Title V Transformation Tools
Recommendations to Support NPM 13 – Oral Health
Jump To: Skills | Knowledge
Significance. The Title V Maternal and Child Health Services Block Grant to States Program guidance1 defines the significance of this NPM as follows:
Oral health is a vital component of overall health. Access to oral health care, good oral hygiene, and adequate nutrition are essential component of oral health to help ensure that children, adolescents, and adults achieve and maintain oral health. People with limited access to preventive oral health services are at greater risk for oral diseases.
Oral health care remains the greatest unmet health need for children. Insufficient access to oral health care and effective preventive services affects children's health, education, and ability to prosper. Early dental visits teach children that oral health is important. Children who receive oral health care early in life are more likely to have a good attitude about oral health professionals and dental visits. Pregnant women who receive oral health care are more likely to take their children to get oral health care.
State Title V Maternal Child Health programs have long recognized the importance of improving the availability and quality of services to improve oral health for children and pregnant women. States monitor and guide service delivery to assure that all children have access to preventive oral health services. Strategies for promoting oral health include providing preventive interventions, such as dental sealants and use of fluoride, increasing the capacity of State oral health programs to provide preventive services, evaluating and improving methods of monitoring oral diseases and conditions, and increasing the number of community health centers with an oral health component.
Background. The Maternal and Child Health Bureau (MCHB) Title V Maternal and Child Health Services Block Grants to States Program has established 15 National Performance Measures (NPMs) for the 2015-2017 grant cycle. In order to effectively address the NPMs, MCH professionals need to think about not only the evidence and strategies to make change, but also the capacity of the workforce to carry out these activities. These lists identify online learning materials, resources, and evidence-based strategies and programs to support the knowledge sets and skills needed to advance each NPM.
Introduction. Six skill sets have been identified by the National MCH Workforce Development Center to support implementation of this NPM: (1) population health; (2) strategic planning and program design; (3) strategic alliances and effective partnerships; (4) consumer engagement and cultural and linguistic brokering; (5) policy and program implementation; and (6) communication.
In addition, two knowledge areas specific to the NPM topic area have been highlighted that are keyed to the evidence base and promising practices: (1) oral health background, recommendations, and guidelines and (2) oral health policies and strategies.
The MCH Navigator, in collaboration with the Center, has developed this crosswalk to guide MCH professionals to online learning opportunities and implementation resources to support these skill sets.
Please click on the Read More buttons below for additional information, learning materials, and implementation resources. You can also email us with suggestions for additions.
Six skill sets have been identified to support implementation of this NPM:
1. Population Health
A renewed focus on MCH population health is key to achieving the NPMs in the era of health transformation. These skills enable Title V professionals to analyze how program interventions and their related health outcomes are distributed among a state’s MCH population. Population health skills complement all of Title V’s work, including program design and implementation, strategic partnerships and communication.
- Ability to conduct surveillance of oral health services during pregnancy, early childhood and adolescence that allows public health practitioners to respond to disparities in utilization of oral health services
- Ability to identify workforce shortage areas related to:
- Dental provider adequacy
- Dental provider competencies
- Primary care provider competencies
- Excess utilization of emergency care for preventable dental problems
2. Strategic Planning & Program Design
Effective strategic planning and program design require the ability to base programs on defined goals and desired outcomes. Strategic planning should include a monitoring and evaluation system to track and monitor progress and inform program alterations as needed. Program design skills must ultimately be coupled with implementation, where program design is carried out.
- Ability to support integration of medical and dental records for pregnant women, adolescents, and children
- Skills to support robust and effective oral health referral systems in community settings for oral health
- Ability to identify and implement evidence-based practices to address provider shortages and provider competencies
3. Strategic Alliances & Effective Partnerships
The wide array of stakeholders and partners in the field of MCH, from providers and insurers to women and children, require a set of skills in strategically aligning Title V goals with those of their partners. In the Title V world, there is an increasing interest in engaging unlikely or nontraditional partners to achieve the NPMs. The skills in this category take that into account and include unique partner groups linked to this measure.
- Ability to convene and train medical and dental providers to:
- Include oral health promotion in primary care settings
- Include primary care health promotion in oral care settings
- Establish/improve bi-directional referral and follow-up systems
- Ability to effectively partner with Medicaid, dental providers, and professional oral health organizations to assess and improve systems for pregnant women and youth, including those with special health care needs
4. Consumer Engagement/Cultural & Linguistic Brokering
Consumers are arguably the most important stakeholders in MCH work, thus skills in consumer engagement and cultural and linguistic brokering are essential to moving the needle for each NPM. In some cases, consumer engagement includes negotiating with other stakeholders on behalf of MCH populations. Closely linked with this skills category are skills in communication and strategic alliances.
- Ability to consider local community culture to identify the most effective strategies and channels of communication for oral health messages
5. Policy & Program Implementation
These skills ensure that MCH priorities are integrated into all aspects of policy and program implementation, as well as ensuring that policies and programs selected are well-aligned with NPMs and other MCH program goals. Implementing policies and programs with fidelity also requires skills in the implementation science drivers: technical and adaptive leadership; selection; training; coaching; systems intervention; facilitative administration; and decision support data systems.
- Skills to ensure that high quality oral health counseling is:
- Embedded in programs for which Title V has authority (including medical home initiatives and EPSDT)
- Offered by providers that serve pregnant women, adolescents, and children, including children and youth with special health care needs
- Skills to support robust and effective referral systems for oral health services within all programs Title V delivers
- Ability to determine legal authority behind existing memoranda of understanding with governmental agencies in regard to dental services
- Skills to develop memoranda of understanding with Medicaid and other payers to develop policies that ensure effective services and reimbursement for oral health services
Communication skills support the creation and delivery of effective messages between MCH professionals, professional and community partners, and populations served by Title V. Effective communication ensures the delivery of appropriate messages to audiences in the way that they were intended and is key to all aspects of MCH work. These skills are linked closely with skills in strategic partnerships and cultural and linguistic brokering.
- Ability to communicate with policymakers about oral health and financial impacts of poor oral health
- Ability to write and disseminate policy briefs and media messages that effectively increase awareness of the need for oral health care during pregnancy, capitalizing on pregnancy insurance coverage benefits
- Ability to communicate, via traditional and social media, accurate, consistent and motivational oral health messages for pregnant women and children, including the benefits of sealants
- Ability to effectively communicate with dentists and professional dental organizations to highlight the guidelines about dental care during pregnancy, infancy, and early childhood
- Ability to communicate with medical homes about the importance of oral health
- Ability to communicate with prenatal care providers about the importance of oral health
- Skills to create effective public health messages about the negative impact poor oral health has on school readiness and academic achievement
- Skills to create effective public health messaging about the relationship between poor oral health care and chronic health conditions such as gum disease, diabetes, heart disease, and stroke
In addition to skills, each NPM requires a knowledge base that will help Title V progress effectively in the measure. Knowledge should be considered at the foundation of achieving all measures.
1. Oral Health Background, Recommendations & Guidelines
- Knowledge of current preventive visit guidelines for pregnant women and children
- Knowledge of fluoridation and sealant recommendations for pregnant women and children
- Knowledge of benefits of oral health for pregnant women and children
- Historical and cultural context of use of dental services in a state/territory
2. Oral Health Policies & Strategies
- Knowledge of essential components of the Affordable Care Act (ACA) and other state and federal policies that facilitate access to oral health services for pregnant women and children, such as reimbursable dental visits during pregnancy
- Knowledge of insurance coverage and common challenges with insurance adequacy for oral health services, including fluoride and sealants, for pregnant women and children
- Knowledge of policies and environmental strategies that increase uptake of dental services for pregnant women and children and the relative effectiveness of these policies
- Knowledge of policies that address workforce shortages
- Knowledge of fluoridation and sealant policies that promote oral health for pregnant women and children
- Knowledge of state and local safety net resources for oral health
- Knowledge about barriers to care (e.g. transportation, time, etc.) for pregnant women and children
See other online learning resources related to health transformation, collected in the Health Transformation Learning Laboratory.
1 Health Resources and Services Administration. 2014. Title V Maternal and Child Health Services Block Grant to States Program: Guidance and Forms for the Title V Application/Annual Report, Appendix F, p. 86.