Survey Logistics for Data Collection

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Health and Wellness for all Arizonans

Healthy Smiles Healthy Bodies

Survey Logistics

for Data Collection

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Margaret Perry, BSDH, MBA, AP HSHB Clinical Trainer

Healthy Smiles Healthy Bodies

Connie Baine, RDH, AP, BS HSHB Administrative Trainer

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Survey Logistics for

Data Collection

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Survey Logistics for Data Collection

Events, processes, procedures & policies for:

• Sample Recruitment & Replacement

• County Contractors & Survey Teams

• School Scheduling

• Survey Participation / Consent

• Equipment and Supplies

• Survey Screening Days at Schools

• Survey Forms

• Invoicing

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Survey Logistics

Setting up

the Survey Sample

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Survey Logistics

Survey Sample & Replacements

• Radom sample: recruit 99 schools (5 feeders)

• Statistical replacement: non-participating schools

• One screening day per school: up to 5.5 hours for screenings

• Randomly selected K & 3rd Grade classes: ask parents to participate (consent)

• Number to screen per school: at least 50 total students but may be up to 100 (will weigh data for reporting)

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Survey Logistics Scheduling Schools

HSHB Survey’s Field Coordinator

• Connie Baine Screening Day

• Schedule, remind & confirm screening day with school

• Remind and promote consent/questionnaire responses School Scheduling & Team Assignment Summary

• School location

• School contact

• Consents

• Randomly selected classes

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School Scheduling & Team Assignment Summary Provides Screening Day Information

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Attachment 1 – School Scheduling & Team Assignment Summary

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Survey Logistics

Setting up Screening Team for Data Collection

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Survey Logistics Collect Survey Data

• Utilize national Basic Screening Survey (BSS) Model

• Collect data through oral, height & weight survey screenings

• Collect data through questionnaire

• Determine estimates of oral health and healthy weight status for K & 3^rd grade children in Arizona (assessment &

surveillance)

• Report for the state, counties and FTF Regions

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Survey Logistics

Screening Teams Collect Data

• County Contractor collect data in <5 months, one screening day per school

• Field Coordinator/OOH distributes consent packets to each school

• Screening Team collects consents/questionnaires, conducts screenings, record data, and processes survey forms (to school

nurse/contact, parents/guardians, and ADHS Office of Oral Health)

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Survey Logistics

Preparing for Screening Day

• Pack survey equipment, supplies & forms o Make sure that equipment works

o Have adequate quantity of supplies & forms

o Have all components for the goodie bags to assemble at the school (check # enrolled children in selected classes)

• Review Training Booklets

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Survey Logistics

Setting Up

Screening Stations

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Survey Logistics

Setting Up Screening Stations

• Transport/unpack equipment & supplies

• Set up a dental station and a height/weight station

• Set up a designated student waiting area

• Organize these areas:

o Infection Control Area o Survey Forms Area

o Goodie Bags Assembly Area

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Survey Equipment & Supplies

• Equipment

- Dental light (with extension cord, bulb & fuse) - Dental Patient Chair

- Dental Operator Chair

- Stadiometer (measure height to 0.1 cm) - Digital Scale (measure weight to 0.1 kg)

• Supplies

- Infection control - Survey forms

- Goodie bags (all components to assemble at school) - Resource materials for school nurse and parents

(low cost dental clinics list & height/weight handout)

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Portable Dental Light,

Operator’s Chair and Dental Chair

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Stadiometer and Digital Scale

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Screener’s Infection Control Area

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Recorder’s Survey Forms Area

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Goodie Bags Assembly Area

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Survey Logistics

Screening Each Child for the Survey

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HSHB Screening of Arizona

Kindergarten & Third Grade Students

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Conducting Oral/Height/Weight Screenings

1. Recorder & Screener check consent for each child

2. Set up “Child Screening Record” – staple white Screening

Recording Form to the positive Active Consent & Questionnaire 3. Screener calls out each of the five oral screening indicators;

Recorder fills in the Screening Recording Form

4. Complete purple Screening Findings Form for each child

5. Add every child needing urgent care to pink Nurse Referral List (one list for the screening day)

6. Recorder measures height and weight (do not call out measures);

fill in data on Recording Form and Findings Form (use cm & kg) 7. Do counts for each class; fill in green School Summary Form

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Survey Logistics

Positive vs. Negative Consent

• Each school choose: Active or Passive Consents

• Active & Passive Consent Packets:

Packet has Parent Letter/Consent Form + Questionnaire o Positive Consent = Screen Child

o Negative Consent = Do Not Screen Child

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Survey Logistics

Missing Item on Active Consent

1. “Yes” or “No” box must be checked AND

2. Parent/guardian signature must be present

• Questionnaire does not have to be completed

• Screener/Recorder should not fill in any blanks

• Option: Ask if school will consider calling parent for clarification (school caller must document/sign/date)

• Missing required item = Negative Consent by default

• Encourage school to check for missing item and fix before screening

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Survey Logistics

Missing Item on Passive Opt-Out Consent

1. “No I give consent” box must be checked AND

2. Parent/guardian signature must be present

• Questionnaire does not have to be completed

• Screener/Recorder should not fill in any blanks on consent form

• Option: Ask if school will consider calling a parent for clarification (school caller must document/sign/date)

• Missing required item = Negative Consent by default

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Survey Logistics

Oral, Height & Weight Screenings

• Screen only assigned grades & selected classes

• For a child with consent to screen, first conduct oral screening

• Finish with height & weight measurements

• Record screening data and check survey forms

• Give the child a Goodie Bag

• Track/record student & consent counts for each class

• Check & organize forms for accuracy/completeness

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Conduct Oral Screening

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Conduct Height Measurement with a Stadiometer

• Remove shoes, keep socks on

• Stand straight

• Lower headrest

• Measure to nearest 0.1 centimeter (cm)

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Conduct Weight Measurement with a Digital Scale

• Remove shoes, keep socks on

• Stand with both feet in the center of the scale

• Record measure to nearest 0.1 kilogram (kg)

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Survey Logistics

Recording Screening Data for Each Child

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Survey Logistics

Screening Day’s Survey Forms

• Active or Passive Consent Form (white)

that may be stapled to a Questionnaire (yellow or blue)

• Screening Recording Form (white)

• Dental Findings Form (light purple)

• Nurse Referral Form (pink)

• School Summary Form/Worksheet (green)

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Survey Logistics

Required Tasks for Survey Forms

• Confirm that Consent Form matches the child in the chair for screening (both Recorder & Screener should confirm)

• Set up a Child Screening Record: Staple the Screening Recording Form to the YES Consent Form and Questionnaire

o Recording Form in front, Active YES Consent Form in middle, and Questionnaire last – have the data sides of the Recording Form

& Questionnaire face outward. If only have the Recording Form and Active YES Consent, then staple them back to back.

• Review forms for completeness & accuracy and sign all forms before leaving the school

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Screening Recording Form - Top

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2014-2015 Healthy Smiles Healthy Bodies Screening Recording Form

1. Survey Information

School Name: First Elementary School Grade: K

Child Name: Adam Smith

Survey ID# ___________________

(for office use only)

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Screening Recording Form - Middle

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2. Oral Health Survey Information

1. Untreated Decay ^{ 0-No}_{ 1-Yes}

4 ^{# teeth}

1-Yes=

At least one tooth with loss of at least ½ mm of tooth structure at the enamel surface

2. Treated Decay ^{ 0-No}

 1-Yes 2 # teeth

1-Yes=

At least one tooth:

- has fillings, crowns or other restoration due to decay OR

- is missing due to decay.

3. Sealants Present ^{ 0-No}

 1-Yes

1-Yes=

At least one permanent molar tooth has a dental sealant OR part of a dental sealant.

4. Sealants Needed ^{ 0-No}

 1-Yes

1-Yes=

At least one permanent molar tooth needs a dental sealant on a fully erupted, virgin AND sound occlusal surface.

5. Treatment Urgency

 0-None

 1-Early

 2-Urgent

0-None= Routine dental care

1-Early= Dental visit within next several weeks 2-Urgent= Dental visit within 24 hours

3. Height/Weight

Height – in cm’s Weight – in kg’s

133^●3 19^●1

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Screening Recording Form - Bottom

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4. Signature

Provider ID # Signature Date

RDH 4444

Mary Jones ^9/1/2014

ASST 2222 Nora Smith 9/1/2014

ASST ---- ---- ----

Comments:

Swelling and pain in the mouth (upper right).  Summary of Findings Form

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Screening Findings Form - Top

38 Student: Adam Smith Date: 9/1/2014

Teacher: Mrs. Cook

Dental Screening

This was only a screening. Your child should still have a regular dental check-up.

 Urgent! A problem has been found and your child needs to go to the dentist within the next 24 hours! Your child has signs and symptoms that include pain, swelling or infection

(abscess).

_______ Possible Problems Found: Your child should see a dentist as soon as an appointment can be made.

_______ No Visible Problems: Not all visible problems can be seen by a dental screening. Your child should have a regular dental check-up at least once a year.

_______ Sealants Needed: Sealants help to prevent cavities on the chewing surfaces of back teeth. A dentist can tell you if sealants would be helpful for your child.

_______ Clean teeth and gums are important. Your child did a good job today.

If your child has AHCCCS or KidsCare insurance, dental care is covered.

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Screening Findings Form - Bottom

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Height and Weight Screening

Your child’s Height: 133.3 cm Weight: 19.1 kg

Please contact your School Health Office for more information.

Comments: Swelling and pain in the upper right part of the mouth.

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Nurse Referral Form

41 Date: 9/19/2014

School: First Elementary School

City: Ace City

The following is a list of children with urgent dental treatment needs. These children have an urgent need for a dental visit within the next 24 to 48 hours.

Grade Student Name Concern

K Betty Howard Abscess near lower left back tooth

K Adam Smith Swelling and pain in upper right part of mouth

3 Jenny Garcia Painful infected teeth

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Over-ride Reporting in Findings Form

What is over-ride reporting for the survey?

• Adjust reporting to parents on the child’s conditions or issues only in the Screening Findings Form

• Treatment urgency could be changed, comments added, and printed text in the Screening Findings Form edited.

• Edits may result in a change from what is recorded in the

Screening Recording Form (be sure to add notation to the Screening Recording Form’s Comments section)

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School Summary Form/Worksheet - Top

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2014-2015 Healthy Smiles and Healthy Bodies School Summary Form/Worksheet

School Name:

 Active Consent

 Passive Consent

School ID: (Nine-digit CTDS #)

123456789

School

Contact: Ms. Jenny Jones, School Nurse Phone Number:

(602) 222-2222

Screening

Date: 9/1/2014

Screening Team:

Screener (ID & Name)

4444 Joyce Benson Recorder Assistant (ID & Name)

6666 Jane Jackson Height & Weight Assistant (ID & Name) 4444 Joyce Benson 6666 Jane Jackson

First Elementary School

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School Summary Form/Worksheet - Bottom

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# Class / Teacher Grade

# Children Enrolled in Selected Classes

# Consent YES

# Consent NO (or opt out)

# Children Screened

# Children Absent

# Children Urgent Referral

1 Mrs. Cook K 25 22 3 21 1 3

2 Mr. House K 22 20 2 20 0 2

3 K

4 K

KINDERGARTEN GRADE TOTAL: K 47 42 5 41 1 5

# Class / Teacher Grade

# Children Enrolled in Selected Classes

# Consent YES

# Consent NO (or opt out)

# Children Screened

# Children Absent

# Children Urgent Referral

1 Ms. Jones K 28 26 2 25 1 2

2 3rd

3 3rd

3RD GRADE TOTAL: 3rd 28 26 2 25 1 2

* SCHOOL TOTAL K+3^rd 75 68 7 66 2 7

 Nurse Received Copy of Urgent Referrals Signature: (Screener) Suzie Day ___________

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Survey Logistics

Processing Survey Forms at the School

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On the Screening Day

Wrap-Up Tasks for the End of Screening Day

1. Record travel hours & screening hours for invoicing

2. Re-pack tubs & fill out order form to replace supplies/forms 3. Clean up areas used for screening and bag/dispose all trash 4. Go to school office to copy pink Nurse Referral Form

5. Organize & keep completed survey forms to be mailed to OOH 6. Deliver to school nurse: Screening Findings Forms, Nurse

Referral Form, resource information, and extra goodie bags

7. Thank the principal, school nurse, teachers & school office staff 8. Inform school office staff that you are finished.

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Survey Logistics

Processing Survey Paperwork

Leave these items with School Nurse/Contact:

• Completed Original Nurse Referral Form (pink form) o Be sure to make & keep a copy to mail to OOH

• Low Cost Dental Clinic List

• Height & Weight Handout (same one place in Goodie Bag)

• One AzSmiles canvas bag

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Processing Survey Paperwork

Mail these forms to Office of Oral Health:

• Checklist on Submitting Survey Forms to OOH (orange)

• School Summary Form/Worksheet (green)

• Copy of Nurse Referral Form (white copy of pink original)

• School Scheduling & Team Assignment Summary (white)

• School Enrollment Information Sheets (e.g., Class Rosters)

• Child Screening Records – bundle by class

(Screening Recording Form / Consent / Questionnaire stapled packets)

• Negative Consent Forms – bundle by class

• Consent Forms for absent students – bundle by class

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Mail Survey Forms to OOH

(Follow Checklist to Bundle & Mail)

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Survey Logistics

Re-Stock for

Future Screening Days

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Survey Logistics

Pack & Re-Stock Survey Supplies/Forms

• Survey Supplies/Forms Packing List

o Tape Packing List to the inside of each tub’s lid

• Survey Supplies/Forms Order Form

o Instructions provided on the form

o Allow at least 7 days for pickup or shipping

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Survey Logistics

Re-Stock for Next Screening Day

• After every screening day, inventory your

supplies/forms for the tubs & central stock; identify ordering needs for OOH

• Complete a Supplies/Forms Order Form when central stock is low

• Email or Fax completed Order Form to OOH

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Survey Logistics

Invoicing

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Survey Logistics Invoicing

County Contractors:

• Use your existing procedure to invoice ADHS Office of Oral Health

• Consult Field Coordinator (Connie Baine) or OOH Chief (Julia Wacloff) as needed

Screeners and Recorders:

• Use existing procedures to invoice

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Survey Logistics

Compliance to Policies & Procedures

• You are representatives of ADHS and the County Contractor in conducting this survey

• Read & comply with policies & procedures for the HSHB Survey

• Will ask Screeners and Recorders to complete/sign forms during Calibration Workshop

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Survey Logistics

Policies & Procedures

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Survey Logistics

ADHS Policies & Procedures

• HSHB Administrator & Provider Scheduling Information

• Reporting Suspected Cases of Child Abuse

• Incident Report

• Infection Control Policy and Procedures

• Immunization Policy and MMWR Report

• Professionalism and Sensitivity

• Data Confidentiality Agreement

(Pledge To Protect Confidential Information)

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Healthy Smiles Healthy Bodies

To our partners…

We look forward to working with you!

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Preparing for Calibration Workshop and Survey Screening Days

Self-Study Assignments

Healthy Smiles Healthy Bodies

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