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2025-109 Kindergarten Oral Health Assessment

Audit Scope and Objectives

The audit by the California State Auditor will provide independently developed and verified information related to local compliance with the Kindergarten Oral Health Assessment (KOHA) Program. The audit’s scope will include, but not be limited to, the following activities:

  1. Review and evaluate the laws, rules, and regulations significant to the audit objectives.
  2. For up to six local educational agencies (LEA), including at least two with evidence of high compliance with KOHA reporting and high screening rates, at least one with low overall KOHA screening rates, and at least one with low compliance with data reporting, evaluate the extent to which schools and districts are complying with the statutory requirements of KOHA by reviewing and evaluating the following:
    • The processes utilized for notification of parents/guardians of the assessment requirement and provision of related health, insurance, and contact information, including whether such information was provided in multiple languages as required.
    • The processes for notifying, following up, collecting and reporting required information, and whether those processes comply with all statutory requirements.
    • The barriers that may exist to participation at all relevant levels in the above reviews, including whether there are language or accessibility barriers to accessing information, lack of clear statutory requirements, inability to find oral health professionals to complete the KOHA, and cost or lack of funding for KOHA.
    • The resources allocated for administration of all requirements of KOHA, how such resources are prioritized, and whether such funds are identified in Local Control Accountability Plan priority funding or Local Control Funding Formula funding.
    • The processes that are in place at the state and local level to evaluate compliance with KOHA requirements and any enforcement mechanisms available and utilized.
  3. For the selected agencies, evaluate the level of compliance with the KOHA screening requirement. Using the data available at the district and county level, determine the following:
    • The number of children in the LEA’s jurisdiction subject to the KOHA requirement, including those who have untreated decay, who have an urgent need for care, and for whom parents or guardians waived the oral assessment and the reasons for the waivers.
    • The number of assessments completed, and the numbers of children for whom there both were no waiver or assessment completed.
  4. Evaluate the data collection system used to collect KOHA data, such as the System for California Oral Health Reporting, and the processes used at all relevant levels for collection and data entry to determine whether these processes comply with existing requirements and relevant best practices. Additionally, identify the processes used by LEAs to evaluate the data for purposes of informing any changes to processes or improvement efforts, and whether this aligns with best practices.
    • As part of the above analysis, evaluate where and to whom the relevant data are being reported, whether such reporting complies with existing requirements, and identify any gaps in reporting that prevent data from being reported to entities that need it, including but not limited to county-based oral health programs, Department of Health Care Services and Medi-Cal, the California Department of Public Health, and the California Department of Education.
  5. For those LEAs that report higher compliance with KOHA, evaluate whether there are best practices that can be used in other areas to improve processes and gain compliance, including practices related to allocation and availability of resources, on-site screening, and passive vs. active opt-out procedures. In addition, evaluate whether any of the reviewed LEAs exhibit best practices with respect to follow-up practices for parents or guardians who cite financial burdens or lack of access to care or have students with an urgent need for care. Additionally, evaluate these processes relative to other potential best practices within the State or other programs to increase compliance, such as hearing, vision, or scoliosis screening requirements.
  6. Evaluate the roles that relevant LEAs play in ensuring adequate processes for information and assessments, as well as provision of resources, to assist with compliance with KOHA, including, to the extent possible, dental and health providers, county-based oral health programs, Department of Health Care Services and Medi-Cal, the California Department of Public Health, and the California Department of Education. As part of this evaluation, determine whether there are opportunities to improve communication or partnerships to better ensure compliance with KOHA.
  7. Review and assess any other issues that are significant to the audit.

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