CDA Essentials 2017 • Volume 4 • Issue 6

23 Issue 8 | 2017 | I ssues and P eople Study examines caregivers’ perspectives on barriers to care Children with special needs face many barriers to care, which can be characterized by the six A’s of access to care: affordability , availability , accessibility , accommodation , acceptability and ability for oral self-care. To better understand how caregivers of children with special health care needs (CSHCN) perceive the barriers they encounter in seeking care for their children, researchers surveyed caregivers of children who were patients at the dentistry department of BCChildren’s Hospital (DD-BCCH) in Vancouver. 1 The findings of this pilot study, published on JCDA.ca, illustrate the difficult and complex realities of finding dental care for children with special needs and suggest some recommendations to enable better access to care for this population. Key Findings: ❘  Affordability of dental services is a concern for most caregivers. Although many caregivers had some form of dental benefits for their child, affordability was a common concern. Caregivers often think dental services at DD-BCCH are free through the BC Medical Services Plan (MSP), although the program covers only the cost of dental general anesthesia at BCCH and any medically necessary extractions. ❘  The majority of children were reported to have dental problems . 74% of caregivers said their child had dental problems (i.e., tooth cleaning challenges, tooth decay, or general concerns about the child’s dental development). Children reported to be without dental problems had been regularly attending the hospital dental clinic or were there in preparation for a medical procedure. ❘  Caregivers expressed frustration with their dentist’s skills in treating their child. These perceived shortcomings of dentists also extended to pediatric dentists. Children whose behaviour was difficult to manage or who were perceived as high risk for medical complications presented the biggest challenges. ❘  Over half of the children have been refused treatment or were unable to receive dental care at a dental office. Over half of caregivers also reported they had tried to have their child seen by a dentist outside of the hospital before being referred. ❘  Caregivers perceived tertiary-care facilities, such as DD-BCCH, as being better equipped to provide services for their children. Comments from caregivers suggest the hospital dental clinic helped families to access care because multiple services were available in the same location, it was relatively easy to get appointments, and there was “specialized attention for apprehensive children.” The study authors suggest that efforts to improve access to care for CSHCN should focus on improving publicly funded dental benefits for this patient group. For example, a benefits package that recognizes the “unusual time and responsibility” code would appropriately compensate dentists when extra time and effort is needed for some patients. Reference 1. VertelN,HarrisonR,CampbellK.Accesstodentalservices forchildrenwithspecialhealthcareneeds:apilotstudyatthedentaldepartmentofBCChildren’sHospital. JCanDentAssoc. 2017;83:h6.