PROMIS oral health toolkit-supported school-based oral health program

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Abstract Dental disease disproportionately affects low-income, underserved and minority children. Schools have been an effective venue for childhood health surveillance and delivery of oral health services. However, traditional surveillance methods are costly and require use of oral health professionals, which limits their ability to screen large populations of children on a periodic basis. Similar constraints also limit the extent to which dentist-based school oral health programs can be used for student populations. Thus, there is an urgent need for a more efficient, feasible and accurate oral health screening approach that can distinguish abnormal from normal oral health conditions and classify children into different levels of oral health treatment need so that they can be referred for timely and appropriate dental treatment. Building on our Oral Health PROMIS (Patient Reported Outcomes Measurement Information Systems) project, which has developed the nation’s first oral health item bank systems and initial effective oral health screening toolkits for children, we aim to establish and test a School-Based Oral Health Program (SBOHP) that includes efficient oral health screening, education, case management and referral. This novel SBOHP will (i) apply innovative Oral Health PROMIS toolkits (short form and computer adaptive testing) to efficiently and accurately identify dental problems and determine the urgency of dental treatment need; (ii) deliver effective and pertinent oral health education tailored to students’ dental treatment need urgency and parents’ health literacy levels to enhance their understanding of the importance of oral health and improve their oral health behaviors; and (iii) use school healthy start coordinators and school nurses to provide case management, referrals and follow-up with available dental hubs and treatment sources. This SBOHP will be developed and tested among students in the Los Angeles Unified School District (LAUSD), who participate in the SBOHP at baseline and 12-month follow-up, to evaluate feasibility, participation rate, efficiency, changes in oral health status, oral hygiene and diet behaviors, having or use of a dental home, and oral health status. The study will be carried out in two phases. Phase I—Preparation Phase will incorporate risk assessment into our existing case-finding-based treatment referral decision making; calibrate Oral Health PROMIS toolkits to fit conditions manifested in the LAUSD student population; validate the accuracy of OH PROMIS toolkits in identifying untreated caries and assigning students to treatment referral categories against dental examination; and develop the procedures, protocols, and documents for testing and evaluating the innovative SBOHP. Phase II—Testing and Evaluation Phase will evaluate feasibility, acceptability and efficiency of the Oral Health PROMIS assessment toolkits-supported SBOHP, and the impact of the SBOHP on children’s oral health status and care over time. The study has great potential to provide critical surveillance information and serve as a model for feasible, acceptable, efficient and sustainable school- based oral health programs for large populations of children across the country.