Food Insecurity and Collateral Consequences of Punishment Amidst the COVID-19 Pandemic.

Bipartisan governmental representatives and the public support investment in health care, housing, education, and nutrition programs, plus resources for people leaving prison and jail (Halpin, 2018; Johnson & Beletsky, 2020; USCCR, 2019). The Personal Responsibility and Work Opportunity Reconciliation Act of 1996 banned people with felony drug convictions from receiving food stamps or Supplemental Nutrition Assistance Program (SNAP) benefits. Food insecurity, recidivism, and poor mental and physical health outcomes are associated with such bans. Several states have overturned SNAP benefit bans, yet individuals with criminal convictions are still denied benefits due to eligibility criteria modifications. COVID-19 has impaired lower-income, food-insecure communities, which disproportionately absorb people released from prison and jail. Reentry support is sorely lacking. Meanwhile, COVID-19 introduces immediate novel health risks, economic insecurity, and jail and prison population reductions and early release. Thirty to 50 percent of people in prisons and jails, which are COVID-19 hotspots, have been released early (Flagg & Neff, 2020; New York Times, 2020; Vera, 2020). The Families First Coronavirus Response Act increases flexibility in providing emergency SNAP supplements and easing program administration during the pandemic. Meanwhile, the U.S. Commission on Civil Rights recommends eliminating SNAP benefit restrictions based on criminal convictions, which fail to prevent recidivism, promote public safety, or relate to underlying crimes. Policy improvements, administrative flexibility, and cross-sector collaboration can facilitate SNAP benefit access, plus safer, healthier transitioning from jail or prison to the community.

Views of Dental Providers on Primary Care Coordination at Chairside: A Pilot Study.

PURPOSE: There is a need for research to facilitate the widespread implementation, dissemination and sustained utilization of evidence-based primary care screening, monitoring and care coordination guidelines, thereby increasing the impact of dental hygienists' actions on patients' oral and general health. The aims of this formative study are to explore dental hygienists' and dentists' perspectives regarding the integration of primary care activities into routine dental care, and assess the needs of dental hygienists and dentists regarding primary care coordination activities and use of information technology to obtain clinical information at chairside. METHODS: This qualitative study recruited 10 dental hygienists and 6 dentists from 10 New York City area dental offices with diverse patient mixes and volumes. A New York University faculty dental hygienist conducted semi-structured, in-depth interviews, which were digitally recorded and transcribed verbatim. Data analysis consisted of multilevel coding based on the Consolidated Framework for Implementation Research, resulting in emergent themes with accompanying categories. RESULTS: The dental hygienists and dentists interviewed as part of this study do not use evidence-based guidelines to screen their patients for primary care sensitive conditions. Overwhelmingly, dental providers believe that tobacco use and poor diet contribute to oral disease, and report using electronic devices at chairside to obtain web-based health information. CONCLUSION: Dental hygienists are well positioned to help facilitate greater integration of oral and general health care. Challenges include lack of evidence-based knowledge, coordination between dental hygienists and dentists, and systems-level support, with opportunities for improvement based upon a theory-driven framework.

Toward Implementing Primary Care at Chairside: Developing a Clinical Decision Support System for Dental Hygienists.

INTRODUCTION: The goal of this project was to use the Consolidated Framework for Implementation Research (CFIR) as the theoretical foundation for developing a web-based clinical decision support system (CDSS) for primary care screening and care coordination by dental hygienists at chairside. METHODS: First, we appraised New York State education and scope of practice requirements for dental hygienists with input from health experts who constituted a Senior Advisory Board for the project, and reviewed current professional guidelines and best practices for tobacco use, hypertension and diabetes screening, and nutrition counseling at chairside. Second, we created algorithms for these four health issues (tobacco, hypertension, diabetes, and nutrition) using evidence-based guidelines endorsed by authoritative professional bodies. Third, an information technology specialist incorporated the algorithms into a tool using an iterative process to refine the CDSS, with input from dental hygienists, dentists, Senior Advisory Board members and research staff. RESULTS: An evidence-based CDSS for use by dental hygienists at chairside for tobacco use, hypertension and diabetes screening, and nutrition counseling was developed with the active participation of the individuals involved in the implementation process. CONCLUSIONS: CDSS technology may potentially be leveraged to enhance primary care screening and coordination by dental hygienists at chairside, leading to improved patient care. Using the CFIR as a pragmatic structure for implementing this intervention across multiple settings, the developed CDSS is available for downloading and adaptation to diverse dental settings and other primary care sensitive conditions.

Oral health and health care for older adults: a spatial approach for addressing disparities and planning services.

The purpose of this paper was to examine the geographic distribution of New York City adults aged 65 and older by race/ethnicity and poverty status. Also analyzed was seniors' access to dental care as defined by the location of dental providers and their proximity to the subway system lines in Manhattan and the Bronx. ArcGIS software was used to create a geographic information system (GIS) incorporating relevant data from a variety of sources. Individual and overlay maps were then produced to examine the aims of this analysis. Data showed that Black race, Hispanic ethnicity, and poverty status tend to co-occur spatially among seniors in Northern Manhattan and the South Bronx. Further, a spatial/transportation barrier may inhibit access to dental care for seniors who reside in these areas. By presenting multiple layers of local information juxtaposed, GIS can help provide directions for planning oral health service delivery for seniors.