Nursery and School

Childsmile Nursery and Childsmile School Programmes deliver a range of preventive care interventions for children who are at increased risk of dental disease from nursery age 3 until they leave primary school.

Health Boards are responsible for the application of Duraphat through a protocol and ensuring that staff who apply it are competent to undertake this. The Protocol for the supply and application of Duraphat varnish to children aged 2 years and upwards in the Childsmile Nursery and School Programme must be read, agreed to and signed by all dental healthcare staff involved in its use. The protocol must be easily accessible to all healthcare staff in the clinical setting.

Working with departments of education

The Consultant in Dental Public Health should contact the Director of Education for the area concerned and provide information about the introduction of Childsmile and joint working arrangements.

Childsmile coordinators should gain an understanding of education department structures in each area and follow local procedures to seek agreement on delivery of Childsmile Nursery and Childsmile School at strategic and individual school levels.

The Childsmile coordinator will take responsibility for initial contact and discussion with nurseries and primary schools. Dental health support workers (DHSWs) can then work with them to arrange dates for consent meetings as appropriate, including fluoride varnish applications.

Preparing for delivery

An indication of items used in the set-up and delivery of Childsmile Nursery and Childsmile School are:

Vehicle:
Caddy Van (leased), fitting and livery

Equipment:
Asceptico red chair x 1, light x 1, trolley x 1, trolley box x 1, screens x 3, laptop x 1, beanbag x 1, stool x 2

Childsmile Volkswagen Caddy or similar leased vans should be ordered by the local Health Board in liaison with the local transport manager to make the livery and fitting arrangements.

Initially vans for order have no internal fittings, for example, no plywood or surfaces that can be wiped clean.

Van livery templates are available from the regional Childsmile administrator.

Childsmile teams

A Childsmile team usually consists of two extended duty dental nurses (EDDNs) and one dental health support worker (DHSW) although this can vary depending upon the size of the establishment and the geographical area.

As a minimum staffing requirement, a Childsmile team attending nurseries and schools to carry out applications should consist of:

  • a nurse trained in Childsmile extended duties and fluoride varnishing
  • a chaperone.

The following gives an outline for introducing the Childsmile Nursery and Childsmile School components within an NHS Board.

Fluoride varnish

Within priority schools, fluoride varnish application should be arranged twice a year. After initial arrangements are made by the coordinator and the school, future dates and times can be arranged by the DHSW.

Parental consent is required for admission into Childsmile Nursery and School fluoride varnish programme. The consent form is usually given out by Childsmile staff at the time of nursery enrolment or during Childsmile consent meetings. Parents/guardians will then receive a fluoride varnish update letter every 6 months which offers the opportunity to update the child’s medical history and other personal details.

Consent forms are available for Coordinators to order from NHS Health Scotland using the Childsmile order form. You can also access and download translated consent forms.

Fluoride varnish application is validated and recorded on the Health Informatics Centre (HIC) system. You can also find details of the Childsmile consent and validation process on the HIC website.

NHS Boards are responsible for purchasing their own stocks of fluoride varnish and all associated equipment for application.

HIC

Electronic class lists are required to populate the HIC database in advance of application visits. If electronic class lists are unavailable, paper copies must be obtained from schools and added to the HIC database locally by NHS Board staff.

All information and user guides for the HIC are available on the HIC website (external link).

The authorisation letter from a Childsmile Programme Director can be used to request class lists.

Identification of target nurseries and schools

Twenty per cent of children in each year group attending nurseries and primary schools are targetted for Childsmile.

Targeting enables Childsmile to offer the programme to establishments with the highest proportion of children living in the most deprived local quintile, as defined by the Scottish Index of Multiple Deprivation (SIMD). If an NHS Board proposes to use an alternative method then details must be agreed with the Childsmile Executive Team in advance.

Calculation for defining nurseries and schools

This is the recommended procedure for identifying target schools and nurseries using SIMD:

  1. Obtain the postcode and linked nursery and school information for children attending local authority nurseries and schools in your NHS Board area.
  2. If you have more than one local authority in your NHS Board area, combine the information for each of them.
  3. Perform the calculation at NHS Board level, calculating separately for nurseries and schools (starting with Primary One and Primary Two pupils) as nurseries are not always attached to schools.

Once teams are trained, the Childsmile Coordinator or one of the DHSWs can begin to contact the identified nurseries and schools to arrange the visits:

  • Create a table in Excel with a row for each child
  • create a column for the name of the child’s school
  • create a column for the child's postcode
  • for each child, match the appropriate datazone to the postcode and assign the SIMD within-health-board deprivation quintile
  • aggregate the data so that for every school there is a count for the number of children in each of the five quintiles
  • if there are issues with data quality, then there may be a number of children at each school with an unknown deprivation quintile
  • for each school, calculate a percentage based on the number of children living in the most deprived quintile divided by the total number of children with a known deprivation quintile.

Assuming Depquin1 is the number of children at a school who live in the most deprived quintile, then the percentage is:

Depquin1 x 100
Depquin1 + Depquin2 + Depquin3 + Depquin4 + Depquin5

Exclude schools where the number of children with a known deprivation quintile is less than 10 i.e. Depquin1 + Depquin2 + Depquin3 + Depquin4 + Depquin5 <10. Rank schools using this percentage (from eight) in descending order.

The schools at the top of the list indicate those with the highest proportion of children from deprived areas and which should be targeted for Childsmile Nursery and Childsmile School.