A.

General Data

1. Description of Site

The idea of a Hughen center started in 1922, by 1933 The Port

Arthur Society for Crippled Children was organized. In 1936 the first class for
crippled children was held at a local charity hospital, towards the end of 1936 the
official school called Thomas W. Hughen School for Crippled Children was built
named after, Thomas W. Hughen who donated property for the building of the first
school house. The original qualification for entry was orthopedic disabilities, to be
able to function in a specialized classroom setting and the students must be
between the ages five and twenty one. The original staff consisted of one teacher,
one therapist, and one helper. On behalf of the Hughen Center, Texas State
Legislator, W.L. Smith introduced the Education Act of 1945. This legislation became
law and was widely recognized as the Foundation of Texas special education for
crippled and handicapped children. Throughout the centers 75 year history, the
center has received generous support from the Southeast Texas community and
legendary icons. One of the most involved supporters was Bob Hope, he was very
involved personally with the children at the Hughen Center and he often traveled to
Port Arthur to hold fundraisers, raising over one million dollars to build a new high
school on the campus. Currently, The Hughen Center is licensed as a General
Residential Operation by the Texas Department of Family and Protective Services. It
is now home for up to 52 boys and girls with disabilities. It is a state-funded
program.
The center is located on 2849 9th Avenue in Port Arthur Texas (77642).

2. Description of Target Group

Our target group is intellectually and developmentally disabled

individuals. Their ages range from 23 to 66 years old. In this target group the
disabilities of the individuals vary. Certain individuals are able to brush their own
teeth, although not effectively. Some are not able to brush their own teeth and rely
on a caregiver to take care of their oral health needs. There about 8 intellectually
and developmentally disabled students to educate and there are 6 caregivers to
participate in the program also.

3. Description of Staff Population

There are 4 general caregivers, a Licensed practical nurse and a

Registered nurse for this group. The general caregivers typically have a high school
education or GED. Their responsibilities is direct care of these individuals. They
assist the disabled individuals with their daily needs. Caregivers rotate shifts at 4:00
after their school day ends, and busses the individuals to a residential address close
to the school, to their residential caregivers.

4. Description of Services Provided

Treatment is provided to the individuals through a transitional living

program, skilled nursing care, occupational therapy, speech therapy, individual and
group therapy, basic child care and life skills training. The Hebert Adult Center is an
adult day care by the Texas Department of Aging and Disability Services, is active in
providing day services for up to 40 adults in need. The services also include lunch,
snacks, skilled nursing care activities such as bowling on Wednesday afternoon,
transportation, computer classes and attendant care.

5. Additional Pertinent Information

The city of Port Arthurs water fluoridation level is currently 0.70

mg/L. The water system type is community and the water source is surface. The
population served is 56,694. (3) This meets the optimal level of fluoridation for the
city of Port Arthur.

B. Information Related to Dental Health

1. Services Provided

The caregivers bring the individuals to their dental

appointments typically every six months for cleanings.

2. The individuals are taught how to brush their teeth according to the
education the caregivers.

3. The individuals are provided toothbrushes and other oral health care
supplies funded by the state through a home and community base service.

4. Previously the center was only provided $1,000 yearly and that has
now recently increased to $2,000 yearly of dental services!

5. The program director was well aware of the effects the oral health has
on the individuals overall health, she was aware of how often the individuals should
have cleanings and that the individuals that are able to brush their teeth are not
doing an effective job.

C. Dental Health Status

1. Dental Caries- Intellectually disabled individuals develop caries at the

same rate as the general population. The prevalence of untreated caries is higher.

2. There are several factors that increase the risk of periodontal disease in
intellectually disabled individuals such as, medications, malocclusion, multiple
disabilities and poor oral hygiene. Depending on the severity of their disability,
certain individuals cannot brush and floss independently. Certain medications may
lead to gingival hyperplasia.

3. Some individuals are not able to independently practice their own oral
health routine. A caregiver provides this for them, therefore, the caregiver should be
educated on correct oral hygiene techniques. Some patients are able to brush and
floss by themselves, but it is often not effective.

4. Malocclusion- Missing permanent teeth, delayed eruption and enamel

hypoplasia are more common in individuals with an intellectual disability.

common damaging oral habits are bruxism, mouth breathing, tongue thrusting, and
other damaging behavior, such as biting of the lips, eating objects or substances
such as gravel, pens, etc.

5. Oral Cancer- Is not relevant to our target group

6. Utilization of Dental servicesGoal Statement:

To provide the oral health knowledge and skills in maintaining optimal oral health to
the caregivers for the intellectual and developmental disable students.
Objective Statements:
Identify dental resources within the community to assist students with dental
health needs.
To decrease the dental plaque score determined from baseline information by 20%
Establish a daily routine of proper oral hygiene for the participants.
To increase the dental health knowledge of the students.
To increase the dental health knowledge of the caregivers.

Rationale:
An oral health program to teach the caregivers of the intellectual and
developmental students can decrease the risk of caries and periodontal disease
through provided knowledge. Caries and periodontal disease are of the most
common oral diseases in patients with intellectual disabilities according to the World
Health Organization, the difference are they are larger from the general population
in terms of the incidence and severity of their oral disease. (4) There are difficulties
in providing dental care for these patients, because of the lack of knowledge about
specific methods of treatment and lack of information from caregivers.
Cooperation during dental treatment for these individuals is often a major obstacle
to receiving treatment. The difficulties of communication and the degree of mental
disability of the individual are considered when receiving dental treatment. Because
of these obstacles there are sometimes doctors reluctant to treat these individuals,
which contributes to worsening the state of health for this group as compared to
healthy subjects.
These individuals often have additional medical disorders that affect their
daily lives. The care givers are mostly focused on these major disorders and not on
the individuals oral health. Because of medication the patients are usually taking,
the individuals can be more at risk for caries and periodontal disease. The oral
health of these individuals is usually only noticed when the patient is experiencing

pain or needs extractions. There is a lack of awareness of modern methods of

prevention for patients with mental or physical retardation.
There is often a financial barrier to the individuals. Medicaid only covers
emergency dental treatment. Regular cleanings can become very expensive for
these individuals. Our group is funded yearly by the state that usually allows them
to have a cleaning once or twice a year at the most. This depends on the xrays the
patient needs, or any additional procedures needing during the year, such as:
extractions, restorations, root canals, etc. Considering the lack of skill these
individuals have to keep their plaque permanently reduced, and the high risk of
caries and periodontal disease, these patients should ideally have a cleaning every
3 months. Since there are not usually funds for cleanings so often, it is important to
inform and teach the caregivers daily plaque control procedures to prevent any
damage to their oral health.
All of these persons have a right to good oral health. The British Social Attitudes
Survey from 1998 has reported that they are frequently treated with prejudice and
discrimination (Fortune, 2004). Later research has showed that these biases still
prevail. One of the most difficult tasks in health care services in every country is
providing them with dental care. From one side, an approach within the realm of
dental treatment and materials should aim at combating discrimination as well as
protecting the disabled people. From the other side, epidemiological studies have
demonstrated difficulties in maintaining the oral health of this group, and the
causes involved in this process are complex.

ACTIVITIES
THE PROGRAM PLAN IS AIMED AT EDUCATING THE PROGRAM DIRECTOR,
CAREGIVERS, OTHER STAFF AND RESIDENTS. THE EDUCATIONAL SESSIONS WILL
CONSIST OF TEACHING BASIC DENTAL HEALTH TOPICS, ORAL HYGIENE PRACTICES
AND THE IMPORTANCE OF GOOD ORAL HEALTH. THE SESSIONS WILL BE PERFORMED
ON A WEEKLY BASIS AT THE HUHGEN CENTER, LOCATED IN PORT ARTHUR TEXAS.
THESES SESSIONS WILL BE DEVELOPED IN THE FOLLOWING WAY:
SESSION 1 - WEEK 1:
A. CAREGIVERS AT THE HUGHEN CENTER AND STUDENTS
INTRODUCTION OF GENERAL INFORMATION RELATED TO THE ORAL HEALTH and how
it relates to overall health of the residents.
1. PRETEST FOR CAREGIVERS
2. DISCUSS THE NEED FOR A PREVENTIVE DENTAL HEALTH PROGRAM FOR THE
RESIDENTS.

3.DISCUSS THE IMPORTANCE OF GOOD ORAL HYGIENE AND HOW TO IMPLEMENT A

DAILY PLAQUE CONTROL ROUTINE FOR THE RESIDENTS
4. DISCUSS THE USE OF THE LIT DENTAL HYGIENE CLINIC FOR PREVENTIVE DENTAL
SERVICES FOR THE RESIDENTS.
5. Take students plaque score for baseline data.
6. Post-test for the caregivers.
SESSION 2- WEEK 2
A. CAREGIVERS AND THE HUGHEN CENTER AND STUDENTS
This session will be aimed
1. Pretest for caregivers
2. DISCUSS NUTRITION ( NUTRTIOUS VS NON-NUTRITIOUS) AND HOW IT RELATES TO
ORAL HEALTH
3. DISCUSS THE PROTOCOL IN THE EVENT OF A DENTAL EMERGENCY.
4. Take the students plaque score for the evaluation data.
5. Post-test for the caregivers

SESSION 3 - WEEK 3:
A. CAREGIVERS AT THE RESIDENTIAL ADDRESS AND STUDENTS
INTRODUCTION OF GENERAL INFORMATION RELATED TO THE ORAL HEALTH and how
it relates to overall health of the residents.
1. PRETEST FOR CAREGIVERS
2. DISCUSS THE NEED FOR A PREVENTIVE DENTAL HEALTH PROGRAM FOR THE
RESIDENTS.
3.DISCUSS THE IMPORTANCE OF GOOD ORAL HYGIENE AND HOW TO IMPLEMENT A
DAILY PLAQUE CONTROL ROUTINE FOR THE RESIDENTS
4. DISCUSS THE USE OF THE LIT DENTAL HYGIENE CLINIC FOR PREVENTIVE DENTAL
SERVICES FOR THE RESIDENTS.
5. Take students plaque score for baseline data.

6. Post-test for the caregivers.

SESSION 4- WEEK 4:
A. CAREGIVERS AT THE RESIDENTIAL ADDRESS AND STUDENTS
This session will be aimed
1. Pretest for caregivers
2. DISCUSS NUTRITION ( NUTRTIOUS VS NON-NUTRITIOUS) AND HOW IT RELATES
TO ORAL HEALTH
3. DISCUSS THE PROTOCOL IN THE EVENT OF A DENTAL EMERGENCY.
4. Take the students plaque score for the evaluation data.
5. Post-test for the caregivers

CONSTRAINTS AND ALTERNATIVE STRATEGIES

1. The students and caregivers will be noncompliant.
-Bring the students and caregivers alternate activities to get them involved.
2. The students being frightened by new surroundings.
-Introduce ourselves properly and get to know the students on a one on one level.
-Create rapport with students to make them feel comfortable.
3. Caregivers do not understand the lesson taught.
- Find out where the caregivers are lacking knowledge and answer questions.
RESOURCES:
PERSONNEL - PROGRAM DIRECTOR, CAREGIVERS, LVN, RN AND STUDENTS
SUPPLIES - TOOTHBRUSHES, TOOTHPASTE, DISCLOSING SOLUTION, CUPS, GLOVES,
COTTON SWABS, MASK, FLOSS,
VISUAL LEARNING AIDS - POWER POINT, BROCHURES, TYPODONT ETC.
Budget:
Box of gloves- $8.00
10 toothbrushes-provided by: Colgate Oral Pharmaceuticals
toothpaste- free
floss- free
disclosing solution- free
masks- $4.00

Brochure- free
mouthwash - provided by: johnson&johnson
Total Cost- $12.00
TIMETABLE:
WEEK 1: MARCH 29TH 2016 4:45PM
WEEK 2: APRIL 5TH 2016 4:45 PM
WEEK 3: APRIL 12TH 2016 12:45 AM
WEEK 4: APRIL 19TH 2016 12:45 AM

EVALUATION
A. FORMATIVE
1. A weekly assessment of plaque control techniques will be
conducted for the students in an effort to modify the techniques as needed for
optimum plaque control.

2. a weekly inspection of students oral debris and plaque will be

conducted. Findings will be reported and compared to assess the degree of
effectiveness of individual plaque control.
3. a weekly review for each group of the information which was
presented during the previous session will be conducted to promote optimal
understanding and retention of information.

4. a weekly consultation with the director of the program will be

conducted to ensure satisfaction and continuation of the program plan or to make
necessary adjustments if needed.
5. success and individual comprehension of each presentation
will be assessed through a question and answer session upon the completion of
each session.

B. SUMMATIVE

1. A pre-test and post-test will be administered to the staff to

assess and compare knowledge in dental health care concepts, as well as their

comprehension of the support and educational role they hold as health care
providers.
2. Baseline data for plaque scores will be taken and compared
to post evaluation data to measure effectiveness of oral health program.

2.. The success of the overall program will be evaluated by a

questionnaire given to the program director upon the conclusion of the program.

References:

http://www.nidcr.nih.gov/oralhealth/Topics/DevelopmentalDisabilities/PracticalOralCa
rePeopleIntellectualDisability.htm#PeriodontalDisease

https://nccd.cdc.gov/DOH_MWF/Default/WaterSystemDetails.aspx

http://cdn.intechopen.com/pdfs-wm/28173.(4)

http://www.sciencedirect.com/science/article/pii/S0149718914000858