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

RC3的目标是展示专门培训的美国印第安人(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 关于西南部一个大型Al保留地的节目。该项目的具体目标是：1)开发一种 由COHS提供的龋病预防计划的手动干预方案；2)实施和 评价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 Varish(FV)，以及由牙科助理提供的更传统的FV程序；以及3)比较 在次要结果(龋齿模式、成本效益、扩散效应)方面的两个方案，如 以及潜在主持人和调解人确定的似乎影响结果的任何差异。 保留地社区中的Head Start中心(N=32)将随机分配到以下其中一个 编程条件。COHS条件将主要不同于VAR条件，因为活动将 包括积极主动地与儿童及其父母合作，启动有效的家庭口腔健康 行为，以及社区教育活动。含氟清漆将按季度在这两个地区提供 程序。儿童将接受为期两年的跟踪调查，龋齿评估由经过校准的牙齿卫生师在 基线、1年和2年。COHS培训协议的内容，该协议最初是在 对北部平原保留地实施的试点研究将进行审查和修订 社区意见。这项研究对设计的cohs方法进行了保守的评估。 克服获得现有牙科保健服务的文化障碍，并使 更广泛地提供预防性服务。不是将Cohs模型与标准的、更高的 成本、专业服务，我们正在与低成本提供商进行比较，后者将部署在 提供主要由药物治疗服务(FV)组成的干预措施的社区环境 这已被证明对预防龋齿有效。CoHS提供商，也是低成本人员，将提供FV AS 那么，中心的研究问题是，是否关注个性化和社区口腔健康 由社区中明确认同的人提供的推广会产生明显更大的影响 对龋齿发病率的影响比低成本的药物治疗预防方案要好。因为问题仍在继续 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 提供有关接受过为期4周培训的预防专家模型的重要信息 以改善学龄前儿童的口腔健康。预计这项研究将被告知并 RC1的早期结果进一步塑造了这一趋势。

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.