The Georgia Health Policy Center recently spoke to Karen McCraw, the vice president of advocacy and development; Melissa Bishop, vice president of nutrition services at Family Health Council; and Fatima Batool, public health program manager, at the Family Health Council of Central Pennsylvania about the implementation of an oral health screening program with the support of Supplemental Nutrition Program for Women, Infants, and Children (WIC) nutritionists and community health workers.
To date, what has been the biggest accomplishment or win in your program?
Karen: One of the most surprising things is that this program is working exactly as we designed it, which is rare. When you design a program for a grant, you don’t always know that it’s going to work. But we have made very few changes, once we operationalized it, and we are serving far more people than we thought we would, which is a nice surprise. We all understand that we are changing the lifelong oral health outcomes for our WIC families.
Melissa: I am proud of how well we were able to integrate oral screening into the WIC service delivery model. WIC is so prescribed in the work they do too, and in the past, one of the largest challenges was getting the workflow integrated into the WIC work. But, we were able to successfully do that quickly. Also, we know that oral health needs exist even outside of these three counties, so we want to replicate it across our 11 counties and even across the state.
What is a tip or early learning that you would share with an organization launching a similar program?
Karen: One of the things we identified is the need to have very strong consortium partners. We had a long history of providing services in these communities, but this program required new partners and even cold calling. It is important to have that comfort to just start calling people and getting to know them to develop those relationships.
The other thing we learned through other programs and applied here is that if you don’t have a structured way to bring people into your program, you might not get people into your program. Just relying on staff to refer people who need oral health care is usually not going to work that well. From the get-go, we knew we needed to have a very structured process to get people in. We developed a routine screening that WIC staff do at every visit, with specific questions: When was the last time you were at the dentist? Do you have trouble paying for the dentist? Do you have dental insurance? And based on that screening, they are referring people to community health workers for assistance, as indicated. If we did not have that defined way to get people into the program, I do not think it would have been nearly as successful.
Fatima: And along the way we elicited feedback from our WIC nutritionists, from community health workers, and from our consortium partners to see if the screening is working. We wanted to know if each question was yielding the response that we need. It is a continuous improvement process to be sure we are not adding work that does not benefit individuals’ care or the program, like for data collection purposes.
How do you see participation in the Federal Office of Rural Health’s Outreach Program impacting your broader health improvement efforts?
Fatima: This program was our first experience with using community health workers. And we have identified opportunities to use community health workers to address social determinants of health in virtually all our other programs that serve central Pennsylvania, including HIV case management, the state opioid response, and family planning. We definitely want to use this model and use what we’ve learned through this program to connect clients in our other programs to services — especially those that address social determinants of health. Overall, the lessons we have learned from this program — evidence-based interventions, strong community partnerships, and client-centered care — can be applied elsewhere to make a significant impact on the health of our communities.
What will your organization be doing more of or differently to emerge stronger from the pandemic?
Melissa: What we learned through the pandemic is to be flexible and adaptable and to meet the clients with the services where they are at the time. A lot of waivers were in place that allowed us to use virtual appointments through Zoom and through the phone. We continue today to use them, and we continue to improve how we use them and even offer virtual translation services now. We are trying to engage our funders to continue those waivers because our clients like services that way. We want to continue having that flexibility so that our clients can continue to receive the services the way they want to receive them.
Karen: Our organization covers a 24-county geographic area and WIC covers 11 counties. We realized that we have a lot of flexibility when we do phone and telehealth because it does not matter as much where our staff are located. So, staff in the county over to the west of our service area can serve someone in the east of our service area. That really has given us staffing flexibility and hiring flexibility that we had not previously had when someone had a place that they had to be every day. And that is something that has impacted all our programs.