Quality Improvement Fund - Migrant Health Center Western Region, Inc. (MHC), publicly branded as Medical Experience by Migrant (MEDX), requests $2,000,000 in FY 2026 Quality Improvement Fund for a 2-year period (September 1, 2026-August 31, 2028) to implement the MEDX Neuro-Friendly Dental Access Program. MHC is a non-profit, Federally Qualified Health Center (FQHC) and Patient-Centered Medical Home (PCMH) providing multidisciplinary and specialized healthcare to medically underserved communities across western Puerto Rico (PR). The project will increase access to dental services, improve health outcomes, and strengthen workforce skills for underage children and youth with neurodevelopmental disorders (NDD). HRSA reporting will focus on ages 2 through 20 with grant-specified NDD diagnosis codes. MHC's electronic health record data shows a substantial access and continuity gap. From January 2025 through June 2026, MHC identified 844 NDD patients aged 2 through 20. Only 164 had a documented dental visit in the last 12 months, and 1 had a recorded dental treatment plan. Caregivers, staff, and community input identified dental anxiety, sensory sensitivity, communication needs, appointment tolerance, transportation barriers, missed visits, caregiver preparation, and treatment-plan follow-up as major barriers. QIF-DNDD funds will build and test a structured NDD-informed dental access pathway. Grant-funded services will be delivered at MHC's directly operated, in-scope site at Calle Ramón E. Betances 497 Sur, Mayagüez, PR 00680. Coordinated readiness, caregiver support, and developmental-health expertise will be aided through MHC's Centro Especializado en Autismo y Desarrollo Infantil (CEADI). The model will include an electronic health record-based NDD dental registry; proactive service navigation; caregiver preparation and coaching; sensory and communication support; dental readiness planning; sensory-adapted appointments; no-show risk mitigation; treatment-plan tracking; community engagement; workforce training; and continuous quality improvement. This approach builds on evidence-based practices for pediatric primary and dental care, children with NDDs, behavior and sensory guidance, and integrated oral health. The program will move children from identification to preparation, dental visit completion, treatment planning, follow-up, and ongoing preventive care. Activities will include home desensitization kits, visual schedules, procedure picture cards, communication boards, sensory support, clinical and scheduling adaptations, caregiver education, transportation, and resource navigation to help children understand, tolerate, and complete dental care. The project will add dedicated capacity in leadership, sensory-adapted pediatric dentistry, dental assistance, sensory integration support, family dental service navigation, data and quality improvement, patient access and training, community outreach, and clinic informatics. By the end of the performance period, MHC will increase the 12-month dental visit rate among NDD children and youth ages 2 through 20 from 19.4% to at least 50%; increase the proportion of NDD children who have an established dental treatment plan from 0.6% to 75%; train at least 40 dental providers and other health center staff; complete 12 structured community engagement activities with caregivers and community partners; and achieve at least 80% positive caregiver experience among survey respondents. MHC will also monitor outreach completion, Dental Readiness Profile completion, missed visits, treatment completion, caregiver participation, and staff competency gains to guide continuous quality improvement. MEDX Neuro-Friendly Dental Access Program will produce a practical, sustainable, and scalable health center model that improves dental access, treatment planning, caregiver readiness, workforce capacity, and dental health outcomes for children and youth with NDDs in western PR.
