Building a community-based dental health program in Nevada

I have been involved with the Incline Village Community Dental Program through my association with Tahoe Family Solutions (TFS) in Incline Village, NV, from the mid-1990s until 2007. TFS (formerly known as the Children’s Cabinet of Incline Village), is a non-profit organization with a long-standing commitment to addressing unmet needs of families in the North Lake Tahoe community.

The dental program originated in the 1990s when TFS identified that the community lacked access to both affordable dental services and oral health education services. With neither a source of funding nor prior experience in dental health, TFS developed an affordable prevention strategy based on periodic free dental screenings, assistance with referrals and transportation to appointments, and the provision of oral health messaging at community and school events. Over the years, free 2-hour dental screenings for children became routine, twice a year, preferably 6 months apart, and held at various locations, including a community center, a school, a doctor's office, and a local hospital. Thankfully many volunteer dentists and event facilitators have pitched in and participated along this journey. The number of children screened per event has ranged from 10 (during a snowstorm) to 61.

In 2007, when the TFS Community Health Clinic transferred management to Nevada Health Centers (NVHC), I and two former CCIV associates continued to organize the free biannual dental screening events. In addition, we began offering free oral fluoride, since drinking water at Lake Tahoe is not fluoridated.

Over the years, we have faced several challenges. Most important among them has been what nonprofit organizations around the world routinely struggle with: effecting behavior change. In our case, many children who attended a dental screening would not return for a follow-up screening. And when given a free prescription for oral fluoride, parents would often miss filling them. Similarly, parents often missed refilling fluoride prescriptions after running through the first month supply which was provided at screening events. Furthermore there was little proof that children were actually given the fluoride treatments at home.

To rectify this situation, we invited the Dental Hygiene program at Truckee Meadows Community College (TMCC) in Reno, NV, to join us. Since 2010 its students, under the supervision of their instructors, have provided topical fluoride (varnish) and oral health education at each Dental Screening. Through actual application of fluoride, each child now receives added protection from tooth decay for at least 6 months. TMCC generously provides the fluoride varnish.

Though we still face challenges, we now have support from Tahoe Forest Health System (TFHS) in Truckee, CA, a non-profit that provides us with a permanent site for the screening events (Incline Village Community Hospital), a designated pediatric dentist (Dr Matthew Gustafsson), and assistance with publicity and promotion from its Outreach Coordinator (Shelia Leijon).

And, very recently TFHS signed a Memorandum of Understanding with our local school district to allow us to initiate a pilot project at Incline Elementary School to provide fluoride varnish and oral health education twice during the school year, thus providing more complete year-round protection against tooth decay. What I have learned through years of community health programming both in the US and internationally, is that driving positive health outcomes and behavior change requires careful observation, commitment to iterating program operations/delivery over time, convening a network of stakeholders to support the process, and strong persistence.

pam portrait bicycle

Pam Straley is a founder and board member of 3rd Creek Foundation. She is an M.S., R.N., and Family Nurse Practitioner with a diverse background in nursing and health care administration. Her international career took off in 1974, when she joined the Peace Corps in Nicaragua as a community health volunteer. Recognizing her passion for global health, Pam continued to work with medical centers in Costa Rica and Indonesia. She has also consulted for the United States Agency for International Development (USAID) as its HIV/AIDS Prevention Project Manager in Zambia, as well as for the American Public Health Association, and Peace Corps. Most recently Pam served as Manager of a clinic in Incline Village serving low income, uninsured residents of Northern Nevada. Pamela earned her B.S.N. at California State Long Beach (1970), and M.S.N./F.N.P at the University of California, San Francisco (1985). She has published a health education manual and guide to general health services for foreigners in Indonesia.