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Helping to Combat Asthma in Rural West Tennessee

By Regina Perry MSN, FNP-BC, Nurse Practitioner, Community Health Dept, Memphis Regional Children’s Health Project

Last month, the Asthma and Allergy Foundation of America (AAFA) released its “2011 Asthma Capitals” in the United States. The city of Memphis was listed in third place and as a resident of the Memphis area and a health care provider at CHF’s Memphis Regional Children’s Health Project, this news is quite worrisome.  Many children living in this city and surrounding areas, particularly those who are poor and living in rural communities, are likely suffering from asthma and don’t have the necessary health care and medications needed to manage their condition.

We’ve known for a while that asthma rates in Memphis were high.  So, in 2009, our team embarked on a mission to bring CHF’s Childhood Asthma Initiative to our program in order to help our kids get properly diagnosed with asthma and learn how to treat this condition. Through the Childhood Asthma Initiative, children with asthma have access to the highest quality care. Clinical visits and medication, asthma severity assessment and allergy skin testing are supplemented by in-depth health education, including access to Children’s Health Fund’s Family Asthma Guide. All of these efforts help children and their families actively manage asthma symptoms. In addition, we provide support for asthma patients and their families, who often experience the anxiety and depression that accompanies chronic illness.

Our progress with this initiative has been fantastic. Many children are learning how to recognize triggers and control their symptoms. Our case manager has assisted numerous families with getting the medications they need to control asthma, regardless of whether or not the family has insurance (as many of you know, asthma control medicines are quite expensive). Through this initiative, we have also helped bridge the gap between primary care providers and patients. Because of transportation barriers, many of our patients can not regularly get to their primary care physician, but because we are available to these patients at their schools, they are able to visit us regularly during the school day. There, we can monitor and manage their symptoms. We also provide ongoing education and medications as needed.

Nurse Practitioner, Regina Perry, with one of the many little patients she sees on mobile medical unit.

It’s wonderful to know that my job helps families combat asthma.  We may be a long way from solving the problem, but every little bit helps children in the Memphis area live a healthier life.

 

Fighting Cavities With Fluoride Varnish

By Delaney Gracy , MD, MPH, Deputy Chief Medical Officer, Children's Health Fund

As a pediatrician and a mom, I know how important it is for kids to practice proper oral health care from an early age. When teeth are not properly cared for, more critical medical problems may occur and in some extreme cases can even lead to death.

As I explained on Give Kids a Smile Day, in the low-income communities where doctors within CHF’s network serve, lack of oral health care is a huge problem and kids are suffering. Luckily, in addition to providing free, comprehensive oral health care—screening, dental exams, digital x-rays, oral health education and dental procedures—many of our programs have also implemented an easy and affordable way to help kids in low-income families keep their teeth safe and clean through the use of fluoride varnishing. Fluoride varnish is a highly concentrated form of fluoride which is applied to the tooth’s surface to help prevent cavities. It is easy to apply, extremely affordable, and is safe for/tolerated by infants, young kids and individuals with special needs. The best part though is that it is effective—several studies have shown a 25-45% reduction in the decay rate with the use of fluoride varnish.

Dental varnish is applied to the teeth with a little disposable brush.In a few easy steps, your dentist, hygienist, or primary health care provider can apply the varnish: ensure the teeth are dry, apply a thin layer of the varnish to all surfaces of the teeth with a disposable brush (almost like painting), and once the varnish comes into contact with saliva, it will harden and you are done!

If, and how often, a child needs fluoride varnish depends on many factors, including the amount of fluoride in their water supply, if they are taking vitamins with fluoride supplementation, their general oral health, and their individual risk factors.

It’s important to note that applying the varnish does not negate the importance regular visits with a dentist, or of daily dental care like brushing your teeth or flossing. It’s just another way to help in the fight against cavities….and that’s a great thing.

Has your child received the varnish application? How did he/she react? Let me know in the comments section below.

Giving Kids A Smile…All Year Round

by Delaney Gracy, MD, MPH, Deputy Chief Medical Officer, Children's Health Fund

Today, as part of National Childhood Dental Awareness month, the American Dental Association (ADA) celebrates “Give Kids A Smile” Day.  This year, over 12,000 dentists have signed up to participate in the program and provide free oral health care to kids from low-income families across the country.  In addition, dental-health focused events across the country will help to shine the light on the many barriers facing low-income families who are trying to access dental care for their kids. 

At Children's Health Fund (CHF), we know all too well how difficult it is for children living in poverty to access dental care. Kids living in poverty have twice the odds of having tooth decay, twice the extent of the decay, twice the unmet treatment need, twice the pain experience, but half the access to dental care than their more affluent peers.   A variety of variables adds to this lack of access:

  • Medicaid’s low reimbursement rate discourages many dentists from participating;
  • Many children in rural communities face transportation barriers in accessing dental care; and
  • In designated dental Health Professional Shortage Areas, too few dentists are available to meet the needs of the community.

At CHF, addressing these low rates of dental care is always a priority. Our National Network programs in Arkansas, Dallas, Idaho, New York City (including Harlem) and Washington, D.C., provide free, comprehensive oral health care – screening, dental exams, digital x-rays, oral health education and dental procedures – to low-income children. Eight of our programs offer fluoride varnishes in the primary care setting, and throughout the National Network primary care providers conduct oral health screenings and provide referrals to collaborating community dentists.  

Today in Idaho, our Idaho Children’s Health Project (ICHP) is participating in the ADA’s “Give Kids A Smile” day!  Dentists will be providing exams, sealants, and fluoride varnishes for 2nd and 3rd graders at Bickel Elementary in Twin Falls and hope to see about 110 kids throughout the day (they will definitely be keeping busy!)  The ICHP is working in collaboration with the Caring Foundation for Children, who will help with paperwork, the College of Southern Idaho, who will bring volunteer dental assistant students, and Delta Dental, who is supplying tooth brush kits for the kids!

We are thrilled to join the ADA’s commitment to helping provide dental care to low-income kids and bring awareness to the many access barriers facing the kids in these communities.  Today and everyday we all need to do what we can to ensure all kids have something to smile about!

The Goal is Control!

by Wendy Quinones, BSN, MSN, CPNP, Co-Director of the Childhood Asthma Initiative, Children's Health Fund’s New York Children's Health Project

I work in the South Bronx, an area that is no stranger to asthma as it has one of the highest rates of asthma prevalence not only in NYC but in the country.  It’s sometimes frightening to think of the huge problem that asthma has become in areas like the South Bronx, but one day at a time, my colleagues and I are trying to help improve management of chronic asthma for thousands of medically underserved children and families through the Children’s Health Fund’s Childhood Asthma Initiative (CAI)

Currently implemented in CHF’s NYC and Washington DC programs, the CAI provides children with asthma access to the highest quality care—clinical visits and medication, asthma severity assessment, and even psychosocial services for families of asthma patients, who often experience the anxiety and depression that accompanies chronic illness.  All of these services are supplemented by in-depth health education, including access to Children’s Health Fund’s Family Asthma Guide. The guide, available in both English and Spanish,is published annually and used as a complement to asthma care to help children and their families actively manage asthma symptoms.  In fact, we received some great news last week that the guide won a 2010 Communicator Award of Distinction!!  Considering the time, research, and team work that is involved in the production on this guide, it’s a great accomplishment to be recognized, but for us, the real reward is being able to watch children and families use the guide to control their asthma.

Our hope for the Family Asthma Guide is that individuals with asthma and their family members will educate themselves and others about the condition and that providers will use it when they are teaching patients about asthma.  As we reiterate many times in the guide…The Goal Is Control!! If we can get a patients asthma under good control—allowing them to live an active life with no hospitalizations—we have done our job.

Have you used the guide before to learn about your own asthma or help someone understand about the condition?  If so, please let us know what you think in the comments section below.  We are always looking for feedback!

Keeping Dental Care a Priority

by Arturo Brito, MD, MPH, Chief Medical Officer & Executive Vice President, Children's Health Fund

The Surgeon General calls dental problems the “Silent Epidemic” that results in more than 51 Million school hours of missed school each year.  For poor children, Medicaid is the principal insurer and its low reimbursement rate discourages the participation of dentists across the country.  It’s a frightening reality, since not properly caring for teeth can bring about more critical medical problems and can sometimes even lead to death.

CHF Idaho Program Staff provide comprehensive dental care to local childrenWednesday'sPittsburgh-Post Gazette brought attention to the low rates of dental care visits among low-income children in the state of Pennsylvania.  According to the article, the Pennsylvania Medicaid Policy Center at the University of Pittsburgh Graduate School of Public Health released an online report that found Medical Assistance (Pennsylvania’s name for Medicaid) covered nearly 1 million (35.5%) of all Pennsylvania children last year and less than half of the children enrolled in Medicaid see a dentist each year.  While the article goes into more detail about how this specifically affects children in the state of Pennsylvania, we know this is a larger problem and children nationwide are not getting appropriate and quality dental care. 

At Children’s Health Fund (CHF), addressing the low rates of dental care visits is a priority—programs in our national network assure that children receiving medical services also receive needed dental services either through a mobile dental clinic or by referring children to collaborating community dentists.  Mobile Dental Clinics in CHF's national network provide comprehensive oral health care - screening, dental exams, digital x-rays, oral health education and dental procedures - to low-income children throughout the country.  

New Study Finds ‘Best Practice’ Asthma Program Saves U.S. Health Care System More than $4500 a Year per Child

by Roy Grant, MA, Director of Research, Children's Health Fund

Asthma is a huge problem in this country…nine million US children are diagnosed with asthma including more than two million who are living in poverty.  In inner city communities, asthma is the leading cause of hospital emergency department visits – as is the case here in New York City.  In fact, the South Bronx has one of the highest asthma prevalence rates in NYC and the country. Rates are even higher in high-risk populations like the homeless. Nearly 32% of the children living in New York City homeless or domestic violence shelters have asthma. 

In 1997, to increase access to health care and improve management of chronic asthma for thousands of medically underserved children and families, Children’s Health Fund’s launched a Childhood Asthma Initiative in New York City. It is currently implemented in CHF’s New York City and Washington, D.C. programs.  Over the years, we’ve worked to track the success of the initiative and its effectiveness in helping children and families control their asthma.  In a new study I worked on with CHF President Irwin Redlener MD and a team that included Mailman School of Public Health, Columbia University and Montefiore Medical Center, we are reporting some important data that shows the effectiveness of this ‘best practice’ asthma program.

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