Strategies for improving access in a school-linked dental program

Tooth Tutor Dental Access Program (TTDAP) is an elementary school-linked dental program connecting Medicaid-eligible children without access to dental care in the last twelve months with a dental home. In Vermont, 57.7% of children receive Medicaid dental insurance and 80% of dentists accept children's Medicaid. In 2011-2012, 32 dental hygienists (Tooth Tutors) and 112 elementary schools participated in TTDAP. The Tooth Tutors' success connecting children and dentists varied. Top reasons for not accessing care included unresponsive parents (73.19%), no follow-through (17.34%), and refused assistance (6.21%). Tooth Tutors cited dentist unavailability <1% of the cases. To improve the quality of TTDAP, Vermont Department of Health (VDH) investigated reasons some Tooth Tutors had higher success rates than others. Following a quality-improvement model, VDH analyzed the percentage of students who successfully accessed care because of TTDAP. To evaluate successful strategies, VDH conducted a survey with Tooth Tutors who reported success rates over 93% in schools with low-SES populations. The strategies they employed include integration into the school community through classroom dental education and participation in school events and committees and building rapport with children, parents, and school nurses. Historically, insurance coverage and dentist availability were believed to be principal factors limiting access to dental care. Findings from the TTDAP survey suggested that these were not issues. Rather, they highlighted the importance of parental involvement in increasing access to children's dental services. Successfully linking children to dental homes depended heavily on establishing meaningful communication and rapport with families, children, and school staff.