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The webinar will start in another minute or two. We're waiting for more folks to come onboard.

The closed captioning will be appearing for those who may need closed captioning and at the bottom in a small box you see on the left side Q&A. You can pose questions by writing them into this box. At the end of the presentation we will try to answer as many of your questions as possible. If you feel comfortable, when you write your question, please state your name and the state that you represent after your question.

Moderator: I guess without further ado, let's get started. We are thrilled today that we've had so much interest in today's webinar. We've had over 170 folks who have registered for today's webinar, many of them are title five directors and staff, oral health and professionals and advocates that are attending today. Today's webinar is on partnering to make oral health services easier to use for families with special healthcare needs.

Just as some background to explain how we got involved in this area, when we first started we heard from many parents and professionals that paying for services with not easy, that it was very challenging. So with the help of our program officer and the program officer for the targeted oral health services system, we were able to connect and begin with a community of practice focusing on the oral healthcare need of children in youth with special healthcare needs. The participants in this community of practice identified several topics and activities that they thought would make oral health services easier. One of them was hosting a webinar such as this one really focusing on how to successfully partner with title five and across other systems. One of the participants was Diane Flanagan. She's one of our speakers today. She is the Children and Youth with Special Health Care Needs Oral Health Project Manager for Wisconsin. Her interest includes pediatric and special needs accidental hygiene. She's been working in the field since 1980, and she will be presenting today with Amy Whitehead, the statewide coordinator for the Children and Youth with Special Health Care Needs program. Amy has over 25 years of experience working within program tools to improve the system of support for families. She's inspired by her son's life and has devoted her career to promoting family and partnerships. I'm going to turn it over to our program officer who will say a few words.

Project Officer: Thank you Myra. On behalf of the division of services I want to welcome you all to this webinar on accessing oral health services. Our mission is to provide national leadership to assure access to a competent community-based comprehensive family center of services for children, youth with suspicion healthcare needs and their families. We use six quality indicators or outcomes to measure. Access to medical home. Continuous screening, adequate health insurance and financing, transition to adult service and finally, easy to use community services, which is, obviously, relevant to the webinar topic today. We accomplish our mission through many ways. We use grants and contracts. The most important way is through partnerships. One of our key partners is the National Centers including the national center for community-based services. Easy to use community services have always been an enigma. On one hand, it indicates great success with the indicator with a huge majority, almost 90% of families indicating that services are easy to use. When we talk to families and look beyond the numbers, we know there are huge cracks. [Pause in transcription] I look forward to hearing the speakers and more important I look forward to advancing and better succeeding and helping families access oral services.

Moderator: We, at the center, have been lucky to have the guidance and vision of Pam Vodicka to support us in our work together, and so as we get started, I want to set the context a bit for everyone regarding the impact of oral health needs for Wisconsin families. I've included a couple of points to consider. First, nearly 200,000 or a little bit over 15% of Wisconsin children have a special healthcare need. Children and youth are nearly twice as likely to have had two or more oral health problems in the past six months compared to children without special healthcare needs. A recent oral health assessment of the head start children in Wisconsin indicated that 10% of head start children have evidence of early childhood care. There was evidence of pain and or infection, and so now I'm going to pass it over to Diane and Amy who will give us an outline for today's discussion and go ahead and begin. Thank you.

Presenter: Thank you. This is Amy whitehead. Welcome everyone. We really appreciate the opportunity top talk with all of you today and address such an important topic. Diane and I have worked together to address the oral health needs for several years and we hope that you will see the benefits of this partnership. We really hope that you come away with some ideas that you can use in your work.

In today's discussion, we're going to focus on the structural foundation for the partnership, and I'm going to tell you a little bit about our Wisconsin Title V children and youth with special healthcare program and its network so that you understand how this partnership was possible and then Diane is going to talk more about the health grant, targeted oral health services systems grant. She will provide you with an overview of outcomes and we'll close with what was it about the partnership that really made things work and made this a success.

In Wisconsin, our children in youth with special fields program is located within our state of Wisconsin, Department of Health Services, Division of Public Health. Our state office is in Madison. We have five public health offices across the state and each regional office plays as role. The MCHB Block Grant funds our special needs program. The program mission is to assure that children in youth with special healthcare needs are identified early, receive high quality coordinated care, and their families receive the support they need. I'm going to try to speak up. I understand it's hard to hear. So let me speak up a little bit.

Our mission is to make sure children with special healthcare needs are identified early and the families receive the support that they need. I want to mention and emphasize that we have families at the center of our work. We have families as partners at every level. Families as staff, families in advisory roles, families as partners in all aspect of the role. We know as Lynda mentioned, the service system is complicated and not always easy for families to use. To address the problem we structured our CYSCHN program as a network of funded collaborators. So I want to tell you about this network and how it's structured and functions, so you’ll understand why it's a perfect match for partnering with the oral health initiative that Diane will describe.

The CYSHCN program is structured by having a small state staff and contracted agency. Each contracted agency addresses a different aspect of the national performance measure and together, they form a collaborative network. For example, Family Voices is a contracted agency to address family leadership. Our regional center for CSHCN addresses the need for community systems to be structured in a way that families can receive services. That gives you a couple of examples. So our collaborators network operates as a closely-knit group of partners that all are working together and they share regularly. They share resources, they share what they're hearing from the local level from families in terms of pressing issues related to children's special healthcare needs, they have monthly teleconferences they have in-person meeting, and they share one another's materials. If someone creates a really great road map to services, it's shared with other partners. The partners also cross promote one another’s materials through conference exhibits, presentation, training and so on. The goal of the network is to ensure that linkages are in place between CSHCN initiatives in Wisconsin and the common set of practices and performance measures.

The guiding principles that we operate under, as you can read here, related to children are served best in the context of their families and within the context of their communities and that collaboration is critical for everything. As I said earlier, the family perspective and presence must be included in all aspects of the system. So, as you can see through from these guiding principles, again I just want to say how important the family is to what we do. Lynda earlier mentioned the national performance measures. We also are addressing through our network these national performance measures. I've described the CYSHCN program and how it’s structured as a network and I’d like to drill down to one part of the network -- the regional centers. You can see how we utilize the network to partner with the oral health initiative.

There are five regional centers, one in each division of public health regions in the state and the regional center provides information and assistance to families and providers. They have walk-in resource rooms where families can look at resources and talk with skilled and knowledgeable experts, many of whom are family members themselves, and regional centers get questions about any topic related to CSHCN--respite, insurance and more. The regional center will either handle the question themselves or make a referral to others in the network. So for example, if a family wants advocacy training, there will be a referral to Family Voices. Or if a family wants to be matched to another family, there will be a referral to parent to parent.

The collaborators network, and the regional centers in particular, is an infrastructure that Wisconsin has used for the last 10 years. We keep making improvements to it, but it has been shown to be a strong and effective approach to address the six national performance measures. This structure serves as a foundation on which to build and integrate new initiatives. Several years ago, a set of WIC nutritionists were established to gain expertise around CSHCN and really devote extra time to that population. These nutritionists work closely with our regional centers resulting in regional centers knowledge of WIC and nutrition issues increasing and likewise the nutritionists and up with increased knowledge about children special healthcare needs and the resources available to them.

When we had our state Combating Autism Act Initiative Implementation Grant, we again built upon the infrastructure of regional centers. In this case, the regional centers gained an immense amount of knowledge and information about autism spectrum disorders and became experts in this area. Likewise, the autism spectrum disorder community became more aware of the children's special healthcare needs program and its network as a set of resources, so it has proved to be an excellent way to build on our capacity. When the CSHCN oral health grant application came out, we knew a partnership between oral health and the CYSHCN program was a natural fit. The design of the oral health grants intentionally built upon the infrastructure, which I just described.

The Targeted Oral Health Services System grant or TOHSS incorporates the regional centers in its core design. The design was that in each regional center, there would be an oral health coordinator to partner with. As in the earlier examples of the partnership, in this collaborative relationship, both the regional centers and the oral health coordinators make referrals to one another. For example, if a family calls the regional center saying they have dental insurance and dental coverage but can't find a provider, the regional center would contact the oral health coordinator and ask for assistance around this question and they work together to help the family. Likewise, if the oral health coordinator is working with a family and the family asked a related question outside of the realm of oral health, the oral health coordinator could refer the family to the regional center and it might not be just a referral, it might a three-way consultation or conversation that would ensure that these resources were shared between the two partners, and human resources and also practical materials and so on were shared. Outreach and training activities were shared.

Before I turn it over to Diane to illustrate how the network strengthens the partnership, we have the circles of life conference and the oral health partners had not known about it, so we invited them to have an exhibit table. At the conference one of our parents went to the exhibit, which displays toothbrushes and other special adaptive tools and the parent had a child with autism and was struggling with her son's inability to brush his teeth effectively. After the family met with the oral health coordinator and talked about what could help the son, a new toothbrush was identified. Since that day, tooth brushing for this individual child has been successful. It's an example of this type we see from this collaboration. I would like to turn it over to my partner, Diane Flanagan who will tell you more about the TOHSS grant. Thank you.

I understand we are having some issues with volume, so I will try to talk loudly. First, to describe Children's Health Alliance (CHA) of Wisconsin—we partner with the Department of Health Services in the oral health program, as well as the children in youth with special healthcare needs program. We are not a state agency, we are a private sector entity. CHA was formed fifteen years ago when Wisconsin leaders in MCH felt there was a need for more focus on child health issues that were falling under the radar. They took a small portion of the MCHB Title V money and issued an RFP hoping that they would receive a response to create an entity that was separate from government but would work closely with government by forming collaborative relationship. Children's Hospital of Wisconsin responded and formed the CHA of Wisconsin. Children's Hospital remains the fiscal agent for the alliance, yet the alliance has its own identity and is viewed as a neutral body willing and able to work with anyone, be that a government agency, professional organization, business, system or anyone focused on improving maternal and child health.

The work of the alliance is not focused on service delivery, but rather system building. We mobilize leaders and lawmakers around our key initiatives. We implement effective programs of policies and build capacities with our partners to drive change. It's because of this statewide focus and collaborative experience that the department of health services oral health program asked the alliance to write for and administer the MCHB TOHSS grant with a focus on improving oral health and access for CYSHCN. The targeted oral health systems grant began September 1st, 2007 and ended August 31st of this year. For simplicity, we have called our program the Wisconsin Special Smiles Program (WSSP).

There are two main goals. Just to paraphrase the goals that you see written here, basically for every health program for CYSHCN, oral health needs to be included. For every oral health program for children, it needs to include children and youth with special health care needs.

The program utilizes services dental hygienists who lead the effort in the five public health regions of the state. The title is regional oral health coordinators or ROHC. The advantage of using an ROHC is they live in the region, they are employed in other public oral health programs, they have established relationships with dental public health programs, and dentists who work in the region. Most importantly, they understand the needs and solutions you can achieve within the region. For example, in the northern region of the state, the ROHC is also involved in Northwoods Dental Project, which was administered by a multi county health department. She works already in Head Start and with the state field smiles practice. She is was ideally positioned to become a regional oral health coordinator for this particular program because she could then use the system show was always working in to improve the access and include children with special healthcare needs.

In Wisconsin, the dental practice act allows dental hygienist to provide services without the supervision of a dentist in three settings, one being working for a public health department, providing services The ROHC can provide services in an academic setting such as a dental hygiene school or university, and providing services in a public or private school, and this is where most of the work and clinical services are provided for our children and youth with special healthcare needs that are part of our program. Because of the regional oral health coordinator can deliver services in school, it makes them the perfect choice to improve access for children and youth with special healthcare needs. I have a slight technical difficulty here. Just one moment.

In the school settings, with the focus on Head Start and special education classrooms, ROHCs actually provide oral health assessments. They look in the mouth, assess the needs of the child and the oral health status, provide fluoride varnish treatments, place dental sealants, develop oral health plans, and do targeted case management. They also provide oral health education. Now I listed a few here, but it seems like we do quite a bit of talking to lots of groups and individuals who work with children and youth with special healthcare needs, not just those who are listed but teachers in the school, nurses, occupational, physical, or speech therapists. Those are largely our targeted group to make sure that they understand the oral health messaging and oral health needs of children with special healthcare needs.

The collaborative partnerships are key to increasing oral health access for children with special healthcare needs. They provide an avenue to insert oral health education to health program for CYSHN to provide oral health education and to provide clinical services. Some of our outcomes, when new programs became part of our collaborators network such as the autism program or family voices, as a member of that network, the Special Smiles Program was able to work with individuals as they developed different materials for families of CSHCN. Some of the materials that include oral health care now but didn’t before are transition to adult healthcare. “Did you know, now you know” training for leaders and family voices and oral health is also included in the finding your way services guide for a child diagnosed with autism. These are a few of the examples of how our collaborative relationship has produced an outcome for families.

Another example of an increase in access to preventive dental services is the Wisconsin Seal Smiles Program, which is also administered by CHA. The number of children with special healthcare serviced by the field smiles program increased 238% from the baseline year of 2005. Basically it was 2005, 2006 school year through the school year of 2007, 2008. This increase can be attributed to the training to the Wisconsin seal of smile staff. An additional increase in the number of CHSCN who received dental sealants was seen in 2008 and again in 2009 and also within this last year. We didn't put them on a graph since we did have a large expansion of the program and it didn't accurately reflect the percentage of children with special healthcare needs that we're seeing.

But the Wisconsin special smiles program collaboration with Wisconsin field smile program has provided training to the staff on the following--accurate identification, recruiting and recording of children with special healthcare need status, data collection forms using the MCHB definition. The training also included inclusion of CYSCHN, including those in non-mainstream classrooms and sealant programs. So during the training we did with the grantees, we also gave them tips of how to find children that they may not be accessing within the schools where they were delivering sealants, such as, in most sealant programs the children are in second or third grade. The age might be somewhere between eight and nine. And children with special healthcare needs, if they were not mainstreamed in the second grade classroom, they may have been left out of the program. So we head the grantees understand they are looking for 8 and 9 and 10-year-old children in the school, regardless of if they were in a classroom of typically developing second graders.

Also, availability of the ROHCs to assist with providing sealants to CSHCN. The ROHC were specifically selected because they had excessive experience in working with children's special healthcare needs. They were then able to join some of the seal and smile programs and deliver sealants and help accommodate the children that have additional adaptive needs. In addition, in the 2009/2010 school year, the ROHCs conducted six sealant clinics and they placed 111 sealants in specialty sealant programs focused solely on children with special healthcare needs.

It didn't end there. We all know access to a dental home is a significant issue for children with special healthcare needs and their families. So part of the grant was to improve dental training for practicing dentists and dental hygienists. Over 400 practicing dentists and dental hygienists and dental hygiene students and four hygiene schools received didactic training, meaning that they had a lecture or some type of training program that wasn’t necessarily a hands on clinical training. In addition, we did have a few dentists who self-selected and wanted to receive additional clinical training, and we were able to arrange clinical sites for those particular dentists to go to receive additional training so that they felt more comfortable in working with children and youth with special healthcare needs. This included two particular dentists who wanted to deliver treatment using general anesthesia and this could be a significant need for the population we serve in that those that have multiple conditions and behavioral issues, may need to have their treatment done under a general anesthesia. We were also able to help those particular dentists with that. And the regional oral health coordinators were able to develop a network within the region to identify dentists willing and able to treat children with special healthcare needs and able to help them receive services and were able to refer.

Another outcome, the Wisconsin special smiles program is an accepted partner in the children and youth with special healthcare needs community throughout the state as a result of our collaborative effort. It's recognized as a resource for oral health information and service for CSHCN and the regional oral health coordinators and the project managers continue to respond to are requests for oral health information and services by families of CYSCHN and the professional who support them. The WSSP website, redesigned, oral resources page and the development of a web page for parents of CSHCN is in response to a need by the professionals and the parents for more resources to assist individuals with their oral health needs.

Another outcome is during the process of the four-year grant, the regional oral health coordinators who meet monthly, via teleconference, identified a need for parents oral health education for children with special healthcare needs at a younger age. A lot of our programming was done in the head start program and by the time they get to head start and as you saw on the slide that Myra did, 25% of the kids in head start had some untreated dental needs. So in response to this, we developed a training program for home visitors to deliver oral health education to parents in the birth to three program.

The dental community cannot do this alone. And because of the on going trusting relationship between the home visitors and families, this was the ideal individual to deliver oral health messaging. It wouldn't have been ideal for a person such as myself to go in as a complete stranger and try to convince families that doing oral health hygiene at home is something they need to do and to tell them, “well, this, you have to do that.” We're not the right messengers, but the home visitor truly is. So we developed this program. We took pictures of all the items that we put in the tool kit and trained the home visitors and at this point we have completed the pilot phase at five different training sites. We are now in the process of reviewing the data and we definitely plan on moving forward on this project and expanding.

Another outcome as relayed to us by the director at northeast regional center is that relationship between the regional oral health coordinator and the regional center and its effectiveness. Here you can read the story about the partnership, increase the center's awareness of oral health and dental refer network. I will ask you to finish this because I definitely have to grab a drink of water.

I'll just read the quote. This is from Cara Van Vooren, at our northeast regional center. She said about the partnership, “The partnership increased our center's awareness of oral health and dental referral network. The ROHC helped us understand challenges families face finding providers and to look at ways to support good oral health practices with children who have special oral health considerations and challenges with daily care.”

In our western region, Winnie Cook said this about the relationship between the regional oral health coordinator and their center. She said, “Our partnership with the Regional Oral Health Coordinators resulted in a mutual increase in our capacity to help families whose children with special health care needs require specialty oral health care. Most recently we worked together to problem solve access to oral health care for a young woman with autism who needed surgery to remove her wisdom teeth. The ROHC was an outstanding advocate who worked with the patient and the oral surgery team so that the experience was positive for everyone. This program will have long lasting positive effects because of the trusting relationships built between the Regional Center and ROHC.”

Our work isn't done and there have been a lot of different challenges. One challenge is the fact that we do not have an environmental survey. An environmental survey would be a survey taken to document all the access points for children and youth with special healthcare needs into the system, and by having an environmental survey, it would be very helpful to identify those access points and provide a better road map of where we're going.

Like most states, Wisconsin has issues with Medicaid reimbursement. Wisconsin itself is near the bottom for reimbursement for dental services and that issue does not look like there will be any change in the very near future. But we work within that system and we try to develop alternative ways of service delivery so that our children can receive services. Education of dentists...that's always an ongoing problem. It's documented throughout the United States. We are fortunate that at Marquette University, Dr. Brian Hodgkins one of our dentist trainers, worked in the dental clinic in the pediatric program and he ensures that Marquette University not only addresses the needs of children in general but CSHCN specifically.

Another challenge that we have is that of geography. Wisconsin has two large metropolitan areas between Milwaukee and Madison and a variety of medium sized cities, but by and large, it is very rural and there are a lot of access issues just due to geography and the fact that to receive dental care for many individuals you have to drive, sometimes as much as two hours to receive care. Then if you have a child that needs to see a specialist, that transportation issue becomes even larger in trying to locate a dental provider. We have found that geography wise and insurance wise, that if a child with special health care needs is covered by private dental insurance, lives in or near a large or medium sized city that has pediatric dentists, they basically can find a dental home relatively easily. It's those children that geography is an issue or they have Medicaid reimbursement as opposed to private dental insurance, those are the children who are having the largest issue with receiving dental care and those are the children that we have focused our efforts on.

The other thing is, one of the first slides I noted but did not mention, the regional health coordinator is .2 FTE, which isn't a lot of time. Since this is a demonstration project, we were committed and all the regional and oral health coordinators were committed to working efficiently and effectively in developing a network of services for the children we serve.

A huge issue is perception. In general, children and youth with special healthcare needs can be treated as invisible children and sometimes it can be because they may not be in mainstream classrooms and sometimes get forgotten. We have to make sure that any our oral health programs that are school-based always seek these children out and provide services to them and if that is not the appropriate service center or venue then to ensure these children can find a dental home in the community. Also, perceptions by the dental community. If the child has a behavioral issue or doesn't fit in their business model or as usual practice model and their lack of education on specific special needs conditions or their ability to do a needs assessment, or provide adaptive techniques, those are also some of our issues.

But one of the perceptions that the regional oral health coordinators identified early on was that teachers, parents and professionals, and their lack of confidence in the dental provider's ability to understand the children and youth with special healthcare needs and treat them appropriately was huge. To break down the barriers and assure teachers, parents, principals that these regional health coordinators could and were capable of providing services to children and families took a little work and multiple encounters. Usually, it started out with doing basic oral health education but it’s interesting that once the confidence was established, the demand was great. The regional oral health coordinator said it actually became very demanding. So that was kind of an interesting outcome.

We've also conditioned our parents and our children to think that general anesthesia is the only way to perform treatment for some of our children with significant needs and behavioral issues. Whereas there are other ways to do things with behavior guidance techniques, desensitization and those are some of the things that we as dental hygienists with experience working with CSHCN were able to bring forward and to help with. But the lack of oral health literacy, we usually think of that when we're thinking about children maybe in a low socioeconomic level, but it crosses all level in the socioeconomic stage. We need to make sure that we provide oral health education to teachers, principals, professionals, anyone who works with children and especially those with children special healthcare needs.

So this made our partnership work. We have a shared vision for making things easier with families. We developed a strong partnership relationship. We're able to provide key contacts. I was able to help identify different contacts, individuals within the dental community and likewise, she was able to provide contacts for me within the children and youth with special health care needs communities and our willingness to reach out and response. This is a very welcoming group. The collaborators network and everyone works together. I also sincerely appreciated the fact that early on Amy included me, I will let her finish because I have that same tickle in my throat. From early on we included Diane and the regional oral health coordinators in our collaborators network. They written invited to calls, they came to meetings, were on our listservs and that made a big difference.

Sustainability…You can see here there are a lot of different agencies listed. Any program that we've established will continue because oral health for children with special healthcare needs is fully integrated in those existing programs. In addition, CHA of Wisconsin is committed to continuing to work with the CSHCN community and to develop oral health programs for all children, including those with special healthcare needs.

So we with like to make a couple of acknowledgements. The regional oral health coordinators who have worked in our program over the last four years, our dentists trainers, who have been very, very helpful and we would really like to pay a special tribute to the MCHB and HRSA for supplying funding for this demonstration grant. In addition, the department of health service and the MCH Title V Block Grant and Myra would make also like to make sure that you understand that this webinar is supported by the MCHB and HRSA. Our contact information is listed, and I would like to say we have not solved all the problems here in Wisconsin by any stretch of the imagination. We have probably made a -- well, I would say relatively small but significant dent in the access issue but these are some of the programs that we've been able to make headway in and we hope that our continued collaboration partnerships and efforts will make access to oral health and oral healthcare easier for children and youth with special healthcare needs and their families.

Moderator: Okay. Well, thank you, Diane and Amy, and this is Myra again. Before we start asking some of the questions, I do want to let folks know because we've gotten a couple of questions about this, we will be having the archive of the webinar on our website and our website will be listed in the next slide, and it is but you will see the next slide that has that.

So let's go ahead and get started and Diane and Amy, if you're ready to answer some questions -- I think the first one we received from a parent was if there had been any kind of media campaign or public awareness campaign of dental issues and oral health, in particular for children with special healthcare needs and any campaign where you were able to tell parents in your area where they could go to go get help.

Presenter: No…in one word. There as not been a publicity campaign surrounding receiving care for children and youth with special healthcare needs. Unfortunately, many of the dentists who do accept Medicaid and treat children with special healthcare needs are overwhelmed, and by and large they don't want anything advertised as, you know, come one, come all, we can treat any child here. It is a huge, huge issue, but at the CHA, we've recently employed an individual that will be helping us with our messaging, our oral health messaging and we do hope to have more oral health information for families, and, again, we will continue to work to improve the network of providers within our system.

Moderator: Okay. Great. And the next question is are there any particular populations that are -- have been challenging in terms of making certain that they have access to oral health and what have you done about it and basically the question is populations based on geographic locations sense you talked about the five different regions or maybe by disability type but if there are special initiatives that you've had to do.

Presenter: Great question and I thank you for asking that particular one. We worked and targeted the federally qualified health centers throughout Wisconsin to provide oral health services for children with special healthcare needs. They also provide services for adults. Geographically in the northern region of the state, the Marshfield Community Dental Centers have been instrumental in improving the access to the large geographically challenged areas of the northern part of the state. Within that program they have been dedicated to improving the access for children and youth with special healthcare needs. They have providers at each one of their sites that are fully trained and capable of treating children with a variety of special needs, whether it be developmental or behavioral, as well as developing a system that has access to general anesthesia should than necessary. So I did forget to mention this very important program, and I am so grateful that you asked the question.

Moderator: Okay. Great. We have another question, and the question is, how or was this project tied into the state oral health program state plan and initiatives?

Presenter: Oh, I am so glad you asked this question too. The Department of Health Services in Wisconsin has been an instrumental partner, and I am extremely negligent in mentioning that. They were instrumental in identifying this grant, identifying the need of the grant and partnering extremely closely with us, providing and implementing the services that we do here in the state. At the time the Department of Health Services Oral Health Program was very small, consisting of two employees. We are very grateful that they were able to receive a CDC expansion grant, which has enlarged the department significantly, and children in youth with special healthcare needs are an integral part of their oral health programming. And they are superb partners to have within this program. As far as the state dental plan, that is a work in progress. It is not completed yet, but with the sealant program plan that was developed, there's a large section in this with -- that addresses the needs of children and youth with special healthcare needs and the state oral health plan will also address that particular issue. Once again, I thank you for that question because they are an integral partner in this program.

Moderator: Okay. I think we have time for probably one more question, and that question is, have you tracked inquiries or requests from families with children with special healthcare needs and if yes, what have you found?

Presenter: We haven't tracked them as far as doing a data collection of them, but during our monthly regional oral health coordinator meetings we do discuss the type of phone calls we receive. The most sought after information is location of a dental provider. That is usual lit number one question we're asked.

Moderator: Great. I'm just looking at the time and I do want to stick to our time frame here. As you'll see on the next slide, there's a link for the survey that we're just asking a couple of questions to see how the webinar went for all the attendees and also at the very next slide, you will see our website where you can find not only the archived recording of the webinar but the PowerPoint slide as well as a section on some oral health resources that also will have the website for Amy and Diane and a bunch of other related materials. So I guess with that, we are ending and we thank all of you for participating and look forward to hearing your feedback via the survey or by email. Again, thank you and have a wonderful afternoon. [ Event concluded ]

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