Table 3.

Evaluation questions and data sources.

EVALUATION QUESTION AND THEME	RESPONSES	DATA SOURCES
		Online Survey (18 States)	Telephone Interviews (7 States)	Administrative Data (18 States)
Expansion of Dental Sealant Programs in High-Need Schools	Fourteen states (77.7%) reported an increase in school sealant program coverage in terms of more high-need schools or students served over the 5-year funding period.	NA*	Interviewees from states O and F reported using mobile units to reach more schools.	Thirteen states (A, B, C, D, E, F, G, H, I, L, N, P, Q) discussed their successes in expanding their school-based sealant programs.
Increased Number of Students Receiving Dental Sealants	Fourteen states (77.7%) reported an increase in school sealant program coverage in terms of more high-need schools or students served over the 5-year funding period.	State E discussed an increase in the number of students receiving sealants.	NA	Three states (G, H, I) highlighted success in increasing the number of students receiving dental sealants within high-need schools.
Obtaining Supplemental Funding to Support Expansion	In addition to Centers for Disease Control and Prevention funding, 8 states reported receiving funding from other federal, state, or private entities.	NA	NA	Eight states (A, D, E, F, H, J, P, R) successfully obtained funding from more than 1 source to support expansion of school-based dental sealant programs targeting high-need schools.
Factors for Expanding Reach of School Sealant Programs
Policy changes reducing dentists' supervision	● Ten states cited existing state policies as barriers to expanding school sealant programs. Elevated operating costs due to policies requiring dentists' supervision of dental hygienists providing sealants in school settings were a barrier to implementing and expanding school sealant programs. Another barrier was a state policy that did not allow dental hygienists to bill Medicaid for sealants delivered in school sealant programs. ● Three states reported policy changes allowing school sealant programs to substitute less costly for more costly labor. Two of these states that already allowed dental hygienists to provide sealants without a dentist’s supervision in certain settings expanded settings to include schools. ● One state reported removing the requirement for dentists’ supervision of dental hygienists in school settings during assessment of students’ need for sealants.	Ten states (B, C, D, F, H, I, J, L, M, Q) discussed the role of a state policy allowing dental hygienists to provide school-based services without the supervision of a dentist in facilitating the implementation and expansion of school-based sealant program.	NA	NA
Increased efficiency	States reported efforts to decrease their labor costs. One state collaborated with dental hygiene education programs, engaging dental hygiene students to assist in sealant placement.	NA	NA	Two states (A, E) reported either hiring dental hygiene teams to place sealants in remote geographic areas or dental hygiene students to assist in sealant placement.
Strengthen school sealant program data collection and reporting	Strengthening school sealant program data collection and reporting allowed states to better monitor local programs and prioritize schools to be served by school sealant programs. One state noted that to reach more students at current funding levels they were planning on diverting resources away from schools with lower student participation rates to those with higher rates.	NA	NA	Six states (B, H, J, M, N, O) reported working with local programs to strengthen school sealant program data collection and reporting.
Challenges
Medicaid payment levels or provider and location requirements for dental hygienist services	Two states noted that Medicaid reimbursements for sealant placement were “…not adequate to cover the cost of transportation, supplies and other logistics.”	Two states (B, C) described Medicaid payment levels as a barrier to school sealant program expansion.	NA	NA
Funding	Six states (33%) discussed funding as a key challenge to expanding school sealant programs. Several states indicated that “…it costs a lot for schools and dentists to implement sealant programs” and that there are not enough resources and dedicated staff to launch broader statewide efforts. Some states noted that “current funding levels not only impede expansion efforts but threaten the sustainability of existing programs.” One state noted, “Without additional funds, we would have to reallocate. We plan to look at programs that are not as productive as others….”	State A's survey response also highlighted this challenge. In addition, open-ended survey respondents from states C and I noted that limited funding was a major barrier for their sealant programs.	Interviewees from states A, B, and F noted that additional funding is required to reach more eligible schools with dental sealant programs.	Three states (A, B, R) indicated in their annual program reports that funding remains a key challenge to implementing their school sealant programs.
Working with mobile providers	Survey respondents from 4 states discussed challenges in working with mobile providers in their states. Mobile programs often did not share data with the state oral health program. As a result, larger mobile programs sometimes served the same schools as state-sponsored school sealant programs.	States A, G, H, and J discussed challenges in working with mobile providers in their states.	NA	NA

^*NA: Not applicable. The data source did not include this question.