DataSpeak Internet Audioconference

["]{dir="rtl"}Integrating Oral Health and Maternal and Child Health
Activities

Wednesday, September 22, 2004

2[:]{dir="rtl"} 00-3[:]{dir="rtl"} 00 []{dir="rtl"}p.m., Eastern
Daylight Time

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Michael Kogan: Good afternoon and welcome to today\'s DataSpeak
conference on integrating oral health and maternal and child health
activities. I\'m Michael Kogan. And I\'m the Director of the Office of
Data and Information Management in the Maternal and Child Health Bureau.
The DataSpeak series is sponsored through the Information Research
Center[.]{dir="rtl"}

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Today we\'re pleased to present the fourth program in the 2004 DataSpeak
series. Information about future programs in the 2004 series will be
shared, as they become available. They\'ll also be posted on the
DataSpeak Web site[.]{dir="rtl"}

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Our program today focuses on HRSA\'s efforts to promote oral health
needs in children and strategies for integrating oral health in maternal
and child health programs. We\'re fortunate to have with us several
esteemed presenters to share their experiences on this topic. Stephen
Smith, Senior Adviser to HRSA\'s Administrator will provide an overview
of HRSA\'s oral health program and the role of Title V Maternal and
Child Health Program in addressing the health needs of children and
families[.]{dir="rtl"}

We\'ll then hear from Judy Gallagher from Health Systems Research,
Incorporated about creating opportunities for collaboration between MCH
and oral health programs[.]{dir="rtl"}

Finally, we\'ll have the opportunity to hear from Dr. Jared Fine about a
collaborative oral health project he\'s established in Alameda County,
California, with the local MCH program[.]{dir="rtl"}

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It\'s now my pleasure to now introduce Beth Zimmerman, the coordinator
of DataSpeak, and the moderator for today\'s program. Beth, I\'ll now
turn the floor over to you[.]{dir="rtl"}

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Beth Zimmerman: Thank you, Michael. And welcome to all of our
participants. We\'re delighted to have everyone with us. Before we begin
our presentations, I have just a few housekeeping items to take care
of[.]{dir="rtl"}

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First, to those of you who are logged into our Internet broadcast,
you\'ll be seeing an ongoing slide show throughout the next hour. At the
end of the program, you\'ll also see a short evaluation form appear on
your screen. We\'d greatly appreciate your taking a moment to respond.
If you\'re on the phone and wish to see the slides as they\'re broadcast
over the internet, go to www.you-niversity.com forward slash w forward
slash DataSpeak, that\'s www.you-niversity.com/W/DataSpeak. And use pin
number 8285100. Again, the address is
[www.you-university.com/W/DataSpeak](http://www.you-university.com/W/DataSpeak)
using the pin number 828-5100[.]{dir="rtl"}

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Although we don\'t anticipate you\'ll have technical problems I'd like
to give you a few tips on dealing with them just in case they come up.
If you are on the web and experience any problems viewing your slides,
please call Technical Support at 1-877-867-7300. Again, that number is
1-877-867-7300 that is located in the bottom left corner of the screen
should you need it. If it appears that the slides are not advancing, you
may need to restart your browser and log back in. If you experience any
difficulty with the audio stream, you may access the audio by phone by
dialing 1-888-604-7272 and entering the password "oral health." If you
do change your audio source, you need to close your browser, log back
in, and select a new audio source to ensure proper slide
timing[.]{dir="rtl"}

Additional resources on our program topic including those that our
speakers will highlight in their presentations can be found on the
DataSpeak Web site and a link to this site is located in the resource
area in the lower left of the screen. After we hear the presentations,
we\'ll have a question-and-answer session. Those of you who are on the
phone will have an opportunity to ask questions through the operator who
will come on at that time to provide instructions as to how to do so.
Questions can also be posted online at any time during the program. If
you\'re logged in through the Internet, click the button that says \'in
writing\' at the bottom of your screen under the heading "communicate
with lecturer" and type your message and click "send." Now it is my
pleasure to introduce our first presenter, Stephen Smith, Senior Adviser
to the Administrator of the Health Resources and Services
Administration. Thank you for being here, Steve[.]{dir="rtl"}

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Stephen Smith: I\'m happy to be here today[.]{dir="rtl"}

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Beth Zimmerman: Steve, over the past few years, the Surgeon General
released two reports on oral health, those were *Oral Health in America*
and *the National Call to Action to Promote Oral Health*. Can you
highlight for us the key issues raised in each report and why they\'re
so important for our efforts to promote the public\'s oral
health[?]{dir="rtl"}

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Stephen Smith: I\'d be glad to. Let\'s start with the Surgeon General\'s
Report on Oral Health in America that came out in 2000. That report made
it clear that oral health is an essential part of general health and
that not all Americans are achieving the same degree of oral health.
It's called attention to the fact that we need to have a coordinated
effort to overcome the barriers to good oral health. Then in 2003 the
Surgeon General was a little more specific in his Call to Action. And he
identified some important steps that people who care about oral health
might want to work on to improve oral health in the country. He wanted
to change the perceptions of oral health. This report recommended that
we overcome barriers by replicating effective programs and improving
important effects. We also want to be sure that the science base is in
practice a little more quickly and that we increase the oral health work
force, the diversity capacity, and flexibility. And the Surgeon General
specifically asked that we increase collaborations among public and
private sector in order to have the greatest impact on the public\'s
health[.]{dir="rtl"}

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Beth Zimmerman: And how has HRSA responded to the Surgeon General\'s
Report[?]{dir="rtl"}

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Stephen Smith: Well, as you know, HRSA has a long history of commitment
to oral health, and we have many programs in HRSA. In fact, we have more
specific appropriation line items than any other part of the Department
of Health and Human Services. We have close to 90 programs now. And
it\'s important for us to coordinate across those programs so HRSA has
worked internally to look at the current set of programs we have to
orient ourselves towards a new statement or restatement of our oral
health mission and rethinking of what our goals and strategies should
be. And in general, we have accomplished at least a statement of HRSA\'s
oral health mission, and you\'ll see that on the slide that\'s coming
up. We hope to improve the nation\'s health by assuring access to
culturally competent, quality comprehensive health care for all as a
component of comprehensive health care. And as many of you who worked on
mission statements know, we paid attention to each of the phrases and
concepts of the mission statements[.]{dir="rtl"}

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We\'re hoping that our oral health goals will reflect our commitment to
making a difference and improving oral health. And if you see the slide
that shows HRSA\'s oral health goals, we are looking to improve the
infrastructure for oral health and hoping that will help assure the
access. We are looking to improve oral health status and outcomes in
order to eliminate those disparities that are identified in the Surgeon
General\'s report. And as we do that, we're always conscious of the
importance of a good quality of health care services for anybody who
receives health care services. And we decided to highlight as well in
our goals a specific goal on improving public-private partnerships,
again to extend the region, extend the capacity of health care system to
make a difference in improved oral health outcomes for all[.]{dir="rtl"}

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Beth Zimmerman: How does HRSA plan to go about achieving these
goals[?]{dir="rtl"}

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Stephen Smith: Well, we\'re hoping to provide some specific strategies
and objectives for our staff to follow and also that might serve as a
framework for working with our external partner. I can give you some
examples here if you look at the slide that talks about improved access.
Our 2010 objective, which by the way Healthy People 2010 goals have been
around for some time, predate the efforts on the Surgeon General report.
And we are in our mission statement not only following through on the
Surgeon General recommendations but also on the Healthy People 2010
objectives. So we now have some objectives for ourselves for HRSA, as
you look at, for example, under access. We\'re hoping to increase the
number of clinical and oral health providers serving in underserved
areas in the country. Between now and 2010, we want to increase those
numbers by 100% We want to increase the number of public health leaders
that are trained to strengthen systems of care at state and local level
and we want to increase those numbers people trained at 50%. So if you
look through the rest of those statements and the objectives for
eliminating disparities, we\'re trying to be concrete about the steps we
hope to accomplish through our program between now and 2010. In
eliminating disparities, we\'re hoping to reduce disparities basically
by improving access and by assuring we are measuring how well that
we\'re doing in measuring oral health programs across the
country[.]{dir="rtl"}

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Beth Zimmerman: Thank you for highlighting some of those objectives.
What activities or initiatives are in place or planned for addressing
these[?]{dir="rtl"}

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Stephen Smith: Well, one of the big initiatives is that part of the
five-year budget initiative the President has established in an effort
to expand community health center sites and services across the country.
We are in many new access points that\'s established as part this
expansion, we are requiring that new health centers coming online have
oral health programs as part of their new sites. We\'re also looking to
add additional oral health services in existing community health center
sites. We started the five-year budget initiative with 3,600 sites
across the country. Over five years we\'re adding 1200 sites and
hopefully adding about 6 million new patients into the health center
system. But the number of patients that are reached for oral health is
much smaller than the total of about 16 million that we\'ll be serving
by the end of 2006. Right now we\'re only a little over a million oral
health patients. So there\'s a lot of room for expansion and improvement
of services in the program[.]{dir="rtl"}

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We\'re also looking to create information sharing on best practices to
look at integrating services and setting up systems within communities
to integrate those services. We\'re looking at State oral health
collaborative system grants that promote oral health in statewide
systems of care. And we're actually taking some lead on looking at
increasing reimbursements for oral health services to the underserved
and uninsured populations living with HIV/AIDS

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If you\'ll look at the next slide, too, on our oral health activities,
you\'ll see we\'re sponsoring partnership grants between dental
education programs and community-based dental providers and working with
oral health care organizations to improve access to oral health services
in rural areas of the country. And we\'re trying to create incentive
programs to increase the work force that\'s willing to serve (in those
underserved areas of the country. As you can imagine with so many
different programs we have many fronts on which we\'re hoping to improve
oral health care[.]{dir="rtl"}

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Beth Zimmerman: Absolutely. And of the activities that you mentioned cut
across HRSA's various Offices and Bureaus we have many folks in our
audience from the maternal and child health care community. For that
reason, I was wondering if you could focus for a moment on what role MCH
plays in this process[.]{dir="rtl"}

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Stephen Smith: Certainly. We have a slide on the MCH Title V and oral
health. And they do play a critical role in achieving the MCH goals set
by HRSA. The MCH program allows us to address access to quality oral
health care for special populations, namely children, and children with
special health care needs. The MCH program supports a wide range of oral
health activities and initiatives by way of grants, contracts, and
cooperative agreements that we have with many organizations across the
country. The MCH program also supports rebuilding oral health program
and infrastructure at the federal, state, and local levels. And it
provides expertise and leadership for children in Head Start and Early
Head Start programs. That\'s the relationship we\'ve had with Head Start
for many years[.]{dir="rtl"}

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Beth Zimmerman: Our next presenters are going to talk about
opportunities for collaboration between MCH and oral health programs.
Before you move on to them, can you give us a quick overview of the
Title V MCH program for people who might not be familiar with
it[?]{dir="rtl"}

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Stephen Smith: Sure. The Title V program is the only federal program
that, as its primary focus, improving health for all mothers and
children. It emphasizes the need for building capacity at the community
level. It is looking at public and private partnerships and
collaboration and in general the program has two aspects. One is state
level funding. And the other is from special projects of regional or
national significance that may go to communities and state service
systems as opposed to just automatically going to states in a Block
Grant. The state level part of the program assures access to quality
health care and sets up systems to help prevent death, disease, and
disability. And at the federal level these special projects of regional
or national significance give us an opportunity to look at innovative
ways to improve and support community-based service
systems[.]{dir="rtl"}

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Beth Zimmerman: What happens at the state level once they proceed with
Block Grant funds[?]{dir="rtl"}

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Stephen Smith: Well, the states must match federal funds that are
provided. Every \$4 of federal funds they need to appropriate \$3 of
state funds. And that really makes us partners in this effort to conduct
comprehensive needs assessment every few years to look at prevention,
primary care for children, to look at children with special health care
needs, and to work with us in performance measures to be sure that the
state programs are moving in the right direction. Now, here we\'re
talking about broader than just oral health care, we\'re talking about
all kinds of health care for mothers and children. States use the funds
to strengthen infrastructure for public health, to promote quality care,
to integrate health care with other areas, again like Head Start program
is a good example or child care systems or schools or other areas in
which state funds might be used for collaboration. The State collects
and analyzes data on what\'s going on with the health of mothers and
children in their state and help us evaluate how the programs
work[.]{dir="rtl"}

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Beth Zimmerman: From your perspective, what can states do to support
HRSA oral health goals[?]{dir="rtl"}

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Stephen Smith: I think there\'s several opportunities for them to
support our goals. They can address oral health in their needs
assessment process. They can include oral health as part of a
comprehensive system of care, and ready to think about that in their
planning and in their funding of efforts where care for mothers and
children are addressed. States should definitely think that oral health
would be part of comprehensive primary care. And we look for the states
to develop partnerships at the state community level with oral health
professionals and professional associations to address the needs of
their states. And also to strengthen data that they collect on oral
health needs and systems to ensure that we are addressing access and
quality problems[.]{dir="rtl"}

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Beth Zimmerman: Well, thank you very much, Steve. We really appreciate
your providing us with a national overview of HRSA\'s oral health goals
and also your ideas about how states in particular can go about
achieving them[.]{dir="rtl"}

Stephen Smith: Well, you\'re welcome. I\'m glad to
participate[.]{dir="rtl"}

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Beth Zimmerman: Thank you. Your presentation leads very nicely into our
next conversation with Judy Gallagher, who is the Director of Maternal
Child and Community Health at Health Systems Research and is also a
former State MCH director of Pennsylvania. She will share her insights
on how we can create opportunities on collaboration between state MCH
and oral health programs. Thank you for being with us,
Judy[.]{dir="rtl"}

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Judy Gallagher: My pleasure[.]{dir="rtl"}

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Beth Zimmerman: Judy, what types of things should planners consider when
thinking about establishing a relationship between oral health and MCH
programs[?]{dir="rtl"}

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Judy Gallagher: I think it\'s especially useful to consider what the two
groups have in common. They can explore together how to build on these
commonalities and create new opportunities. Some of the things held in
common are goals, population groups and resources they hold individually
and can hold collectively and the issues that are faced by both
groups[.]{dir="rtl"}

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Beth Zimmerman: Can you talk a bit more about how MCH and oral health
programs complement each other[?]{dir="rtl"}

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Judy Gallagher: Basically oral health and maternal and child health are
about the same things. They\'re about health promotion, the prevention
of health problems and increasing the quality of the availability,
accessibility, and delivery of care. Oral health and MCH serve similar
population groups, children, young people, women, children with special
health care needs, and families. Each also has resources that can be
used in common. For example, maternal child health Title V mandate
focuses on all the child health care population groups, not just
low-income groups but all children. . The Block Grants, both the
Maternal and Child Health Block Grant and (inaudible) Block Grant offer
resources that can be used.. The comprehensive needs assessment that\'s
required by the Block Grant is another opportunity that\'s a resource
that was used by both groups. The Block Grants also provide flexibility
to the states as to how they can use those issues. And what I mean by
"being on the side of the angels" is really that both groups can garner
a fair amount of social capital, which is really doing good things for
children and families[.]{dir="rtl"}

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Beth Zimmerman: Let\'s follow up on the resource issue, which always is
an important one. What kinds of challenges do MCH and oral health
programs face regarding resources[?]{dir="rtl"}

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Judy Gallagher: Well, I kind of call these the "up against it" issues.
Nothing like common problems bonds us together. I think one of the
issues that both MCH and oral health are up against are the "state
budget blues." The State budgets are still in difficulty. Some states
are doing better with their financial picture, but much of that has been
related to the fact they\'ve reduced services. So oral health and MCH
people are really facing issues in their own states in terms of the
availability of funding. I think both MCH and oral health kind of suffer
from the \'nobody understands us\' syndrome. A lot of folks are confused
about what\'s included in maternal and child health and very often folks
see oral health as being just about teeth. Also because of the
difficulty in people understanding what the programs are about, it\'s
easy to get run over by other programs and "sort of issues du
jour[."]{dir="rtl"}

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Beth Zimmerman: Steve Smith mentioned earlier one of HRSA\'s health
goals is to improve the quality of health care of oral health services
for everyone. What can MCH do for this goal[?]{dir="rtl"}

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Judy Gallagher: I think this is another area of convergence of interest
of both groups. As Steve mentioned, the Maternal and Child Health Bureau
has promoted the performance measures within the Block Grant
requirements. There are now 18 national health performance measures that
all states must address. One of those is focused on oral health, which
is focused on sealants for children in elementary school. There\'s also
an opportunity for each of the states to develop their own
state-negotiated performance measures and several states have included
oral health in those performance measures. I think the effect of this
that is particularly interesting, though, is that 35 states have
identified oral health as a priority in the maternal child health Block
Grant. And I think this presents a significant opportunity for MCH and
oral health to focus on common priorities[.]{dir="rtl"}

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Another opportunity for collaboration is the five-year needs assessment
that\'s a federal requirement of all states for the Maternal and Child
Health Block Grant. That five year needs assessment will be due in July
of \'05. MCH focuses on all the maternal child health population groups.
This is a very comprehensive needs assessment, so therefore that would
include an oral health needs assessment and this is an opportunity for
the oral health folks to use the seven steps to assessment process that
was developed by ASTDD as a component of the Block Grant. There\'s an
opportunity for oral health and maternal and child health to use this
integrated assessment to drive program planning as well as resource
allocation. This is a way to make the best use of resources by directly
targeting needs within the resources that are available[.]{dir="rtl"}

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Beth Zimmerman: MCH and oral health programs clearly have a lot in
common. What can they do to achieve their shared goals[?]{dir="rtl"}

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Judy Gallagher: Well, I think this is really all about collaboration.
And, of course, it\'s easier to talk about collaboration than to do it.
Therefore we really need to think about what collaboration means and to
develop some concrete steps as to how we get this going, understanding
that collaboration doesn\'t just happen. It really requires a change in
our behaviors to get out of our rut in the way we\'ve always done things
and think about doing business differently. I think a way to help us do
that is to really consider the maternal child adolescence health system
and its components. I think if we think about what maternal child health
systems look like, it\'s easy to visualize how we can
collaborate[.]{dir="rtl"}

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So as we see on the slide, this is a model that identifies the various
components of a maternal child health adolescence health system. Looking
at this we can see multiple opportunities for collaboration between oral
health and maternal and child health. For example, around preventive
care certainly with well-child care, there\'s a goal for oral health. If
we look at the health education component, there is a role there for
maternal child health education as well as oral health and so on.
Thinking about that system, then I believe it\'s easy to identify and
work together to leverage what we have in common so that we can build on
what we share, our goals, population groups, the public health time work
that we each work within as well as taking the systems approach
improving child health including oral health. And consider what maternal
and child health and oral health can each contribute to achieving the
shared goals of healthy children[.]{dir="rtl"}

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Beth Zimmerman: Thank you so much, Judy. You\'ve really provided us with
a lot of helpful tips on how we can foster these
collaborations[.]{dir="rtl"}

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I\'d like to now turn to Dr. Jared Fine. Jared is the Dental Health
Administrator at the Alameda County Department of Public Health. He was
instrumental in establishing a successful oral health collaboration in
Alameda County[.]{dir="rtl"}

Thank you for being with us, Jared[.]{dir="rtl"}

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Jared Fine: Thank you. It\'s my pleasure[.]{dir="rtl"}

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Beth Zimmerman: Jared, can you tell us about the type of collaborative
activities that the oral health and maternal and child health programs
in Alameda county have been involved in[?]{dir="rtl"}

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Jared Fine: Yes, currently, there are three examples. We have just
completely the conduct of our first-ever countywide oral health needs
assessment of children in kindergarten and third grade. This was
conducted performing visual inspections of children throughout the
county utilizing a nationally developed assessment tool[.]{dir="rtl"}

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The second example is our school-based school dental sealant program. It
is directed to low-income children. It provides the application of
dental sealants at schools and provides assistance in linking to
insurance coverage, ongoing care, and other needed health social
services[.]{dir="rtl"}

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The third and our newest program is a demonstration program which we\'ve
entitled "Oral Health for Healthy Births" for African-American women who
are at risk for poor birth outcomes. Recent literature has motivated us
to consider the low birth associated with periodontal disease, or the
risk of poor birth poor outcomes associated with periodontal disease,
but also because of our own desire to assure that pregnant women have
access to needed dental care[.]{dir="rtl"}

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Beth Zimmerman: So did the needs assessment which is an area that has
been mentioned several times as being important provide an opportunity
for collaboration between oral health and MCH? What was your rationale
for organizing needs assessment activities at the county
level[?]{dir="rtl"}

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Jared Fine: One of our fundamental public health functions, of course,
is the assessment of both disease and health in the population as well
as assessment of the resources to address those identified needs. Prior
to this, there was no local oral health needs assessment in our county.
And we have been forced to use 10-year-old data that has been adjusted
from the statewide needs assessment. So our rationale was to generate
local, current surveillance data with which we could educate the
community and policymakers for resource planning about where to focus
our efforts for the evaluation of sealants and the extent to which they
were being made available as well as treatment programs and as well as
advocacy in overcoming disparities[.]{dir="rtl"}

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Beth Zimmerman: What was involved in conducting this county-level needs
assessment? And if you would, could you please comment a bit on what you
think it achieves[?]{dir="rtl"}

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[]{dir="rtl"}Jared Fine: Yes. We used a survey tool that Judy mentioned
that was developed by the Association of State and Territorial Dental
Directors in which we screened over 3,200 children in 33 schools using
our staff and the invaluable help of volunteer dentists, dental
hygienists from throughout the community. We achieved as a result of
that a measure of the oral health indicators for our County Health
Status Report. In addition to that we now have measures for our maternal
and child health plan at the local level of sealant utilization and
access to care as well as others. We\'re now able to compare to the
statewide needs assessment. And this was our first full-scale
implementation, so now we can plan to institutionalize the conduct of a
needs assessment in the future. Naturally, this also provides an
opportunity for us to assist individual families in accessing needed
services[.]{dir="rtl"}

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Beth Zimmerman: What was it about this partnership that you think made
it a successful collaboration[?]{dir="rtl"}

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Jared Fine: Well, there are a number of things. First of all, our
department has committed to aligning its programs and resources and
policies with health surveillance in our attempt to overcome
disparities. We could manifest resources by partnering with schools,
dental societies, community-based organizations, and families, all of
which represent longstanding relationships. Finally, we were able to
access federal financial participation matching funds through our
partnership with the maternal and child health program that could be
used for both program planning and coordination[.]{dir="rtl"}

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Beth Zimmerman: Could this needs assessment approach be brought to the
state-level of California as well as to other states and communities in
the country[?]{dir="rtl"}

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Jared Fine: I would say emphatically yes. First of all, it fulfills the
Title V mandate of conducting a comprehensive needs assessment every
five years. The Association of State and Territorial Dental Directors
survey tool is extremely user friendly. It\'s widely available and
accessible and federal financial participation funding can be accessed
in partnership with MCH for the planning, coordination, and conduct of
the assessment. As we speak, this very planning is being implemented in
California in which the natural partners have convened to conduct
California\'s next oral health needs assessment which will include the
State Office of Oral Health, the Office of Maternal and Child Health,
the local county programs, the California Dental Association, Dental
Hygiene Association, and the California nonprofit, The Dental Health
Foundation[.]{dir="rtl"}

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Beth Zimmerman: What lessons would you like to share with our audience
about integrating oral health in MCH programs for women and
children[?]{dir="rtl"}

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Jared Fine: We\'ve heard from the Surgeon General\'s Report and the
Surgeon General\'s Call to Action years ago and now more recently. Of
course, at the local level every day we get a call for help from our
clients. It seems to me that it\'s only a simple act of courage for us
to envision the opportunity and the possibility of improving the oral
health of women and children. And so we need to recognize and identify
those who share the commitment to that goal, which obviously maternal
and child health and oral health professionals do. And if we focus on
that goal and cooperate with the recognition and respect with the value
that each partner brings to that effort then I believe and I think I\'ve
experienced that the natural strategic relationships will develop and
unfold as well the necessary resources[.]{dir="rtl"}

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Beth Zimmerman: Thank you so much, Jared, for sharing your experiences
in Alameda County and also your lessons for other states and communities
that are interested in conducting collaborative activities[.]{dir="rtl"}

[]{dir="rtl"}

In a moment we\'ll open up the discussion for questions from our
audience. But before we do that, I\'d like to ask one more question of
Judy[.]{dir="rtl"}

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Judy, Jared mentioned a variety of factors that make the Alameda County
partnership a model of successful collaboration. Do you have any
additional thoughts or suggestions about how other states and
communities can foster successful collaboration between MCH and oral
health[?]{dir="rtl"}

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Judy Gallagher: I think forging collaborations requires us to think and
act differently. After all, if we want different outcomes, we have adopt
some different behaviors. There\'s an old saying that says, "if we
always do what we\'ve always done, we\'ll always get what we\'ve always
gotten." This means we need to adopt a new kind of leadership. By that I
mean we need to move away from leadership that focuses on control of
others. The leadership that facilitates change among them and an array
of partners. We need to move eye way from working in isolation to
working together and in terms of resources we need to move away from
thinking in terms of "mine" and "yours" to thinking about "ours." And in
addition in regard to resources, too, we need to consider the full range
of resources. Certainly money is important, but there are also other
resources that we can identify and mobilize and use together such as
information, political decision-making influence and access to the
population groups that we\'re concerned about. And, again, I want to
mention that collaboration doesn\'t just happen. It\'s people that make
things happen[.]{dir="rtl"}

[]{dir="rtl"}

Beth Zimmerman: Thank you, Judy and Jared for your presentations and
insights. And I want to again thank Steve Smith for providing our
overview presentation. We\'re now in the question-and-answer portion of
our program. And we have all of our presenters with us to take your
questions. As I mentioned at the beginning, we will be taking questions
both online and from our telephone participants. If you\'d like to post
a question online, click the button that says \'in writing\' on the
bottom of your screen under the heading "communicate with the lecturer"
and just type your message and click "send." Operator, could you please
tell our telephone participants how they can ask a
question[?]{dir="rtl"}

[]{dir="rtl"}

Operator: Ladies and gentlemen, if you have a question, you will need to
press the "star key" followed by "one" on your telephone. Please be
aware that your question also be taken in the order they are received.
If your question has already been answered, you may remove yourself from
queue by pressing the star key followed by two[.]{dir="rtl"}

[]{dir="rtl"}

Beth Zimmerman: Thank you. While we\'re waiting for our telephone
audience to line up with their questions, I have one from a member of
our Internet audience. And this one is appropriate for
Jared[.]{dir="rtl"}

[]{dir="rtl"}

Jared, the question asked if you could please describe the oral health
for healthy births project that you have in Alameda in a little bit more
detail[.]{dir="rtl"}

[]{dir="rtl"}

Jared Fine: Yeah, I would like to describe that. This project was
motivated by our interest in the recent research about the correlation
between periodontal disease and poor birth outcomes. I approached our
Health Director with this preliminary research and compressed my own
reticence because it was early research. However, she pointed out to me
that irrespective of what the weight of research shows over time, the
fact that is pregnant women do require dental care, and we should do
what we could to increase access to dental services. So the thrust of
the program is both educating the dental community both the public and
the private sector about dental care for pregnant women and the recent
literature around periodontal disease and birth outcomes. And also
measuring the periodontal conditions that the dentist would be
diagnosing when they are referred in the program. We partnered with the
maternal and child health program in California known as the Black
Infant Health Program, which has a case management component, and the
case managers, who are in contact with each of the clients on a monthly
basis, will be doing a level of health education and will be referring
the individual clients into the dentists with whom we are developing a
very tight relationship[.]{dir="rtl"}

[]{dir="rtl"}

Beth Zimmerman: Jared, while you\'re at it, why don\'t you also take a
moment to describe the other project that you mentioned at the beginning
about the school-base sealant program[.]{dir="rtl"}

[]{dir="rtl"}

Jared Fine: Yeah, our dental sealant program is one that is designed to
reach children who might not otherwise have early access to dental care.
It\'s not a particularly new idea. There are many sealant programs
around the country, but through our partnership with Maternal and Child
Health, we are able to fund the staffing that organizes and coordinates
a program of bringing portable instruments and equipment into schools
that are primarily low income and that have a high number of Medicaid
children so we can provide dental sealants on site as well as refer the
children to ongoing dental care in the community and identify other
needs they may have for which we are able to provide some referral and
liaison. This is exciting in terms of our partnership with MCH because I
think it in many ways epitomizes the idea of all that is required to
organize and conduct such a community-based program and yet oral health
alone wouldn\'t have all the resources to be able to do
that[.]{dir="rtl"}

[]{dir="rtl"}

Beth Zimmerman: Thank you very much. They're all wonderful programs.
I\'m glad we have the opportunity to hear about them today as well as
the many hundreds of people we actually have on the phone with us.
We\'re glad to have everyone here[.]{dir="rtl"}

[]{dir="rtl"}

[]{dir="rtl"}Kevin, I\'d like to ask you if we have any people who are
from our telephone audience who would like to ask a
question[?]{dir="rtl"}

[]{dir="rtl"}

Operator: Our first question is from Tim Berry[.]{dir="rtl"}

[]{dir="rtl"}

Beth Zimmerman: Hi, Tim[.]{dir="rtl"}

[]{dir="rtl"}

Tim Berry: Hi there[.]{dir="rtl"}

[]{dir="rtl"}

Beth Zimmerman: Go ahead and ask your question[.]{dir="rtl"}

[]{dir="rtl"}

Tim Berry: We had a question about in some of the discussion you
mentioned that there will be a training for public health leaders to
strengthen system of care. Can you describe what that is and what the
training is and what you\'re hoping to achieve with that
training[?]{dir="rtl"}

[]{dir="rtl"}

Beth Zimmerman: Is that question directed to Steve Smith or to
Jared[?]{dir="rtl"}

[]{dir="rtl"}

Tim Berry: To Steve Smith, I believe[.]{dir="rtl"}

[]{dir="rtl"}Beth Zimmerman: Okay. Great. Steve, could you comment on
any initiatives you have related to training[?]{dir="rtl"}

[]{dir="rtl"}

Stephen Smith: HRSA supports many training activities and conferences
and that particular one, I don\'t have much in the way of details on it
other than to say it is part of our ongoing activities to try to
encourage and support training for clinical providers in the best
quality methods of delivering services[.]{dir="rtl"}

[]{dir="rtl"}

Beth Zimmerman: Okay. Thank you. Good information can be provided if we
follow up with someone in HRSA[?]{dir="rtl"}

[]{dir="rtl"}

[]{dir="rtl"}Stephen Smith: Certainly[.]{dir="rtl"}

[]{dir="rtl"}

[]{dir="rtl"}Beth Zimmerman: Okay. Thank you[.]{dir="rtl"}

[]{dir="rtl"}

Kevin, do we have anyone else on our telephone audience[?]{dir="rtl"}

[]{dir="rtl"}

Operator: Yes. Our next question is from Dr. Nilsa Toledo[.]{dir="rtl"}

[]{dir="rtl"}

Beth Zimmerman: Yes[.]{dir="rtl"}

[]{dir="rtl"}

Nilsa Toledo: Hi, I'm Nilsa Toledo and Chair of Pediatric Dentistry at
Nova Southeastern University. We are about the only dental school in the
southern part of Florida and so we are Medicaid recipients in our school
but nonetheless, we have a shortage of patients, of child patients and
we would like very much to collaborate with the community health system
in the community or whichever other and actually take care of all those
underserved.We have a large population of Hispanic patients and mothers
are not well trained or do not know about oral health care, or how to
help their children with early childhood caries[.]{dir="rtl"}

[]{dir="rtl"}

We have a high incidence as well. He we have a large Indian Native
American Indian population that is not well taken care of. And we would
like to give them services and to outreach to them. But how would we be
able to collaborate or to hook up with the system so we can have those
patients taken care of by our residents[?]{dir="rtl"}

[]{dir="rtl"}

Beth Zimmerman: Well, this is great, because usually we hear about not
enough providers for the patients. So it\'s wonderful to hear about
services that are available. And I\'d like to ask Judy to start and
perhaps Jared to follow up on. This is partnership building. This is
marketing. What tips could you offer[?]{dir="rtl"}

[]{dir="rtl"}

Judy Gallagher: Well, I think the first thing would be to think about
where are the kids and families already going? Where are they located?
Where can you go and find them? And places that come to mind would be
childcare centers in Head Start and community health centers. And you
mentioned various population groups there who may have their own
particular community centers or faith community of each of those. I
think outreach is important but I think that would clearly need to me
coupled with some education. We certainly found that oftentimes parents
of young children don\'t understand that it\'s important to get their
dental health needs met. They think that, well, their baby teeth will
fall out and so forth and so on, and don\'t really appreciate the
linkage between dental health and overall child health and well
being[.]{dir="rtl"}

[]{dir="rtl"}

This may be a place, too, to make a connection with your state and
county health MCH departments in that I\'m sure they would have entrees
into various places and programs and initiatives in the community that
could provide you with the menus. They may, in fact, even run some other
kinds of clinics ranging from health care, to family planning, and so
forth. Again, where families would be located to do some outreach and
education with the families[.]{dir="rtl"}

[]{dir="rtl"}

Nilsa Toledo: Yes. Are there any forms of applications that we could do
to partner with these MCH clinics or as Steve Smith was saying, for us
to be able to partner with them and provide the oral health care that is
not being probably provided at the--(inaudible)[.]{dir="rtl"}

[]{dir="rtl"}

Judy Gallagher: Oh, I would think so. And I think that would be the way
to go. For example, very often the children in child care, in Head
Start, the oral health needs and those providers are interested in
trying to link up their families and kids with other resources. So I\'m
sure they\'d be happy to work with you if there\'s a well-baby clinic or
a community health center that\'s providing some care, very often
they\'re just desperate to find someone to partner with to work with
them around oral health issues. So I think once you find these folks,
went to talk with them and could identify what their needs are and how
you could help them meet that needs that a marriage would be in the
moving[.]{dir="rtl"}

[]{dir="rtl"}

Nilsa Toledo: Thank you very much[.]{dir="rtl"}

[]{dir="rtl"}

Beth Zimmerman: Thank you for asking[.]{dir="rtl"}

[]{dir="rtl"}

Jared Fine: I\'m going to answer that if I may, Beth[.]{dir="rtl"}

[]{dir="rtl"}

Beth Zimmerman: Okay[.]{dir="rtl"}

[]{dir="rtl"}

Jared Fine: I would also encourage connecting with the local chapter of
the American Academy of Pediatrics[.]{dir="rtl"}

[]{dir="rtl"}

Nilsa Toledo: Actually some of our faculty are. We would like as a
School of Dentistry to be able to partner and get that benefit from HRSA
to have to be like a trainer for these group of people, of dentists in
the community[.]{dir="rtl"}

[]{dir="rtl"}

Jared Fine: Well, I see that as a natural opportunity for some training,
some grand rounds possibility and certainly well-baby visits are a
perfect avenue for referring children into the school of dentistry for
care not no mention the education of the medical community[.]{dir="rtl"}

[]{dir="rtl"}

Beth Zimmerman: At this point I\'m pleased to report I have a huge pile
of questions in front of me. To encourage people to get in touch with
the presenters after if we can\'t get to your question here or you\'d
like to engage in further discussion. And their information is on the
Web site

[]{dir="rtl"}

I have a question for Steve. Steve, somebody notes that the first
speaker, that was you, made reference to a compendium of best practices.
They\'re asking for more detail on that. Specifically, will this focus
on clinical performance service measurement or will it focus on how to
develop coalitions and other partnerships[?]{dir="rtl"}

[]{dir="rtl"}

Stephen Smith: We would be looking at both[.]{dir="rtl"}

[]{dir="rtl"}

Beth Zimmerman: At both[.]{dir="rtl"}

[]{dir="rtl"}

And do you have any details on when that will be available and how it
will be made available[?]{dir="rtl"}

[]{dir="rtl"}

Stephen Smith: That\'s an objective for us to complete in 2005. Of
course, we have in the past done some attempts to put together lists of
best practices. But we\'re trying to update that for 2005[.]{dir="rtl"}

[]{dir="rtl"}

Beth Zimmerman: Okay. We\'ll look forward to receiving
that[.]{dir="rtl"}

[]{dir="rtl"}

Jared, we have a question related to matching of Title V funds with the
federal financial participation through Medicaid. Can you expand on that
subject and how it can be used in a community-based
organization[?]{dir="rtl"}

[]{dir="rtl"}

Jared Fine: My experience is the organization needs to partner with
local government. The federal financial participation funds are made
available through both state and local government for administrative
activities with the goal of assisting Medicaid eligibles to enroll in or
take advantage of the services that are made available to Medicaid
recipients. So it would have to be a partnership with local government.
However, the matching money could be general fund dollars that are
either local or state, or it could be philanthropic funds as long as
they\'re not federal matching dollars, that matching requirement could
be met[.]{dir="rtl"}

[]{dir="rtl"}

Beth Zimmerman: Thank you[.]{dir="rtl"}

[]{dir="rtl"}

Jared let me ask you for some more detail on your oral health program
for pregnant women. We\'ve had a variety of questions about that. Two of
those are what specific services are you going to be providing for
pregnant women? And how is it financially sustained[?]{dir="rtl"}

[]{dir="rtl"}

Jared Fine: The program is based as a demonstration a pilot for those
women who are already on the California Medicaid program. So the scope
of benefits are those that are covered by the benefits in the Medicaid
program in California. The coordination of the program, however, is a
combination of matching funds from the Office of Dental Health, my
program, and again these federal financial participation funds that come
through the local maternal and child health program. The case management
component that I mentioned is completely funded by maternal and child
health here at the local level and it\'s a California-wide program known
as Black Infant Health[.]{dir="rtl"}

[]{dir="rtl"}

Beth Zimmerman: Thank you very much[.]{dir="rtl"}

[]{dir="rtl"}

Some questions here relate to Head Start programs, which are obviously a
very important vehicle for reaching children who are in need of oral
health services. And this question is asking for some general tips that
you might be able to give to Early Head Start and Head Start programs
that would allow them to immediately begin addressing the issue of
access to oral health services, which we know can be difficult to
achieve sometimes[.]{dir="rtl"}

[]{dir="rtl"}

[]{dir="rtl"}Jared, would you like to start[?]{dir="rtl"}

[]{dir="rtl"}

[]{dir="rtl"}Jared Fine: Well, I think one of the things that Judy
mentioned is in everyone\'s favor, and that is that Head Start has an
obligation to assure that children coming into the program have had an
oral health assessment and hopefully all of their dental treatment needs
are achieved. So there\'s an opportunity there for a natural partnership
between possibly the local public health department or a variety of
other groups that might be committed to and could come to the table to
organize services for the head start program[.]{dir="rtl"}

[]{dir="rtl"}

This, of course, is a natural for the local dental society, the local
dental hygiene groups, and other nonprofits or community-based and
public health center organizations that could provide these services.
I\'m also pointing to the fact that it\'s an issue of someone taking the
leadership. It could be head start. It could be the health department.
It could be the local health center, to bring to bear the stakeholders
to get them around the table and to identify the means by which these
services can be provided[.]{dir="rtl"}

[]{dir="rtl"}

Beth Zimmerman: Great. I also want to note that the Maternal and Child
Health Bureau has been sponsoring for several years regional forums as
well as state forums around the country to bring together partners
between Head Start, MCH, WIC and all the variety of partners that are
interested in that, and there\'s information available on that on the
National Maternal and Child Oral Health Resource Center. And we can put
a link to that on the DataSpeak Web site[.]{dir="rtl"}

[]{dir="rtl"}

Question here has come in noting that dental care has been a problem
that we\'ve been dealing with for a long time and noting that our supply
of dentists is really not enough to provide care to everybody who needs
it. What might you offer in terms of strategies for addressing that
especially in terms of expanding the provider base beyond
dentists[?]{dir="rtl"}

[]{dir="rtl"}

Jared, you can start on that and then I\'d like to ask Steve Smith to
comment[.]{dir="rtl"}

[]{dir="rtl"}

Jared Fine: Well, the natural approach from a public health perspective
is that we need to go upstream with a highly preventable disease and do
what we know that works to effect a reduction in the downstream effects
of this disease. You know, the recent literature around early childhood
carries and the admonition in the medical community to assure that a
child has access to dental care by their first birthday is a good reason
from a policy standpoint as well as from a scientific standpoint for us
to be hopeful about the fact that we can manifest resources that are
outside the dental arena from in the past[.]{dir="rtl"}

[]{dir="rtl"}

The medical community, the nursing community, the child care community,
Head Start and WIC all have a part to play in the possibility of
actually turning around a disease which is chronic and progressive and
starts as soon as teeth come into an infant or toddler\'s mouth. So I
would put my efforts in that area along with all of the efforts that
communities have to decide upon that would address the treatment needs
of diseases that have already been well established. But it\'s two-fold.
It\'s not one or the other, as Judy said. If we keep doing what we\'ve
always been doing, we\'ll always get what we\'ve always gotten. We've
never been able to treat the disease. We don\'t have enough resources or
capacity. We have to go upstream and attempt to prevent it[.]{dir="rtl"}

[]{dir="rtl"}

Beth Zimmerman: And in support of that, the American Academy of
Pediatrics and the American Academy of Pediatric Dentistry, I know, have
been working together to support physicians\' abilities, specifically
pediatricians\' ability to screen babies and young children and at-risk
children to dentist at earlier ages. And more information can be found
on their Web sites[.]{dir="rtl"}

[]{dir="rtl"}

[]{dir="rtl"}I have a question that I think Judy, as the past Title V
Director, you may be able to comment on. And that is what outreach
efforts have you found to be the most effective in reaching at-risk
populations[?]{dir="rtl"}

[]{dir="rtl"}

Judy Gallagher: That depends very much on the population that you\'re
trying to reach. You need to know who they are, where they are. You need
to could some research about what they perceive as needs, as benefits,
where they\'re interested in obtaining education and information as well
as services. And then as we mentioned a moment ago with another caller,
it\'s really once you\'ve done that to go where people are that we
sometimes expect that folks are going to come to our doorstep and, in
fact, they either may not know where our doorstep is and they may not
find this particularly appealing, and are also very busy. So it\'s
really important to research your targeted audiences. Who are you trying
to reach? And then go where they are and work with those folks and those
community-based organizations who may already be working with them to
find out more about what particularly resonates with them and then to do
it. We do a fair amount of work in conducting qualitative research and
in conducting focus groups. And this is the way to go into the
community, pull together some of the high-risk people you\'re interested
in, and have a focused discussion on their perceptions, their needs and
how they think are the best ways to get information and outreach and
refer information to their community[.]{dir="rtl"}

[]{dir="rtl"}

Beth Zimmerman: Thank you. We\'ve reached 3: 00, everybody. But we do
have many more questions. So I\'m going to go over just a few minutes to
give us a chance to address some of these. Kevin, do we have any folks
in our telephone audience who are waiting to ask a
question[?]{dir="rtl"}

[]{dir="rtl"}

Operator: We do[.]{dir="rtl"}

[]{dir="rtl"}

[]{dir="rtl"}Beth Zimmerman: Okay. Why don\'t we take the next
caller[.]{dir="rtl"}

[]{dir="rtl"}

Operator: Okay. Our next question is from Dr. James
Delaney[.]{dir="rtl"}

[]{dir="rtl"}

Beth Zimmerman: Hello, Dr. Delaney[.]{dir="rtl"}

[]{dir="rtl"}

[]{dir="rtl"}James Delaney: Yes. I\'m a pediatric dentist. This is to
Judy and Jared. Part of it is regarding the prenatal care, what programs
they have. There\'s been significant research out that shows products
like XYLITOL can inhibit various processes to children when the mothers
are treated. Now, it\'s not financially supported by the associations of
dentistry yet. Do you think that\'s a possibility to be included
programs[?]{dir="rtl"}

[]{dir="rtl"}

Beth Zimmerman: Jared, do you want to start with that[?]{dir="rtl"}

[]{dir="rtl"}

Jared Fine: Yeah, I do believe that this XYLITOL is a useful approach
that should be promoted. Frankly, I\'m not certain it is a reimbursable
substance because it\'s very available over the counter. It can be
purchased in pharmacies, in gum and a number of other products are being
developed as I understand. So I don\'t necessarily see it becoming
something that is a reimbursable or prescription item[.]{dir="rtl"}

[]{dir="rtl"}

Beth Zimmerman: Is it something you\'re covering in your program for
pregnant women? Or how are you addressing it[?]{dir="rtl"}

[]{dir="rtl"}

Jared Fine: We\'re promoting it in our statewide curriculum that we are
developing that will train physicians, dentists, and nurses throughout
the state of California over the next three years. We\'re not giving it
out per se but we are including it as something we think is an important
tool when jumping to the reduction of bacterial levels[.]{dir="rtl"}

[]{dir="rtl"}

James Delaney: If I might interject one second. I know we\'re short on
time. But it\'s really not really available. Is a, and it\'s only
available in one gum significantly that I know of just from the Hershey
group. And I think the reality of the research has been shown
particularly in Europe that it will reduce caries for the five years of
children\'s life which is anything cant we should look into it seriously
and make sure it is involved in our program and make it
accessible[.]{dir="rtl"}

[]{dir="rtl"}

Jared Fine: Yeah, I concur. And I\'m not an expert in the research of
its use. But we are promoting it as an adjunct that should be considered
especially someone with a high-risk history and since we know that that
there is horizontal transfer of the bacterial problem, we want to
encourage its use by --care givers[.]{dir="rtl"}

[]{dir="rtl"}

James Delaney: It has to be used three to maybe five times a day, which
a lot of people don\'t recognize \-- thank you. Very informational.
Appreciate it[.]{dir="rtl"}

[]{dir="rtl"}

Beth Zimmerman: Thank you very much for joining us[.]{dir="rtl"}

[]{dir="rtl"}

Do we have anyone else on the telephone line[?]{dir="rtl"}

[]{dir="rtl"}

Operator: I do. Our next question is from Suzanne Camden[.]{dir="rtl"}

[]{dir="rtl"}

Beth Zimmerman: Welcome, Suzanne[.]{dir="rtl"}

[]{dir="rtl"}

Suzanne Camerdeez: Is that me[?]{dir="rtl"}

[]{dir="rtl"}

Beth Zimmerman: That\'s you[.]{dir="rtl"}

[]{dir="rtl"}

Suzanne Camerdeez: It\'s Camerdeez. I\'m sorry. I\'m a dental hygienist
and I work at Children\'s Hospital in Washington, D.C. and I\'m very
interested in what\'s being said here. I have a couple of thoughts, one
you\'re talking about partnerships, and I\'m trying to partner with WIC
program here at the hospital with exactly what we\'re talking about with
birth weight as related to pregnant moms and also about early childhood
carries and how to reduce the early childhood carries. But that\'s
Agriculture Department and I know HRSA is something different. There's
no mention of WIC. I don\'t know what\'s being done, because there\'s
really nothing here in Washington, D.C., that I can see that we\'re
actually doing something with the WIC program along with trying to
improve the birth weight of the babies from the WIC moms and also
educate them about early childhood carries. I know California is very
active, proactive in many of these areas. But are there any thoughts
about what\'s going on with WIC along with HRSA along with maternal and
childcare[?]{dir="rtl"}

[]{dir="rtl"}

Beth Zimmerman: That\'s probably best directed to you,
Steve[.]{dir="rtl"}

[]{dir="rtl"}

Stephen Smith: I\'d be glad to take that question[.]{dir="rtl"}

[]{dir="rtl"}

Beth Zimmerman: Thank you[.]{dir="rtl"}

[]{dir="rtl"}

Stephen Smith: Because there\'s actually another program in addition to
WIC I\'d like to mention which is the Healthy Start program. And it\'s
funded by HRSA. And it\'s aimed at providing reaching out, finding
pregnant women who need to get into prenatal care, and it\'s a real
focus on health literacy for those moms in addition to getting them into
care to getting them to learn more about things they can do to improve
their own health and the health of their newborn babies. And I think
that would be a good connection to talk about oral health for the
infants, do that through the Healthy Start program. We do also have
connections to the WIC program in many of our community health centers.
And while it is a Department of Agriculture program, I think many people
who work in services to low-income individuals know how to make the
connections to the WIC program. So I think that\'s another good idea to
try to use WIC as a place to do that, health education and do a little
outreach and get infants and their moms into oral health
care[.]{dir="rtl"}

[]{dir="rtl"}

Judy Gallagher: Yeah. I would agree with that. I think that the federal
agencies do best to collaborate at that level and sometimes it works
well and sometimes less well. But I think sometimes we need to start
with collaboration at the local level and simply go talk to the WIC
people. Go meet with folks involved in your local WIC programs and talk
to them about what they\'re seeing, what you\'re concerned about, and
they\'re interested certainly in the health and well being of the moms
and kids that come to WIC and you are, too, as a dental hygienist. So,
again, there seems to be a marriage there[.]{dir="rtl"}

[]{dir="rtl"}

Suzanne Camerdeez: Yeah, and the other comment I\'d like to make. I
hear, you know, you\'re talking about how we can outreach to nurses and
medical providers. But we also need to look at dental hygienists,
there\'s a transition there that needs to be looked at, because I think
we are the educators of the dental profession. And if you look at many
of our programs that have been started in other areas, it has been
dental hygiene who\'s been very instrumental in getting a lot of these
educational programs up and running and even writing them
actually[.]{dir="rtl"}

[]{dir="rtl"}

Judy Gallagher: Right. That\'s true[.]{dir="rtl"}

[]{dir="rtl"}

Suzanne Camerdeez: So just a plug for us[.]{dir="rtl"}

[]{dir="rtl"}

Beth Zimmerman: Absolutely. And I know Jared, you\'ve extensively use
dental hygienists in your activities. Correct[?]{dir="rtl"}

[]{dir="rtl"}

[]{dir="rtl"}Jared Fine: Yes, we do. And I would encourage the
on-the-ground connection with WIC which has as one of its obligations
education of the clients[.]{dir="rtl"}

[]{dir="rtl"}

Suzanne Camerdeez: Yes[.]{dir="rtl"}

[]{dir="rtl"}

Jared Fine: And so there\'s a natural connection there between the
desire on your part to provide some educational information and WIC\'s
need to actually provide that service[.]{dir="rtl"}

[]{dir="rtl"}

Suzanne Camerdeez: Right. And I\'ve actually writing a grant. We\'re
waiting to hear back from Agriculture to see if we can implement some of
this into our WIC program and having it as the pilot for the D.C. area,
so I am actively working with our WIC program[.]{dir="rtl"}

[]{dir="rtl"}

Jared Fine: Great[.]{dir="rtl"}

[]{dir="rtl"}Wonderful. Thank you so much for calling in[.]{dir="rtl"}

[]{dir="rtl"}

Suzanne Camerdeez: Thank you[.]{dir="rtl"}

[]{dir="rtl"}

Beth Zimmerman: I got a message in from one of our online participants
from the American Academy of Pediatric Dentistry who would just like to
note for everyone that the American Academy of Pediatric Dentistry
Foundation is currently supporting research on the efficacy of ZYLOTOL
and it\'s being done by the University of Indiana of School of
Dentistry[.]{dir="rtl"}

[]{dir="rtl"}

I\'d like to ask one more question before we close. I think there\'s a
question important question that Judy you\'ll be able to comment on. It
comes from Family Voices, which is a well-known organization, and
they\'re asking if there are any good examples of way to include
families of collaboration and advocacies in areas of oral health beyond
the care of their own children[.]{dir="rtl"}

[]{dir="rtl"}

Judy Gallagher: I\'m not sure I understand the question[.]{dir="rtl"}

[]{dir="rtl"}

Beth Zimmerman: Well, I think perhaps you could comment on in the
process of developing systems of care and implementing systems of care
that do identify and address and prevent oral health needs, how might
families be included in that process[?]{dir="rtl"}

[]{dir="rtl"}

Judy Gallagher: Well, as a primary caregivers of their children, it\'s
the family, moms and dads and grandparents who know their children best,
and are primarily responsible for the health and well being of the kids.
Certainly makes sense, there that they\'re involved in the development
of these kinds of programs. I think in terms of maternal and child
health, many state agencies have a family advisory committee or group
set up. So this is clearly a place where families can get involved in
providing input into all kinds of maternal and child health issues and
resource allocation and, of course that would include oral health as
well[.]{dir="rtl"}

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I think since the question came from Family Voices, we should also just
make a special point of how important it is when we\'re talking about
oral health and access to dental services to always focus in on the
children with special health care needs very often have special oral
health needs and particular difficulty in accessing care. And so that\'s
another area that both the oral health people and the maternal child
health people have in common and should focus on[.]{dir="rtl"}

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Beth Zimmerman: Thank you very much, Judy. Unfortunately, we\'ve gone
beyond the time that we are allotted. And we do have to close the
discussion today, but I want to thank everyone so much for your
participation both as presenters and participants and for sending in so
many questions. And we will look through them and as appropriate post
the questions and responses to them so that will become part of the
archive, which will be available on the DataSpeak Web site in the next
few weeks[.]{dir="rtl"}

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Before you log out today, we greatly appreciate your taking a moment to
complete the feedback form that you\'ll be seeing on your screen. And if
you have any further comments that you\'d like to give us beyond what
you\'re able to say in that evaluation, please feel free to use the
function through which you send in online questions. We\'d love to have
them. Well, that is all we have for today. We look forward to having you
join future programs. The audio conference is now officially
adjourned[.]{dir="rtl"}

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