Envisioning a Better Future for Oral Health Utilizing Community Dental Health Coordinators Oral Health Florida 2012 National amp State Best Practices Conference Lewis N Lampiris DDS MPH Director ID: 762387
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Envisioning a Better Future for Oral Health Utilizing Community Dental Health Coordinators Oral Health Florida 2012 National & State Best Practices Conference Lewis N. Lampiris DDS, MPH Director, Council on Access, Prevention and Interprofessional Relations
Today’s discussion ADA Basics The CDHC Pilot Program Background Education and training Current status of the pilot program Evaluation update Potentials for CDHCs
ADA Vision and Mission The ADA: To be the recognized leader on oral health The ADA is the professional association of dentists that fosters the success of a diverse membership and advances the oral health of the public 3
ADA Strategic Plan Goals: 2011-2014 Goal: Provide support to dentists so they may succeed and excel throughout their careers Goal: Be the trusted resource for oral health information that will help people be good stewards of their own oral health Goal: Improve public health outcomes through a strong collaborative profession, and through effective collaboration across the spectrum of our external stakeholders Goal: Ensure that the ADA is a financially stable organization that provides appropriate resources to enable strategic and operational initiatives 4
Governance The House of Delegates is the legislative and policy making body of the Association. The supreme authority. The Councils are Standing Committees of the House and report to the ADA House of Delegates. The Councils submit recommendations to the House through the ADA Board of Trustees. The Board of Trustees is the managing or administrative body of the ADA. They are responsible for implementing policy and overseeing the day to day business of the ADA.5
© 2009 American Dental Association. All rights reserved.
ADA Councils and Commissions Council on Access, Prevention and Interprofessional Relations (CAPIR) (19 members including AMA & AHA representatives) Council on Communications (CC) Council on Dental Benefit Programs (CDBP) Council on Dental Education and Licensure (CDEL) Council on Dental Practice (CDP) Council on ADA Sessions (CAS) 7
ADA Councils and Commissions Council on Ethics, Bylaws and Judicial Affairs (CEBJA) Council on Government Affairs (CGA) Council on Membership (CM) Council on Members Insurance and Retirement Programs (CMIRP) Council on Scientific Affairs (CSA) There are two Commissions which operate at an arm’s length: Commission on Dental Accreditation and the Joint Commission on Education and Testing. Their membership includes outside stakeholders. ADA sponsors, but does not control Commissions. 8
9 ADA Members
CAPIR Mission CAPIR is the primary agency dedicated to providing leadership, vision, and coordination of the ADA’s activities to: advance oral health care within the health delivery system promote prevention as the cornerstone of oral health improve access to oral health services for underserved populations 10
CDHC Background ADA 2004/5 Workforce Models Taskforces Define, recommend training and certification process for proposed new dental team members ADA 2006-2008 National Coordinating and Development Committee develop the CDHC model training program pilot, including curriculum, with implementation and evaluation guidelines, identify pilot sites.
CDHC………………….a new perspective Working remotely with teledentistry Based in a community clinic and providing care A community health worker with dental skills and a member of the dental team In the community promoting healthy living
Program Philosophy: Educate students who Will work in communities where residents have no or limited access to dental care Will come from the community in which they will serve Will understand the culture, language, barriers to care because they are members of the community
The CDHC Focus The CDHC’s focus is on reducing the oral health disparities by targeting social determinants of oral disease and improving access to dental care PRIMARY PREVENTION
Seven Roles of Community Health Workers Bridging/cultural mediation Providing health education and information Assuring people get services they need Providing informal counseling and social support Advocating for individual and community needs Providing direct services Building individual and community capacity
2006 – From the APHA CHW Special Primary Interest Group definition Frontline public health workers Trusted members of the community Serve as a liaison/link/intermediary between health/social services and the community Facilitate access to services and improve the quality and cultural competence of service delivery Build individual and community capacity through a range of activities such as: outreach, community education, informal counseling, social support and advocacy.
Facts about CHWs Approximately 120,000 CHWs working in the U.S. Source: Health Resources and Services Administration. Community Health Workers National Workforce Study. HRSA 2007; Available at URL: http://bhpr.hrsa.gov/healthworkforce/chw/default.htm. For every dollar spent on the CHW, there is a reduction in health care cost of $2.28 Source: Journal of Health Care for the Poor & Underserved 2006 by Elizabeth Whitley & others
Facts about CHWs Who receives services from a CHW? 71% of uninsured individuals 49 % of immigrants 41% of homeless individuals 31% of isolated rural residents and migrant workers Source: Background, resolution recognizing and supporting the work of Community Health Workers which is before the 110 th Congress in the 2nd session
Reduce oral health disparities Improve access to dental care Health Promotion Community Engagement ADA VISION Patient Navigation Palliative Care Prevention of Dental/ Oral Diseases
Patient Navigation Coordinate dental care – manage all aspects of appointment behaviors Register for Medicaid or other appropriate dental care programs Arrange transportation Provide support for other potential personal access barriers: language, fear/anxiety, etc.
Health Promotion/Community Engagement Community Organization Assessing community needs Partnership/leadership development Health Promotion Motivational Interviewing Stages of Change Health Literacy Nutritional guidanceTobacco cessation
Primary and Secondary Prevention Under supervision of dentist per state statute : Caries risk assessment Oral hygiene services Fluoride -- topical application Scaling (type 1 gingivitis) Sealants Clinical and radiographic screeningTemporary restoration placement
Scope of training program Online - 12 Month Didactic Training Dental Skills Modules CHW Skills Module Community-based internship - 6 months Certificate of Completion – College credits
Current Training Sites Temple University Kornberg School of Dental Medicine University of Oklahoma Arizona School of Dentistry and Oral Health Rio Salado College
CDHC Curriculum Community health worker & health promotion modules Interviewing Skills for Dental Health Advocate Oral health Communication Dental Health Legal and Ethical Issues Dental Health Advocacy and outreach
CDHC Curriculum Dental Skills Modules Introduction to dentistry Screening & classification Prevention of dental caries Prevention of periodontal diseases Prevention of oral cancer Palliative care Financing and payment for dental careCommunity-based internship (6 months)
CDHC trainee status Cohort 1 March 2009 -- September of 2010 2 cohorts; total 12 trainees; 10 graduated Cohort 2 March 2010 -- September 2011 3 cohorts; total 18 trainees; 8 graduated Cohort 3 kick March 2011 – September of 12 3 cohorts: total 20 trainees; 16 still in training Evaluation continues through September 2013
Evaluation of the Project: Goals To evaluate a new dental team provider model through a thorough review of the pilot training program and field internship. To determine the value of the new dental team provider in a variety of practice settings.
Evaluation Questions Does the program contribute to improvements in access to oral health care? Has the program positively impacted oral health outcomes? Has the program impacted the financial sustainability of the dental health clinic sites? How can the CDHC initiative be improved post pilot?
Access and Patient Outcomes: Data Analysis Clinic Variation: Rural Urban Indian Health Limitations for Data Collection Practice management software Staff resourcesDevelop metrics for the evaluation Core indicators Site-specific indicators
Types of Data Collection Clinical profile Community profile Feedback from community stakeholders Outreach activity data Encounter data captured by clinic computersPatient satisfaction surveys Clinics are never identified in external reporting All data is confidential Fully HIPAA compliant and secure database
Patient Access and Outcome Metrics Implement school-based programs to improve access for children Improve access for a disease specific population Improve access to underserved populations Change in dentist productivity Assess clinic revenue impactChange in active patient rates
The Future: CDHC as a Career Ladder Residents of the community who are : High school graduates Dental assistants Dental hygienists Other health care/health service providers Community health care workers without dental skills
CDHCs can reach into the community Schools WIC Head Start LTC facilities and other institutional settings Social Service agencies Community dentists
Summary The ADA has committed substantial resources to developing and evaluating the CDHC as a new member of the dental team. We believe the CDHC is an ADA legacy program that dentists will be proud of for generations to come.
Questions? Lewis N. Lampiris DDS, MPH LampirisL@ada.org 312 440-2751