Preventing Caries in Preschoolers: Testing a Unique Service Delivery Model in Am.

RC 3的目标是证明受过专门训练的美国印第安人（Al）社区的有效性。 口腔健康专家（COHS）为参加Head Start的儿童提供龋齿预防计划 在西南部的一个大型Al保留地上的节目。该项目的具体目标是：1）开发一个 由COHS提供的龋齿预防计划的手动干预协议; 2）实施和 评估COHS提供的口腔健康促进和氟化物项目的可行性和可接受性 清漆（FV），以及由牙科助理提供的更传统的FV程序;和3）比较 两个项目的次要结果（龋齿模式，成本效益，分散效应）， 以及可能影响结果的潜在主持人和调解人确定的任何差异。 整个保留地社区的开端中心（N=32）将被随机分配到其中一个 程序条件。COHS条件与VAR条件的主要区别在于，活动将 包括积极主动地与儿童及其父母合作，开展有效家庭口腔保健 行为，以及社区教育活动。每季度将在两个区域提供氟化物清漆。 程序.儿童将被随访两年，由校准的牙科医生进行龋齿评估， 基线、1年和2年。COHS培训协议的内容最初是在 一项在北方平原保留地实施的试点研究将进行审查和修订， 社区投入。这项研究提供了一个保守的评估COHS的方法，这是设计 克服文化障碍对获得既定牙科保健服务的阻力， 更广泛地提供预防服务。而不是比较COHS模型与标准，更高 成本，专业服务，我们正在与低成本供应商谁将部署在一个比较， 社区设置，提供主要由药物治疗服务（FV）组成的干预措施 已经被证明对预防龋齿有效。COHS供应商，也是低成本人员，将提供FV， 那么，中心研究问题是， 由一个明确认同社区的人提供的晋升会产生更大的效果 比低成本的药物预防计划更能降低龋齿发病率。随着问题的继续 提出了关于农村和其他服务不足环境中人口的新交付模式，这项研究将 提供关于预防专家在4周方案中接受培训的模式的重要信息， 改善学龄前儿童的口腔健康。预计本研究将被告知， 由RC 1的早期结果进一步塑造。

The goal Of RC3 is to demonstrate the effectiveness of specially trained American Indian (Al) Community Oral Health Specialists (COHS) for delivering a caries prevention program to children enrolled in Head Start programs on a large Al reservation in the Southwest. The specific aims of the project are: 1) to develop a manualized intervention protocol for a caries prevention program delivered by COHS; 2) to implement and evaluate the feasibility and acceptability of a COHS-delivered program of oral health promotion and fluoride varnish (FV), as well as a more traditional FV program delivered by dental assistants; and 3) to compare the two programs in terms of secondary outcomes (caries patterns, cost-effectiveness, dispersion effects), as well as any differences identified by potential moderators and mediators that appear to affect outcomes. Head Start Centers (N=32) in communities across the reservation will be randomly assigned to one of the program conditions. The COHS condition will differ from the VAR condition primarily in that activities will include a proactive approach to working with children and their parents to initiate effective home oral health behaviors, as well as community educational activities. Fluoride varnishes will be provided quarterly in both programs. Children will be followed for two years, with caries assessments by calibrated dental hygienists at baseline, 1 year, and 2 years. The content of the COHS training protocol, which originally was developed in a pilot study that was implemented on a Northern Plains reservation, will be reviewed and revised with community input. This study provides a conservative evaluation of the COHS approach, which is designed to overcome resistance to cultural barriers to accessing established dental care services, and to make preventive services more widely available. Rather than comparing the COHS model with standard, higher cost, professional services, we are making a comparison with low-cost providers who will be deployed in a community setting to provide an intervention that consists primarily of a pharmacotherapeutic service (FV) that has proven efficacy for caries prevention. COHS providers, also low cost personnel, will deliver FV as well, so the central research question is whether a focus on personalized and community oral health promotion provided by someone clearly identified with the community provides a significantly greater effect on caries incidence than a low-cost pharmacotherapeutic prevention program. As questions continue to be raised about new delivery models for populations in rural and other underserved settings, this study will provide important information about the model of a prevention specialist trained in a 4-week program to work for improvement in the oral health of preschool children. It is anticipated that this study will be informed and further shaped by early results from RC1.