Skip Navigation

Strengthen the Evidence for Maternal and Child Health Programs

Sign up for MCHalert eNewsletter

Evidence Tools
MCHbest. Preventive Dental Visit: Child.

MCHbest Logo

Strategy. Early Head Start Integration. (13.2)

Approach. Integrate oral health activities into Early Head Start Programs

Return to main MCHbest page >>

Overview. Research suggests that Head Start, a comprehensive federally funded school readiness program for children from families with low incomes, improves utilization of dental care services for this population.[1] Access to oral health care services for these children is further enhanced in the presence of oral health care financing reforms in state Medicaid programs.[2,3] Through a comprehensive, integrated array of services and support, Early Head Start. (EHS), a nationwide comprehensive early education program established in the 1990s for Head Start families with low incomes and children from birth to age 3, also has been shown to promote oral health care utilization.[4,5] It has been demonstrated that when preventive oral health services are integrated into Early Head Start program activities and Medicaid medical benefits, access to preventive services and oral health care utilization among young children is significantly improved.6

Evidence. Moderate Evidence. Strategies with this rating are likely to work. These strategies have been tested more than once and results trend positive overall; however, further research is needed to confirm effects, especially with multiple population groups. These strategies also trend positive in combination with other strategies. (Clarifying Note: The WWFH database calls this "some evidence").

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source. (Read more about understanding evidence ratings).

Source. Peer-Reviewed Literature

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Health and Health Behaviors/Behavior Change. This strategy improves individuals' physical and mental health and their adoption of healthy behaviors (e.g., healthy eating, physical activity).
  • Utilization. This strategy improves the extent to which individuals and communities use available healthcare services.
  • Access to/Receipt of Care. This strategy increases the ability for individuals to obtain healthcare services when needed, including preventive, diagnostic, and treatment services.

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Health Teaching (Education and Promotion) (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Individual/Family-Focused

Examples from the Field. Access descriptions of ESMs that use this strategy directly or intervention components that align with this strategy. You can use these ESMs to see how other Title V agencies are addressing the NPM.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the Results-Based Accountability framework (for suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies).

Quadrant 1:
Measuring Quantity of Effort ("What/how much did we do?")

PROCESS MEASURES:

  • Number of Early Head Start (EHS) programs that integrate oral health activities into their services. (Measures adoption of oral health integration)
  • Number of oral health professionals partnering with EHS programs to provide education, screening, and referrals. (Assesses engagement of dental workforce)

Quadrant 2:
Measuring Quality of Effort ("How well did we do it?")

PROCESS MEASURES:

  • Percent of EHS staff trained on oral health topics and integration strategies. (Measures workforce capacity building)
  • Percent of oral health activities in EHS programs that adhere to evidence-based guidelines and best practices. (Evaluates fidelity to standards)

Quadrant 3:
Measuring Quantity of Effect ("Is anyone better off?")

PROCESS MEASURES:

  • Number of EHS programs that have a formal memorandum of understanding (MOU) with dental providers for care coordination. (Measures care integration infrastructure)
  • Number of EHS programs that implement a standardized oral health risk assessment and referral protocol. (Assesses systematization of process)

OUTCOME MEASURES:

  • Number of children in EHS programs who establish a dental home and receive regular oral health care. (Assesses continuity of care)
  • Number of EHS programs that demonstrate sustained oral health integration one year after initial implementation. (Measures long-term adoption)

Quadrant 4:
Measuring Quality of Effect ("How are they better off?")

PROCESS MEASURES:

  • Percent of EHS programs serving communities with lower incomes for rural areas that adopt oral health integration. (Measures focus of implementation)
  • Percent of EHS oral health partnerships that engage parents and community members in program design and implementation. (Evaluates community voice and leadership)

OUTCOME MEASURES:

  • Percent of children in EHS programs who receive preventive oral health services, such as fluoride varnish. (Measures delivery of evidence-based prevention)
  • Percent of EHS families who report increased knowledge and positive attitudes toward oral health after program participation. (Evaluates impact on oral health literacy)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.

References

1 U.S. Department of Health and Human Services. 2010. Head Start Impact Study: Final Report. Washington, DC: U.S. Department of Health and Human Service. https://www.acf.hhs.gov/sites/default/files/documents/opre/executive_summary_final_508.pdf

2 Lipton BJ, Decker SL, Stitt B, Finlayson TL, Manski RJ. 2022. Association between Medicaid dental payment policies and children’s dental visits, oral health, and school absences. JAMA Health Forum 3(9):e223041. doi:10.1001/jamahealthforum.2022.3041. https://jamanetwork.com/journals/jama-health-forum/fullarticle/2796209

3 Nasseh K, Vujicic M. 2015. The impact of Medicaid reform on children’s dental care utilization in Connecticut, Maryland, and Texas. Health Services Research 50(4):1236–1249. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4545356/

4 Early Childhood Learning and Knowledge Center. About the Early Head Start Program [webpage].

5 Burgette JM, Preisser Jr JS, Weinberger M, King RS, Lee JY, Rozier RG. 2017. Impact of Early Head Start in North Carolina on dental care use among children younger than 3 years. American Journal of Public Health 107(4):614–620.

6 Burgette JM, Preisser JS, Rozier RG. 2018. Access to preventive services after the integration of oral health care into early childhood education and medical care. Journal of the American Dental Association 149(12):1024–1031. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7239644/

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.