grammardog guide to civil disobedience by mary jane mckinney
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FS 80, FS 80 R, FS 85, FS 85 R.BAINIHU.COM/upfiles/editor/files/capstone-microturbine-user-s-manual.pdf Oral disease can have an impact on physical, psychological, social, and economic health and well-being through pain, diminished function, and reduced quality of life. These impacts were underscored in the Surgeon General's 2000 report, Oral Health in America, which referred to oral health as a “silent epidemic” of dental and oral diseases that burdens children and adults throughout the United States. 4 Although tooth decay is largely preventable, more than nine in 10 adults have experienced tooth decay (dental caries). Most dental, oral, and craniofacial conditions arise from complex interactions of biological, behavioral, environmental, and higher system-level factors. Consideration of these interactions is essential to understanding the causes and -pathological processes of oral diseases and can greatly enhance more rapid discovery of -interventions that will improve their prevention, diagnosis, and treatment. Barriers to oral health care One of the greatest barriers to oral health care is a lack of dental services. This can be called the greatest unmet oral health need in the United States. 14, 15 Many people living in the United States have poor oral health due to lack of access to care, because oral health is not universally integrated into primary or behavioral health-care services. As a result, dental care is usually set apart from other types of health care. This separation of services results in a lack of integration between medical and dental records, a lack of use and acceptance of dental diagnostic codes, and separate insurance coverage and payment systems, treatment delivery, and health-care systems. Greater interprofessional education and collaborative practice could help integrate oral and primary health care and improve patient-centered care.http://limpiasol.com/wp-content/plugins/formcraft/file-upload/server/content/files/16292c2e2d96ec---97-suzuki-gsxr-600-service-manual.pdf Although community and clinical approaches have been shown to reduce oral diseases, lessen dental care costs, and improve the quality of individuals' lives, these approaches are not being used to the greatest extent possible. 1, 16 The cost of dental care and lack of dental coverage are often cited as reasons individuals do not seek needed dental care. 17 Publicly financed reimbursement programs covering the provision of oral health services are often limited in scope or are nonexistent for adults. For example, Medicare provides 22 preventive screenings for eligible individuals but does not include oral health services. Medicare is limited in its scope of coverage for dental care and, typically, dental care must be related to a covered medical procedure provided in a hospital setting. Although most state Medicaid programs cover emergency dental procedures for low-income adults, only 28 U.S. states provide dental benefits to Medicaid-enrolled adults beyond medically necessary care in emergency circumstances. 18 Emergency room treatment for preventable dental conditions, estimated at 830,000 visits in 2009, is expensive and continues to increase. 19 In addition, the geographic distribution of dentists varies substantially. In 2011, the number of dentists per 10,000 population ranged from 4.2 (in Arkansas and Mississippi) to 10.8 (in the District of Columbia). 20 The lack of oral health literacy also presents a barrier to oral health. Effective communication between oral health and other health-care providers and their patients is the foundation for improved oral and general health outcomes. Engaging in meaningful patient-provider interactions, where patients understand their oral health status and treatment options, continues to be a concern. According to Selden et al., “An individual may have adequate understanding of material with familiar content, but struggle to comprehend information with unfamiliar vocabulary and concepts.” 21 A survey of U.S.https://training-solutions.ro/wp-content/plugins/formcraft/file-upload/server/content/files/16292c2eac6b7f---97-subaru-service-manual.pdf adults found that more than one-third had limited health literacy. 22 Tools, resources, and training to enhance health literacy are available and offer promise for enhancing oral health and health provider skills. However, many providers have limited knowledge of these tools or are only beginning to explore their potential for providing improved service delivery. In addition to observed disparities in health status, inequities exist in the number of dental visits and receipt of clinical and preventive services. RELATED FEDERAL INITIATIVES This Framework represents the most recent demonstration of the federal government's commitment to oral health. The first-ever Surgeon General's report on oral health, Oral Health in America, in 2000 was followed by the National Call to Action to Promote Oral Health in 2003 and the HHS 2010 Oral Health Initiative. 4, 25, 26 Although some improvements in oral health have been achieved in response to recommendations outlined in these reports, further action leading to measurable results is still needed. Strategies and actions that result from these initiatives can be crosscutting and incorporated into oral health activities. Two broad federal initiatives recognize the integral role of oral health: Healthy People 2020 and initiatives related to the Patient Protection and Affordable Care Act. 16, 30 In the private sector, the U.S. National Oral Health Alliance (hereinafter, Alliance) has launched a parallel effort to address oral health for vulnerable populations. The Alliance has created an action plan, An Emerging Framework for Action, that reflects the wisdom and ideas of multiple disciplines and establishes a common platform for working together. 31 Alliance initiatives and the Framework provide opportunities for HHS, other federal partners, and external stakeholders to jointly engage in activities to improve oral health and reduce oral health disparities.BAIGIANGTOANHOC.COM/upload/files/capstone-microturbine-installation-manual.pdf Healthy People 2020 Healthy People 2020 objectives are science-based, measurable, 10-year national objectives for improving the health of all Americans. Oral health is included as one of 12 Healthy People 2020 leading health indicators. One important provision is the inclusion of pediatric dental coverage as part of the essential health benefits, which must be included in non-grandfathered individual and small-group market insurance plans (inside and outside Marketplaces), and Medicaid Alternative Benefit Plans. 30 In addition, a qualified health plan must include pediatric dental benefits unless the qualified health plan is in a Marketplace that offers stand-alone dental plans. 32 THE VISION The vision of this Framework is the commitment by HHS and other federal partners to increase the public's understanding that oral health is integral to overall health. HHS strives to leverage public and private sector partners to achieve better oral and overall health for all populations across the lifespan. The Framework provides the roadmap for engaging and resolving ongoing disparities in oral health. Guiding principles The Framework is grounded in three guiding principles:THE COMMITMENT The Framework serves as the catalyst for moving a national oral health agenda forward. The five major overarching goals, plus strategies and selected activities, underscore the ability of HHS and other federal partners to collectively address the nation's oral health concerns and disparities. Each plays a unique role in promoting knowledge and awareness, providing treatment and related oral health services, and translating biomedical and behavioral research to further the science and promote scientific advances into evidence-based practices. The Framework is a guide for working collaboratively to achieve greater impact. It acknowledges the need to undertake several different approaches concurrently that respect racial and cultural differences, language barriers, behavioral health, and the health literacy levels of diverse individuals in need of oral health services and education. The Framework allows agency leadership and entities responsible for implementing oral health initiatives the flexibility to develop creative solutions and respond to new oral health issues. HHS challenges itself, other federal partners, and external stakeholder groups to commit to engaging in concerted efforts to create oral health equity for all populations. By working collaboratively, existing partnerships are strengthened and opportunities for engaging with new partners are identified. Through these collective efforts, HHS, federal partners, and oral health stakeholders have a greater opportunity to realize the vision that HHS and other federal partners are committed to increasing the public's understanding that oral health is integral to overall health. GOALS The goals outlined in the Framework are intentionally broad but well founded in the existing literature. The five overarching goals are:Prevent disease and promote oral health. Increase access to oral health care and eliminate disparities. Increase the dissemination of oral health information and improve health literacy. Advance oral health in public policy and research. Below each goal is a set of strategies and actions. STRATEGIES AND ACTIONS Included within the Framework are examples of activities recently completed, currently underway, or planned. Each example relates to a particular strategy and goal, and each activity is identified by the primary federal partner responsible for the overlying strategy. Examples include training and technical assistance; evaluation, data, and policy; service delivery improvements; and opportunities for public and stakeholder engagement. GOAL 1: INTEGRATE ORAL HEALTH AND PRIMARY HEALTH CARE The U.S. health-care system has historically separated oral health care from overall health care in the health professions' education, practice, and payment systems. The lack of interoperability between medical and dental records further adds to segmentation of health-care delivery. This group of primary care professionals has the capacity to incorporate oral health information and the provision of preventive oral health services into their day-to-day practice. Concurrently, dental professionals can serve as key players in detecting chronic diseases such as diabetes, -hypertension, and hypercholesterolemia in dental practices. A recent study showed the potential savings to the health-care system from increased efforts to screen for chronic conditions in dental offices. 37 In 2012, the Health Resources and Services Administration's (HRSA's) Integration of Oral Health and Primary Care Practice Initiative created a set of oral health core clinical competencies and implementation strategies appropriate for primary care clinicians. 38 Most states currently allow the provision of preventive dental services in primary care practice, especially during well-child visits. Early detection of oral disease, delivery of preventive interventions, and referral to oral health professionals could improve oral health for all populations, especially for underserved populations that have significant oral health disparities. Strategies for goal 1 1-A. Advance interprofessional collaborative practice and bidirectional sharing of clinical information to improve overall health outcomes. 1-B. Promote education and training to increase knowledge, attitudes, and skills that demonstrate proficiency and competency in oral health among primary care providers. 1-C. Support the development of policies and practices to reconnect the mouth and the body and inform decision making across all HHS programs and activities. 1-D. Create programs and support innovation using a systems change approach that facilitates a unified patient-centered health home. CMS supports state Medicaid programs and the Children's Health Insurance Program (CHIP) to implement policies that encourage the integration of oral health and primary health care. CMS provides technical assistance to state Medicaid and CHIP dental programs on reimbursing primary care medical providers for oral health services, including through managed care contracting arrangements, on tracking the provision of those services on line 12f of the CMS Form 416 (Annual Early and Periodic Screening, Diagnostic, and Treatment Participation Report), and on implementing strategies to convert physician visits into referrals to dental providers for follow-up care. 39 (Strategy 1-C) HRSA. HRSA supports the National Center for Interprofessional Practice and Education to provide sustainable national leadership in transitioning from a focus on care delivery to a focus on health, and promotes collaboration, avoids duplication, and creates definitions and standards to advance interprofessional practice and education. HRSA also supports the Integration of Oral Health and Primary Care Practice initiative and pilot project by providing technical assistance and support to community health centers to create systems-level change through education of primary care providers, demonstration of oral health competency in practice, and integration of communication, health records information, and workflow processes to support continuity and patient-centered care. 40 (Strategy 1-A) HRSA will develop a set of oral health core clinical competencies for primary care clinicians, delineate the elements that influence the implementation and adoption of competencies, and outline the basis for implementation strategies and translation into primary care practices in safety-net settings. NIH evaluates the effectiveness of training pediatric clinicians to administer fluoride varnish and patient-centered counseling on the reduction and prevention of ECC by conducting research to inform decision making on activities to decrease ECC. NIH also evaluates the effect of increased clinician knowledge of ECC and counseling to reduce ECC among children. (Strategy 1-C) Office of Minority Health (OMH). OMH incorporates oral health screening into primary care providers' practice standards and convenes meetings with partners to begin discussions about incorporating oral health screenings into primary care practice standards. (Strategy 1-D) Substance Abuse and Mental Health Services Administration (SAMHSA). SAMHSA educates the workforce through continuing education activities on tobacco cessation and alcohol screening and intervention, as well as mental and substance use disorders, and educates dentists on the medical science behind mental and substance use disorders and associated risks to oral health. SAMHSA disseminates information electronically through webinars and in-person trainings and presentations. HHS, along with public and private partners at the national, state, tribal, and local levels, can increase the reach of preventive interventions that promote healthy behaviors, such as effective self-management activities to improve health and quality of life. Strategies for goal 2 2-A. Promote delivery of dental sealants in school-based programs and expand community water fluoridation. 2-B. Identify reimbursement strategies and funding streams that enhance sustainability of prevention programs. 2-C. Coordinate federal efforts focused on strengthening the infrastructure and capacity of local, state, and regional oral health programs. 2-D. Explore new clinical and financial models of care for children at high risk for developing caries, such as risk-based preventive and disease-management interventions. Federal partners Administration for Community Living. The Administration for Community Living (ACL) encourages the Aging Services Network to engage in oral health promotion and disease prevention interventions for older adults and people with disabilities by utilizing resources available on the Administration on Aging oral health Web pages. (Strategy 2-A) The ACL also encourages innovative programs and partnerships that improve the oral health status of older adults and lists innovations on the Administration on Aging website. 49 (Strategy 2-C) Centers for Disease Control and Prevention (CDC). CMS, CDC, and HRSA work together to identify actions that enhance children's access to and use of dental sealants, such as providing funding to state oral health programs, strengthening technical assistance, and setting state-specific goals to increase the use of sealants among Medicaid-enrolled children. (Strategy 2-A) Multiagency efforts by CDC, CMS, and HRSA also encourage states to incorporate oral health innovations in their efforts to redesign their health-care delivery systems, support payers and funders to design and implement payment and funding approaches that favor prevention and better health outcomes, and encourage cooperation between payers and funders to magnify the effects of available dollars. (Strategy 2-B) CDC and HRSA coordinate program oversight and monitoring of related oral health programs, increase communication and knowledge sharing between project officers, and hold regularly scheduled discussions across agencies. Despite these efforts, oral health disparities persist and affect self-esteem, employability, productivity, nutrition, ability to learn, and overall wellness. More than 4 million people receive dental services through health center programs, and dentists are working in underserved areas through various federal and state programs. However, the oral health crisis continues to be a problem, especially for vulnerable populations. A report by the U.S.