INTRA-AGENCY AGREEMENT BETWEEN

THE ADMINISTRATION FOR CHILDREN AND FAMILIES

ADMINISTRATION ON CHILDREN, YOUTH AND FAMILIES

HEAD START BUREAU AND THE PUBLIC HEALTH SERVICE

HEALTH RESOURCES AND SERVICES ADMINISTRATION

MATERNAL AND CHILD HEALTH BUREAU

Fiscal Year 2004

  1. PURPOSE

This Agreement sets forth the terms for the provision of technical expertise in oral health by the Public Health Service (PHS), Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB), to the Administration for Children and Families, (ACF), Administration on Children, Youth and Families (ACYF), Head Start Bureau (HSB). MCHB will assist the HSB, and the ACF Regional Offices to assess its oral health program needs, to collaboratively develop strategic plans to meet these needs, and to design materials and programs to implement these plans. The overall long term goal of this multi-year Agreement is to achieve optimum oral health for all Head Start (HS) and Early Head Start Start (EHS) children.

  1. AUTHORITY

This Agreement is made under the authority of the Economy Act approved June 30, 1932, as amended (31 USC 1535) and under the provisions of general and pertinent regulations of the Comptroller General, Head Start Act, P. L. 105-285 and P.L. 107-116 of the Appropriations Act of 2002.

  1. BACKGROUND

From 1966 to the mid-1990’s, MCHB/PHS/HRSA and its predecessor dental programs had a close working relationship with the HSB.Head Start. MCHB dentists provided dental training and technical assistance (T/TA) to Head Startead Start programs across the country, and also assisted the HSB in developing dental program policies and standards. Dental T/TA networks were developed using the infrastructure of established state run dental programs, professional dental organizations and training institutions representing dentists and dental hygienists. Appropriate best practice interventions and training programs were developed to support the dental consultant network assisting grantees to meet these needs. Dental consultant manuals were developed and annual workshops were conducted to train new consultants and to develop standardized interventions to address problems common to several grantees. In 1993, in an effort to consolidate T/TA services and to better meet the needs of Head Start HS grantees, the HSB ended its relationship with MCHB and revised its T/TA system to include health.

The oral health status of low-income children has gained considerable interest among various Federal programs due to recent research indicating that dental caries is a preventable disease and that low income children experience dental disease at a higher prevalence than children from families with higher incomes. A review of recent and current Head Start Program Information Report (PIR) data indicates that access to oral health services is the number one health problem affecting HSHead Start children and families. It is the most frequent health concern expressed by ACF Regional Office Program Specialists, Head Start Directors, Health Managers, and parents. In 1994, Early Head Start (EHS), a new program for low-income families with infants and toddlers and pregnant women was established. EHS programs also report difficulties in obtaining both preventive and treatment services for pregnant women, infants, and toddlers.

In 1998, the MCHB and The Health Care Financing Administration (HCFA), (which has subsequently been renamed as the Centers for Medicare and Medicaid Services (CMS), developed a joint Oral Health Initiative to address the oral health needs of children enrolled in Medicaid and the State Child Health Insurance Program (SCHIP). In 1999, representatives from MCHB and The Special Supplemental Nutrition Programs for Women, Infants and Children (WIC) approached the HSB to discuss strategies for improving the oral health status of low-income children. The Head Start and Partners Forum on Oral Health was held in September of that year. The purpose of the Forum was to develop strategies that increase collaboration at the Federal, state, and local levels and to improve oral health services for low-income children and families. Each of the Federal partners contributed funds for the development of three research papers that were presented at the Forum. The papers addressed oral health and nutrition, caries risk assessment and prevention, and access to oral health services, and were subsequently published in the summer 2000 issue of the Journal of Public Health Dentistry.

In response to recommendations made at the September 1999 Oral Health Forum, the HSB and the MCHB entered into an Intra-Agency Agreement in 2001. Both the HSB and the MCHB realize a long-term incremental program was required to implement the recommendations made at the Forum and to accomplish the overall long term goal of this Agreement. The first threetwo years of the Agreement focused on plan development and on capacity building at the Federal, regional, state, and local level. ACF Regional Offices and states established oral health teams with representatives from other Federal programs serving low income children, such as WIC, Medicaid, and MCHB Regional Office Dental Consultants, State Dental Directors, ACF Regional Office staff, State Head Start Associations, State Collaboration Offices, T/TA providers and Head Start staff. Since 2001, 12six Regional Oral Health Forums have been held and 38 state Oral Health Forums were funded with purpose of developing Regional and state Oral Health Strategic Plans. The first three years of this Agreement also focused on elevating the profile of Head Start among the dental community and beginning to rebuild community linkages between HS/EHS programs and dental providers; assessing national, regional, state and local levels barriers to oral health services for HS/EHS children; and developing strategies to remove these barriers. It has also has served to gather and assess education, preventive, early intervention and access to dental care practices currently being used by HS/EHS programs. From these and other models known by MCHB, the process has begun to select promising models to determine their applicability for use by HS/EHS programs.

. In addition to developing Regional and state strategic plans, the initial phase of the Agreement has focused on elevating the profile of Head Start among the dental community and beginning to rebuild community linkages between Head Start programs and dental providers; assessing national, regional, state and local levels barriers to oral health services for HS/EHS children; and developing strategies to remove these barriers. This initial phase also has served to gather and assess education, preventive, early intervention and access to dental care practices currently being used by HS/EHS programs. From these and other models known by MCHB, the process has begun to select promising models to determine their applicability for use by HS/EHS programs. This and subsequent Agreements will build upon successes made to date. This and subsequent Agreements will build upon successes made to date. The HSB and MCHB recognize that activities contained in the Agreement are in various stages of development and implementation, and that the Agreement will serve as the principle mechanism for the HSB to implement oral health programs to support local HS/EHS programs in meeting the oral health requirements of the Head Start Program Performance Standards.It will support the HSB in its efforts to implement the goals of its revised technical assistance system, including the Head Start Learning Center (HSLC), in implementing evidence based preventive, early intervention and oral health service delivery models, promising practices and strategic plans developed at the national, regional, state and local levels. Formal agreements will be developed with dental and other health professional organizations to ensure that all HS/EHS children have a dental home. This Agreement will also support mechanisms to enhance the availability of an appropriately trained and supported dental workforce that will provide services to HS/EHS children.

The Agreement will serve as the principal vehicle for the HSB to implement oral health activities. It will support the HSB in its efforts to implement its recently established comprehensive Training and Technical Assistance Program and to assist programs in meeting their oral health Performance Standards. The Agreement will serve to implement the strategic plans developed at the national, regional, state and local levels and will build capacity to implement these strategic plans. It will also serve as a vehicle to develop preventive, early intervention and service delivery care models and assist the HSB to implement them through on-site and distance learning modalities. Formal agreements will be developed with dental and other health professional organizations to assure that HS/EHS children have an ongoing, continuous source of dental care. The Intra-Agency Agreement will also support mechanisms to enhance availability of an appropriately trained and supported dental workforce to treat these children.

  1. SCOPE OF WORK AND RESPONSIBILITES

The HSB will:

  1. Designate a person to serve as the MCHB liaison;
  1. Keep MCHB informed of the evolution and approval of pertinent policy and program developments;
  1. Provide MCHB with current contact information for ACF Regional Office staff and technical assistance network staff who will support the Regional, State and local efforts of this Agreement;
  1. Provide periodic feedback to MCHB on its implementation of the Agreement;
  1. Represent the HSB on the Association of State and Territorial Dental Directors (ASTDD) Head Start Advisory Committee and other committees as established to accomplish the goals of this Agreement;
  1. Establish a HS-MCHB Intra-Agency Workgroup to coordinate national efforts to accomplish the goals of this Agreement, including the development of the oral health content of the HSLC. This Workgroup will meet, at a minimum, semi annually.
  1. Provide funds to MCHB for services provided as set forth in this Agreement; and
  1. Maintain responsibility for the disbursement of Head Start funds.
  1. The HSB MCHB Liaison will keep HSB and RO staff informed about activities carried out related to this Agreement and progress made in meeting its overall goal of improving the oral health status of HS/EHS children and families.

MCHB will provide these services to the HSB:

  1. Serve as Liaison to all Federal, State and Community Programs and Foundations as it relates to Head Start/Early Head Start Oral Health Issues
  • MCHB will provide information regarding the oral health needs of HS/EHS children and their families in its ongoing relationships with private foundations, Federal programs including Centers for Medicare and Medicaid Services (CMS), the National Institutes for Health (NIH), Centers for Disease Control and Prevention (CDC), Indian Health Service (IHS), the Bureau of Primary Health Care (BPHC) and others for integration into their programs. A strategy for outreach to special populations, such as Hispanics and Native Americans, will be developed by MCHB and shared with the above mentioned Federal programs.
  1. Provision of Oral Health Expertise to the Head Start Bureau
  • MCHB will continue to provide professional advice, consultation and training to HSB staff on all matters of oral health. MCHB will also provide oral health leadership and serve as a liaison to dental and other professional organizations, training institutions, and other Federal and state agencies as it relates to education, prevention, early intervention, research and access to care for HS/EHS children.
  • MCHB will assist the HSB in the development of the oral health content for the Head Start Learning Center (HSLC) and will develop an Oral Health Logic Model that is compatible and supports similar efforts of the HSB.
  • Enhance the HS/EHS capacity of MCHB Oral Resource Center to: 1) gather and assess any prevention, education and service delivery models appropriate for Head Start programs; 2) develop oral health informational and training materials specific to HS/EHS programs; 3) create a central repository for these materials and, 4) assist the HSB to implement these programs through on-site, web-based and distance learning modalities.
  • Work with HS/EHS, the ASTDD, the American Academy of Pediatrics (AAP), the Maternal and Child Oral Health Policy Center (OHPC) and the American Academy of Pediatric Dentistry (AAPD) and others in the assessment, adaptation, and development of promising practices, education and service delivery models and T/TA materials for use in HS/EHS programs.
  • MCHB will conduct and maintain an inventory of oral health policies in state programs (i.e. SCHIP, EPSDT, and Medicaid) which impact on services to HS/EHS children and families.
  1. Provision of oral health expertise at Regional Office Level

In each ACF-MCHB Regional Office, MCHB, in partnership with ACF, will:

  • Assist ACF staff in implementing recommendations formulated at Regional and/or state HS/EHS Oral Health Forums.
  • Establish and maintain an oral health dental consultant pool that will provide on-site oral health expertise to the ACF Regional Office.
  • Assist the ACF Regional T/TA Liaison, Health Liaison and/or Health Content Expert to develop 1) grantee specific T/TA plans and 2) state-based oral health consultant networks to help implement these plans.
  • Assist the ACF Regional Offices in establishing and maintaining partnerships between the Head Start State Collaboration Offices, MCH state oral health programs and other institutions and agencies that impact oral health of HS/EHS children.
  1. Integration of Head Start and Early Head Start into State Dental Programs and Dental Directors Ongoing Activities

In each state, MCHB will:

  • Assess State Oral Health programs readiness and ability to support HS/EHS programs and locally based HS/EHS training and technical assistance specialists and develop a plan for HS/EHS support based on this assessment.
  • Through State Oral Health Forums and other means develop and implement a strategic plan for State Oral Health programs to assist HS/EHS Programs at the state and community level.
  • Encourage the development of partnerships and agreements between Head Start State Collaboration Offices and State dental programs to support the technical assistance and oral health program needs of HS/EHS programs.
  1. Increase the Number of Pediatric and General Dentists Available to Treat Head Start and Early Head Start Children

Increase the number of pediatric dental residents trained in MCHB Dental Pediatric Leadership Centers that will serve as specialists in the care of HS/EHS children.

Utilize MCHB Dental Pediatric Leadership Centers to serve as a resource to provide on-site and distance continuing education and clinical expertise required to treat Head Start children from 6 months to 5 years of age.

  • Develop a strategic plan and initiate the necessary steps for implementing a system of dental care at the local level that links general dentists, pediatric dentists, MCHB dental leadership centers and other health care providers to comprehensively meet the oral health needs of HS/EHS children.
  • Provide two HS Pediatric Oral Health Fellows/Residents at an academic level that will be responsible for training pediatric dentists on working with HS/EHS programs and providing oral health services to HS/EHS children.
  1. Continue to Raise Public and Professional Awareness of the Oral Health Needs of Head Start and Early Head Start Programs and Develop Collaborative Programs With These Organizations

MCHB will establish a partnership with the American Dental Association, the American Dental Hygiene Association and other dental provider organizations and expand and build upon its activities with the American Academy of Pediatric Dentistry (AAPD) and other organizations to:

  • Through Profession Organization Forums assess the organizations willingness and ability to support HS/EHS grantees in meeting their oral health educational and clinical service needs.
  • Initiate programs (i.e. marketing) and campaigns to make the dental, medical, public health and other professions, as well as the general public, more aware of the oral health needs of HS/EHS children.
  • Establish collaborative agreements and service delivery program with the AAPD to engage more dental and other health professionals in education, prevention and treatment programs that benefitHS/EHS children.
  1. REPORTING REQUIREMENTS

The HSB Project Officer and the MCHB Project Officer will:

  • Conduct monthly briefings on the progress of activities described in the Agreement, barriers to accomplishing the goals of the Agreement and other pertinent information.

The MCHB Project Officer will: