ARKids First is Arkansas’s version of the federal Children’s Health Insurance Program (CHIP). ARKids provides healthcare coverage for uninsured children under age 19 who do not qualify for Medicaid or benefits under the Affordable Care Act. ARKids First is administered by the Division of Medical Services of the Arkansas Department of Human Services (DHS).
Studies show health behaviors of at-risk populations tends toward reactionary, acute care rather than prevention or wellness care. Because dental health is an indicator of overall health in children, the client (DHS) wanted promotion that focused specifically on the importance of regular dental checkups for kids, and to encourage Arkansas families with ARKids-enrolled children to actually use their coverage for regular dental checkups, instead of waiting until something was wrong to see a dentist.
We used secondary research data from the Arkansas HEDIS Report (Healthcare Effectiveness Data and Information Set) to review dental checkup rates in all 75 counties in Arkansas. Our review indicated that nearly 40 percent of ARKids First-enrolled children had not visited a dentist in the previous year. The HEDIS data review allowed us to rank the Arkansas counties with the lowest dental checkup utilization rates. We used this data to develop a targeted outreach campaign for 14 of the counties with the lowest pediatric dental checkup rates.
Additional secondary research gained from Arkansas Department of Health data indicated that in many lower socioeconomic households, the chief method by which parents received routine health information was when it came from their child’s school or when their children received required school immunizations at the local health department. Our goal was to develop a messaging strategy, guided by our research, focused on outreach to ARKids-enrolled families in those 14 lowest-ranked counties.
Traditionally ARKids has used TV and radio advertising, but the client budget could not accommodate that this year, so we had to get a little more creative with our promotion. Our research helped us narrow our focus to a school-based strategy. This outreach campaign was aimed at parents and guardians of elementary school-aged children in the 14 counties with the lowest dental checkup rates. The objective was to use an unconventional, non-broadcast method to get parents’ attention at least one time during the school year, in the 14 target counties and put information in their hands about the importance of regular dental checkups while reminding them to use their benefits since ARKids coverage paid for twice-annual dentist checkups. We implemented the promotion during National Children’s Dental Health Month in February, a not-too-busy time for schools.
- Database – We obtained Department of Education lists for elementary schools, Arkansas Better Chance programs (Pre-K) and Head Start preschool programs and local health units in our 14 target counties. From those lists, we built a distribution list of 173 ABC, Head Start programs, 57 elementary schools and 15 local health units, along with the corresponding number of children in each county matching the criteria, giving us a quantity of approximately 35,750 children.
- School nurse partnership – The School Nurse Association was able to give us a list of licensed school nurses. We matched up the nurse list with elementary school coverage in our 14 target counties and surveyed the nurses to see if they would distribute a flyer about dental checkup coverage. They told us a flyer would be thrown away unless they “stood out” or got the parents’ attention. We asked them if free toothbrushes would serve as an incentive and they agreed they could. The school nurses were more than willing to be part of the distribution plan for the campaign.
- ARKids First Toothbrushes – We ordered 36,000 toothbrushes imprinted with the ARKids toll-free phone number and attached them to “SMILING Arkansas” cards.
- SMILE card – We designed simple cards with the headline “SMILING Arkansas” and hand-assembled the card + toothbrush combination. The cards included simple facts for parents about the importance of regular checkups with the dentist and the fact that ARKids coverage paid for visits twice a year. The call-to-action was to visit the ARKids First website, find a dentist in the community and schedule a dental checkup for their child.
- Distribution plan – The distribution plan included shipping a package of toothbrushes and SMILE cards to each school nurse prior to National Children’s Dental Health Month. Each package included an instruction letter for the nurses and thanked them for participating in the campaign.
- Social media content – We supported the campaign with 30-days of social media content created for posting on DHS’s social media channels.
- Post-campaign surveys – We emailed an 8-question survey to all of the school nurses, pre-K program directors and the local health unit partners in the month following the campaign to assess the perceived educational value of the SMILING campaign.
36,000 imprinted pediatric toothbrushes were shipped to 245 locations in the 14 target counties; along with the production of the SMILING cards, supporting social content and the post-campaign surveys. Resources used included our PR team, our graphic artist and the agency’s social media specialist. We used Survey Monkey for the post-campaign surveys of nurses.
The two biggest challenges were creating the distribution database – we had to merge a lot of lists from a variety of sources and getting responses to the post-campaign survey. We had to send at least three reminder emails to most of the partners to achieve a reasonable response rate.
Everyone on the team agreed that running a broadcast schedule would have been a lot less work, but it would not have put toothbrushes and dental wellness messages in the hands of children and their families in the target counties. Ultimately, at the end of the one-month campaign, the ARKids toothbrushes and SMILING cards had been distributed to 245 locations in the 14 highest risk counties, with a potential reach of 35,729 children.
We received a 39 percent response rate to the survey of partners. The results indicated that the health and school partners saw value in the unconventional outreach method:
- 85% of respondents felt they had educated families
- 85% distributed all of the SMILING toothbrush packets
- 89% said they would definitely distribute them again next year if asked
- 89% were interested in receiving a digital ARKids First flyer explaining wellness coverage to families
It’s almost impossible to correlate a “happy toothbrush” kit to a corresponding health action by a parent; nonetheless, available health data recorded a 14 percent overall increase in dental visits by ARKids patients in the targeted counties. That, coupled with the value and benefit perceived by our distribution partners, led the team to consider the dental outreach campaign a success and recommend repeating it in coming fiscal years with an expansion of the target counties.