Glendale Healthy Kids Give Kids a Smile Program Evaluation
Kate Karpenko
Keck School of Medicine, University of Southern California
Description of the Agency
In 1993, the community of Glendale had recognized an ongoing problem and came together in order to address it. The 3 local hospitals in the Glendale area performed a needs assessment to confirm their suspicions. At the time, there was an abundance of immigrant children, specifically that of the Armenian population, entering the school system with no health insurance, vaccinations, or physicals and were mainly receiving their primary care from school nurses and the emergency rooms of local Glendale hospitals. The hospitals each pitched a certain amount and Glendale Healthy Kids was born to provide referrals and educational services to children who are either under-insured or have no insurance within the Glendale Unified School District at low or no cost to them. The president and the CEO of the organization, Lynda Burlison, was a school nurse who has been a part of the organization from the very start. She’s also one of the individuals who has seen the rising issue first hand and is determined in making a difference in the Glendale area among the youths.
The Give Kids a Smile Program within the organization works on improving and ensuring that children have good dental hygiene. The 5 key functions of organization are implemented for the success of the program. The staff work to refer, educate, facilitate, access, and provide services for the participants. Glendale Healthy Kids is able to refer the children to physicians in the area who have volunteered their time to provide the services at no or low costs. They are able to educate with the help of health educators who come to schools and educate the families as well as the kids through activities. The organization is able to facilitate through the screen and clean clinics, such as that of the USC Mobile clinic, where graduate student volunteers from the dental school come out to the elementary schools to provide services and notify individuals of whether they need to schedule an appointment to see a dentist/orthodontist/endodontist.
The organization constantly strives towards ensuring that all children have access to health care and health education and are able to accomplish it by providing over 400 referrals to health care physicians a year, educating over 2600 1st graders on dental hygiene, and educating parents and childcare professionals. With their help, the pupils in Glendale Unified are finally able to receive the services they otherwise wouldn’t be able to acquire.
Description of the Public Health Problem/Literature Review
Every day around the world, the quality of life and overall health in children is being compromised by their access to health care and poor oral health, yet policy regarding health insurance in many countries is sub-optimal, leaving many individuals without sufficient care. The number of underinsured and uninsured children is troubling. They are the ones that are most affected by changes in insurance policy, which is becoming a larger issue in the United States. While uninsurance is a prevalent issue on its own, a recent study chose to address another important issue – underinsurance. Kogan et al. assessed the health insurance state of over 90,000 children in the United States to conclude that there is a large number of U.S. children and adolescents that do have full-year insurance coverage who have great difficulty acquiring the needed care. This implies that the problems faced by individuals who are underinsured in terms of health care quality and access are more of the same as those who are uninsured. Over 14 million, or 22.7% of children with continuous health insurance are underinsured and that number increases daily with older children, Hispanic children, and children with poor overall health being more susceptible to being uninsured. This points to a clear insurance crisis in the United States that is compromising the health of thousands of children and putting them in danger of having chronic health conditions later on in their lives.
The status of one’s oral health plays a significant role on the overall health of the individual. This has been shown through numerous studies that have linked oral health to diseases and health conditions, such as endocarditis, premature birth weights, and cardiovascular disease among others. Additionally, the effects are not only seen on the children’s health in the years to come, but instead can be observed almost immediately through the way they develop and the way they perform in schools. For instance, children with poor oral health status are three times as likely as their peers with good oral health statuses to miss school. When we take a look at the world’s children population it is estimated that dental-related illnesses, including those that are easily preventable, make up more than 51 million school hours lost. This has a direct influence on children’s performance in the classrooms and their ability to interact among their peers and strengthen their communication skills during this critical stage in their development. Yet, despite all of the data on the negative impacts of poor oral health, 1 in every 5 children age 5-11 has at least one untreated decayed tooth. This emphasizes the importance of how crucial it is to address the issue of poor oral health habits and help children gain access to the needed services in order to have a population of individuals who are less susceptible to chronic health conditions and are living the best version of their lives imaginable.
Project Aims/Purpose
Glendale Healthy Kids has a couple of Health Educators who make weekly visits to the nearby schools to educate the first-grade students about their oral health in their Give Kids a Smile program that runs through the course of the year. The purpose of this intervention is to teach children good dental hygiene practices early on and take the skills into their adult lives. Through these on-site visits, presentations, demonstrations, and activities the children are able to receive real-time presentations of dental care activities using mock-ups, giant toothbrushes, and stuffed animals with teeth/gums. The dental supplies provided to each individual are meant to remove potential barriers to maintaining good oral hygiene. By distributing these materials at events, the organization is insuring that the students have access to all the right materials to help them achieve and/or maintain good oral health.
Theoretical Foundations
Give Kids a Smile program aligns with many of the constructs of the Social Cognitive Theory, such as that of self-efficacy, knowledge, behavioral skills, social support, barriers and opportunities, and normative beliefs. Through education and practice of good oral habits as well as parent counseling on insurance plans, nutrition, and accessibility options they are building and improving the parents’ and child’s confidence. This simultaneously builds up their knowledge on the matter and emphasizes the important of good oral hygiene on their child’s overall health. With the in-class activities on how to take care of your teeth as well as hands on learning with the puppets, the children are acquiring behavioral skills that are necessary for their optimal health. Parent and child education as well as information on key resources, such as that of healthy eating and available physicians that will be able to see the child at no or low costs provides social support for many families that might feel isolated when it comes to receiving health services. With the help of referrals to dentists in the area and the free dental hygiene kits that are available to participants at the events, the barriers of maintaining good oral health can be achieved.
Methods
Give Kids a Smile Program includes several components among which the following are: at school education, free dental supplies, parent counseling, and access to dentists in the area. For the at school education portion, I worked alongside of one of the health educators, Julie, to help with the curriculum for the upcoming year. Since the start of the organization, the staff have been utilizing the same materials that they have trusted and seen to be effective, such as that of “Goofy Over Dental Health” movie and “Healthy Otter” books that discuss oral health. I was able to view the material and discuss the upcoming sessions with Julie, while giving my feedback. The supplies that are passed out are standard and were easy to distribute and package with the information. Currently, parent counseling is done only when the individuals are asked to come into the office to have a short interview and find a physician that is close to the family. There were previously sessions at school sites, however they have stopped a couple of years ago due to lack of participants. I have conducted phone interviews with many of the family members and tried counseling them as to what their next steps should be in acquiring care or getting a referral through Glendale Healthy Kids. Access to the dentists in the area is done either through the nurse’s office who sees a child that does not have health insurance complain about tooth aches, through screen and cleans where graduate students come out to see the children at their schools, or through surveys that parents fill out about their health insurance status. Once these forms were received by the office, I was able to go through them and confirm with the parents that the information they had provided was accurate, so the organization could match them with a physician in the area. These physicians were then found through an extensive log list that the organization has kept, since the very start.
Results
After my work alongside the health educators at Glendale Healthy Kids, I have realized that many of the resources are outdate and may not be suitable for the population. Adaptations might be necessary in order to obtain desirable results with the primary, secondary, and tertiary prevention practices. The movie that the program relies upon and many health educators at Glendale Healthy Kids complement, “Goofy Over Dental Health”, was made in the 1990s and comes on a VHS cassette. This does not seem appropriate. The movie itself can be as old as the parents of these first-grade students. Many of these children probably have never even heard of a VHS cassettes or tapes. Even though it does include Disney characters, there has not been quantitative data collected on this group of individuals to confirm that they will identify and see Goofy as a role model in this scenario. Since the original movie that they use in the classroom setting only comes on a VHS cassette, this may be a barrier for future programs as it is becoming harder to find a VHS player that actually works, considering that they are no longer being produced. The movie itself, created by Disney, has evolved over the years and now uses new characters, new data, and a new displaying platform – one that is easy to find nowadays compared to VHS players. The quality of the movie isn’t anywhere near as high of definition as the movies they view on the daily basis, which may lead to them being uninterested in the material and see it as untrustworthy. There are numerous other videos/movies that offer educational material that is more up to date with new findings that the organization can test out. Although the classroom sessions do show Goofy and the otters practicing healthy oral health habits, there are no identified individuals, such as that of family members, an athlete that they look up to, cartoon character that they relate to, or anything similar within the classrooms. Surveys or short interviews need to be collected before implementation of these sessions in order to be most effective.
The kids overcome a barrier with the program in that it provides them the skills and the supplies in the classroom session. However, when they go home we are not sure whether they are practicing what they have learned and if they are applying everything taught to them. Parent involvement might show drastic results in the population. While I was identifying whether each student qualifies for the free screenings and services with the physicians in the area, I had found out via phone interviews that many of these family members are not familiar with their health insurance coverage. Many of them have full coverage Medical, which includes dental services for their kids, but they were under the impression that their children do not have dental coverage. Many others were unsure as to how to find a doctor, so if Glendale Healthy Kids is able to educate the parents and send easy to read and understand insurance information home that might connect more students to providers. Lastly, the organization was using outdated physician logs to provide referrals. Many of these physicians have long retired and their office space has been occupied by different staff. Upon calling every office on the extensive list that has been used, since the 1990s, I had found that only a fraction of them were still active and were willing to provide no cost or low-cost services for the children in their area.
The participation rates for in school parent counseling could be increased if the program had included the families as a component within the intervention. Without family involvement in the program, the children are left unsupervised relying on their memory to use the skills that they have learned within the classrooms when taking care of their teeth.
Application of Results and Discussion
The Give a Kids a Smile program provides an opportunity to bridge the gap between insurance statuses and ensure that every individual has good oral health. After evaluating the materials, the staff could use the findings to create a quasi-experimental design with new learning material, such as that of using the new version of “Goofy Over Dental Health” as well as many other materials that are currently available on DVD devices that are easily found in today’s world, unlike that of working VHS players. This program could be split into the exponential and control groups and test out whether the individuals who have been using new materials are showing better oral health habits, learning faster, and are overall more knowledgeable on their oral health at the end of 8 sessions. This program could also be taken to many other grade levels and expand to schools outside of Glendale Unified, such as those in Pasadena and La Canada, since many of the doctors who have agreed to provide no cost or low-cost services have offices in those areas, but the children attending those school do not have opportunities to receive these services.
The staff within school can work closely with Glendale Healthy Kids in order to address the issue of insurance knowledge. With the help of partnerships from nearby hospitals, that the organization already has strong ties to, classroom sessions could be created for the parents, where they would be split up into groups whose members have the same insurance coverage. Within these sessions, Health Educators will discuss their coverage, how to receive services, the fees associated with the said services, and how to navigate the healthcare system. These could be classes that are offered either in the evening time, when most parents are home from work, or it could be an event that happens on the weekends, where parents would then have the opportunity to personally speak with the staff if they still need help, instead of trying to figure out the complicated health care system on their own.
The staff at Glendale Healthy Kids and school teachers can survey the family members in order to find out as to which days and times they would be able to come in for education sessions, such as the ones that are currently done during the school hours. During these sessions, members from both schools and Glendale Healthy Kids could educate the individuals on the impact their diet has on their oral and overall health, how to create healthy meals, how to read labels on packages, and have parents work with the kids during the sessions as to how to properly take care of their oral health. This will provide support, build self-efficacy, and close a barrier that the children might feel when there are no health educators in their home setting.
Additionally, Glendale Healthy Kids could work with the city of Glendale to implement new policies, such as in the case of school lunches and snacks. The current lunches can be analyzed by nutritionist and the health educators to determine whether they’re sufficient for the children’s overall health. Items with high sugars, cholesterol, and sodium could be replaced on the menu with more health friendly options. More servings of fruits and vegetables can be added to support their overall health and encourage a healthy lifestyle from an early age. The vending machines within schools that contain unhealthy snacks and beverages could also be replaced with healthy food options, so the children are not tempted and have a variety of options. With these changes, Glendale Healthy Kids could help build a healthy school environment and help address all aspects that surround poor oral health.
The results of the project could be utilized by an array of individuals in numerous sectors of the school district. If the organizations follow the suggestions and stays on top of their physicians logs more children could get screenings, serviced, and a larger population could be influenced as ever before. The organization already addresses the issue on numerous levels, however there is always room for improvement, which the organization is in need today in order to continue the work that they have been doing for almost 30 years now effectively.