Oral health is vital to systemic health and quality of life (Kabani et al., 2018). Despite Alachua County having Florida’s only state funded dental school, rates of negative dental disease are higher than other counties (Tomar, 2018). In a 2018 annual screening of all Alachua County public school third graders, between 20-60% had untreated dental caries (Tomar, 2018). In one school, over 20% of children needed urgent care due to clinical signs of infection or toothache (Tomar, 2018).
Rates of childhood dental disease in Alachua County are alarming alone, but become more critical when compounded with Adverse Childhood Experiences (ACEs) and a systemic crisis in dental care access. Disparities in dental health are exacerbated in children facing psychosocial issues (Bright et al., 2014). Studies both internationally, and in the United States have demonstrated that children with a higher number of ACEs have a dose response risk of poor oral health in childhood and into adulthood (Bright et al., 2014).
Children’s access to dental care is strongly associated with reimbursement rates and dentist participation in Medicaid (Chalmers & Compton, 2017). When Florida’s Medicaid Program announced coverage of some adult dental services in 2019, it came at the cost of lowered reimbursement rates for children’s dental services; likewise putting Florida at one of the nation’s lowest rates of dentist participation in Medicaid (Tomar, 2018). In 2021, Alachua residents visited emergency departments 2,332 times for dental problems, a number almost double Florida’s rate (FDOH, 2021). Only 52 of these visits were not preventable, pointing to systemic barriers to routine care (FDOH, 2021).
Due to these factors, unique intervention is required to reduce heightened rates of childhood dental disease in Alachua County. Intervention must increase both access and empowerment surrounding childhood dental health. This program seeks to mitigate the effects of childhood dental disease through trauma-informed approaches.
Public Health Framework
This intervention is designed to mitigate the effects of trauma exposure on dental disease through increasing personal resilience, empowering familial supports, and improving access to dental care supplies in the built environment. This program primarily focuses on a primary and secondary prevention public health framework (Philanthropy Network Greater Philadelphia, 2016). Primary prevention in this program aims to prevent dental disease before it occurs for all children, regardless of if they have experienced ACEs. In this intervention universal protective steps include health marketing tools to increasing awareness of dental pit stop and the availability of the dental pit stop to all students at their convenience. Secondary prevention in this program hopes to reduce the impact of existing untreated dental caries observed in the first screening by preventing them from getting worse or increasing in number by the second screening. Secondary steps would include parental education and resiliency components of the dental class curriculum aimed at children facing ACEs and likewise facing a greater risk for dental disease (Bright et al., 2014). Presentation curriculum will aim to empower children who lack emotional, instrumental, or financial support to utilize the dental pit stop and build self-esteem for personal dental habits through Dr. Kenneth Ginsbug’s seven elements of individual resilience in children: confidence, connection, character, contribution, coping, and control (Feuer-Edwards, 2023). Parental education aims reduce the effects of neglect through education on the criticality of childhood dental disease, promoting communication strategies to emotionally support and teach dental habits, and raising awareness resources to navigate professional dental care, medical transportation, and copay assistance.
Levels of the Social Ecological Model
This intervention seeks to address the individual, interpersonal, and community levels of the CDC’s social ecological model (CDC, 2022). Individual health knowledge and resilience are key to building the positive health habits needed to improve dental health in childhood and maintain these health behaviors throughout adulthood (Kabani et al., 2018). By providing dental care supplies in public schools, this intervention also seeks to lower the impact of inadequate interpersonal support on the dental health of children. This could refer to children who face financial and/or emotional neglect and do not have access to dental care supplies or support in maintaining dental care habits at home. This intervention addresses the community level of the social ecological model because even if families have attempted to arrange professional dental care for their children, their access is constrained by community barriers. The goal is to foster a community where children are empowered to maintain dental health habits through personal resilience and their built interpersonal and community environment.
Trauma-Informed Principles
As a first step in approaching childhood dental disease through a trauma-informed lens, all Resilient Care staff members have received training on ACEs, community resilience, and trauma-informed principles (Philanthropy Network Greater Philadelphia, 2016; SAMHSA, 2014). These principles include safety, trustworthiness and transparency, peer support, collaboration and mutuality, empowerment, voice, and choice, and cultural, historical, and gender issues (SAMHSA, 2014). This intervention focuses on safety by placing dental pit stops in a location that can be discrete. Trustworthiness is shown through clarity in health-literacy appropriate communication materials and consistency in the availability of the dental supplies at the pit stops. Peer support is utilized through monthly rewards for bringing a friend to the dental pit stop and through parental education on communication strategies to emotionally support and instrumentally teach dental habits. Collaboration and mutuality is demonstrated through involvement of community partners in the program activities, who see first-hand the response of community members to the program. Empowerment and choice are the foundation of the resilience curriculum in the presentations, which aims to build strengths like self-worth, validate capability, and increase knowledge surrounding dental habits. Historical, cultural, and gender issues are acknowledged by making parental education materials availability in multiple languages and using inclusive language in all health communication materials. This intervention contains a midpoint quality evaluation involving community partners, in order to maintain constant attention, caring awareness, and sensitivity required for a trauma-informed approach (Philanthropy Network Greater Philadelphia, 2016).
References
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