From The Field S E P T E M B E R 2 3 , 2 0 1 3 The Role of Evaluation in Designing CHOMPERS! and Bringing Dental Care to Kids LISA PAYNE SIMON, M.P.H. Program Advisor, Health Foundation for Western and Central New York A silent epidemic, dental disease is the single most com- curricula and materials appropriate for almost any type of early mon chronic childhood disease in the United States. child care setting. Children in low-income families are especially at risk of Whereas WDSF had always directly trained preschool teach- developing dental disease, and it is much more likely to be left ers in the CFK curriculum, the Health Foundation wanted to untreated. This can result in not only pain, but also difficulty in take a different approach. To spread the CFK curriculum in eating, speaking, and learning, all of which can affect children, western and central New York in a sustainable way, the Health their chances for success in school, and the rest of their lives. Foundation used a unique “hub-and-spoke” design. Through But while the problem is widespread, almost 100 percent of this train-the-trainer model, the Health Foundation asked dental disease is completely preventable. WDSF to train “hub” organizations, which would then be In response to the clear and urgent need to improve the dental responsible for recruiting and training preschool teachers health of young children living in poverty in western and central throughout the regions. New York, the Health Foundation for Western and Central New York (Health Foundation) launched CHOMPERS! in EVALUATION IS KEY 2010. A $1.3 million, multiyear initiative, CHOMPERS! is The Health Foundation believes that conducting independent designed to improve the oral health of young children by bringing dental education, prevention, and treatment to places evaluations is important to not only inform its own work, but they already go. also to help other funders and shape overall improvements in In designing CHOMPERS! as a comprehensive approach to the field. improving dental health, the Health Foundation chose two Because the Health Foundation was taking a brand new proven strategies: approach in implementing CFK, a strong evaluation was criti- cal. The two foundations wanted to understand whether the 1. Educate children and families about good dental health “hub” model would work, and whether or not the two compo- and the importance of preventive care by implementing nents of CHOMPERS! would work together. Harder + Cavity Free Kids (CFK), a best practice oral health Company is conducting the evaluation, led by Clare Nolan. curriculum, in early childhood programs, including The evaluation report for CHOMPERS!’ first two years of Head Start. the CFK program was completed in January 2013. Data to 2. Provide restorative and preventive treatment to young inform this evaluation included interviews with the hubs, children by bringing portable dental care to children teacher surveys, and parent surveys before and after the CFK where they already gather, including preschools and intervention. community centers. This model helps safety net dental clinics develop a new, sustainable line of business; EVALUATION RESULTS: THE IMPACT OF improves access to high-quality dental services; and CAVITY FREE KIDS creates a permanent dental home for young children and their families. The evaluation found that CFK—structured as a train- the-trainer program—was well implemented. CAVITY FREE KIDS Collectively, the six hubs: Initially designed by the Washington Dental Service • trained 622 teachers, 68 percent of whom were Head Foundation (WDSF) for Washington State’s Head Start pro- Start/Early Head Start teachers, and grams, CFK has evolved over the past decade to include • reached 397 classrooms and an estimated 7,465 children. In addition to Head Start teachers, CFK hubs trained family Through the CHOMPERS! evaluation and ongoing com- advocates, home visitors, and day care providers. munication with hubs, the Health Foundation found that Hubs reported a high level of satisfaction with the CFK hubs: curriculum and with their role as regional trainers. Teachers • are still using the CFK curriculum, implementing CFK, and reported a high degree of satisfaction with the CFK curricu- training and re-training teachers as needed; lum, training, and materials. Following training, teachers reported that they felt confident and excited about bringing • are interested in expanding CFK into other communities CFK into their classrooms. Results showed that 82 percent of and into other types of child care settings; trained teachers incorporated CFK activities into their class- • want to learn strategies and tools to more effectively engage rooms at least once a week, and 81 percent used CFK with parents and conduct outreach to public schools, physicians, parents at least once a month. and other health care providers; and There are also attitude and behavior changes occurring as a • expand access to portable dental services for young children. result of CFK in three key areas: Hubs also wanted continued access to CFK training resources • Parent Knowledge: At follow-up, parents reported a high and materials, training in new tools and curriculum provided degree of oral health knowledge following CFK, and 97 by WDSF, and greater opportunity for peer learning among percent of parents agreed that oral health and proper dental hubs. care are priorities. • Child Practices: Day-to-day oral health practices and NEXT STEPS: EXPANDING CAVITY FREE KIDS habits improved, including statistically significant improve- Moving forward, both the Health Foundation and WDSF ments in eating fruits and vegetables, using fluoride have incorporated the evaluation findings and hub recommen- toothpaste, and drinking water with fluoride. Rates of dations into future plans. brushing and flossing teeth at home also improved. There For example, WDSF has made specific changes to its cur- were, however, some persistent bad habits that showed lit- riculum and created new materials based on feedback from tle improvement, such as eating or drinking right before program participants, including developing and testing shorter bed, drinking juice or soda, and eating crackers and sweets. training modules and modified materials for use with different • Access to Care and Support: At follow-up, young chil- audiences and in different settings. dren were visiting the dentist more often, and parental The Health Foundation has also identified a number of confidence in supporting their child’s oral health important next steps for improving CFK implementation, improved. The majority of children reached through CFK including conducting parent focus groups to gather feedback now receive regular dental care. on specific outreach materials and strategies in order to develop better ways to engage parents. WHAT HAVE WE LEARNED? The Health Foundation plans to award grants to expand the CFK hub train-the-trainer model in western and central New The evaluation identified promising practices and lessons York counties that currently do not currently have a CFK hub, learned to support future CFK implementation. For example, as well as grants that would target the original CFK hubs to hubs learned that CFK training can be tailored to different support sustainability and the expansion of CFK. In addition, audiences, and CFK kits and materials can be tailored to the Health Foundation will have existing hubs mentor new appeal to different age groups and child care settings. Hubs hubs and will create a learning community for hubs to identify recommended that WDSF design shorter CFK training mod- and share best practices. ules to use with very large or very small groups. Hubs also To spread the reach of CFK even further, the Health learned that hands-on activities, demonstrations, and interac- Foundation is now working with additional partners, such as tive elements increase engagement among teachers and young Sesame Workshop and local dental societies, to develop power- children and are easily incorporated into CFK trainings. ful and exciting new ways to make a greater impact on Hubs and teachers also identified some challenges. For children’s oral health in the future. hubs, these challenges included time management; ensuring The Health Foundation will be continuing and expanding teacher follow-through with CFK implementation; and incor- CFK for at least the next two years. porating the CFK curriculum in day care centers, school districts, and Early Head Start home visits. One challenge For more information, visit www.hfwcny.org. teachers faced was using the standard CFK curriculum in set- tings other than Head Start classrooms. And while evaluation findings underscored how important parental reinforcement of CFK messages in improving oral health habits in young Views from the Field is offered by GIH as a forum children is, teachers also felt less prepared for working with for health grantmakers to share insights and experiences. If you are parents. interested in participating, please contact Osula Rushing at 202.452.8331 or orushing@gih.org.