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Mobile-dental-unit initiative offers lessons

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John Frank

John Frank

Todd Cohen

WINSTON-SALEM, N.C. — The lack of dental care is a widespread problem in North Carolina, which has one of the lowest ratios of dentists to overall population of any state and last year actually saw a decline in the number of dentists.

From 1995 to 2005, concerned about dental care for children and adults, particularly in low-wealth counties, many of them rural, the Kate B. Reynolds Charitable Trust in Winston-Salem granted a total $16 million to 108 programs promoting access to oral-health services for financially needy and underserved populations throughout the state.

Those grants included $3.5 million to 16 groups to support mobile or portable dental units, with the mobile units mainly serving children at schools, and the portable units
mainly serving elderly people at nursing homes.

Based on a recently-released study that assessed the impact of the grants, the foundation has concluded the initiative in fact improved access to dental care for vulnerable populations, particularly children and the frail elderly.

The study also found that the strategy of providing care could be sustained over time because the populations it targeted are eligible for Medicaid reimbursement for that
care.

The study is the first the foundation ever has conducted of any of its programs that provide funding for broad priority needs, let any agency apply for funding, and set no
limits on the amount of funding applicants can seek.

The results of the study also underscore the importance of building dollars into grants to help agencies evaluate the impact of the funding they receive.

“We are really trying very hard to make an impact, whatever the program is, to try to get good data back, did we make a difference,” says John Frank, director of the health
care division for the Reynolds Trust.

Of the 16 mobile or portable dental units the foundation funded, 14 still were operating in 2006 and providing over 27,500 annual visits to over 13,500 underserved North
Carolinians, many of them children, the study found.

Six of the mobile units, which served children in 13 counties, including Forsyth and Davie, reported handling at least 1,800 patient visits a year each, while seven of the
mobile units, which served children in 27 counties, reported handling fewer than 1,800 patient visits a year.

Two portable units, including one in Guilford County operated by Access Dental Care and one in Mecklenburg County, served mainly elderly or disabled populations, or both, while a portable unit operated by volunteers for the Open Door Dental Clinic of Alamance County, provided 10 to 12 weekend clinics a year.

Because a big obstacle to providing dental care is a reluctance of many patients simply to show up for services, Frank says, the mobile and portable units were able to
serve children and elderly patients by delivering services to schools and nursing homes.

Those patients also had access to dental services and follow-up care they otherwise might not have received because few of them, most of whom receive Medicaid support, had private dentists or access to any dentist.

In fact, the difficulty of finding and retaining dentists represents a big problem for the delivery of dental care in the state, Frank says, and in some cases led to lapses and even cancellation in service provided by the units the foundation funded.

The foundation also found the local units could be sustained financially because the target populations were eligible for Medicaid reimbursement.

“We’re always concerned about sustainability,” Franks says. “I don’t think we, or most funders, want to help start new programs in communities where they can’t sustain themselves.”

Frank says the study was designed in part to help other funders and agencies that might seek grants better understand how to set up mobile dental units and what makes them succeed.

The study, a copy of which is available on the foundation’s website, also has led the Reynolds Trust to conclude it should allocate more funding in future grants it makes to evaluate the impact of the grants.

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