Emerging Models of Dental Practice Aim at Addressing Needs of the Aged.

Currently, about 46 million seniors, citizens over the age of 65, live in the United States. That number is expected to roughly double to more than 98 million by 2060, an increase from the current 15% of the population to 24%. Seniors are living longer and, due to advances in dental care and access to fluoridated water, keeping more of their teeth. As a result, many will be seeking to access services through a dental care delivery system that is already struggling to meet existing need. This article will describe emerging oral health workforce models, as well as interprofessional team approaches, that may help improve access to the growing population of senior citizens. The article will include discussions on dental therapists, dental hygienists, physicians, nurses, and physician assistants.

A Workforce Strategy for Reducing Oral Health Disparities: Dental Therapists.

This article seeks to chronicle how dental therapists are being used to bolster the supply of providers for the underserved and explore their potential to diversify the field of dentistry and improve public health. Of the factors that contribute to persistent oral health disparities in the United States, an insufficient oral health workforce figures prominently. A growing number of states are authorizing a midlevel dental provider (often called a dental therapist) to address this problem. Dental therapists work under the supervision of dentists to deliver routine preventive and restorative care, including preparing and filling cavities and performing extractions. They can serve all populations in 3 states, are caring for Native Americans in an additional 3 states under federal or state authority, and are being considered in about a dozen state houses.

Expanding Where Dental Therapists Can Practice Could Increase Americans' Access To Cost-Efficient Care.

Since 1923, more than fifty countries have improved access to dental care by allowing midlevel providers-frequently called dental therapists-to offer preventive and restorative treatment, primarily in the public sector. A growing body of research has found that dental therapists provide high-quality, cost-effective care and improve access to care for underserved populations. This article explores the evolution of the dental therapy movement in the United States, where multiple barriers to oral health care have created persistent unmet needs. We examine developments since the 1940s that have led to the authorization of dental therapists in parts of Alaska and the states of Minnesota, Maine, and Vermont; and the approval of national accreditation standards for dental therapy training programs by dental educators. We also show how dental therapists might fit within a health care system that is being transformed.

Mental health and juvenile justice: moving toward more effective systems of care.

This issue brief discusses the mental health needs of youth who are involved with the juvenile justice system, how they come into contact with the system, and the evidence of the availability and quality of mental health services for such youth. The paper also explores public policy options for avoiding dependence on the juvenile justice system as a last resort for treating youth with mental disorders.

The provider system for children's mental health: workforce capacity and effective treatment.

This issue brief examines two issues that are key to meeting children's unmet needs for mental health care: ensuring that the provider supply is adequate and that the care delivered is effective. It describes the shortage of qualified providers to address children's mental disorders, as well its possible causes; it describes how managed care, to a certain extent, drives practice patterns; and it discusses the gray areas in deciding which providers are most qualified to deliver what care. In addition, this paper introduces what is known about evidence-based care in children's mental health, the extent to which it is being taught and practiced, the extent to which health plans are adopting such practices, and the effect such strategies may have on the makeup of the children's mental health provider field.

Children with mental disorders: making sense of their needs and the systems that help them.

This paper examines the nature, severity, and prevalence of mental, behavioral, and emotional disorders among children, as well as the types of services that could help them. It looks at how they are served by the education, health care, and child welfare systems, and it identifies the gaps in these systems of care. It also examines the extent to which Medicaid, SCHIP, and private health insurance finance mental health care services for children.

Reauthorizing Head Start: the future federal role in preschool programs for the poor.

This paper describes the implications of President Bush's proposal to devolve authority for running the Head Start program to the states and to alter the organization and funding of all government early childhood programs--with the goal of improving the school readiness skills of low-income children. The administration plan to allow states to mix Head Start funds with state-funded preschool money and, if desired, child care monies to create a more uniform early childhood care system with an educational focus raises numerous questions. This paper addresses questions raised by this plan, including the potential quality of these new systems, the extent to which the programs will offer health and family support services (as Head Start now does), the capacity of states to administer large-scale preschool systems, and the prospects for adequate funding of new systems, given state budget deficits and demands for providing more child care for low-income working parents.

Federal child care funding for low-income families: how much is needed?

Setting a dollar amount for government spending on child care is a major issue in reauthorizing the 1996 welfare reform law. Two key components in pending Congressional proposals involve the Temporary Assistance for Needy Families block grant and the Child Care and Development Fund, which together provide the bulk of government child care funding for low income working families, whether or not these families are directly involved in the welfare system. The choices for Congress involved in setting an appropriate child care funding level are complex and fraught with questions about quality and cost tradeoffs. This issue brief provides background on current child care use, arrangements, and cost, as well as research findings on the measurement of quality in child care programs.

Promoting marriage as welfare policy: looking at a public role in private lives.

This paper discusses the interest in and politics surrounding government's using welfare reform legislation to carve out a stronger role in promoting marriage. It examines trends in family formation, their impact on society, and the effect of single parenting, divorce, and step-parenting on child well-being. The paper also looks at the treatment of marriage in current government programs, new state activities to promote marriage, proposals for a stronger government role, and marriage experts' expectations for the success of marriage education programs.