Can you work on this

Oral health is the health of your mouth, including your teeth, gums, throat, and the bones around the mouth. Problems, like gum disease, may be an indication that you have oral health problems; gum diseases are infections caused by plaque, which is a sticky film of bacteria that forms on your teeth (U.S. Department of Health & Human Service, 2017).

According to the U.S. Department of Health & Human Services, oral health is essential to general health. It can show signs of nutritional deficiencies and diseases that affect the entire body that can be first detected because of oral problems (U.S. Department of Health & Human Services, 2019). Over one third of the U.S. population (100 million people) has no access to community water fluoridation (U.S. Department of Health & Human Services, 2019). Over 108million children and adults lack dental insurance, which is over 2.5 times the number who lack medical insurance (U.S. Department of Health & Human Services, 2019).

Oral health can affect someone’s quality of life. Oral health means much more than the care of just teeth alone it can affect physical health as well as someone’s health psychologically. The oral health of someone may undermine their self-image and self-esteem, and discourage social interactions, that may cause other problems like chronic stress and depression (Office of the Surgeon General, 2019). Chronic stress and depression may also interfere with vital functions such as breathing, food chewing, swallowing, and speaking (Office of the Surgeon General, 2019). Tooth loss is associated with deteriorating diet and compromised nutrition, which may exacerbate destruction of soft tissue in the mouth (Locker, 1992). This may lead to eventual poor oral hygiene and dental cavities and caries.

In the U.S., dental care coverage is an issue that is yet to be solved for most Americans (Healthy People, 2020). Dental cost is seen to be pricey and most dental care clinics are selective of the insurance coverage they accept from patients. These issues pose the biggest threats to low income individuals that are dependent on government medical insurance to get dental care. Medicare excludes the coverage of routine dental care and in many states Medicaid programs do not provide dental coverage for eligible children or adults (Institute of Medicine, 2002). Fewer that 1 in 5 Medicaid-covered children received a single dental visit in a recent year-long study period according to a report from the Surgeon General (DHHS, 2000). People of color are seen to experience a disproportionate level of oral health problems in the U.S. Children of color visit dentists and receive preventive services, such as fluoride treatments or sealants, less often than their white peers do (Griffin et al., 2014). Only 10 percent of Hispanic and Black children received any preventive service in 2009, compared with 17 percent of white children who received preventive treatment (Phipps & Ricks, 2015).The low use of dental care and preventive dental services among children at high risk for dental problems is likely to be associated with financial barriers and low oral health literacy (Griffin et al., 2014).

The financial burden of oral health problems is extensive and can be severe to the vulnerable populations. According to Sheiham (2005) treating caries in the U.S. is estimated to be $3,513 per 1,000 children, which could possibly exceed a low income family’s total health budget for children in low socioeconomic status. In a survey conducted in 2015 by American Dental Association (ADA) in Illinois it found that among respondents who had not visited a dentist or dental clinic, 64 percent cited cost as a reason (Illinois Children’s Healthcare Foundation, 2016). In addition, the Illinois Medicaid reimbursement rates are not sufficient to cover the costs of providing comprehensive oral healthcare (Illinois Children’s Healthcare Foundation, 2016).

The target population for the oral health intervention we are proposing is women and children. According to a report by CDC children ages 5-19 years old with untreated dental caries were reported as 16.9 percent, adults ages 20-44 with untreated dental caries were reported as 31.6 percent (Center for Disease and Prevent, 2017). One in four Americans adults have untreated tooth decay, this equates to almost 2.5 million in the U.S. (University of Illinois College of Dentistry, n.d). In Chicago, almost half of children 11 years and under suffer from dental caries making dental caries one of the most common chronic diseases in childhood (Benjamin, 2010). About 65 percent of third graders have cavities and more than half go untreated (University of Illinois College of Dentistry, n.d).

It would be important to deliver the interventions in underserved communities to women and children because these are areas where dental health disease is seen to be prevalent. The elevated prevalence of tooth decay among under-served children has even more negative impacts on family's quality of life given the potentially long-term impact on speech, nutrition, and school effectiveness. Hispanic and Black children ages 2- to- 8 year-olds were about twice as likely to have untreated decay (Dye et al., 2015). Severe caries in children are very serious problems as they can experience pain, discomfort, disfigurement, infections, and eating and sleep problems. Children are at higher risk of being hospitalized as well and therefore miss a lot of school days and consequently have diminished ability to learn (Sheiham, 2005). According to data collected in 2011, Black working-age adults were nearly twice as likely to have untreated decay as White working- age adults, 42 percent compared with 22 percent (Batliner et al., 2011). In women, poor oral health may also be associated with a range of health problems, such as the birth of preterm, low-birthweight babies to heart disease, diabetes, and cancer (Janket et. al, 2003).Oral disease in pregnant women and young mothers can be transmitted vertically to their offspring, perpetuating a cycle of disease (Committee on Oral Health Access to Service, 2012). Oral health problems among pregnant women follow similar disparities with respect to race, ethnicity, income, insurance, and age pregnant women are susceptible to periodontitis, loose teeth, as well as pyogenic granulomas, which is also referred to as pregnancy oral tumors (Silk et al., 2008; Steinberg et al., 2008).

Dental health problems are a public health concern because dental problems in children affect a child’s performance and health. A study carried out by the Herman Ostrow School of Dentistry at the University of Southern California reported that about 1,500 elementary and high school students from disadvantaged backgrounds in Los Angeles, California, 73 percent of these students were reported to have dental caries. The study found a correlation between these dental issues, lower grades and increased missed school days among these students (CDC, 2017).

School-based delivery sealant programs have been developed and implemented to provide sealants to children who may not receive routine dental care (CDC, 2019).Sealants prevent dental caries from developing in the pits and fissures of teeth where dental caries are most prevalent (CDC, 2019). These school sealant programs are especially important for reaching children who are at greater risk for developing cavities and are less likely to receive private dental care (CDC, 2019).This is because children who are at high risk of developing caries who have access to school-based dental sealant programs are more than twice as likely to have sealants than children without access (Siegal & Detty, 2010). The implementation of these programs target schools with a higher percentage of children eligible for free and reduced-cost lunch. This is typically done at no cost and can last 2 years (Siegal & Detty, 2010). Despite their effectiveness, few children have sealants, 32 percent of 8-year olds and 21 percent of 14-year olds were said to have sealants in the United States (Dye et al., 2007). Unfortunately, there are limitations with school based sealants. Children must return a permission slip with consent from parents. This could possibly mean that low consent rates could pose a potential barrier to low-income children receiving the sealant (Griffin et al., 2016). Low consent rates may also be associated with low oral health literacy. According to Griffin et al. (2016), low sealant prevalence is associated with low health literacy or low parental education therefore if a parent does not understand the importance of the program then they will most likely not participate in the program. School staff and teachers, who may also influence children’s participation may be unaware of the benefits of sealant programs, therefore are not able to fully explain why it is important that the children bring back their permission slip forms. (Griffin et al. 2016). Therefore accentuating the education gap in oral health throughout the United States that must be closed in order to relay important information efficiently.

There has also been research conducted that shows that fluoridate water keeps teeth strong and reduces cavities by about 25% in children and adults (Hannan & Espinoza, 2019). Community water fluoridation is the most efficient and cost-effective way to deliver fluoride to everyone in a community (Hannan & Espinoza, 2019). Community water fluoridation is the controlled addition of fluoride compound to a public water supply to achieve a concentration optimal for dental caries prevention (Hannan & Espinoza, 2019). However, there have been some concerns regarding lead in water in Chicago where community members in Chicago are not quite sure if the public water supply in Chicago is healthy enough for drinking. A report study carried out by Eng has been proven to show that some procedures repair on pipes might spike lead level for residents in Chicago (Eng, 2019). According to a study conducted by the University of North Carolina at Chapel Hill in 2017, children and adolescents who did not drink tap water were more likely than tap water drinkers to have tooth decay, but were less likely to have elevated blood lead levels (Sanders & Slade, 2017).

There are also some concerns with fluoridation in water, for example, fluoride intake through fluoridate water is uncontrollable (Auon et al., 2018). Adults and children are drinking the same amount of fluoride in the water. This may be concerning to some as water intake for adults and children is different and may affect children differently than adults (Auon et al., 2018). There is the risk that excessive fluoride intake may cause dental fluorosis (Auon et al., 2018). Dental fluorosis occurs only when fluoride is ingested in excessive amounts during the maturation stage of enamel formation in the course of tooth development therefore children should be supervised when drinking fluoridated water (Auon et al., 2018).

Oral health affects many aspects of a person’s functioning and overall health and well-being, this includes speaking, eating, and maintaining one’s appearance, self-esteem, physical comfort, activity level, and quality of life (Drum et al.,1998). Behavioral and social factors highly impact oral health. Pain management, treatment adherence, oral hygiene practices, knowledge and oral health literacy, access to healthcare and dental insurance, as well as other socioeconomic factors, are some of the many behavioral and social oral health-related issues (Martino, 2011). Effective oral health promotion calls for multiple factors to be involved in prevention, interventions, and recovery (Simpson, 2012).

Our key theory for oral health problems is based on the systemic organization, Health Inequality, relating to race, gender, class, and sexual orientation (Baciu, 2017). Which is intertwined with the following factors, unequal social, economic, environmental health factors that make up the root cause of inequality in oral health. Our investigation and intervention planning is focused on the access at the individual level, social and environmental health factors.Improving access to oral health care is a critical and necessary first step to be able to improve oral health outcomes and reduce disparities.

For every person without medical insurance, almost three people are without dental insurance (Artiga et al., 2020). Access and affordability is widely an unmet health need. In 2008, 4.6 million children did not obtain needed dental care because their families could not afford it (Institute of Medicine and National Research Council, 2011). Dental care remains as one of children’s most unmet health needs (Grant & Peters, 2016). As a repercussion of this, cavities (tooth decay) are the most common chronic health problems of children in the U.S. (Dye et al., 2007). Lack of access to oral health care may have serious consequences including progressive dental disease and costly hospital use (CHCS, n.d.). According to Healthy People 2020, there are many consequences to lack of dental insurance, one of them being wasteful emergency room visits for preventable dental conditions.

Approximately 92 percent of professionally active dentists work in private practice (ADA, 2009). About 60 percent of private practice dentists work alone (Wendling, 2010). Thirteen percent of private practice dentists are employees, and 3 percent work as independent contractors (ADA, 2009). Private practices are often located in areas that have the population to be able to support them, therefore more practices are located in urban areas and in high-income areas than in rural and low-income areas (ADA, 2009, Solomon, 2007, Wall & Brown, 2007).

Oral health literacy among the public and many health care professionals may also limit people’s ability to understand the importance of good oral health to someone’s overall health status (Institute of Medicine and National Research Council, 2011). The American Dental Association (ADA) defines oral health literacy as the degree to which individuals have the capacity to obtain, process and understand basic health information and services (ADA, n.d.). Low oral health literacy creates obstacles to be able to recognize the risks for oral diseases, as well as recognizing when it is the appropriate time to see a specialist. Poor oral health literacy is strongly associated with self-reported lower oral health status, lower dental knowledge, and fewer dental visits (IOM & NRC, 2011).

Oral health is prevalent among people, women and children of color. People of color who develop oral cavities have consistently had poorer survival than Whites. This is because the majority of people of color live in underserved neighborhoods with less access to quality education, access to good health care, fresh fruits and vegetables etc.

According to a report by Koppelman and Cohen (2016), children of color see dentists and receive preventive services, such as fluoride treatments or sealants, less often than their white peers do. For example, only 10 percent of Hispanic and black children received any preventive service in 2009, compared with 17 percent of white children. Poverty, which disproportionately affects communities of color, can create additional hurdles for children in accessing dental care. Also, only about one-third of U.S. dentists accept Medicaid which is an insurance that is mostly used by people of color (Cohen & Koppelman, 2016).

Women of color in low-income residents, suffer disproportionately from tooth decay and gum disease and are less likely to visit a dentist than urban, white, and more well-to-do American women (Kessier, 2017). This is due to the fact that some women of color and their children have government insurance and are unable to access dental care in some clinics who do not accept government insurance. These various issues that women of color and their children face is one of the reasons why this intervention is focused on on women of color and their children.

Goal 1: Increase access to dental care for mothers and their children ages 3 to 12 years old through providing dental vans at FQHCs in order to provide preventive services and dental care in underserved communities in Chicago Southside neighborhoods.

Process objective: By the end of 2021, the program will have recruited 3-5 of FQHCs in the Southside neighborhoods to participate in the mobile dental vans visits.

Outcome objective: 80% of the patient population who receive healthcare from FQHCs will increase access to preventative oral health services.

Impact objective: By the end of 2025, mother’s and their children ages 3-12 years old on the Southside of Chicago will exhibit significantly improved oral health by 25% because of increased access to oral healthcare.

Goal 2: Within 5 years between August 1, 2020 and July 31, 2025, prevent and control tooth caries that lead to cavities in children ages 3-12 years old on Chicago’s Southside neighborhoods by educating mothers who visit FQHCs on healthy food options in order to reduce intake of sugary food options and learn about the importance of fluoride through workshops conducted by the mobile dental van’s personnel (3 CHWs).

Process objective: By the end of each year, the program will deliver 200 educational workshops across FQHCs in the South Side Chicago.

Outcome objective: By the end of each year, 65% of mothers who participated in attending monthly workshops at FQHCs will decrease their sugary food intake and increase their fluoride intake.

Impact objective: Reduce tooth caries and cavities in children ages 3-12 years old by 20% on the Southside Chicago because of knowledge gained by mothers through educational programs at FQHCs.

Interventions

For our program, we will be conducting our intervention on the Southside neighborhoods of Chicago where the population is underserved and much of the population lacks access to oral health care. Oral health is an essential and integral part of people’s overall health. According to the Heartland Alliance’s, Chicago Community Oral Health Forum (CCOHF), good oral health requires a comprehensive approach to prevention that includes fluoridated water or fluoride toothpaste, regular access to professional dental care, daily routine of home dental care and a nutritious diet that is low in sugar. Our intervention plans to incorporate this kind of comprehensive approach for our target population. Researchers have found that women with periodontal disease (an infection of the gums) are at increased risk for delivering preterm low birth weight babies (Heartland Alliance, 2011).

The health assessment conducted by Heartland Alliance (2011) found there were 66 safety net dental clinics in Chicago that provide care for the underserved population. Chicago had 753,281 Medicaid enrollees, thus only one safety net clinic for 11,400 enrollees. This was further limited because many of these clinics do not provide a full range of basic dental services (Heartland Alliance, 2011). One of the interventions we are implementing is to provide access to low income and vulnerable populations on the Southside neighborhoods of Chicago specifically for mothers and children who are participants of Medicare and received services at FQHCs. This would expand the much-needed service to this vulnerable population as many of the dental clinics in Chicago have been closed down due to budgetary constraints (Health Alliance, 2011). By creating comprehensive dental services in visiting dental vans we will be able to reach both mothers and their children because even with Medicare and the establishment of safety net clinics many safety net clinics do not treat children. We believe that by providing these visiting dental vans services it would lessen the gap of those without dental care and widen the access to oral health services for this population. Public financing of dental coverage can remove the financial barrier to accessing dental care.

The participating FQHCs will have the dental vans visiting schedule and will inform patients when their visits will occur so that they remain informed. There will be 2 dental vans providing access to 19 FQHC’s throughout the Southside neighborhood on a rotating schedule monthly. The staff in each of the dental van’s will be 2 dentists, 1-2 Community Health Workers (CHW), and 1-2 student volunteers.The staff at the participating FQHCs will provide brochures to interested mothers who are patients at the FQHC. Dental van’s will provide a comprehensive dental clinica that has the same features and services as a “traditional” dental clinic, with the capability to perform X-rays, complex restorative procedures, educate on oral care, and provide routine cleanings.

The delivery of fluoride education will be conducted on the Southside of Chicago with trained Community Health Workers (CHW) to educate mothers of children ages 3-12 years old on the effects of fluoride to the teeth as well as on the different measures to get fluoride to the teeth. Before being seen by a dentist as they are filling out any required paperwork or waiting for their appointment they will be provided with a short 10 minute workshop focused on the effects of fluoride on oral health. This will be done in a separated room inside of the dental vans. Fluoride varnish will be recommended for mothers to receive during their visit to see a dentist. Mothers will be educated on different measures of how to incorporate fluoride daily such as in toothpaste and water. This will be conducted through in-person workshops provided by the dental vans personnel, Community Health Workers. Participants will receive informational pamphlets to take home with them as well.

According to the Journal of American Academy of Pediatrics, Professionally Applied Topical Fluorides (PATFs) prevent caries which it must be applied at regular intervals. PATFs include gel, foam, in-office rinse, and varnish (Hawkins et al., 2003). PATFs are safe and useful, with varnishes having the benefits of adherence to the tooth surface, decreasing probability of ingestion, and expanding time of contact between the fluoride and tooth surface. Self-administered fluorides, like dietary fluoride supplementation and fluoridated toothpaste, have proven to be effective, providing low but protracted elevation of fluoride concentrations. Caries reduction associated with self-administered fluoride supplementation ranges from 32% to 72% in the primary dentition, these are the teeth that will be lost as the permanent teeth erupt (American Academy of Pediatrics, 2008) In children and adolescents, fluoride toothpastes, mouth rinses, and gels decrease dental caries to a similar extent (American Academy of Pediatrics, 2008). Our comprehensive dental vans provide these PATFs to patients upon assessment of need, along with the educational workshops by the CHWs to provide information on what fluoride is and its important impact on oral health.

Alongside fluoride education and intervention implementation, Community Health Workers (CHW) will educate parents on the Southside of Chicago on the effects of feeding their children healthy options like fruits and vegetables. Mothers will be educated on the effect of sugary drinks and offered different measures to use to reduce children from drinking sugary drinks. Mothers will also be educated in regards to newborns and toddlers on how to reduce the risk of newborn babies and toddlers from getting cavities and caries. They will be educated to wipe babies mouths after receiving breast milk after each breastfeeding. Mothers will also be educated to use sippy cups for toddlers to avoid them sleeping with bottles while feeding them with artificial milk. All these measures addressed to parents to implement will help reduce the risk of kids having cavities and caries.

Carbonated soft drinks are strongly associated with increased Early Childhood Caries (ECC) rates (Kim & Donald, 2016). With the absence of adequate fluoride exposure the intake of other sugary beverages and foods, like fruit juice can lead to ECC. Despite anecdotal claims that fruit juices are healthy, high volumes of fruit juices increase ECC rates (Kim & Donald, 2016). Milk intake is also negatively associated with ECC (Kim & Donald, 2016). Foods associated with ECC are sweet snacks, confectionaries (e.g., candies, chocolate and toffee) and chips as well as a high snacking frequency is associated with ECC. The study also reported that children with two or more between-meal snacks per day had higher rates of ECC than children who snacked less frequently. Eating at bedtime is also associated with increased risk of ECC (Kim & Donald, 2016). The intervention we are proposing will provide mothers with the knowledge to engage in healthy nutritional habits for their children and will thus lead a lower risk for their children to develop cavities and caries.

Change Theory

Goal 1: Increase access to dental care for mothers and their children ages 3 to 12 years old through providing dental vans at Federally Qualified Health Centers (FQHCs) in order to provide preventive services and dental care in underserved communities in Chicago Southside neighborhoods.

Outcome Objective 1: By January 1, 2022, 80% of the patient population in the Southside of Chicago who receive health care from FQHCs will increase their knowledge, skills, and resources on preventative oral health care and services.

Research Question 1: Will increasing access to dental care for mothers and children on the Southside of Chicago reduce the risk of cavities and caries for children 3-12 years old at the end of this intervention?

Research Question 2: Will increasing access to dental care for mothers’ on the Southside of Chicago reduce the risk of poor oral health at the end of this intervention?

Goal 2: Within 5 years between August 1, 2020 and July 31, 2025, prevent and control tooth caries that lead to cavities in children ages 3-12 years old on Chicago’s Southside neighborhoods by educating mothers who visit FQHCs on healthy food options in order to reduce intake of sugary food options and learn about the importance of fluoride through workshops conducted by the mobile dental van’s personnel (3 CHWs).

Outcome objective 2: By the end of each year, 65% of mothers who participated in attending monthly workshops at FQHCs will decrease their sugary food intake and increase their fluoride intake.

Research Question 3: Does providing an educational intervention to mothers in the Southside neighborhoods of Chicago decrease the amount of sugar intake among children ages 3-12 years old?

Research Question 4: Does providing an educational intervention to mothers in the Southside neighborhoods of Chicago increase the amount of fluoride intake in children ages 3-12 years old?

The evaluation research design plan we will use is a quasi experimental design. A quasi-experiment is an empirical interventional study used to estimate the causal impact of an intervention on the target population without random assignment (Trochim, 2020). The research design is appropriate for the intervention and the target population because this design is very helpful to evaluate the benefits of specific interventions that are used and is also the best approach to use for the people on the South Side of Chicago because considering the fact that there is little or no knowledge of how to navigate around mother’s in this community. The use of different approaches to offer intervention and evaluating to see which specific approach works well for the intervention will be of great benefit in the intervention.

This evaluation design is appropriate for the target population because it allows for the investigators to see if the intervention has a lasting effect and can provide valuable information about long term impacts that might be needed to aid in making the intervention successful for the people of the South Side of Chicago. Our target population are the mothers, children, and parents in neighborhoods in the South Side of Chicago who are often an underserved population. This kind of research design is simple and does not impose additional work for the participants. This design is also helpful in relaxing some of the key requirements of a true experiment, making them more practical to implement in many cases but also reducing the strength of the causal claims that can be made.

We decided to conduct a convenience sampling strategy which would best fit our intervention. This kind of non-probability sampling method relies on data collection from the population members who are conveniently available to participate in the program. Recruitment of participants will be conducted at the participating FQHC’s. Participants would be approached by the program personnel if they are interested in the oral health education workshops as well as approached by medical staff if they would be willing to participate in the oral health care intervention.According to Jager et al. (2017) the key advantages of convenience sampling are that it is inexpensive, efficient, and simple to implement. Convenience sampling will help gather useful data and information that would otherwise be very difficult and would require more access to the population than what is available.

An appropriate sample size for this intervention is a sample size of 300 participants to be recruited a year. The population of the South side neighborhoods of Chicago is about 752,496 according to the U.S. Census Bureau (2008). There are approximately 19 FQHC’s in these neighborhoods as well (Chicago’s Primary Care Community Health Centers, 2014). Given the large population size and the number of FQHC’s in the neighborhoods we believe that this number is achievable for the intervention purposed. With the sample size of 300 participants, the investigators can collect a large enough sample to have enough statistical data to detect a meaningful affect.

Before the program begins a pre-test will be conducted by mothers of children who will participate in the oral health education workshops. The post-test will be conducted during their routine visit at FQHC. The pre-test will have the the following questions:

1. How many times a day are your children brushing their teeth?

2. How many times a day do you (mother/father) brush your teeth?

3. What kind of food do the parents provide their children to eat?

4. Does the family have dental insurance?

5. How often do parents visit the dental clinics with their children?

The data collected from these pre-test questionnaires will inform the stakeholder’s and program manager on understanding the community needs, as well as identifying good intervention services for meeting the needs of the people on the South Side of Chicago.

A post-test will be conducted once the participant decides they no longer want to participate in the program. It may be conducted at any point during the intervention. Mothers in the South Side of Chicago will be asked the following questions in a post-test questionnaire:

1. Do mother’s feel they have benefited in the intervention program that has been going on for the past three years?

2. Do mothers have any concerns or need more clarity about the intervention that has been offered to them in the intervention program?

The data will be collected through the course of the dental van outreach intervention through a questionnaire survey at the end of each dental van outreach visit. The essence of this questionnaire survey is to measure the effectiveness of the program and address any problems or concerns that might have been filled out in the survey.

This survey will be provided by the CHW to each participant after the dental cleaning has been provided by a dentist, dental assistant or dental hygienist. The survey will contain questions about the dental van outreach and what participants think about the program, i.e. if they think the program has been helpful or not helpful to members of the community. Also, the survey will contain information about other resources that participants might feel will help reduce oral health problems in the community. Furthermore, the survey will contain questions like what are other aligning issues that might pose a risk factor for participants in the community to practice healthy dental behaviours.

This questionnaire survey will be very resourceful to the program manager of the intervention because based on the goals and objectives of the intervention which is to decrease the rate of dental cavities and caries for mothers and children in the South of Side of Chicago. The survey will help inform the program manager understand what works in the intervention which will help program managers to focus resources on the essential components of the program model that benefit participants of the intervention. Also, knowing "what does not work" allows program managers to improve and strengthen their service delivery models. Not knowing what is working may waste valuable time and resources in the intervention (Metz, 2007).

The outcome data will be collected, managed, and utilized at the end of each year of the program in December and it will be used to measure the effectiveness of the program intervention and address any areas that may need improvement. This will be conducted by the program manager with the help of the CHW’s. The FQHC’s will be involved as well, they will utilize the data gathered to help plan future initiatives and programming for their patient population.

Because the overall goal is to reduce the cavities and caries in children and mother’s in the Southside of Chicago, it is critical to assess the specific aims at reducing the prevalence of cavities and caries in these population groups. By assessing the data from pre-tests to post-tests, we will be able to assess the knowledge development by the program participants, compare changes in behavior over time, and decide where to allocate new resources. The oral health screening and mothers and children’s dental health outcomes will be assessed primarily through Healthy Chicago 2.0 to see if the intervention has made a difference in the Southside neighborhoods. The outcome data will help the program director document the level of success in accomplishing objectives. Monitoring and evaluation can be used to demonstrate to the stakeholders (FQHC’s and UIC School of Dentistry partnerships) the program efforts with measurable data the impact on expected outcomes and the program's efficiency. Evaluation is critical to further develop the intervention’s objectives and to measure the use of resources.The data will be shared in quarterly meetings to discuss ongoing program details, data collection and annual reports. The purpose of sharing this data with stakeholders is to continue to form strong lasting partnerships and relationships that will in turn allow for there to be sustainability in the program.

Some potential barriers that may arise when conducting intervention evaluation may be retention of participants. If participants only choose to take part in the dental vans visits once and no longer participate throughout the entirety of the program that may cause problems with retention and collecting valuable data. The completion of both pre-and post-test is necessary in order to perform program evaluation, if there are missing mother’s pre/post-tests the data will not fully capture any changes in knowledge, behaviors, and attitude about oral health and sugar reduction in foods.

These barriers may be addressed by conducting Follow- Up communications with participants, this includes sending a brief email, text, or postcard to participants to remind them of their next appointment. The Follow - Up will be conducted 6 months after their last date of participation with the program. This will be conducted and participants will be asked about their current oral health habits and if they have seen any changes in their oral health since participating in the program.This will help ensure that participant retention will be sustained.

A. Personnel: Provide employee(s) (including names for each identified position) of the applicant/recipient organization, including in-kind costs for those positions whose work is tied to the grant project.

FEDERAL REQUEST

JUSTIFICATION:Describe the role and responsibilities of each position.

(1) The Project Director will provide daily oversight of the grant and will be considered key staff.

(2) The grant coordinator will coordinate project services and project activities, including training of CHW’s, will work to support all program staff and all areas of the program

(3) The dentist will provide dental care, provide tooth decay, fill cavities, and repair fractured teeth. Dentists will diagnose and treat problems with patients' teeth, gums, and related parts of the mouth. They provide advice and instruction on taking care of the teeth and gums and on diet choices that affect oral health.

(4) The Community Health Workers will provide educational workshops to participants of the program, other duties may be assigned. They will have different salary ranges depending on experience.

B. Fringe Benefits: List all components of fringe benefits rate

FEDERAL REQUEST

JUSTIFICATION: Fringe reflects current rate for agency.

(1) FICA benefit is important for employees of the project because this will help employees have a backup plan for retirement. Fringe benefit is usually calculated at 22.12%. The fringe benefit rate for part time and full time differs. Full time employee is calculated a t7.65%

(2) Workers compensation is important for workers in the project because it provides exclusive remedy for injured employees. Like in an event where any employee of the project happens to sustain any injury of any kind at work. This compensation will cover the cost of medical expenses of the employee.

(3) Insurance compensation is important to employees of the project because it will cover medical costs for employees in the project.

C. Travel: Explain the need for all travel other than that required by this application.

FEDERAL REQUEST

JUSTIFICATION: Describe the purpose of travel and how costs were determined.

(1) Project coordinators will be involved in traveling to collaborate with other FQHC clinics for conferences that might help make the project successful.

(2) Project coordinator will engage in meetings with local leaders in the South of Chicago to ensure that the intervention is carried out successfully.

D. Equipment & Supplies: Equipment includes articles of tangible, nonexpendable, personal property having a useful life of more than one year. Supplies are materials costing less that $5,000 per unit and often having one-time use.

FEDERAL REQUEST

JUSTIFICATION: Describe the need and include an adequate justification of how each cost was estimated.

(1) Office supplies, copies and postage are needed for general operation of the project.

(2) The 2 laptop computers are needed in the two mobile dentist vans. Dentists will use these laptops connected to the FQHC’s EMR system.

(3) The 3 chromebook computers are needed for both project work and presentations at the workshops that will be provided. This will be used by the CHW’s and program director.

(4) The projector is needed for presentations and outreach workshops.

(5) Education curriculum workbooks will be used as supportive guides for the CHW’s to use throughout their educational workshop presentations.

(6) The dental care packets are needed to give to patients after their visit with the dentist at the dental vans.

All costs were based on retail values at the time the application was written.

E. Contract: A contractual arrangement to carry out a portion of the programmatic effort or for the acquisition of routine goods or services under the grant. Such arrangements may be in the form of consortium agreements or contracts. A consultant is an individual retained to provide professional advice or services for a fee. The applicant/grantee must establish written procurement policies and procedures that are consistently applied. All procurement transactions shall be conducted in a manner to provide to the maximum extent practical, open and free competition.

IF APPLICABLE, NUMBERS OF CLIENTS SHOULD BE INCLUDED IN THE COSTS.

FEDERAL REQUEST

JUSTIFICATION:Explain the need for each contractual agreement and how they relate to the overall project.

(1) Certified trainers are necessary to carry out the training for the Community Health Workers. An intensive 5 day training provided by the ADA will equip the CHW’s with the resources needed to be able to provide educational workshops to the public on oral health prevention and health food.

(2) The partnership with UIC School of Dentistry dentists will be a vital part of the intervention as they will be providing the oral care to the patients of the program at the dental vans visits. The UIC School of Dentistry dentist’s salary will be supplemented by the salary provided by UIC School of Dentistry as well as from the grant project.

(3) Evaluator is provided by an experienced individual (Ph.D. level) with expertise in oral health, research and evaluation and is knowledgeable about the target population and will report program data.

(4) The partnerships with FQHC’s will provide the program with a trusted space and recruitment methods for the intervention. The program will work with neighborhood FQHC’s to provide oral health care to mothers and children.

* Represents separate/distinct requested funds by cost category

F. Other: expenses not covered in any of the previous budget categories

FEDERAL REQUEST

JUSTIFICATION: Break down costs into cost/unit (e.g. cost/square foot, etc.). Explain the use of each item requested.

(1) Office space is included in the indirect cost rate agreement, this is because this space is very helpful in assisting the internal duties to be carried out successfully in the intervention which justifies the need for rent expenditure in the intervention.

(2) The monthly telephone costs reflect the % of effort for the personnel listed in this application for the SAMHSA project only.

(3) Dental vans will be used at various FQHC’s to promote oral health education by cleaning and checking mothers and children's teeth.

(4) Brochures will be used at various community functions (health fairs and exhibits) and will be provided at the health education workshops to participants of the program.

(5) The volunteer college students/dental students will provide assistance in the educational workshops.

TOTAL PROJECT COSTS: $1,648,611

FEDERAL REQUEST: $

* FOR REQUESTED FUTURE YEARS:

1. Please justify and explain any changes to the budget that differs from the reflected amounts reported in the 01 Year Budget Summary (for example, travel costs). If changes are due to cost of living adjustment, please also state that here.

The increase in the budget for Personnel displays a 1.5% increase to cover potential cost of living and/or merit increases to staffing positions throughout the 5 years of the program execution.

The increase in the budget for Indirect charges displays a 1% increase to cover any of the facilities and administrative costs that are not specifically identified within the budget but are necessary for the operation of the program.

The change and increase in Total Direct Charges shows a 1% increase throughout the 5 years of the program to allow for there to be room in a budget for any direct charges that were not identified specifically in the budget.

The increase in the budget of fringes displays a 1% increase to enable employees of the project see an increase in their benefit package.

The increase in the travel plan displays a 1% increase to cover traveling cost needed for the project intervention.

Table 1.

Table 2.

[1] Vega-Lopez S, Lindberg NM, Eckert GJ, Nicholson EL, Maupome G. Association of added Attesugar intake and caries-related experiences among individuals of Mexican origin. Community Dent Oral Epidemiol. 2018;00:1–9. https://doi.org/10.1111/cdoe.12378

ADA. (2009). Proceedings of the March 23–25, 2009, Access to Dental Care Summit. Chicago, IL: American Dental Association.

ADA. (n.d). Health Literacy in Dentistry. American Dental Association [website]. Retrieved from https://www.ada.org/en/public-programs/health-literacy-in-dentistry