WIC: Early Intervention for Oral Health

WIC: Early Intervention for Oral Health provides a simple yet powerful solution to the problem of preventing dental disease in low income children. It brings comprehensive preventive dental services directly to vulnerable children.  It uses WIC, the Special Supplemental Nutrition Program for Women, Infants and Children, as the delivery point for the services, a place where very young children and their parents are eminently accessible. By providing dental care on site at WIC, the Program is able to provide dental care at an age when the disease can actually be prevented.

Dental caries can lead to serious consequences if left untreated. The impact of untreated decay received national attention last year when Deamonte Driver, a 12 year old child in Maryland died from a brain infection originating from an untreated cavity.  
Caries is almost entirely preventable if care starts by age one and if parents understand and practice health promoting behaviors. Unfortunately, infants and toddlers from low-income families rarely have access to a dentist. In California, only 0.7% of children under 1 on Medicaid saw a dentist during 2008.

Without early prevention, children suffer. In California, more than 70% of children have decay by third grade.  5.5% of low-income children sitting in classrooms need immediate care due to abscesses and severe decay.  If left untreated, any of these children could suffer the same fate as Deamonte.

Finding dentists to accept low-income infants and toddlers and overcoming all the barriers for getting the families to these appointments is impractical and expensive.  WIC offers a venue to efficiently bring preventive dental visits to the children.  WIC is one of the largest providers of service to at-risk children.  More than 60% of all children born in California are served by WIC in California. Parents are required to come to WIC offices for food vouchers and education. They bring their babies as well as older children.  The Program works to build partnerships between WIC centers and public health and safety net clinic dental providers who deliver their services at the WIC site.

Under the Program, dental visits are offered to parents on the days that they are already scheduled to pick up their food voucher.  Both infants and older siblings receive a dental assessment and preventive treatments.  While they might receive similar services in a dental office, the greater emphasis of this program on healthy diet and feeding practices for young children make this service integration extremely potent.  Parents are counseled about proper feeding and brushing practices, and then referred to a dental provider for follow-up care. Since most children enrolled in WIC are Medicaid eligible, dental providers can bill for this service, covering much of their costs.

Dental Visits Requirements

Dental providers and WIC agencies partner to provide oral health services at WIC.  Dental providers can include county programs, dental clinics or private practitioners.

• Work together to develop protocols for the dental visits. Dental visits can take place in the WIC site, in a dental van, or, when the WIC site is adjacent to the dental clinic, at the dental clinic. WIC will market dental visits to their clients and assist in setting up appointments. 
• Provide dental visits at one WIC site one day per week in year one and provide dental visits at a second site in year two or provide dental visits two days per week at the same site. The dental visits consist of a dental exam; risk assessment; fluoride varnish application; toothbrush prophy; and anticipatory guidance.
• Work together to develop a plan for parent education, either during the visit or in classes to  parents of children receiving dental visit
• Track number of children seen
• Ensure that children who require follow-up care are case managed into care
• Attend two collaborative meetings per year to share what information.

The Dental Health Foundation currently has three separate grants focused on providing dental visits at WIC. For each grant DHF provides:

• Technical assistance and onsite visits
• Curriculum and other program material
• Recommendations for protocols
• Two learning collaborative meetings per year
• Software for tracking progress
• Evaluation

The WIC: Building Collaboration for Oral Health was designed to increase the number of at-risk one year olds who receive preventive dental services, access early dental care and have a relationship with an identified dental provider by developing and implementing systems that will enable WIC to serve as the entry point for dental care for these children. The Project started with 2 Pilot sites involving partnerships between a WIC Agency and a dental program

•     Alameda County Public Health Department
•     Humboldt County Department of Health and Human Services

San Ysidro Health Center in San Diego, which was already providing dental visits at its WIC sites, serves as the benchmark site.
Three new Partnerships in San Diego County, Calaveras & Amador Counties and Orange County were added in the fall of 2008. Three additional partnerships will be added in the fall of 2009. All participating sites meet twice per year.

The Southern California Well Baby Dental Visits at WIC Collaborative is a two year project, funded by Kaiser Permanente Southern California, that builds upon the federally funded WIC: Building Collaborations for Oral Health.  The Project is intended to expand the number of sites in southern California that are providing “well baby dental visits” by initiating a learning collaborative that will identify and support WIC/dental provider partnerships; transfer innovations and materials between sites; and promote strategies for sustaining the efforts. There are six participating partnerships in Pomona, Riverside County, San Bernardino County, Orange County, San Diego County and Kern County.

The Los Angeles Well Baby Dental Visits at WIC Collaborative is a two year project, funded by First 5 LA that builds upon the federally funded WIC: Building Collaboration for Oral Health and the Southern California Learning Collaborative, funded by Kaiser.  The Project is intended to expand the number of Federally Qualified Health Centers (FQHCs) in Los Angeles County that are providing “well baby dental visits” by initiating a learning collaborative that will identify and support WIC/dental provider partnerships; transfer innovations and materials between sites; and promote strategies for sustaining the efforts.  Seven FQHCs will be partnered with one or more WIC sites as part of the Project.  The Community Clinic Association of Los Angeles County (CCLAC) will assist in coordinating the activities of the seven participating FQHCs.