Healthy Smiles Training
Program Summation Report
September 2017
Executive Summary
When the Health Smiles Training program commenced in 2012, it was initially introduced as a 2 ½ day face to face workshop. The training participants included primary healthcare professionals with a Child Health portfolio.
The program was seen as a translation of the research evidence into clinical practice. The
evidence was provided by the 2005 – 2009 Menzies School of Health Research ‘Strong Teeth for Little Kids’ (STLK) research study. The primary goal of the STLK study was to develop, implement and evaluate the effectiveness of a community-orientated primary healthcare intervention to prevent dental decay among pre-school children in Aboriginal communities in the Northern Territory. It also confirmed that 6 monthly applications of fluoride varnish to the teeth of children aged from eighteen months translated to 25 – 45 percent reduction in decay rate.
Outcomes from the STLK research project provided the rationale for Oral Health Services NT (OHSNT) to initiate development of a comprehensive primary healthcare intervention. At the same time the Federal Government initiated Stronger Futures (followed by Northern Territory Remote Aboriginal Investment) funding agreement. Emphasising the importance of the program was the inclusion of the number of participants as one of the required targets. The agreed participant targets were: 2014 – 60 participants; 2015 – 66 participants; and 2016 – 72 participants. Additional to participants’ numbers, the application of fluoride varnish by primary healthcare professionals following their training contributes to meeting targets for the application of fluoride varnish to 80 percent of the target population (18 months – 16 years) over the duration of the funding period.
To cement this as a priority action for Oral Health Services, it was embedded into The Northern Territory Oral Health Promotion Plan (NTOHPP) 2011-2015. It was detailed into Action Area 3 as follows:
Actions
3.2 Oral health status checks be incorporated into standard assessment protocols for under five year olds
3.3 OHS-NT will facilitate the training of relevant staff in the assessment of oral health needs of infants and young children
3.4 Training in the use and application of fluoride varnish will be provided to relevant staff 3.5 Collaboration between OHS-NT, Remote Health staff and DET staff will ensure that regular fluoride varnish programs are accessible to high risk children.
Standardised oral health checks
In acknowledgment of the significance of the STLK project, consultation occurred to determine the feasibility of including oral health items in the Healthy Under 5 Kids Care Plan & Well Child Health Checks( HU5K) delivered in rural and remote communities.
The adoption of the Healthy Under 5 Kids (HU5Ks) Well Child Check by Department of Health provided the ideal vehicle to achieve this. It incorporated a series of age specific child health checks which includes growth assessment and childhood vaccination schedule. The program was developed to focuses on facilitating prevention, management and early intervention of common and treatable conditions in remote communities in the NT.
HU5K Care Plan provided a framework that assisted in creating a supportive environment for parents and children to access preventive oral health care. The oral health items comprised:
• A Lift the Lip oral health check and risk assessment;
• Appropriate referral pathways to oral health services;
• Provision of anticipatory guidelines (age relevant oral health messages for parents and
• Application of fluoride varnish at 6 monthly intervals from 18 months to 4 years of age and an established 6 month recall.
The Healthy Smiles training program commenced following the release of the National Industry Skills Council Oral Health Skill Set modules. Two representatives from the NT contributed as members of the consultation committee in the development of these modules. HLTOHC408A Apply fluoride varnish provided the accredited competency unit for the delivery of the program for registered health professionals in the NT, in particular Registered Nurses and Aboriginal Health Workers. The unit of competency was released in late 2010.
During the development of the course content and resources significant consultation also occurred with Colgate Oral Care, Remote Health Branch, Chief Health Officer NT, NT Drugs & Therapeutics Committee, Environmental Health and oral health clinical staff. As part of the consultation The Healthy Smiles – Oral Health & Fluoride Varnish Information for Health Professionals manual was peer reviewed by 2 external academics at University of Melbourne and University of Adelaide who were Professors in areas of Oral Health.
The HS training package was designed to target and provide registered health professionals, in particular, nurses and Aboriginal & Torres Strait Islander Health Practitioners (ATSIHP) with the underpinning oral health knowledge and practical skills to effectively implement the oral health components of the Northern Territory Government Department of Health’s Healthy Under 5 Kids Well Child Health Check (HU5K).
Around the same time as the development of the HU5K program, oral health and fluoride varnish information was embedded in remote healthcare practice. This was achieved by inclusion in the Primary Health Care manuals used by health professionals, namely the Central Australian Rural Practitioners Association (CARPA) Standard Treatment Manual and the Clinical Procedures Manual for Remote and Rural Practice (CRANA Plus).
The issue of application of fluoride varnish by non-oral health professionals was addressed through legislative changes and the development of the Certificate IV competency unit HLTOHC408A Apply fluoride varnish.
Evaluation Methodology
The Healthy Smiles Training Evaluation Model is closely based on the Training Evaluation Framework and Tools (TEFT) which is a set of resources designed to help evaluators,
implementers, and program managers plan successful evaluations of in-service training program outcomes.
This evaluation model has been developed to facilitate this Mid-point survey. The model will also enable ongoing assessment of the impact and effectiveness of the training over the life of the program. However the main reporting requirements Stronger Futures National Partnership Agreement was the number of workshop participants and applications of fluoride varnish by primary healthcare professionals for the period 2014 – 2016.
Telephone interview details
Structured telephone interviews with participants were conducted by the Oral Health Promotion Planning & Evaluation Officer (OHPP&EO). This was to determine if and how participants had applied the skills and knowledge acquired during the workshop into their everyday practice.
The Oral Health Promotion Unit developed the telephone interview tools. Prior to the
implementation the final telephone script and questions were endorsed by the Executive Director Territory Wide Services.
Telephone interviews took an average of 10 minutes to complete.
An introductory email was sent to all registered 2013 Healthy Smile Participants. The email
outlined that participants would receive a call from Oral Health in a set time frame. As the majority
of participants worked in remote areas across the Territory, it was deemed necessary to offer participants an option of participating in the telephone interviews or completing an online survey.
The online survey questions were drafted from the telephone survey questions however the OHPP&EO was allowed some flexibility when conducting the telephone interviews.
Quantitative Outcomes
Stronger Future/NTRAI targets Actual &
Targets
Number of Primary Health staff received training
2014 60
2015 2016
66 72
** Shaded area indicates actual targets for remainder of NTRAI. Early indications are that the targets will be achieved.
Time Period Applications
of Fluoride Varnish by Primary Healthcare staff
Before 2012 there were no FV applications
Jan – Dec 2012 88
Jan – Dec 2013 82
Jan – Dec 2014 314
Training Program Findings
Key Findings Recommendation
Quantity of information greater than allocated workshop time
Increase the current allocated time for the face to face training workshop
Post workshop support for participants
• Development of Post training communication strategy
• Investigate IT modalities for post training support
• All registered dental practitioners undertake Vocational Skills Supervisor training
Skills and confidence development for participants within workshop
Invest in oral health simulation aides to allow participants opportunity to practice in a lifelike practice session prior to applying varnish on children for their workshop proficiency assessment.
Requirement for provision of ongoing oral health
knowledge
Inclusion within proposed communication strategy
Finalisation of assessment Task 3b
Implementation of schedule for post workshop competency assessment
Ongoing access to PCIS;
Communicare data
Negotiate access to HU5Ks/Partnering with Families reports
Continuation of oral health component within next version HU5Ks
Increase the volume of health practitioners requiring Healthy Smiles training.
Post Script
The Mid Point Evaluation was undertaken on accredited training program HLTOHC408B Apply Fluoride Varnish. In 2015, Service Skills Organisation (SSO) updated the competency unit. The superseded unit is known as HLTOHC006 Apply Fluoride Varnish. Any further evaluation will be conducted on this unit.
Given the time lapse between the Evaluation findings and the release of the Summation report, majority of the key findings have been adopted within the Healthy Smiles Training Program.
A final Evaluation is to be undertaken. It is anticipated that it will commence before December 2017.