment2007

and Improvement

[1] A community water system is defined as a water system which supplies drinking water to 25 or more of the same people year-round in their residences (Source: U.S. Environmental Protection Agency).

[2] Healthy People 2010 Oral Health Objective 21.9: Increase persons on public water receiving fluoridated water to 75%.

[3]CDC Morbidity and Mortality Weekly Report, Recommendations and Reports, September 29, 1995/Vol. 44/No.RR-13.