The Maternal and Child Health Bureau (MCHB) is accepting applications for a four-year pilot grant program, the Perinatal & Infant Oral Health Quality Improvement (PIOHQI) Pilot. The purpose of the project is to integrate a successful community-based approach into a health care system with statewide reach, accomplishing statewide availability and increased utilization of quality preventive dental care and restorative services for pregnant women and infants most at risk. The long-term goal of this effort is to achieve sustainable improvement in the oral health care status of this MCH population. Documentation of successful outcomes and lessons learned will be applied to the development of a national strategic framework for the purpose of replicating effective and efficient approaches to serving the oral health care needs of this targeted MCH population. The PIOHQI Pilot grant program is authorized by Title V, § 501(a)(2) of the Social Security Act as amended (42 U.S.C. 701(a)(2)).
An evidence-based, oral health care approach that serves pregnant women is the ideal for improving the oral health disparity among this MCH population. Yet, while evidence-based practice guidelines do exist, such as those recognized in the Oral Health Care During Pregnancy – A National Consensus Statement, a statewide approach that is integrated into a comprehensive system of care, providing for oral health care needs of both pregnant women and infants, remains elusive.
The Health Resources and Services Administration (HRSA) recently identified perinatal oral health as one of four strategic oral health priorities. The PIOHQI Pilot funding directly contributes to the Healthy People 2020 Leading Health Oral Health Indicator (OH-7): Increase the proportion of children, adolescents, and adults who used the oral health care system in the past year. It also advances several HRSA strategic goals, including: (1.b) Expand oral health and behavioral health services and integrate into primary care settings, (1.d) Strengthen health systems to support the delivery of quality health services, and (4.b) Monitor, identify and advance evidence-based and promising practices to achieve health equity.
Perinatal and Infant Oral Health National Initiative
The PIOHQI Pilot grant program is the first phase, of the three-phase MCHB Perinatal and Infant Oral Health National Initiative (see Appendix C). This three-phase initiative will be supported through three separate, consecutive grant funding opportunities which will result in:
(1) Statewide implementation of an oral health program that demonstrated success at the community level (the Implementation Phase...the PIOHQI Pilot);
(2) Successful targeted demonstrations for replication and expansion of statewide implementation (the Expansion Phase); and
(3) An evidence-based national strategic framework for statewide implementation, based on the findings and lessons learned from the first two phases (the National Outreach Phase).
Project Description –
PIOHQI Pilot grant program
This grant program, a four-year pilot, will assist up to four states and/or state organizations which have already demonstrated success in developing community-based oral health programs for pregnant women and infants. The purpose of the pilot is to integrate a successful approach into a health care system with statewide reach that succeeds at improving the oral health status of pregnant women and infants most at risk. The overarching goals of this pilot grant program will be to develop, put into practice, and continuously assess:
(1) A statewide approach that responds to the comprehensive oral health needs of pregnant women and infants most at risk;
(2) A state data system that drives quality improvement; and
(3) A fiscal leveraging strategy that achieves program sustainability.
Collaborative learning methodology2 will be used to support the grantees as they adapt and adopt innovative approaches across multiple settings statewide, achieving systems change to deliver effective prevention and treatment services. All grantees are required to participate in both intra- and interstate collaborations:
(1) Individually through a team specifically selected for the purpose of implementing a strategic plan with statewide reach and
(2) Collectively through a state-national learning network that includes the project leaders of this pilot program, key state private and public partners and national stakeholder organizations.
Successful outcomes and lessons learned by these early adopters, as they implement their approach statewide, will contribute to the development of a national strategic framework that will translate new knowledge into successful replication and expansion of these efforts.
State-National Collaboration – An overarching link between these three phases of MCHB’s Perinatal & Infant Oral Health National Initiative (see Appendix C ), is the participation of the four (4) grantees of the pilot grant program in a state-national learning network. This collaboration and partnership between the grantees funded under this initiative, key state private and public partners, and national stakeholder organizations will collectively act on a common mission to achieve quality improvement in the health care system(s), with statewide reach, that serve pregnant women and infants. While recognizing common goals and standards are necessary to champion change across a nation, it is accepted that real improvement needs to take place in local settings where the state’s various stakeholders know and work with one another. Through inter- and intrastate collaboration, the goals of the learning network partnership will achieve an understanding and documentation of: (1) the vital elements of implementation fidelity as they relate to the individual approaches selected by the successful applicants and (2) how implementation improves the impact of these approaches on the oral health status of targeted pregnant women and infants. Goals will be realized through lessons learned as successful applicants plan and administer the selected approach.
During the PIOHQI Pilot project period collaborative learning methodology will be used to support individual pilot project efforts as they adapt and adopt innovative approaches across multiple settings, achieving systems change to deliver effective prevention and treatment services. The collaborative learning will continue throughout the second phase, supporting the expansion efforts of this initiative. In support of this Expansion Phase, the PIOHQI Pilot grantees, in collaboration with the state-national learning network partners, are required to serve as mentors to no more than three mentees during years three and four of this project period. Mentoring the Expansion Phase grantees will include guidance for replication of promising approaches that implement the principles and key steps for effective and efficient statewide systems change.
All applicants must agree to and plan for the participation in a MCHB-supported state-national learning network that will commence the second year of the pilot project. To support an effective learning network experience, applicants must allocate an appropriate level of funds for this purpose in years two (2) through four (4) of the grant project period. It is expected that the applicant will budget for this effort no less than $25,000 in year 2 and $50,000 in years 3 and 4. Effective use of these funds will be determined by the applicant's ability to justify the support of the collaborative learning effort with the use of the funds (i.e., adequate personnel cost for time and effort in support of the state-national collaboration, including the mentoring responsibilities).
National Strategic Framework - Changing a state health care delivery system that assures quality oral health care for pregnant women and infants requires a strategic process that state and community stakeholders must undertake in partnership. A strategic framework, thorough in its design to deliver long-term and sustainable benefits, can identify a series of implementation principles that are fundamental in the integration of successful approaches into a statewide system of care that reduces disparity at the state and community level.
Documentation of effort throughout the three-phase national initiative, beginning with this pilot program, will be used to construct this national strategic framework that translates new knowledge into successful replication and expansion of effective approaches. At the conclusion of the Expansion Phase, these findings will be used to finalize the Strategic Framework for Improved Perinatal and Infant Oral Health.
The PIOHQI Pilot grantees, in collaboration with the state-national learning network partners, will begin to formulate such a framework as the PIOHQI Pilot grantees develop, put into practice, and continuously assess their pilot project proposal. The experiences of these pilot projects, including outcomes and lessons learned, will provide the knowledge base for MCHB’s National Strategic Framework for Improved Perinatal and Infant Oral Health. The development of this framework will begin with the PIOHQI Pilot applicant's response to a preliminary strategic framework, proposed below. It is required that the applicant incorporate all five steps into their proposal.
The following outline lays out five (5) steps of a Preliminary Strategic Framework from which this project will begin. Throughout the course of the first and second phase of this national initiative, it is expected that the successful applicants awarded funds during both the Implementation and Expansion Phase will contribute to refining this preliminary strategic framework, resulting in a final strategic framework that will allow for successful statewide replication on a national scale (what begins the National Outreach Phase).
1) Profile population needs, resources, and readiness to address the problems and gaps in service delivery.
Address this step in the INTRODUCTION and NEEDS ASSESSMENT sections of the proposed Project Narrative.
ASTDD’s Best Practice criteria : Objectives/Rationale
2) Mobilize and/or build capacity to address needs.
Address this step in the METHODOLGOY section of the proposed Project Narrative.
ASTDD’s Best Practice criteria : Objectives/Rationale and Collaboration/Integration
3) Develop/Finalize a comprehensive State Strategic Plan.
Address this step in the WORK PLAN section, specifically the strategic implementation of the PIOHQI Plan, and RESOLUTION OF CHALLENGES sections of the proposed Project Narrative.
ASTDD’s Best Practice criteria : Objectives/Rationale, Collaboration/Integration, Efficiency, and Sustainability
4) Implement evidence-based prevention policies, programs and practices and infrastructure development activities.
Address this step in the WORK PLAN section, specifically the Administration Plan, and RESOLUTION OF CHALLENGES sections of the proposed Project Narrative.
ASTDD’s Best Practice criteria : Collaboration/Integration, Efficiency, and Sustainability
5) Monitor process, evaluate effectiveness, sustain effective programs/activities, and improve or replace those that fail.
Address this step in the EVALUATION AND TECHNICAL SUPPORT CAPACITY section of the proposed Project Narrative.
ASTDD’s Best Practice criteria : Impact/Effectiveness and Sustainability
Criteria for Success –
A. Early Adopters1
Applicants, as early-adopters, must clearly demonstrate: (1) they have successfully integrated effective oral health practices for pregnant women and infants into some portion of the state’s health care system at a community level and (2) a capability of taking this innovation to scale statewide, documenting successful outcomes and lessons learned..
Applicants will prove they are early adopters in this effort by providing documentation that supports ALL of the following applicant characteristics for demonstrating success:
Participation in the development or implementation of a comprehensive State Oral Health Plan (SOHP) or similar documentation (e.g., practice guidelines and/or policy briefs) which address the state’s effort to improve perinatal and infant oral health status.
Participation in other systems building efforts that substantiates a commitment to improving the availability of quality perinatal and infant oral health services at a community or state level.
Evidence that challenges and lessons learned (as a result of developing or implementing the SOHP and other efforts) have contributed to improvement in the oral health care delivery in the state.
Evidence of collaborative partnerships with other state programs funded by MCHB (e.g., Healthy Start), HRSA (e.g., Community Health Centers), DHHS (e.g., Medicaid/CHIP Programs, Early Head Start) or other Federal-supported programs (e.g., Indian Health Service, Tribal Programs) whose purpose is to improve the health and health care services for pregnant women and infants across the state. [See section VIII. Tips for Writing a Strong Application]
Participation in and/or demonstrates access to state-based, public and/or private collaborative efforts that use quality improvement and a systems approach to change healthcare infrastructure and practice. [See section VIII. Tips for Writing a Strong Application]
Evidence of robust efforts in support of evaluating the state’s oral health delivery system; efforts to evaluate the status of the pregnant women and infants served by this system of care are an added strength. [See section VIII. Tips for Writing a Strong Application]
Evidence of sustainability efforts intended to improve the viability of oral health care delivery at the local/community level, including but not limited to Federal, private-public partnership, and/or philanthropic support. [See section VIII. Tips for Writing a Strong Application]
Documentation of these characteristics will be acknowledged in the Program Narrative section Organizational Information. If unable to document ALL characteristics at the time of submission, the applicant will provide persuasive rationale that the lack of this experience will not impair their effort(s) to achieve the goals set forth in this grant program (e.g., Lack of collaborative partnerships with other state programs funded by MCHB is balanced by a commitment to enter into a well-defined partnership with documentation of this planned partnership submitted with the application).
A PIOHQI Pilot Project Application Checklist and Glossary of Terms are available in Appendix A and Appendix B, respectively, to support an applicant’s effort to provide a complete application. An application that does not contain the Required Application Content will NOT be reviewed for funding.
It is preferred that the successful applicants will plan for statewide implementation of an evidence-based, community-level approach that has proven to increase the use of preventive and restorative dental services by pregnant women and infants most at risk. To be considered evidence-based, the proposed approach will be substantiated with at least one peer-reviewed impact study that statistically proves improved oral health status among pregnant women in some portion of their state, at the community level. These results must include some if not all of the select indicators described under the section Data Indicators.
If the selected approach cannot be substantiated as evidence-based, the applicant must propose a promising approach. The promising approach is an approach that is well-founded given the best available evidence — the approach is emerging or promising in its design, allowing for innovation while still incorporating lessons learned, such as those found in the ASTDD’s Promising Best Practice Approaches.3 It is understood limited evidence exists that identifies evidence-based approaches for systems change in support of oral health care. Though an evidence-based approach is preferred, if not evidence-based, the applicant must provide persuasive rationale that substantiates the selection of a promising approach, presenting results that compare favorably with the select indicators described under the section Data Indicators.
In describing this approach, the applicant must clearly justify how the selected approach will meet the needs of the targeted population and can be implemented statewide. Whether evidenced-based or a promising approach, the applicant must also account for how the selected approach does or does not align with the five (5) best practices approach criteria established by the Association of State and Territorial Dental Directors (ASTDD).
Program implementation and evaluation are inextricably linked and should be conceptualized together when developing a sustainable statewide approach to improve access and utilization of quality oral health care for pregnant women and infants. Implementation of the pilot project will be directed by two distinct plans: (1) a strategic plan for the successful integration of the selected approach statewide and (2) an administration plan for operationalizing and managing the selected approach in the targeted communities. The success of a statewide approach will be dependent on a plan that clearly identifies the strategies for implementation across the state; inclusive in this strategic plan is the effort to sustain the systems change. A well-defined plan for administrating the selected approach at the community level will prove to operationalize the statewide strategic plan as well as manage and maintain the systems change beyond Federal funding. Inclusive in an administration plan is the need to continuously monitor for quality improvement. To