Children with special health care needs (SHCNs) live in every one of our communities. They are prone to broad-reaching health disparities when their individual SHCNs are impacted by social determinants of health. Children with SHCNs present with a diverse group of diagnoses including:
- complex chronic conditions and diseases
- physical, developmental, and intellectual disabilities
- sensory, behavioral, emotional, psychiatric, and social disorders
- cleft and craniofacial birth defects, anomalies, and syndromes
- inherited conditions causing abnormal tooth development.
Wicked Problem Description:
Children with SHCNs are best served in a dental home where all aspects of their oral health care are delivered in a comprehensive, continuously accessible, coordinated, culturally competent, interdisciplinary, and family-centered way. A dental home is best provided under the direction of knowledgeable, experienced dental professionals who are comfortable and competent when addressing their unique dental health issues. Close collaboration between the child’s dental home and medical home is also important.
Today, Minnesota has a limited number of trained professionals who are prepared to offer a dental home for children with SHCNs. As a result, these children either go untreated or are subjected to a disorganized system where children with SHCNs often travel great distances to engage with a tangled web of pediatric healthcare professionals, general dentists, local dental specialists, and regional tertiary dental centers. This fractured infrastructure results in duplicated appointments and imaging, treatment delays, inadequate management of oral pain, and oral dysfunction. A stronger network of oral health care providers across Minnesota is needed to support a culture of oral health and a dental home for every child with SHCNs in Minnesota.
- Meeting with diverse stakeholder groups: parents, family advocacy organizations, pediatric healthcare providers, state appointed leaders in developmental disabilities, dental insurance and government-supported Medicaid plans, academicians working in interdisciplinary team environments, and leaders of health professions organizations. The goals of these meetings are to identify themes and areas of focus to drive our project in years 2 and 3.
- Attending Project ECHO replication site training in August 2017 on the use of the Project ECHO infrastructure and methodology
- Partnering with the University of Minnesota Office of Continuing Dental Education to develop outreach materials, draft an online and social media strategy, and outreach/promotional plan for those who will comprise the core participants of our pilot phase Project ECHO clinics.
- Completed discussions with a first round of stakeholders including oral, mental, and physical health university-level educators and care providers, community health workers, family liaisons and nonprofit organizations.
- Linked with Minnesota’s leading pediatric dentistry professional organization.
- Drafted engagement materials introducing the broader community to our project.
- Developed position descriptions for contracted partners, including 3 family navigators, 3 community health workers, and 30 to 45 core pilot phase project participants.
- Drafted web page concept for outreach and overview purposes.
- Discussed social media engagement strategies.
Anticipated Future Outcomes
- Complete additional stakeholder discussions by August 2017.
- Launch web, social media, YouTube, and live presentation materials by October 2017.
- Select and contract with 3 family navigators, 3 community health workers, and 30 to 45 core participants for work between January and June 2018 by November 2017.
- Identify and schedule professional content experts to present training to Project ECHO clinic attendees, based on stakeholder findings between November 2017 and June 2018.
- Conduct 6-month pilot of 3 monthly Project ECHO clinics.
- Award Continuing Dental Education credits to oral health care professionals who attend our online or live presentations between August 2017 and June 2018.
- Collaborate with the Minnesota Community Health Worker Alliance to gain insight on services and engagement strategies between November 2017 and June 2018.
- Collaborate with Family Voices, a Minnesota nonprofit, to gain insight on how to partner with parents and caregivers who have children with SHCN between November 2017 and June 2018.
July – December 2017
• Recruit 30-45 core participants for Project ECHO clinics
• Prepare curriculum and invite content experts for Project ECHO clinics
• Pre-test core participants of Project ECHO clinics for knowledge and comfort in providing oral health services for children with SHCNs
• Invite interested healthcare providers and stakeholders to participate in Project ECHO clinics as guest attendees
January - June 2018
• Launch 3 monthly Project ECHO clinics each involving 10-15 core participants
• Launch Facebook group to provide social environment for core participants to meet and engage professionally across Project ECHO clinics
• Present, discuss, and plan care for 40 to 50 children with SHCN via Project ECHO clinics
• Plan first annual conference related to oral health care for children with SHCNs
July - August 2018
• Sustain existing and launch additional Project ECHO clinics
• Evaluate treatment, case management infrastructure, and clinical outcomes of children with SHCNs presented during Project ECHO clinics
• Gauge initial impact of our wicked project idea
• Post-test core participants of Project ECHO clinics for change in knowledge and comfort in providing oral health services for children with SHCNs
September 2018 through June 2019
• Train larger audience of oral health care providers
• Expand number of Project ECHO clinics
• Engage additional community health workers and family navigators to expand reach of oral health educational materials and awareness of dental home network into communities
• Plan second annual conference related to providing care for children with SHCN
July - August 2019
• Evaluate project
• Re-engage stakeholders in long-term planning
• Distribute project findings
• Expand the telementoring network
(1) Jo Peterson, Ph.D., Director of the Office of Continuing Dental Education at the University of Minnesota School of Dentistry, and her team on curriculum development, participant engagement, technical assistance, event planning, and daily operations of the telementoring program. (2) Certified community health workers affiliated with the Minnesota Community Health Worker Alliance and family navigators employed by Family Voices of Minnesota to participate in Project ECHO clinics, share insights with telementoring participants during and after the clinics, and serve as advisors during planning and implementation of the telementoring program. (3) The Project ECHO Superhub on curriculum development, data collection, reporting, and fidelity of our telementoring program to the Project ECHO methodology.
We will evaluate the overall success of our project and approaches by:
- Assessing change in provider knowledge and comfort in providing oral health services for children with SHCNs through participation in the Project ECHO telementoring program through pre- and post-pilot phase evaluations.
- Compile utilization data for the Project ECHO telementoring program.
- Solicit feedback from core Project ECHO telementoring participants about the effectiveness of the clinics to support their ability in providing oral health services to children with SHCN.
- Compile utilization data on the use of project educational resources used by providers caring for children with SHCNs.
- Track the number of continuing education credits awarded by the project.
- Obtain insights and feedback from participating community health workers and family navigators
- Track the cases presented during Project ECHO clinics and determine if treatment plans were completed in a timely and effective manner.