Children with special healthcare needs (SHCNs) live in all of our communities. They 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, and inherited conditions causing abnormal tooth development. These children are prone to broad-reaching health disparities when their individual SHCNs are exacerbated by social determinants of health.
Oral health disparities are especially pervasive in this population. SHCNs frequently impact the growth, development, and health of the oral tissues, the teeth, jaws, and the craniofacial skeleton. Tooth decay, gum disease, dental injuries, tooth misalignment, oral infections, and other oral abnormalities are commonly seen or reported in the health history of children with SHCNs. Nationally, dental and oral health care ranks as the second most common unmet health need, according to the most recent National Survey of Children with Special Health Care Needs.
Wicked Problem Description:
Children with SHCNs need a dental home where all aspects of their oral health care can be delivered in a comprehensive, continuously accessible, coordinated, culturally competent, interdisciplinary, and family-centered way under the direction of knowledgeable, experienced dental professionals comfortable and competent to address their unique dental treatment needs. Sadly, Minnesota doesn’t have enough dental professionals ready and able to meet the demand. As a result, children with SHCNs either go untreated or are subjected to disorganized handoffs between pediatric healthcare professionals, general dentists, local dental specialists, and regional tertiary dental centers. These handoffs are a source of unnecessary appointments, treatment delays, inadequate management of oral pain and dysfunction, and result in negative dental treatment outcomes. The time has come to support and prioritize a dental home across the pediatric life course for all children with SHCNs in Minnesota.
The project will begin by identifying and engaging people, organizations, and communities across all sectors as stakeholders in the development of a dental home network throughout Minnesota. The needs of these stakeholders will be determined and resources to address their challenges in incorporating oral health into a broader culture of health will be developed and put into place. An interdisciplinary Project ECHO telementoring and case-based learning network will educate dental professionals and pediatric healthcare providers who are interested in providing a dental home for children with SHCNs. Community health workers (CHWs) will be integrated into the telementoring network to facilitate distribution of oral health educational materials and other project resources, provide insights on cultural competency, coordinate referrals within the dental home network, assist patients in healthcare navigation, and conduct project quality improvement initiatives. Clinical Scholars, key personnel, and the project’s advisory board will identify best practices that emerge and facilitate their use along with the established infrastructure to support improved clinical care in other health disciplines where children with SHCNs face disparities.
This Wicked Problem Impact Project aims to increase the number of dental professionals providing a dental home for children with SHCNs, better define referral processes needed to effectively organize the dental home network, institute measures to strengthen communication pathways among healthcare providers, social service agencies, community organizations, and families, prioritize and advocate for prevention of oral disease and maintenance of a dental home, and ultimately improve the self-efficacy of local dental professionals to provide a dental home for their communities’ children with SHCNs.
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
Minnesota-certified CHWs will be hired with the help of the Minnesota CHW Alliance. The Project ECHO Superhub stationed at the American Academy of Pediatrics in Elk Grove, Illinois will provide training, technical assistance, and guidance in curriculum development for the project’s telementoring network. An interdisciplinary, cross-sector group of leaders from Minnesota health organizations, community advocacy groups, pediatric professional chapters, and interprofessional university programs comprise the project’s advisory board.
Quantitative and qualitative data will be continuously compiled and interpreted in the following areas to promote project improvement over the duration of the Clinical Scholars program.
- Provider knowledge and comfort in providing a dental home for children with SHCNs
- Parent and caregiver satisfaction surveys of network operations and CHW effectiveness
- Utilization and effectiveness of Project ECHO telementoring sessions
- Distribution and reach of educational and informational materials
- Growth of dental home network capacity in Minnesota