HOW IS THE MYSMILEBUDDY PROGRAM IMPLEMENTED?

Implementation through Existing Networks of Child Care Providers

IMPLEMENTATION MODELS

Coached & Stand-alone Program Delivery Models

The MySmileBuddy program can be delivered as a Coached Program, allowing guided navigation, or as a Stand-alone Program that is self-guided by the individual user, independent of a MySmileBuddy Coach. The delivery model most appropriate for a given site will depend on the needs of the population served or the availability of personnel. Sites may choose to implement either model or make both models available, establishing a site-specific protocol for determining whether the Coached or Standalone model is most suitable for a given family.

The Coached Implementation Model is designed to pair individuals with a Coach (e.g., a community health worker, lay health worker, hygienist, Head Start Family worker) who can help navigate the technology side-by-side with a parent or caregiver. This guided navigation can be accomplished in-person or virtually using teleconferencing software (e.g., Zoom) and enables real-time education, individualized coaching and supportive counseling that integrates key tenets of Motivational Interviewing to support sustainable health behavior change. The Coached model of implementation is particularly beneficial for children at high risk of caries (e.g., those with a history of surgical restorations or diagnosed with severe early childhood caries), which places them at elevated risk of future oral disease throughout the lifespan, and with families that face structural and logistical barriers to engagement in the healthful dietary and oral hygiene behaviors targeted by MySmileBuddy. The Coached model allows individuals to receive ongoing support from trained health workers who work closely with them to identify and address socio-environmental challenges (e.g., food, income and housing insecurity) that impede their ability to engage in the daily behaviors necessary for optimizing oral health, facilitate enrollment in safety net programs (e.g., WIC, SNAP, Medicaid) and provide support through healthcare navigation (e.g., identifying local providers, providing translation and transportation services).

The Standalone Implementation Model allows for independent navigation of the MySmileBuddy Program. This model allows individuals to be provided with a link through which they can independently access the MySmileBuddy software platform. They can check-in and follow-up with a clinical team or Coach and progress can be managed by the referring entity, but this program implementation model is designed to allow the individual parent or caregiver to self-navigate through the program components independently. The Standalone model is most suitable for utilization with families of children at low- to moderate-risk of caries and those with minimal external barriers to engagement in the targeted dietary and oral hygiene behaviors.

Regardless of the chosen implementation model, children and families must be linked to the MySmileBuddy Program. The best approach for identifying, referring and supporting potential users to the MySmileBuddy Program will be dependent upon the needs of the settings and communities in which the Program is implemented.

SAMPLE CLINICAL WORKFLOW

SAMPLE COMMUNITY-BASED ORGANIZATION WORKFLOW

Identifying children at risk who would benefit from the program

The first step in the workflow for engaging families with MySmileBuddy is to identify those who could benefit from enrollment in the Program. In a clinical setting, this could be accomplished by utilizing a risk assessment tool to screen patients at-risk for caries (e.g., CAMBRA or other risk scoring system) or employing established clinical criteria for risk-based identification (e.g., prior caries experience, history of missed appointments or failed treatment plans). Key staff, roles and responsibilities for each team member must be clearly established to ensure smooth and consistent implementation of the referral and enrollment protocol.

Referring families to the MySmileBuddy Program

Once children and families who may benefit from engagement with MySmileBuddy have been identified, a formal referral to the program must follow. A site-specific protocol for referral to the MySmileBuddy Program must be established, detailing:

Who follows up after risk identification;
How follow-up and referral occur;
What is said, done and documented; and
When the referral process initiated and completed.

Key personnel responsible for referral in a clinical setting may be a dentist or hygienist who introduces the MySmileBuddy Program to the patient and parent/caregiver, then refers them to a coordinator or other staff member to facilitate enrollment. This referral may be through provision of an informal “MSB Rx” (MySmileBuddy prescription) or similar flyer that can be handed to patients during clinical encounters. If a site offers both the Coached and Standalone implementation model, the referring clinician or Coordinator may determine which model is most appropriate for the individual family. The Coordinator responsible for enrollment in the program may then provide additional details about Program participation (e.g., process, expectations, duration of engagement, etc.) and obtain consent to enroll, if necessary depending on the site-specific protocol. The Coordinator then registers the family and obtains primary and secondary contact information (including email address and mobile phone number for delivery of automated follow-up messages) and creates a profile through the MySmileBuddy software platform. During Program registration, a unique Site Code is entered and registered families’ profiles are linked with referring sites (e.g., clinical practice or community-based organization) and a site-specific Coach. This allows the Coach and site supervisors to manage registered families, review progress throughout engagement in the Program, and generate site-specific reports to monitor utilization.

Arranging parent Engagement

Following enrollment and registration in the MySmileBuddy Program, the protocol for family engagement ensues. Under the Standalone implementation model, families are provided with a link to the MySmileBuddy online platform so they may access their account independently. Registered families may then navigate through the online platform using the embedded prompts and guides that facilitate independent utilization. Under the Coached implementation model, an appointment is scheduled for administration of the MySmileBuddy Program in tandem with the assigned Coach.

Delivering MySmileBuddy

Under the Coached model, the initial visit consists of the Coach navigating through the MySmileBuddy software platform together with a registered family. If implementing the Standalone model, a registered family would self-navigate through the platform. In both models, the initial process of navigating through the MySmileBuddy software platform includes:

Completion of the risk assessment modules (dietary recall and feeding, brushing, fluoride use, dental home and oral health questions);
Education and engagement;
Identification of individual risk areas;
Establishing a personalized primary behavioral goal; and
Detailing a tailored action plan

MySmileBuddy Program Follow-up

Following completion of the initial visit, the MySmileBuddy software delivers automated follow-up messages via email and/or text message, depending on the registered family’s preference. The automated follow-up is designed to reinforce key educational messages presented throughout engagement with the MySmileBuddy software, provide supportive reminders to promote sustained engagement in targeted behavioral changes, and foster ongoing engagement with the Program.

Under the Coached implementation model, an in-person or virtual follow-up appointment is scheduled at the close of the initial visit, once a personalized goal and tailored action plan have been established. This appointment is dedicated to evaluating progress toward reaching the established goal, addressing barriers to goal completion (if not yet achieved), and identifying a new goal based on remaining risk areas identified by the MySmileBuddy software. Progress over time and barriers or facilitators to goal attainment are evaluated and tracked in the MySmileBuddy software platform, establishing a record of engagement and enabling ongoing review and management of family caseloads.

The number of follow-up visits a participant receives is dependent on several factors, including the number of risk areas identified by the MySmileBuddy software platform, the individual needs of the enrolled family and the challenges to initiating and maintaining targeted behavior changes that family experiences, and logistical constraints of the site implementing the Program (e.g., staff time and availability). The timeline for implementation is therefore variable, but the figure below presents an example overview of the Program implementation process.

Documentation and Recordkeeping

To facilitate ongoing quality assurance and enable sites to manage families enrolled and registered in the MySmileBuddy Program, data collected during engagement with the software platform are stored in the system and easily queried. The MySmileBuddy software includes embedded reporting functionality so Coaches and site supervisors can review real-time Program data to monitor progress and implementation.

The MySmileBuddy Team has also established guidance for users to facilitate collection of supplementary data external to the MySmileBuddy software that may be useful for Program evaluation. This includes a series of logs that may be maintained by Coaches to maintain and document:

Participant contact information
Outreach and communication (attempts, notes and outcomes)
Visit logs
Goal, education and action planning details
Time management
Travel
Social service and community needs
Referral tracking

Moreover, recommendations by the MySmileBuddy Team for note keeping and files to manage Coach caseloads include securely maintaining documents containing:

Personally identifiable information (e.g., names, addresses, identification numbers)
Sensitive and confidential information
Case files
Progress notes
Calendaring/scheduling information

Withdrawing Participants from the MySmileBuddy Program

In the unlikely event that an enrolled participant elects to cease participation and withdraw from the MySmileBuddy Program, a formal site-specific protocol for managing such requests must be established. The MySmileBuddy Team has developed recommendations for such protocols that include detailing the following steps, at minimum:

Document withdrawal request
Notify supervising management and relevant staff
Discontinue outreach
Archive files and documents

Adjunctive Support: Social Service Navigation and Facilitating Connections

The social determinants of health have gained increasing recognition for the role they play as drivers of oral health outcomes. The socio-environmental conditions in which we live, learn, work and play influence health at numerous levels, from the individual, to interpersonal and greater community and societal levels.

Under ideal conditions, oral health is optimized, but all too often for children most affected by caries, such conditions impose burdens that drive oral health inequities throughout the lifespan.

Drivers of oral health Inequities

As a result, the MySmileBuddy Program was designed to acknowledge these factors and provide opportunity for Coaches – like Community Health Workers – to address the barriers imposed by them to optimize success in the Program.

Community Health Workers Connect Families to Services and Resources