CIRS Blog about Rural California

By Lynn Graebner

One third of California residents and half of the state’s children qualify for Denti-Cal, the state’s Medi-Cal dental program. So leaders in counties like Santa Cruz, where 82 percent of the dentists don’t take Denti-Cal, are seeking new ways to serve this long-suffering low-income population.

“Most California dentists want nothing to do with Denti-Cal,” stated an April report by the Little Hoover Commission, an independent state oversight agency. It hammered Denti-Cal — calling it a broken system that has alienated its partners in the dental profession. Less than half of Denti-Cal beneficiaries use their benefits because they simply can’t find a dentist who will see them.

That has left counties, community clinics, nonprofits and private dentists to cobble together programs and safety nets for thousands of residents. Some of those are showing promise and some counties plan to expand them by applying for part of the $740 million state and federal agencies have allocated for the new Dental Transformation Initiative. It is meant to incentivize more dentists to offer preventative dental care to children.

While the California Dental Association, counties and private dentists say this is an encouraging step, there’s a long way to go to reviving the dysfunctional system, they say.

Dientes Community Dental Care, a community dental clinic receiving federal funding through Santa Cruz County, decided to commission its own report: Increasing Access to Dental Services for Children and Adults on the Central Coast, released in April. It showed that of the 80,000 people on Medi-Cal in Santa Cruz County, only 31 percent of them were able to see a dentist in 2014. Thirty-one percent of children under age 11 in the County have never seen a dentist and seniors on Medicare have no dental benefits except for extreme needs.

“Insurance does not equal access,” said Laura Marcus, Dientes’ executive director.

Despite its expansions, Dientes has to reject about 20 calls daily for dental service. Gaye Hancock was among them. She lost her job during the economic downturn and is working again but now has Denti-Cal. She started calling Dientes two years ago and finally resorted to getting her teeth cleaned at the Cabrillo College Dental Hygiene Clinic by student hygienists. They found cavities and bone loss which have forced Hancock to chew on just one side of her mouth since 2014.

“I’m 63, I’m just fighting to keep my teeth healthy,” she said.

As a result of the Santa Cruz report, the Santa Cruz County Oral Health Access Steering Committee emerged, including Santa Cruz and Monterey County government, education and dental industry representatives among others. They plan to present strategies in December 2016.

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By Claudia Boyd-Barrett

It took a year for Elvira Gomez of El Monte to realize something was wrong with the therapy her son was supposed to be receiving at school.

Jose Antonio Suarez, then 5 years old, was scheduled to see a therapist once a week in his kindergarten class at a Los Angeles County elementary school. But in 2014, a year after the therapy started, Gomez had yet to see any improvements in her son’s hyperactive and aggressive behavior.

“I went to the school and asked, ‘How often is the therapist going (to the classroom)?’” recalled Gomez, a native Spanish speaker. She was shocked to find out that the therapist came only once or twice a month.

“I thought, I have to be more on top of this,” she said.

Gomez is one of thousands of parents across the state who have struggled to get their children adequate mental health services at school. She’s also part of a population that advocates believe is especially vulnerable to having their children’s special education and mental health needs neglected: parents with limited English skills.

Legally, school districts are supposed to provide students experiencing emotional and behavioral difficulties with mental health assessments and individualized services to help them benefit from their education. But a report earlier this year by leading advocacy organizations found half of all students with these difficulties get no mental health help at all.

Other students who do receive services, the researchers found, frequently don’t receive them enough or don’t receive the right kind of intervention to make a difference.

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By Lily Dayton 

As summer wanes and students head back to school, farmers on the Central Coast are draping fields with plastic, preparing for fall fumigations that will sterilize soils before the next growing season. And if previous years’ trends continue, more than 35,000 Monterey County schoolchildren will attend schools near fields treated with high levels of potentially dangerous pesticides—including chemicals that are known to harm the brain and nervous system, cause genetic mutations and disrupt hormonal regulation.

“I’m really worried about our students and how it affects their developing bodies and brains,” says Karin Wanless, an intervention teacher who works with kindergarten and first-grade students in the Pajaro Valley school district, which straddles agricultural areas in both Monterey and Santa Cruz Counties. Some schools within the district are surrounded by fields ranked highest in the state for pounds of pesticides applied, yet application regulations differ between the two counties.

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By Lily Dayton

In the predawn hours of Oct. 3, 2012, two farm labor crews arrived at fields southeast of Salinas to harvest lettuce. A light breeze blew from the north across rows of head lettuce and romaine. As the sun rose higher in the sky, the workers started to smell an acrid odor that some described as paint, others as cilantro seeds or diesel fumes. The workers’ eyes began to burn and water; many complained of nausea, headache, dizziness and shortness of breath. No pesticides were being sprayed at the time, but still, the workers were displaying classic symptoms of pesticide illness.

The source of the odor was drift from a pre-plant strawberry field—a 25-acre barren plot of soil that had been fumigated the day before with a mixture of highly toxic and volatile chemicals 1,3-dichloropropene (also called 1,3-D and sold under the brand name Telone) and chloropicrin.

On the morning of Oct. 2, the fumigant had been injected into the soil through a drip irrigation system beneath high- barrier tarps. Eighteen hours later, 43 people—many of them working as far away as 2,000 feet south of the field—were sickened from poisonous gases that had escaped.

This case, like so many others listed in the state’s Pesticide Illness Surveillance Program, highlights a major problem with pesticides—they don’t necessarily go where they’re intended and, once applied, they don’t necessarily stay there.

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By Hannah Guzik

Although more than half of California’s children are enrolled in the state’s low-income health program, the state does not report how many of them are born at a low birth weight, receive a developmental screening in their first three years of life or have a suicide-risk assessment if they have a major depressive disorder.

These are just a few of the indicators that the federal government uses to assess the quality of the Medi-Cal program, which will cost the state about $18 billion this year.

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