I. Agency Information Eisner Pediatric & Family Medical Center (EPFMC) is a quality-focused, nonprofit community health center dedicated to improving

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1 I. Agency Information Eisner Pediatric & Family Medical Center (EPFMC) is a quality-focused, nonprofit community health center dedicated to improving the physical, social, and emotional well-being of people in the communities we serve, regardless of income. Founded in 1920 as the Anita M. Baldwin Hospital for Babies, the agency originally occupied only three beds on the campus of California Hospital (CHMC). By 1945, we had opened the first preschool dental clinic in the western U.S. and were overseeing 30 pediatric medical beds at our own facility. Sixty-eight years later, our patient-centered medical home model encompasses nine sites and incorporates a range of services from primary care and childbirth classes to family therapy and periodontal treatments. Programs and Services: Adult and Pediatric Medical Clinics (primary and episodic care); Women's Health Center (family planning, gynecology, maternity care); Dental Clinic (screening, treatment, oral health instruction); Mental Health Department (group and individual therapy, parenting classes); ancillary services (occupational therapy, pharmacy, lab, digital x-ray); four School-Based Health Centers; the portable San Pedro School Dental Clinic; and one WIC site. Target Population: EPFMC is located in both State Assembly and Senate districts identified as having the highest levels of non-elderly uninsured in California (UCLA, 2009). Our Primary Service Area (PSA) encompasses downtown and South Los Angeles, Koreatown, Westlake, Leimert Park, Jefferson Park, Crenshaw, and Mid-City. The majority of our patients live and work in neighborhoods characterized by high population density, crime, sparse commercial services, high unemployment, and low levels of education. In 2012 we provided 113,802 clinical visits to 29,284 unduplicated patients. Ethnicity: 82.9% Latino; 12.5% African American; 2.6% White; 1.3% Asian;.7% Other. In 2012, 96.7 % of our patients reported living below 150% of the Federal Poverty Level. o 53.8% of households reported incomes of less than $25,000/year. Educational attainment: 40% of residents over 25 have not completed high school; 23% have HS diplomas; 21% have some college; and 16% hold a BA or higher degree. 71.7% of households in our PSA reported speaking a language other than English at home. Single parent families make up 43.6% of the total families in our service area. Accomplishments: From three beds in a borrowed facility in 1920, we have grown to a year-round staff of 281 working at multiple sites. Since being designated a Federally Qualified Health Center in 2004, we have expanded our facilities, our geographical penetration, and our provision of services. We've not only managed three successful capital campaigns (totaling $17.8 million), but have also increased our service visits by 35 percent. Three highlights of the past few years include: Our acquisition of the Women's Health Center in 2007 greatly improved the medical landscape for women in our service area. It transformed EPFMC from an outpatient-only, primary care FQHC into a comprehensive women's medical home/hospitalist practice staffed by the largest Certified Nurse-Midwifery program in California. In 2011, EFPMC formed a partnership with USC and CHMC to establish and manage the USC-Eisner Family Medicine Center at California Hospital for low-income medically underserved residents of downtown and South LA. Staffed by USC clinicians, the FMC is the principal training site for CHMC's Family Medicine Residency program. The dental component of our 2011, $6M Health Resources and Services Administration Capital Development Grant (targeting provision of care for indigent and very low-income children) included the construction of three new exam suites (giving us a total of 14) and has increased our service delivery capacity by 27 percent. 1

2 II. Project Description A. Summary: EPFMC is seeking $1,000,000 for the Everychild Dental Home Initiative (EDHI), an innovative group of on-site, portable dental clinics housed in parent/multipurpose rooms at four neighborhood schools. During the three-year grant period, ECF funds will be used, first, to expand our current dental clinic at San Pedro Elementary, a PK-5 school located just south of downtown LA; and, second, to establish three new clinics at schools within our PSA. We expect to provide over 15,000 screening, preventive, and restorative treatments to 3,150 children during the grant period. When fully operational, the EDHI will deliver over 7,000 onsite treatments every year to roughly 1,540 PK-5 students at the four schools. With dentists available twice a week at each location, we can provide reliable care in a familiar place where children feel welcome and comfortable not only reducing anxiety and keeping them out of class only as long as scheduled appointments, but also ensuring parents will not have to miss work. The EDHI's community-based service integration model is extremely potent, reaching our patients where and when they are most likely and able to take advantage of the services offered. B. Critical Unmet Need: Dental caries (tooth decay) is the single most common chronic infectious disease among California children five times more common than asthma and seven times more common than hay fever. Failure to prevent and treat tooth decay has farreaching effects on children's development, compromising their ability to eat, speak, and concentrate in school, reducing self-esteem, and leading to failure to thrive (NMCOHC, 2004). More than one-quarter of the State's K-5 students have untreated tooth decay. Of those five to eight years old, 25 percent have never been to the dentist (CDHF, 2006). This "silent epidemic" is particularly prevalent among the young people we serve: In LA County, low-income minority children have about twice as much decay as white children (CDHP, 2009). Seventy-two percent of low-income children under five years old in the County have untreated decay, and 40 percent have rampant decay (seven or more teeth affected). o Poorer children in homes where English is not spoken and where parents are not high school graduates are significantly more likely to show evidence of dental caries. Compared with those from higher income families, poor children have nearly 12 times as many restricted-activity days due to dental problems (2.1 missed school days on average per child). Dental pain is one of the leading reasons children miss school (CDC, 2011). Five percent of parents reported staying home to care for a suffering child (CDHP, 2009). Barriers to access such as transportation and work schedules are exacerbated by scarcity: EPFMC is located in a federally designated Dental Care Health Professional Shortage Area, a label used for communities characterized by factors that hinder or prevent residents from receiving care. "A Dental Office in Every School" Mia was an un-smiling first grader at San Pedro last fall when she enrolled in our dental clinic. Although only seven, many of her teeth were broken or worn to the gums, and her poor oral hygiene had left her in constant pain with 12 cavities. Mia's disease was so extensive that it had reached the nerves, and two baby molars required root canals. We arranged for her parents to come to school, thus allowing us to provide treatment under local anesthesia. Each week, we scheduled an appointment for Mia and called her out of class when mom or dad arrived. The 15 treatments she received proceeded with minimum anxiety and maximum effectiveness. When she came in for her six-month check-up, we were thrilled to congratulate her on her vastly improved oral health: She was pain-free, with one small "observation only" area of decay. And we finally got to see Mia smile. 2

3 C. Description of Project 1. Activities to be Undertaken: We currently provide free basic dental care (screenings, x- rays, fluoride and sealants, fillings, etc.) and oral hygiene education for PK-5 students (3-11 years) at San Pedro Elementary School (SPE). Initially launched as a collaboration between EPFMC, LAUSD, and The Center for Oral Health, the SPE program is an innovative, on-site, "portable clinic" model aligned with CDC recommendations. "Portable" means an exam chair that can be set up in 15 minutes; an x-ray machine the size of a blow dryer; and a rolling dental care system that looks like a nightstand, complete with hand pieces, drill, compressor, irrigator all in an impact resistant "wheelie" case. The on-site, portable model works particularly well for our clients, reflecting as it does our mission of integrated, whole family care that stresses continuity, relationships, and respect for cultural norms. The EDHI builds on the SPE program, and is designed to 1) scale up EPFMC's presence as a pediatric dental home throughout our service area, and 2) establish a foundation for regional/national replication of the model. Major grant-funded activities include: Expand dental services at SPE: We launched the program with the youngest children in spring 2011, adding 2 nd /3 rd graders in the fall and 4 th /5 th graders in EDHI will allow us to achieve our goal of enrolling 90% of uninsured students by fall of Expand services to three new sites: Similar demographically both to SPE and our target population, Lizarraga (K-5), 28 th Street (K-5), and 10 th Street (1-5) Elementary Schools together serve an additional 2,300 students and their families. We have agreements in place from all three EDHI expansion schools. In the past, we have looked at mobile vans as a service delivery option; however, in the tight-knit communities our clients call home, permanence and stability can be in short supply. We don't visit a school once every 12 months: We are on each campus two days a week throughout the school year. Parents can plan on reliable, consistent access to care, at school or (if needed) at EPFMC without struggling to fit an appointment into family schedules or worrying about whether a van will be there when needed. Project Timeline. Rollout plans reflect what we learned at SPE: Initiate with PK-2 (January- June), and then add grades 3-5 when protocols are in place and familiar to the school community (July-December). An expansion school will be added each year (2014, 2015, 2016), with quality management, program maintenance, and evaluation activities ongoing at established sites. 2. How Will Grant Funds Be Used? The three-year rollout of the EDHI is expected to cost $1,648,846. Everychild funds will be combined with other revenue streams to cover: Start-up and operational costs for the expansion, including the purchase of diagnostic and treatment equipment, medical and dental supplies, and education/outreach materials. New staff: EDHI case manager/outreach coordinator charged with administrative oversight, stakeholder communications, tracking patient data, and other tasks as needed. Dental staff: Our lead dental provider, Dr. Daniel Romo, directs the SPE program and will lead the EDHI. He is responsible for supervising personnel, overseeing on-site functions, and establishing/monitoring quality standards. He manages two dental assistants, a team of school-based paraprofessionals, and Healthy Way volunteers. By Year 3, EDHI staff will include four dentists and eight DAs, plus school support staff. Program monitoring, assessment, and evaluation; marketing and outreach; and staff training as needed. 3

4 D. Goals and Objectives What Will Be Achieved? The benefits associated with full implementation of the EDHI are both short- and long-term. Diagnostic and preventive services (exams, cleanings, fluoride, and sealants) have been proven effective against decay, especially when done through school-based programs (ASTDD, 2011), while research has shown that selfcare education in early childhood results in benefits that last a lifetime. Restorative treatments (fillings, extractions, etc.) stop the spread of disease, relieve pain, and reestablish proper functioning and development. The program is also proving to be an effective community-based outreach strategy, an entry point for families to learn about and access a range of high quality, primary care options, whether at EPFMC's Olive Street campus or from another provider/agency. Outcome Goals. The EDHI has been designed to align with Federal HealthyPeople 2020 goals and standards of care related to reducing dental caries, reducing untreated decay, increasing rates of sealant use, increasing preventive services for low-income children, and increasing the number of School-Based Health Centers with an oral health component (criteria in Section E). EDHI Goal 1: A regional, school-based system of quality dental care for low-income children. EDHI Goal 2: Quality patient outcomes achieved using state-of-the art technology and research, employed in a caring, culturally responsive environment. EDHI Goal 3: "High dental IQ" patients with knowledge of oral health and self-care behaviors. E. Evaluation: We will use a mixed-methods approach to monitor processes and progress (formative) and evaluate effectiveness and outcomes (summative), using a five-stage workplan designed and implemented by our long-term research and evaluation consultant Kamella Tate, EdD. Evaluation strategies will include a review of the literature; instrument development and administration; staff training in data collection, management, and analysis; and project documentation and reporting. Assessment Criteria Goal 1: 90% of each school's students not covered by private insurance will enroll in the EDHI and receive preventive dental care and treatment services. Assessment Criteria Goal 2: As needed, EDHI participants will receive sealants and other preventive/restorative care; reductions in caries will be seen in 95% of returning patients. Assessment Criteria Goal 3: Consistent observations of exemplary health instruction/ outreach at EDHI sites; increased patient reports of healthy behaviors and understanding of the value of lifelong dental self-care; and positive feedback on experience and value. F. Replication: LAUSD Superintendent John Deasy and Maryjane Puffer, Executive Director, Los Angeles Trust for Children's Health, have proven to be two of our most ardent advocates. They and their colleagues see EDHI not only as a replicable model for all of LAUSD, but more broadly as contributing to the District's guiding purpose: To ensure students achieve "greatness." Healthy students are more likely to be engaged students; engaged students can be great students. Our goal is to standardize the model, producing training and "how-to" materials for providers to set up and manage EDHs in local and regional service areas. G. Recognition: Naming the project for the Foundation will ensure ECF's support is "framed" when the EDHI is discussed in outreach materials, presentations, reports, etc. Then: ECF's name and logo will be placed on signage at all school sites, on transport vans, and on banners and promotional materials available at clinic sites and health fairs. Marketing, outreach, and educational materials will credit ECF as the founding funder, and the project will be featured in our newsletter, Annual Report, and press releases. A set of pages will be created on our website for the EDHI, targeting patients, providers, and researchers who want to enroll or learn about the model, ECF, progress/results, etc. 4

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6 IV. Budget Narrative A. Budget Issues/Justification: Personnel: The EDHI roster will incorporate both current and new personnel. During the threeyear roll out, the latter will be hired to establish and maintain operations at expansion schools. Schools will be assigned one dentist and two DAs. General oversight will be provided by EPFMC's Dental Director and day-to-day operations by Lead Dentist Daniel Romo. In Year 1, Dr. Romo will manage the first phase of the project himself, handling the maintenance of services at San Pedro while launching a new clinic at School #2. The Case Manager (new) will be the primary coordinator of EDHI activities, recruiting and supporting parents, scheduling appointments, collecting data, making promotores presentations, engaging with replication venues such as libraries and rec centers, etc. Working directly with parents and caregivers, the Outreach & Enrollment Specialist will educate participants regarding their rights and responsibilities under Medi-Cal, assist with paperwork, and ensure qualified individuals obtain appropriate insurance coverage. Evaluation: Research and evaluation are critical quality management strategies at EPFMC, and we have committed significant resources to measuring and reporting on care processes, client values and satisfaction, and health outcomes. Our consultant, Dr. Kamella Tate, is an educational psychologist with deep knowledge of our community and experience with large-scale, complex projects such as the EDHI. Among others, she was responsible for our Women's Health Center evaluation, a 2010 study that attracted the attention of the office of Health and Human Services Secretary Kathleen Sebelius. In addition to her private practice, she is the Director of Research and Evaluation at The Music Center and an adjunct professor at Claremont Graduate University. B. Sources of Funding for Budget Amounts Not Covered by Everychild Funds: The projected $648,846 funding gap is spread over a three-year period. Current funders will be approached for renewed support; those listed below as "new" include those who have funded projects in the past (in bold). Three-year Medi-Cal/insurance reimbursements estimated to be at least $128,846. Grant requests will be submitted to current funders of the SPE project (amounts reflect totals over three years): Green Foundation ($100,000); George Hoag Family Foundation ($75,000); Albert & Elaine Borchard Foundation ($40,000); Kathryn Kurka Children's Fund ($30,000); Los Angeles Trust for Children's Health ($60,000); Samuel D. Harris Fund for Children s Dental Health ($15,000). Three-year total: $320,000 New applications have been or will be submitted to: Oral Health America ($20,000, pending); Healthy Smiles, Healthy Children ($20,000); Henry L. Guenther Foundation ($50,000); California Dental Association Foundation ($25,000); Sketch Foundation ($25,000); Carl & Roberta Deutsch Foundation ($10,000); Crowns for Kids ($25,000); and Norris Foundation ($25,000). Three-year total: $200,000 C. Sustainability: We plan to sustain the EDHI using multiple sources of earned and contributed revenues: Medi-Cal and insurance reimbursements; corporate and foundation grants; and awards from public health agencies. With the implementation of the Affordable Care Act, revenue sources for the EDHI could actually increase when the Exchanges become fully operational. EPFMC's experienced eligibility staff will actively recruit and help qualified parents fulfill the requirements to enroll family members in Medi-Cal, an Exchange, or other insurance programs. LA County is also expected to continue to provide support for undocumented children through Healthy Way L.A. Finally, in the replication period (post-year 3), our intention is to form financial partnerships with host sites such that expenses and efforts are shared efficiently. 6

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