The Kindergarten Oral Health Assessment and district survey results

A kindergarten student at a school dental screening.

In 2005 California legislators passed Assembly Bill (AB) 1433 to create the Kindergarten Oral Health Assessment (KOHA) to help improve student health and strengthen efforts to reduce absenteeism. However, the assembly bill needed additional funding and infrastructure to realize a successful implementation. Then in 2018, KOHA was amended with the passage of Senate Bill (SB) 379, which allowed for onsite screening with an opt-out consent option for parents with the goal to screen more children and identify which children need urgent care and find them a dental home. With oral screenings made available at the schools, officials can now improve data collection to measure the success of oral health prevention and intervention programs.

Why California Needs the KOHA

A 2020 Smile Survey found that by the time Los Angeles County’s children enter kindergarten, almost half have experienced tooth decay. In addition, almost 20% or 43,500 kindergartners and 3rd graders experience severe tooth decay. On any given day more than 4,500 Los Angeles County kindergarten and third-grade children need urgent dental care, which means they may be experiencing mouth pain or a serious infection. If left untreated, tooth decay can affect essential aspects of daily living, including eating, speaking, and performing at home, school, or work. Children with poor oral health miss more school and receive lower grades than those with better oral health. Early dental care plus regular and consistent prevention are key to improving the oral health and overall health of children in Los Angeles County. This highlights the need for ongoing screening, referral, and case management services in schools that serve children at greatest risk.  

The L.A. Trust and the KOHA District Survey Project

Last year The L.A. Trust partnered with the Los Angeles County Department of Public Oral Health Program to survey how 28 school districts with the largest elementary enrollments in L.A. County are reporting and collecting KOHA project. The culmination of that research was shared by The L.A. Trust in person and via Zoom on May 16, 2022, at the Endowment Center in Los Angeles with L.A. Unified, L.A. County and Smile California. The L.A. Trust shared key findings from the survey that highlighted best practices, challenges of gathering the necessary data, and recommendations on how to improve reporting to capture accurate and timely data.

This study analyzed the implementation of KOHA in 28 of the largest school districts in Los Angeles County, including the 574,570 students enrolled in LAUSD. This is the total number of students enrolled in LAUSD, not just the kindergartners. This information will be used to improve reporting, and support districts and families to receive more oral health care as the effort progresses.  Understanding the reporting mechanism will help schools focus on how to efficiently streamline reporting data to the state and use it to improve children’s oral health. The L.A. Trust also looked at the reporting mechanisms and promotion strategies of the 28 school districts.

There are layers of complexity when it comes to optimizing the implementation of KOHA in Los Angeles County.  L.A. County is the largest county in the United States, with 88 cities and 80 school districts, including the second largest city in the nation, and the second largest school district. The county is also one of the most diverse regions of the country where one third of the residents are immigrants and an estimated 185 languages and dialects are spoken. In addition, the need is critical: surveys show that 47 percent of the county’s children may have experienced tooth decay by kindergarten.

Challenges with the System for California Oral Health Reporting

KOHA data should be entered into and managed by the System for California Oral Health Reporting (SCOHR). Today data is collected via paper forms distributed to parents through various channels. While many districts distribute the forms in enrollment packets, survey results indicate that the best results come after an in-person consultation or a presentation.

Most school districts surveyed reported that their student oral health data is housed in either paper forms or in spreadsheets. If KOHA data is uploaded in the system, it is entered manually and not automated. Many districts reported that SCOHR does not work as advertised and that the system displays severe undercounts that do not reflect the data put into the system. A majority of districts also reported that school staff lack the training on how to use the system properly.

Recommendations for Improvement

Below are the recommendations unveiled by The L.A. Trust in the KOHA convening on May 16.

1.       Update the SCOHR reporting system.

2.       Improve and standardize the Oral Health Reporting form. A scannable form matched to a state scanning system would obviate the issues with the SCOHR reporting system.

3.       Increase the Los Angeles County Office of Education’s support of KOHA data submission. 

4.       Until other reporting system improvements are made, train and assist districts to submit summary information from their data systems into the SCOHR system.   

5.       Provide materials and training to districts and schools to improve oral health support to families. 

6.       Provide training and support to assist school districts in utilizing dental partnerships to screen students and assist them in obtaining a dental home.

School readiness is much more than attending to children’s early learning and cognitive development. 2021 marked the inaugural launch of the district survey on KOHA data collection, and we look forward to working with our partners to ensure that we gather the most accurate and comprehensive information available. The L.A. Trust will continue to create opportunities to partner with communities, local schools, and health officials to improve data collection systems and processes. Children’s oral health is a pillar issue that impacts the overall health of the student as well as their performance in school. Ultimately it affects family finances as well as school and community economics. Through schools and local health advocates working together, we can promote oral health and put children on a path to wellness and academic success. There is no better investment in the future than supporting the health and well-being of our children.

Project Leader: Casey Balverde, Data and Research Analyst at The L.A. Trust