The Inland Empire Smiles Mobile App

At Alluma, our solutions are based on our policy and technical expertise – but before we even start coding, it is our human-centered focus that delivers meaningful connections between people and the services they need.

As part of a pilot through California’s Dental Transformation Initiative, Alluma worked in partnership with First 5 Riverside, the Center for Oral Health, and The Children’s Partnership to create a technology solution that would allow community health workers to easily assess the dental health of children in a region of Southern California known as the Inland Empire. With the compelling goal of helping kids gain healthy oral habits and get connected to a dentist when needed, we knew it was critical that the technology solution meet the needs of the community health workers who speak directly with the parents and guardians of children living in the region.

Our Shared Goal
To empower community health workers in two of Southern California’s largest counties as they connect families to necessary dental care and give families the tools to assess their children’s oral health.

To accomplish this goal, we needed to leverage our policy knowledge and tech expertise, and place our human-centered design principles at the core of the product.

The Challenge
Members of the Dental Transformation Initiative (DTI) wanted to do more for the children enrolled in Medi-Cal.

In the Inland Empire, more than 20% of children live below the poverty level. In addition, there is a lack of access to affordable, quality dental care in this region, leaving low-income families struggling to find children the dental services they need. Although five million of California’s children have dental insurance through the Medi-Cal program, accessing meaningful dental care and intervention continues to be a challenge for many of them. Without good oral health, California’s children are missing 874,000 days of school because of dental health-related problems, and overall nutrition and brain development can be impeded as a result.

Looking at evidence-based practices, the DTI pilot in the Inland Empire introduced innovative interventions to improve the oral health of children through an integrated system of community health centers, early care and education centers, schools, and home visitors. One key intervention is to help educate parents about good oral health habits and the importance of preventative dental visits.

Our Solution
In 2017, Alluma began collaborating with First 5 Riverside and other community partners to build a cloud-based, risk assessment mobile technology tool that would allow community health workers to conduct a simple survey based off the Early Childhood Oral Health Assessment (ECOHA). The assessment would have easy-to-understand results and help educate parents and guardians on good oral hygiene habits with educational materials that could be used in real time. Children who needed immediate attention based on the assessment could also be connected to a dentist. The mobile application, the Inland Empire Smiles mobile app, was created in response to these critical needs.
Inland Empire Smiles App 

The Inland Empire Smiles mobile app enables non-dental professionals to assess the oral health of children, and guide families to scheduling a dental appointment.

Built with Community Health Workers in Mind

The Inland Empire Smiles mobile app allows for service providers to assess children’s dental health needs, provides families with helpful educational resources, and enables community health workers to identify kids who need immediate dental services. While mobile apps are not always the answer to challenges of access, it was critical in this case for community health workers to be able to easily use an app in a variety of settings: at a clinic, home visit, school, or health fair.

Before development of the mobile app began, Alluma focused on understanding the users in order to design a tool that would be easy to use in their regular workday. “We wanted to know how a community health worker was going to use the app, including how they would first identify parents to do the assessment with,” noted Sonal Ambegaokar, Executive Director of Policy Innovation at Alluma.

After learning more about the goals of the assessment and the community health workers’ workflow from our clients and subject-matter experts, Alluma created an initial prototype of an app to share with the users before any code was written. Over two days, we connected with 10 community health workers and asked them to try out the app. They shared what they enjoyed about the experience, what some of the challenges were, and suggestions for potential fixes. With this initial feedback, Alluma began development of the app using an agile method: after each sprint, a demo of the app would be shared with First 5 Riverside for further input leading to continual iterations.

This collaboration with First 5 Riverside and the input from community health workers was vital in creating our mobile-based application.

Alluma gained insights from the usability testing and learned about the conditions that the community health worker was under while interacting with families. Many health workers would be conducting assessments with parents who were at a clinic to see a doctor, so to ensure that an application was completed, even if a parent was called into their appointment, a “Save for Later” function was implemented that allowed an assessment to be saved, and allow for the health worker to restart where they left off in the assessment.

While community health workers walked through the assessment with parents, they were also able to pull up related educational resources while asking them about their children’s eating habits and dental health. This allowed for a more conversational approach that enabled parents to connect with the health worker in a context-sensitive manner. The content on the platform was also simplified to a sixth-grade reading level, and was available in Spanish to allow parents to better understand the useful material.

Feedback Made Easier with Text Messaging

Many times, with mobile applications and government websites, people do not receive follow-up contact after completing an assessment. With the Inland Empire Smiles mobile app, community health workers could use text messaging to share the results of the assessment that were initially given to parents verbally in person and help connect parents with important information to take better care of their child.

Parents who opted in were sent educational resources via text on oral health and parenting, as well as the results of their child’s dental assessment. They also received text messages on how to find a dentist who accepted Medi-Cal and were reminded about upcoming dental appointments. These text messages allowed for easy feedback between parents and the community health workers assisting them.

Inland Empire Smiles App Messaging 

Community health workers could utilize the mobile app to send text messages to families. Health workers could share assessment results and follow up on appointments.

Case Management - Connecting Health Workers to Families

Alluma also created a web portal with key case management features to allow the community health worker to follow up with families that had completed an assessment.

Using the web portal, community health workers can manage various tasks, such as: send reminders for appointments, keep track of the assessments they completed, review a specific child’s assessment, and search for high-risk children for follow-up.

Inland Empire Smiles App High Risk 

If a child's assessment resulted in identification as a high-risk need to see a dentist, a community health worker could provide educational resources on proper dental care and help parents find a dentist.

Our Impact
We care deeply about the impact that we can make in collaboration with our partners, such as First 5 Riverside.

As children of the Inland Empire continue to be connected to dental care, First 5 Riverside has fortified community partnerships, while delivering an effective pilot bridging the gap between services and the people that need them most.

We at First 5 Riverside and our partners are determined to ensure that all children of the Inland Empire have access to dental care. The Inland Empire Smiles mobile application not only allows families and non-dental professionals to screen high-risk children, but bridges the gap between community health workers and the families they meet every day. - Tammi Graham, Executive Director, First 5 Riverside

As of February 2020, the Inland Empire Smiles mobile app has screened nearly 9,000 children, connecting them to important dental services. As a result of the pilot, more than a dozen community health workers across the Inland Empire are using the mobile app on a daily basis, allowing them to better spend their time doing what they do best - helping people connect to the support and services they need.

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