Head Start (HS) Programs began in 1964 as a federal matching grant program. The focus of HS programs is to improve the social skills, learning skills, and health status of children who qualify.1 This program developed as part of the “War on Poverty,” which over the years, has received great bipartisan and public support.1 Because this program is federally supported, there are eligibility requirements in order to be selected to participate in this program. The U.S. Department of Health and Human Services developed The Head Start Act, which involved income eligibility and poverty guidelines.2Table 1 outlines the Head Start Family Income Guidelines.2
Federal Family Income Guidelines for 2009
2009 Poverty Guidelines for the 48 Contiguous States and the District of Columbia
Persons in Family
For families with more than 8 persons, add $3,740 for each additional person.
Once it has been determined that the eligibility requirements have been met, it is necessary to file an application. The program would then contact the individuals who are accepted.
Population Trends: Kent County has a wide assortment of races. Figure 1 below illustrates estimates of the current population.
Information taken from www.accesskent.org
Kent County comprises 16.4% of the total Michigan population.3 The majority is of Caucasian race (73.90%) while the next largest group is Hispanic (8.60%), followed by African American (8.48%). Kent County is the fourth largest in Michigan and is rapidly growing.3 Age distribution is as follows: According to the U.S. Census Bureau, 7.8% of the population is under the age of 5, 22.3% from 5-10 years of age, 14.1% 20-29, 14.0% 30-39, 15.4% from 40-49, 12.1% 50-59, and finally 14.1% were 59 years of age and older.3
Education also is an important component of the demographics of a county. The percentage of at least a high school level of education includes 84.9% of those 25 years of age or older in Kent county. 24.3% of those 25 and older have obtained a bachelors degree. 15.1% of those 25 and older have not received a high school diploma. Education often determines family income. Kent County’s average household income is $46,826 with a median income for a family averages $57,288.3 The population percentage below the standard poverty level is at 12.9% in which of the total poverty population, 36.2% are under the age of 18 and 6.80% are 65 or older.
Oral Health Status
Michigan continually ranks second highest in the country for oral health disparities and access to oral health care facilities’. One in nine children who are in the third grade also demonstrate symptoms or signs on dental infection, swelling, and pain.4The American Academy of Pediatric Dentistry and American Association of Pediatrics recommends that children be seen by a oral health professional for proper assessments and evaluations of children’s’ health during their first year of life.5 Healthy People 2010 have set objectives to reduce childhood decay through education and prevention.6
In the U.S., children with dental-related illness lose approximately 51 million school hours a year.6 Untreated dental disease in children can cause pain/dysfunction, problems concentrating, time away from school, poor appearance--all of which have a big impact on their quality of life and ability to succeed.7 If educated, parents may view oral health disease (i.e. tooth decay) as a serious enough phenomena to impede with every day health, wellness, and ability to attend school; therefore they are more likely to endorse and attend oral health education programs.8
Barriers to Care
The Center of Disease Control (CDC) is a federal agency responsible for promoting oral health through constant efforts to reach those most affected by oral health disparitites.9 The article entitled Chronic Disease Prevention and Health Promotion from the Center for Disease Control discusses’ how cost is a major deterrent to being able to access oral health care for many Americans.9 With 12.9% of Kent County being at or below what is considered the average poverty level, dental visits may not be a top priority.3 Geographic access to oral health care facilities is also a common barrier to care. Kent County offers the GO! Bus; this is a public transportation route sponsored by Kent Counties community health care, which could help improve access to health care facilities.3 The Go! Bus information will be given to the parents with children at MFR during their oral health prevention presentation in the power point outline.
There are certain populations in communities who are at an increased risk for oral disease and who experience obstacles in gaining access to oral health care. These populations include: low income families, the uninsured or underinsured, those with special needs, elderly, and minorities.6 The Surgeon General of the United States has spoken of a “silent epidemic” of oral disease which is affecting our most vulnerable citizens, particularly children living in poverty, and members of racial and ethnic minority groups.3,10 Those who are uninsured are those particularly suffering from poor oral health.6 Children who do not have insurance are also 2.5 times more likely to suffer from untreated oral disease than children who have insurance.6 Nationally, 37% of poor children aged 2 to 9 have one or more untreated decayed primary teeth, compared to 17% of non-poor children.11 These groups correspond with those involved in HS/EHS programs.
An increased chance for optimal oral health can be obtained by providing health/nutrition education and information on access to care through HS Programs. “Most Head Start children are eligible for dental care through Medicaid and its Early and Periodic Screening, Diagnosis and Treatment program or the State Children’s Health Insurance program.”12 Once screened, parents/caregivers can find out what locations in Kent County provide dental care to those with special considerations such as HS/EHS participants. This information can be found on the Michigan Dental Association website that states who accepts (or participates with) MIchild, Medicaid, or other state funded programs.13 Bilingual staff is available to accommodate those at MFR where English is not their primary language (Spanish and Vietnamese are available). In Kent County alone there are 17 Health/Dental Clinics existing.13
Stressing the importance of the link between oral health and systemic (general) health is crucial. The correlation is important to educate parents/caregivers so they are informed of the magnitude and seriousness of oral disease. Too often parents/caregivers are unaware that good oral health is essential to good overall health, and fail to recognize that oral health problems contribute to other diseases such as heart disease, diabetes and stroke, and are associated with serious problems for newborns. Yet, oral disease is preventable.10
Michigan Family Resources
Michigan Family Resources (MFR) is a Kent County, Michigan based Head Start (ages 3-4) and Early Head Start (age’s birth-3/pregnant women) Program that focuses on holistic, family-centered services in a supportive environment for children and low-income families. It is a very welcoming environment with colorful pictures on the walls and very friendly staff. There are numerous classrooms at MFR that provide an excellent learning environment for the children with educational toys, videos, etc. The focus of this program is to provide thorough education/support for a good start in life which includes comprehensive education systems and health services. Trainings for providing proper/up-to-date education and information are scheduled periodically throughout the year for staff.14 These training sessions would benefit from having new oral and systemic health information that will be provided in the Oral Health Promotion Plan. Monthly meetings are also open for parents to attend at MFR as well. These meetings are to engage parents on current issues/information regarding the health and well-being of their children. These monthly meetings would be a great opportunity to implement preventive dentistry and tooth healthy nutrition information for parents.
The learning process at MFR revolves around health, education, and parent involvement to prepare children of low income families for success in school and life. Love et al describes the basic mission of a Head Start and Early Head Start (EHS) Program as the following: “Mission is to focus on enhancing children’s development while strengthening families.”15 The Oral Health Project’s mission is to increase availability prevention information (i.e. dental decay brochures) for parents, children, and teachers involved with the HS and EHS program. MFR’s health services program manager stated one of the main objective that needs to be met is informing parents of effective oral health habits and tooth friendly nutrition so they can demonstrate this for their children, who are dependent on their care.
Those who participate in MFR are in need of increased access to services and health promotion activities to assist them in attaining and upholding oral health.14 According to the HS program manager, many of the staff and their families have limited access to oral health resources and find it challenging to promote something that they don’t value highly themselves.14 As determined by the Federal Government, 1,417 of the 1,861 children enrolled in the 2009-10 HS program were at or below the poverty level.14 Only 37 children’s families at MFR have incomes above the poverty level.
Of the 1,861 children enrolled at MFR, 1,357 of them have English as the primary language spoken at home while 445 children use Spanish as their primary language.14 Finally, race and ethnicity varies considerably at MFR. Of the total population: 838 are white, 723 are black, 241 are bi-racial, 52 identify as American Indian/Asian, and 5 are Pacific Islander. The parents of children enrolled in our programs are of similar race and cultural backgrounds. Any information to be shared would need to be available in English and Spanish. The parents educational levels, for the most part are at a high school level. They are considered to be living “in poverty.”14 If they have insurance for the children, it is Medicaid and many of them fail to maintain their Medicaid status (by not supplying needed information to DHS).14 Vulnerable populations include low income families, uninsured/underinsured, racial/ethnic minority groups, and children in poverty.6, 10 MFR exhibits the need for oral health education for disease prevention.
In addition to decay prevention strategies, effective nutrition counseling for the parents and staff will also be provided. Choosing teeth friendly foods coincides with proper oral hygiene prevention tactics to help keep the mouth healthy and disease/decay free. MFR has already planted the seed for proper nutrition by supplying healthy snack choices for the children. The Oral Health Promotion Plan will be the fertilizer to help this concept expand and grow for more awareness and education on this important topic. Choosing the right foods in one’s diet is essential for obtaining healthy teeth and a healthy body. Establishing good nutritional habits in young children can be especially beneficial for good eating patterns and food choices throughout their life time.
Having a healthy, disease free mouth is imperative to everyday life. A healthy mouth gives people the ability to: nourish the body (chew/swallow), provide good speech/communication (convey our feelings through facial expressions), smile, taste, and have confidence in how one perceives him/herself. Healthy mouths are free from pain/discomfort, therefore allowing a high quality of life. The aim of this oral health promotion program (early education/prevention) is to provide the skills necessary to avoid unnecessary pain, suffering, disease, and to help parents prioritize the need for early oral health care for children in underserved/uninsured populations in order to minimize unnecessary pain and suffering.
Early screening, risk assessment, and preventive programs in WIC, Head Start, and Early Head Start populations hold a great deal of promise for preventing dental decay in high-risk children.16 This program will provide children and adults with access to the knowledge and skills to practice a healthy, productive lifestyle. The Oral Health Promotion Plan will engage in efforts to improve community oral health to ensure high quality of life. Statistically, the average attendance percentage is 26% of all parents whose children attend MFR. Therefore, the program plan will also have gift bags with oral hygiene products as an incentive for better participation at the monthly meeting.
Program Plan and Narrative
Community Program Plan Goal
To provide information to Head Start staff and parents about the importance of regular preventive dental visits and tooth healthy nutritional foods for children.
Healthy People 2010: Oral Healthy Objectives
21-1. Reduce the proportion of children and adolescents who have dental caries experience in their primary or permanent teeth.
21-2. Reduce the proportion of children, adolescents, and adults with untreated dental decay.
21-8. Increase the proportion of children who have received dental sealants on their molar teeth.
21-10. Increase the proportion of children and adults who use the oral health care system each year.
21-12. Increase the proportion of low-income children and adolescents who received any preventive dental service during the past year.
21-13. (Developmental) Increase the proportion of school-based health centers with an oral health component.
By the end of the program, each staff member and at least 50% of the parents at MFR will have attended the Oral Health Promotion Plan lecture/demonstration.
MFR makes this a requirement for staff/educators and will have a sign in sheet for parents.
Outcome Indicators: 100% of staff will attend to gain knowledge and at least 50% of parents will attend.
There will be an AM and PM presentation available to be flexible with work/personal schedules.
Gift bags will be provided for those parents who attend for incentive to participate.
By the end of the program MFR staff and parents will demonstrate increase knowledge on oral disease prevention and tooth healthy nutrition for a healthier lifestyle for themselves and the children at MFR.
Evaluation measure: Staff and parents will be given a questionnaire regarding information on oral health and nutrition at the beginning and end of the program.
Outcome Indicators: The questionnaire collected at the end of the program will have at least 90% accuracy.
Lecture: A lesson plan will be given with specific oral health/nutrition information
Discussion: interaction with both staff/parents to find causes and solutions to problems in oral health/nutrition among MFR’s participating children
Demonstration: illustrate effective brushing/flossing technique so staff/parents are able to assist children at home/school.
Video- Dr. Oz Plaque animation
Video- Dr. Oz- Attack of the Plaque
By the end of the program MFR staff will be provided with tools and materials that will help them incorporate the information into their daily schedules.
Brochures/information packets given to staff who will sign a paper upon receiving this information.
Outcome indicators: 100% of the staff will receive a packet of information.
Print outs will be available of the power point presentation lecture given so information is readily available for review to implement into daily curriculum.
Brochures will be given as well including nutrition information, oral disease prevention strategies, etc
Smilemichigan.com-smilematters patient fact sheet
Dr. Oz- Oz Radio-children’s dental health
Open wide and Trek Inside-children’s educational material FREE from NICDR website.
Program Plan Narrative
In order for increased awareness on oral health disease prevention to take place, staff/parents need to demonstrate they comprehend the information given in the lecture and demonstration. A lecture will be given on proper oral health and nutrition choices via a power point presentation. The power point will have a stimulating presentation, which, according to Mason, will have a positive impact on the learning environment.1 There will be time allotted for discussions in issues that parents and staff feel are important to address.
Also, a large typodont (an extra large model of human teeth), will be used for demonstration on proper flossing and brushing techniques for optimal plaque removal; this reinforces proper brushing and flossing technique which ultimately will prevent accumulation, decay and disease. Another educational video will be provided from The Dr. Oz Show. This instructional media uses great visual aids and a demonstration on the effect plaque has on oral health. This visual media emphasizes the learning objective for increased awareness on oral disease and prevention.
Finally, information will be given on tooth friendly nutrition choices. Healthy food choices are a big factor in keeping teeth healthy and disease free. Parents and staff will be provided with appropriate snack/lunch food choices for the children at MFR.
The Healthy People 2010 Tookit emphasizes the importance of engaging partners. It is vital for the entire staff who works with the children at MFR attend the Oral Health Promotion Plan presentation, and at least half of the parents to make an impact. Having this participation will establish a sense of ownership for those involved to change their thought process on the importance of oral health.
Being flexible for the staff and parents is essential for participation. Therefore, providing both AM and PM presentation times for the parents will accommodate schedules, giving all who is interested the chance to participate. Electronic communication (such as email, electronic newsletters, etc), website announcements, and letters given children to take home will publicize the presentation to take place. Children already take home daily letters to their parents for topics of the day. Having a different color (other than the usual white) to grab the attention of parents will be used for the announcement of this special presentation. This may help grab the attention of parents to reach the goal of 50% participation. As for the staff, information will be given during the staff training sessions. Oral disease prevention and healthy, tooth friendly nutritional choices will be described in the special staff training session edition. The presentation will be in the lecture room for both the parents and staff to have use of multimedia for the power point presentation.
Many are influenced by incentives. Therefore, for the parents who attend, complementary gift bags will be given that include various oral hygiene products that will be discussed in the presentation.
One of the Oral Health Promotion Plan’s goals is to inform staff and parents at MFR of the seriousness and relevance of oral disease and its’ effect on the human body. Emphasizing the importance on how effective oral hygiene affects one’s general health and well-being at each stage in life in crucial. For instance, high tooth decay rates can potentially affect children’s well being by not being able to focus in school due to pain and suffering. This preventable disease can take away from children’s ability to learn. A brochure on healthy food choices and the decay process will be provided.
Low income, low education, and minority families are at an increased risk for dental disease. This program will act as an intervention providing scientific based information as guidance to promote/instill effective preventive habits into the daily lives of the staff/parents and their children. To help aid staff in accomplishing effective teach strategies, print out of the power point presentation with crucial information will be provided for each teacher. To help with student involvement, Open Wide and Trek Inside interactive educational segments will be implemented into daily schedules as well. These materials are free from the NIDCR website that include: coloring books, DVD’s, and computer based learning activities.
Factors that increase dental disease can also raise risk for systemic disease/illness. Frequent snacking on unhealthy food choices (i.e. high fructose corn syrup), increases the chance of dental decay and obesity. Counseling and education can help to effectively reduce the risk for diseases and provide a better quality of life. Therefore, once the staff and parents are educated on this topic, they will be able to provide this information to the children to reduce their risk of disease. Implementing the food pyramid guide for tooth friendly food choices will be instilled into the HS program.
Finally, prevention can lessen the economic burden of the cost for restorative dental work. Discussing the cost savings on prevention will be a great motivator. Being proactive can help prevent a potential crisis (pain from dental disease, hospitalization from an abscessed tooth, etc) rather than having to react to them.
Jennifer Smits, RDH
University of Michigan E-Learning Program
Assessment: Recognize Community Need, Identify Community Program
Implementation: Send out email/newsletter to inform parents of presentation. Notify staff.
Implement: After presentation at monthly staff meeting, give and receive post test for comparison of comprehension.
Implement: AM & PM presentation for parents
Implement: Give presentation for MFR staff
Give gift bags here!!
Evaluation: Compare pre/post tests given.
Evaluation: Discuss with MFR staff if program met goals/objectives.
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