Community Needs Assessment

By Aaron, Alex, Alyssa,Taylor and Xiaoru

Target population: Low income Women, Children, & Infants
Who WIC serves:
● Pregnant women nutritionally at risk.
● New or breastfeeding moms.
● Children under age of 5.
What WIC does:
● WIC is a nutrition program for pregnant women, new and breastfeeding
moms, and children under five.
● In Washington State, WIC reaches over 195,000 women, infants, and children
in 205 clinics each month and provides services to over 315,000 individuals
●
each year.
Who is eligible?
● Family who participates other
certain programs might
automatically eligible
● Federal medicaid program
● SNAP-AKA food stamp
● TANF- temporary assistance
needs family
● Pregnant teen in foster care
● Foster children
(Washington State Department of Health [WSDOH], n.d.)
(WSDOH, n.d.)
Needs for establishing infancy oral health care
● Maternal and infant oral health are linked beyond pregnancy
(microbiome)
○ Dental caries is a transmissible disease (can be passed by
mother to infant)
● Establishing care at early ages will promote better habits for the
kid and get them acclimated to regular dental visits
○ The American Academy of Pediatric Dentistry (AAPD)
recommends that infants should establish care once the
1st tooth erupts, or by their 1st birthday
● Education by a dental health care professional to inform how to
properly care for infant’s/young children's oral health
○ Regularly wiping infant’s gums with warm, wet cloth
○ Supervising/assisting children <6 with their toothbrushing
and oral hygiene habits
 Needs for ECC prevention

● Back in 2007 Washington State Department of Health release a public Oral Health Burden document
● Washington State Smile Survey (completed every five years) looks at prevalence of caries in children
from low-income families
● Since 1994 when the survey was first released: health disparities for minorities and low-income
children, caries rate, dental treatment needs, and untreated caries have all significantly increased
● The figures above depict most recent survey results (2005) showing the disparities between
white/english speaking children and minority/non-english speaking children
Needs for pregnancy periodontal diseases prevention
● Center for Diseases Control and Prevention reports that 60%
to 75% of pregnant women have gingivitis.

○ Untreated gingivitis can lead to periodontitis which has

been linked to poor pregnancy outcomes including
preterm birth and low birth rate

● According to the CDC, pregnant women may also be at an

increased risk for cavities due to behavioral changes.

○ Important to educate mothers about how they could

potentially transmit bacteria from their mouth to the
mouth of the baby

○ With pregnant women that experience morning

sickness they can rinse with 1tsp of baking soda in a
glass of water to help rinse the acid away after being
sick
Proposal
● In WIC, there are needs for
○ Advocating for oral care prior to and during pregnancy
○ Establishing care for infants
○ ECC prevention

● Educating mothers, children, and or other family members

can be done by…
○ Interactive learning
○ Speaking with families
○ Recommending resources

One of the best way to distribute this knowledge is through

pamphlets, flyers, or hand outs.
Proof Of Needs
“Children of mothers who had high levels of
untreated caries were more than three times as likely
… to have higher levels of caries experience (treated
or untreated dental caries) compared with children
whose mothers had no untreated caries.” (Dye, 2011)

“Nearly 60 to 75% of pregnant women have

gingivitis, an early stage of periodontal disease
that occurs when the gums become red and
swollen from inflammation that may be
aggravated by changing hormones during
pregnancy.” (CDC, 2022)
STRENGTHS WEAKNESSES
● Apple Health (Medicaid) covers many
preventative dental services ● Language barriers
● Public health dental clinics ● Not prioritizing dental care as a need
● School sealant programs ● Patients unaware of the benefits to having
● Community water fluoridation routine preventative care
● Registered Dental Hygienists
● Dentists
● Healthcare Professionals

OPPORTUNITIES THREATS
● Education at WIC locations on dental health ● Negligent caregivers
related to systemic diseases ● High cariogenic diets
● Providing oral hygiene instructions for patients ● Low income
and their children ● Lack of dental insurance
● Nutritional brochure handouts on the ● Existing dental caries/poor maternal oral
importance of well-balanced meals and
health
reducing sugary beverages/snacks
● Relationship of pregnancy and oral health
changes/possible adverse outcomes with poor
oral health
 Stakeholders
● Pregnant women, breastfeeding mothers,
and children under 5 years of age
● Caregivers for children under 5 years old
● Foster children under 5 years old and
pregnant teens are eligible for benefits
● Healthcare workers and WIC employees are
significant in promoting these kind of
resources
● Medicaid
● Food banks
● Registered Dental Hygienists
● Dentists
● Community Health Centers
● Healthcare Professionals
● Community Leaders
● Seattle Central College
Mission Of WIC
The goals of WIC are to improve the health of the target population
through…
1. Nutritional Education
● Kid approved recipes
● One-on-one appointments
with nutritionist
● Ideas to keep the family
active
2. Breastfeeding support
● Information about
breastfeeding benefits
● One-on-one appointments
with lactation consultant
● Ways to network with
breastfeeding WIC mothers
● Access to breast pumps at
some locations
Mission (Con.)
3. Healthy foods
● Monthly benefits for healthy foods
like milk, cereals, fruits, and
vegetables
● Extra food for fully breastfeeding
participants
● Iron-fortified formula
● Jarred baby foods
4. Health screenings and referrals
● Measuring growth, height, weight,
and blood iron levels.
● Immunization screenings
● Identifying health risks
● Referrals to other services
○ Health insurance
○ Medical care
○ Dental care
○ Family planning clinics
○ Local food banks
○ AND MORE…
● Increased number of participants utilizing WIC
● Reduce number of ECC and oral health diseases (periodontitis, caries)
● Nutrient dense diets
● Established care for routine medical and dental visits for families
● Mothers practicing breastfeeding
● Thoroughly educated patients to make informed decisions

Vision
 INSTRUCTIONAL GOALS
1. Educate pregnant mothers on the importance of maintain good oral hygiene before, during, and after
pregnancy.
a. Including risks for periodontitis and possible adverse outcomes (low birth weight).
b. Validating the need to continue to see the dentist during pregnancy for preventative care.
c. Education on pregnancy-related gingivitis and other dental conditions
2. Educate mothers/caregivers on the caries process.
a. Discuss what Early Childhood Caries (ECC) is and how to take preventative/protective measures
b. Discuss how dental caries is a transmissible disease and therefore important to address any current dental restoration needs.
3. Education on oral hygiene instruction for self, infant, and/or children.
a. Demonstrate C-shape flossing for adults and floss picks/floss holders for children
b. Demonstrate different brushing techniques for adult and children on Colgate tooth model, have them repeat it back to measure
their comprehension.
c. Discuss important of wiping infant’s gums daily with wet rag and establishing a ‘dental home’ by first tooth eruption or first
birthday.
d. For children less than 3 years old use a rice-sized smear of fluoride toothpaste to brush 2x/day; for children aged 3-6 years old
use a pea-sized amount of fluoride toothpaste to brush 2x/day
4. Education on nutritional importance.
a. Low cariogenic foods to reduce risk of caries
b. Nutritionally dense food to promote optimal growth for fetus during pregnancy
c. Nutritionally dense food to promote optimal growth for children
d. Resources available to utilize (MyPlate.gov)
Surveys to assess the needs of pregnant
women, mothers, kids
● Surveys dispersed in local grocery stores, medical and dental
facilities, DSHS offices
● Surveys will provide insight on the perceived needs of target
population (whether its nutritional, dental, or medical)
● Utilize information to reform any changes necessary
● Option for electronic and physical survey (for convenience)
○ QR codes, paper surveys, email listings
Analyze/Assessment
● Studies show that children from low-income and minority families
experience a disproportionate burden of oral disease and are more prone to
low health-literacy
● Contributing factors may include lack of community water fluoridation,
dental workforce shortages, high cost of care and accessibility
● Cultural beliefs, values, and practices are also often implicated as causes of
oral health disparities
○ Dismissing pain and discomfort because your teeth look “fine” (no
preventative care)
● A lot of cultures believe in only going to the dentist or doctor when they feel
something is wrong, or if damage has already been done
○ Western cultures are more proactive with the use of preventative care,
and routine oral hygiene practice
*Importance of cultural diversity in the healthcare field
 Design
● Provide clear and easy to understand
handouts and brochures that outline risks and
progression of periodontal disease
● Explain impacts of periodontal disease on
overall health of the body
● Emphasize importance of routine professional
dental care as well as maintaining good home
care
● Demonstrate proper brushing and flossing
techniques either with videos or physical
models
● Demonstrate use of supplemental oral hygiene
aids (interproximal brushes, rubber tip
stimulator, water flossers, tongue scrapers,
etc.) and their individual benefits
 Nutritional goals for infants and mothers
● Mothers should attempt breastfeeding until age 2
● Foods high in calcium (milk, cheese, yogurt)
● Sufficient intake of Vitamin D (many dairy products are fortified with Vitamin D)
● Water in between meals (community fluoridated water highly encouraged)
● Reduced intake of sugary acidic foods/beverages (sweets, soda, energy drinks)
● Fortified/enriched baby food
 6 Step Theory to Promote Health
1. Perceived susceptibility
a. Explain to them their risk based on their personal risk factors.
2. Perceived severity
a. Explain the consequences.
3. Perceived benefits
a. Explain what the recommended actions is and when to do it.
Also include the positive results from doing this action.
4. Perceived barriers
a. Be supportive and reassuring! (This is also the time to correct
misinformation)
5. Cues to action
a. Get them ready to make a change, Demonstrate and find a
reminder system.
6. Self-efficacy
a. Make sure they are ready and confident to take action
 Plan
● Provide handouts in multiple different languages
based on the population serves within the area
● Use simple terminology and media that is easy to
follow that demonstrates proper home care
techniques
● Provide handouts with comparisons of common
cariogenic foods and healthier alternatives
○ Offer healthier alternatives to cultural foods as
well, depending on target population
● Be aware of oral hygiene practices and beliefs in
different cultures and advise accordingly
● Show what gingivitis may present as as well as
other clinical conditions such as caries, gingival
recession, attrition etc.
A plan for pregnant women
A handout with:

● Nutrition information: dietary habits on

oral health, nutritional needs for
health.
● Oral hygiene homecare instruction:
flossing, rinsing, brushing, cleaning.
● Oral hygiene education: relation of
pregnancy and periodontal diseases.
● Professional care information: safety
and necessity of professional care.
Implementations
-Challenges included: not advertising the booth enough prior to presentation, pamphlets only in
English, not many people stopped by because they were “in-and-out” for their appointments

-We had a few instances within our target population that did not speak English, but we were
fortunate to have Xiaoru and the security guard in the lobby translate our information in Mandarin
and Spanish

-Presentation took place in the lobby of Neighborcare Health Meridian

-Resistance to routine care possibly due to cultural disbelieve and language, financial barrier that
limited their access to healthcare.
● Be culturally aware and trained to understand the different cultural beliefs and practices of their patients.
● Provide interpreter services.
● Provide patient education pamphlet and brochure in various languages.
● Respect the cultural practices of their patients. Void judging patients beliefs and practice.
● Adopt a patient-centered approach to care that takes into account the patient's cultural background and beliefs.
● Diversify Healthcare Workforce.
Evaluation

Describe evaluation methods and expected outcomes based on oral health values
of the target population
- Primary evaluation method used was interviewing those who came up to our
booth to have a discussion with us. We were able to speak with one lady who
actually worked for WIC, we had at length discussions with her on the
importance of why it is recommended for children to establish a dental home
by first tooth or first visit. Our hope is that by educating her on many of these
topics she will be able to provide that education back to those who come to
the WIC clinic for services.
Resources
Centers for Disease Control and Prevention. (2018, July 25). Products - data briefs - number 307 - April 2018. Centers for Disease
Control and Prevention. https://www.cdc.gov/nchs/products/databriefs/db307.htm

Centers for Disease Control and Prevention. (2022, March 18). Pregnancy and oral health feature. Centers for Disease Control
and Prevention. Retrieved December 8, 2022, from
https://www.cdc.gov/oralhealth/publications/features/pregnancy-and-oral-health.html#:~:text=Pregnancy%20may%20make%20w
omen%20more,for%20the%20mother%20and%20baby.

Dye, B. A., Vargas, C. M., Lee, J. J., Magder, L., & Tinanoff, N. (2011). Assessing the relationship between children's oral health
status and that of their mothers. Journal of the American Dental Association (1939), 142(2), 173–183.
https://doi.org/10.14219/jada.archive.2011.0061
Washington State Department of Health. WIC Nutrition Program. Washington State Department of Health. (n.d.). Retrieved
November 17, 2022, from https://doh.wa.gov/you-and-your-family/wic