Lifesmiles 4 Koori Kids
An Oral Health Program for Aboriginal Children
Greater Southern Area Health Service
Lifesmiles 4 Koori Kids (LS4KK) program was developed collaboratively with the aim of improving the oral health of the aboriginal children of Greater Albury Cluster. Staff members of Albury Wodonga Aboriginal Health Service (AWAHS) are trained in promoting oral health in house and at schools in a culturally appropriate manner. AWAHS facilitate access to oral health services, liaising with stakeholders and providing transport. Dental time is dedicated so that LS4KK appointments have priority on certain days. Partnerships, skills and resources shared have resulted in productive use of clinician’s time, culturally appropriate services, positive community response, improved oral health outcomes for the children.
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To reduce the incidence of dental caries for aboriginal children in the Greater Albury Cluster, and facilitate access to oral health services through skill sharing and collaborative partnerships with other services.
Nature of the Problem
Despite significant focus on improving access to oral health services, aboriginal children have poorer oral health and are less likely to complete a course of dental care than non indigenous counterparts. (AIHW DSRU 2003, Brennan & Carter 1998.)
Historically the NSW School Assessment Program has been less successful for indigenous children with evidence showing that aboriginal children attending dental services are more likely to attend only for urgent or serious problems and less likely to complete a course of care and miss or arrive late for subsequent appointments.
Consultation with AWAHS revealed that issues of transport, culturally appropriate communication and education were major issues to be addressed.
Extent of the Problem
Numerous studies of Aboriginal communities highlight poorer oral health than their non-indigenous counterparts. Twelve year old children have almost twice the caries rates in permanent dentition, more frequent visits to dental services for a serious problem, fewer fillings, and higher rates of extractions. (AIHW DSRU 2003.)
Albury Dental Clinic records reveal that indigenous children are also more likely to miss or arrive late for appointments, and less likely to return to complete a course of care resulting in poorer long term oral health outcomes and wasted clinical time.
Consultation with relevant stakeholders revealed barriers preventing families accessing oral health services, relate to communication, transport and lack of ownership of the Dental Clinic.
It was decided to establish stronger links between AWAHS and the dental clinic, train AWAHS employees to deliver health information, facilitate access to services by offering transport and provide LS4KK days at the Dental Clinic.
NSW State Health Plan Strategic Direction 4: LS4KK is building regional partnerships between AWAHS, education dept and GSAHS Oral Health Services to facilitate access to and the delivery of oral health outcomes for indigenous children. Community consultation and coordinated services ensure improved, culturally appropriate communication, transport, upskilling of staff and improved identification and referral pathways for children to oral health services.
NSW Oral Framework for Action 2010: 3.4 including priority 3.4.3. Upskilling of health staff in the Aboriginal medical service establishment of strong relationships and improved referral pathways, transport have reduced barriers for children to access the service.
Planning and Implementing Solutions
AWAHS received funding to provide an oral health care program for aboriginal children in 2006. The target group was primary school aged children with the intervention group being aboriginal health worker and oral health clinical staff. Since the inception of the Lifesmiles 4 Koori Kids program it has expanded to include the preschool 0-5 age group. Professional and cultural direction and advice were provided by CEO of AWAHS, community consultation, teachers, Centre for Oral Health Strategy and cultural awareness educator.
The project group has representation from AWAHS, the aboriginal community, aboriginal clinic nurse, education dept, aboriginal liaison officer, and oral health staff.
Project strategies resulting from consultation
AWAHS is respected and successful service provider for the aboriginal population. Expand skills and responsibilities of AWAHS to bridge the gap between oral health services and the aboriginal community. AWAHS staff member trained to take responsibility for delivering oral health education at schools, communication with families, to liaise with dental clinic, develop or source culturally appropriate oral health promotion material and advocate for oral health. To organise transport to and from school and home for children and families, liaise with schools and others.
Establish culturally appropriate service delivery from Oral health Services. Training in cultural awareness for oral health and AWAHS staff.
Dental Assessment offered for aboriginal school groups at dental clinic on dedicated LS4KK days along with oral hygiene education. Where possible this time is arranged when school time was scheduled for cultural activities in the Koori classroom. Aboriginal support teacher accompanies the children on the bus, participates in culturally appropriate oral health education in meeting room with children while waiting for oral health assessment in clinic. Transport, consent and supervision of children were organised by AWAHS.
Dedicated LS4KK Treatment days at clinic where required. Family groups, and siblings / friends appointed together to promote positive experience and community atmosphere and enable group transport arrangements.
Some flexibility of appointment times is expected on LS4KK days.
Outcomes and Evaluation
Collaboration of services through the LS4KK has resulted in an increased number of aboriginal children with dental needs completing a course of care and achieving stable oral health status in 2008.
In 2006 only 38 children sought assessment as a result of the program targeting aboriginal children, of those assessed as having dental caries, 50% required care because of dental pain, but only 5 returned to have all treatment completed after the initial relief of pain visit.
In the first half of 2008, improvements in the program LS4KK resulted in 120 children assessed. 67% had high oral health treatment needs, 24% being urgent. All children requiring care have either completed treatment or are currently undergoing a course of care.
Anecdotal evidence provided by clinicians reveals better manual dexterity and a more positive attitude to oral hygiene and dental visits for those children who have participated in the program.
Parent/guardian interviews spoke positively about the AWAHS based oral health promotion officer who had facilitated access and or awareness of services available. 6 of the 10 interviewed believed that they would not have been able to get timely treatment for a child in pain without the transport offered by the service.
LS4KK has been established as a valuable program, facilitating the oral care of aboriginal children in the community. It is supported by an MOU between AWAHS and Albury Community Health. Performance indicators listed in the funding agreement have been met supporting ongoing funding opportunities for AWAHS and NSW Health.
Strong communication and working relationships have been established between all stakeholders along with community support. LS4KK has enhanced the oral health focus at AWAHS through staff awareness, knowledge, training and participation in other oral health programs and establishing referral pathways. Increased oral health information, literature and posters are available in the waiting room at AWAHS.
The concept of training a non clinical staff member from the Aboriginal health service to deliver oral health messages in schools and to liaise with patients and parents using culturally appropriate methods, resources materials and communication styles is effective and resource efficient. This model is applicable to other health disciplines enabling clinicians to use their time for clinical activities, capitalising on established relationships, communication pathways and community rapport for delivery of health messages and improving client access to services.
Opportunities for Otitis Media and health screening to take place during dental visits is being explored, community consultation is soon to take place.
- NSW State Health Plan
- NSW Oral Health Promotion Framework for Action 2010
- AIHW DSRU 2003, Brennan & Carter 1998, Brownlea & Taylor 1984; NSW Dept. of Health 2002b; Dept of the Senate 1998; Saggers & Gray 1991; Schamschula et al. 1980a & b; Taylor et al. 1996.