COordinated Oral health Promotion (CO-OP) Chicago

 描述(申请人提供)：近一半的11岁及以下的儿童患有龋齿，使龋齿成为儿童最常见的慢性病之一。低收入和少数族裔儿童承担了这一负担中不成比例的一部分。在芝加哥，这些差异是显而易见的，芝加哥地区63%的三年级学生患有龋齿，其中超过一半的龋齿没有得到治疗。儿童龋齿与疼痛、更严重的感染、营养不良、语言障碍、学习成绩差、美容问题以及整体较低的生活质量有关。虽然已经开发了许多口腔健康干预措施来降低龋齿的发生率，但即使是最成功的项目对高危儿童的有效性也是有限的。提供和接受适当的预防性口腔保健涉及个人、家庭和社区层面的社会和环境因素。多层次干预措施认识到有必要同时针对这些水平，但缺乏初级预防龋齿的多层次口腔健康干预措施。协调口腔健康促进(CO-OP)芝加哥汇集了临床儿科医生和牙医、研究人员、健康心理学家和政策专家组成的团队，严格测试口腔健康促进干预措施的能力，以改善儿童和家庭的口腔健康。主要的干预措施是来自社区卫生工作者的以家庭为重点的教育和支持；这一干预措施将应用于一系列环境，以确定哪些环境或环境的组合能够产生最佳结果。UH2阶段的目标是使伙伴关系正规化，并最终确定研究设计和方案。这包括：1)进行形成性评估，以确定合作伙伴的业务、资源和需求；2)CHW培训；3)试行招聘和干预方案；4)制定最终程序手册；5)获得所有机构和社区合作伙伴的许可/合同。然后，UH3阶段在15个诊所、15个WIC地点和1520个家庭实施和评估干预措施。目标1评估以诊所为基础、以家庭为重点的CHW干预措施改善儿童口腔健康的能力；目标2评估以WIC为基础、以家庭为重点的CHW干预措施改善儿童口腔健康的能力；目标3评估以家庭为重点的家庭CHW干预措施改善儿童口腔健康的能力；以及目标4确定综合干预措施的附加值。假设是，接受基于家庭的CHW和基于诊所或基于WIC的CHW干预的参与者在12个月时将获得最佳的口腔健康结果。主要结果是儿童早期龋齿的发生率，由龋齿严重程度指数决定。研究还将使用RE-AIM框架(REACH、有效性、采用、实施、维护)来评估计划的有效性。这项研究的结果有可能影响口腔健康规划、劳动力发展和地方、州和国家层面的报销。

 DESCRIPTION (provided by applicant): Almost half of children 11 years old and younger suffer from dental caries, making caries one of the most common chronic diseases of childhood. Low income and minority children bear a disproportionate portion of this burden. In Chicago, these disparities are obvious with 63% of Chicago-area 3rd-graders having dental caries and over half of these caries are untreated. Pediatric dental caries are associated with pain, more severe infections, malnutrition, speech difficulties, poor school performance, cosmetic problems, and an overall lower quality of life. While many oral health interventions have been developed to reduce the incidence of caries, even the most successful programs have limited effectiveness in high risk children. The delivery and receipt of proper preventive oral healthcare involves social and environmental factors that operate on individual, family, and community levels. Multi-level interventions recognize the need to target these levels simultaneously but multi-level oral health interventions for the primary prevention of dental caries are lacking. COordinated Oral health Promotion (CO-OP) Chicago brings together a team of clinical pediatricians and dentists, researchers, health psychologists, and policy experts to rigorously test the ability of an oral health promotion intervention to improve child and family oral health. The primary intervention is family-focused education and support from community health workers (CHWs); this intervention will be applied in a range of settings to determine which settings, or combination of settings, result in the best outcomes. The Aim of the UH2 Phase is to formalize partnerships and finalize study design and protocol. This includes: 1) A formative assessment to determine partner operations, resources, and needs; 2) CHW training; 3) Pilot testing of recruitment and intervention protocols; 4) Creation of a final Manual of Procedures; and 5) Obtain clearances/contracts from all institutional and community partners. The UH3 Phase then implements and evaluates the intervention in 15 clinics, 15 WIC sites, and 1520 individual families. Aim 1 is to evaluate the ability of a clinic-based family-focused CHW intervention to improve child oral health; Aim 2 evaluates the ability of a WIC-based family-focused CHW intervention to improve child oral health; Aim 3 evaluates the ability of a home-based family-focused CHW intervention to improve child oral health; and Aim 4 determines the added value of combining interventions. The hypothesis is that participants receiving home-based CHWs and clinic-based or WIC-based CHW interventions will have the best oral health outcomes at 12-months. The primary outcome is incidence of early childhood caries, determined by the Caries Severity Index. The study will also employ the RE-AIM framework (Reach, Efficacy, Adoption, Implementation, Maintenance) to evaluate program effectiveness. The results of this study have the potential to influence oral health programming, workforce development, and reimbursement on the local, state, and national level.