The proposed Community Oral Health Interventions Program (COHIP or CO-HIP) was designed in collaboration with community patners of the currently-funded Detroit Center for Research on Oral Health Disparities (a.k.a Detroit Dental Health Project (DDHP)). This document describes the administrative center, overall design, management and structure of COHIP. It also describes the research training program. COHIP proposes to develop and implememt a sustainable healthy community model which integrates community-based oral health promotion programs, provided by culturally competent community health teams, with evidence-based clinical and preventive care provided by dental clinicians working in four Federally Qualified Health Centers' (FQHCs) dental clinics (COHIP clinics) in Detroit (Eastside, Nolan, Bruce Douglas, and Thea Bowman). The primary interveners in the COHIP model will be community health workers (CHWs) who will be trained by local and national team of experts. The CHWs will be trained to advcoate for the families of children aged 0-11 years and their caregivers living in low-income areas, coordinate their dental care, provide motivational interventions to reduce dental anxiety and fatalism, develop preventive plans, manage diabetes, improve their oral hygiene practices, increase nutritional literacy, and promote tobacco cessation. The CHWs will provide formal social support and will follow-up with the families on regular basis. To develop these interventions COHIP has teams of experts in social interventions, motivational interviewing, diabetes education, clinical care, oral health and health litearcy; in addition to teams of statistical experts and managers of research projects. COHIP will collaborate and share resoucres with the University of Michigan Clinical and Translational Science Award (CTSA) and the Michigan Institute for Clinical and Health Research at the School of Medicine. COHIP will recruit 1,510 famiilies with eligible children living in 27 census tracts around the four clinics. The families reside in randomly selected segments within these tracts. The segments will be assigned into either an intervention or comparison arms. The families in the comparison areas will by visited by trained research staff (not CHWs) and be provided with information on dental care but not scheduled by the staff to visit the clinics. They will also not receive any social or behavioral interventions at their homes. They will be treated by the regular dental providers at the clinics who will follow their existing standards of care. For the families in the intervenion areas, the CHWs will provide integrated motivational interventions as described above. These families will be cared for by a COHIP-hired clinical team that will work in the 4 FQHC clinics. The team will follow new protocols for diagnosis, risk assessment, restorative/surgical care and provide evidence-based preventive care based on risk status of each participant. COHIP management is comprised of an experienced team with extensive field experience in coordinating complex community-based interventions as well as observational studies. The team has experience in recruitment, data collection, analysis, and publications in the current funded disparity center. COHIP will target 11 clinically meaningful outcomes to reduce health disparities in children and adult caregivers. COHIP research training program will target students from the middle school level until the doctoral level and will be based on the CTSA program as well as those offered by the School of Public Health. COHIP as model has received strong support from the regional office of the Health and Resources Services Administration, the National Network for Oral Health Access (NNOHA), and it has generated an interest among researchers from the Schools of Medicine and Pubic Health, the Institute for Social Research, and several other local, national, and international organizations. The COHIP model can be leveraged to address other health disparities and it can be financially sustainable based on the recruitment of Medicaid eligible families to receive dental care at Federally Qualified Health Centers. Finally, as endorsement and trust that the University of Michigan has in the proposed program, a $1 Million gift will be awared to COHIP to fund its programs and support its mission. The COHIP team brings a wealth of expertise and knowledge to develop and implement programs to significantly reduce or eliminate the burden of oral health inequalities.
