envisioning a better future for oral health utilizing community dental health coordinators oral...

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, MPHDirector,

Council on Access, Prevention and Interprofessional Relations

© 2012 American Dental Association, All Rights Reserved

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

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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

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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.

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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)

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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.

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ADA HODLegislative/Governing Body

501(c)6Makes Policy

Enacts Ame4nds Appeals Constitution and By Laws

Grant, Amend, Suspend Revoke Constituents

Creates Special CommitteesElects Officers Including Treasurer

Elects Board of TrusteesReceives and Acts on Reports

Adopts Annual BudgetCourt of Appeal

Transfers Powers to BOT in Emergency

Board of TrusteesManaging Body

Conducts BusinessEstablishes Rules and Regulations

Calls Special SessionPublish or Omit from ADA Publications

Prepare Budget, Reports for HODElects Associate Members

Makes Nominations for CouncilsOversees Investments

Interim PolicyRemoves Council MembersElects Honorary Members

Appoints CommitteesInterim Supervision, Monitors, Guides activities of Councils / Special Committees

Transacts business by unanimous consent by mail ballotAppoints agents to supervise, manage and conduct business

Executive Director, Chief Operating OfficerPreserve and Protect Constitution and By Laws

Facilitate activities of Officers and TrusteesEngage the staff, direct and coordinate activities

Provide leadership in formulation and recommendation of new policies to BOTOversee management of policies adopted by BOT/HOD

Assist BOT in supervising, monitoring and guiding Councils, Commissions and Committees

Systematize preparation of reports for BOT/HODEncourage the exchange of information

Maintain effective internal and external relationshipsPerform other duties per the By Laws

Commission on Dental

Accreditation29 members

4 ADA4ADExA4ADEA

1ADHHA1ADAA1NADL1ASDA

1Each Spec.1 Post Doc

4 Consumers

Joint Commission on National

Dental Examinations15 Members

3 HOD6 AADE3 ADEA1 ADHA1 ASDA1 Public

Audit Committee Compliance

Officer

Finance Committee

Compensation Committee

Future of ADABEI

Board Rules Review

ADAidm Advisory

State Gov Affiars

Strategic Planning

New Dentist Committee

Diversity Committee

Committee on International

Programs and Development

Chief Legal Counsel

Chief Legal Counsel

Council on Dental

Education and Licensure

CAPIR

Council on Membership

Council on Scientific Affairs

Council on Ethics Bylaws Judicial Affairs

Council on Communication

Council on Dental Practice

Council on Dental Benefit

Programs

Council on Government Affairs

Council on Members Insurance and

Retirement

Council Annual Session

ADAFPRC

501(c)3Sole Corporate Member is ADA

ADABEI For Profit wholly

owned ADA Subsidiary

Pension Committee

IT Committee

Officers: President

President ElectFirst Vice President

Second Vice President

Speaker of House

Secretary

EHR

FDI Delegation

Code Revision Conmmittee

PRC

Management Committees of the Board of Trustees

Work Groups of the Board

ADPAC

Councils of the House of Delegates

Commissions of ADA

Treasurer

Committees of the BoardADA Organization and Operations

Executive Director

Special Committee’on

Financial Affairs

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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

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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 clinicand providing care

A community health worker with dental skills and a member of the dental team

In the communitypromoting

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

1. Bridging/cultural mediation

2. Providing health education and information

3. Assuring people get services they need

4. Providing informal counseling and social support

5. Advocating for individual and community needs

6. Providing direct services

7. 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 110th Congress in the 2nd session

Reduce oral health disparities

Improve access to dental care

Health PromotionCommunity Engagement

ADA VISIONPatient

Navigation

PalliativeCare

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 guidance Tobacco 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 screening Temporary 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 care

• Community-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:RuralUrban Indian Health

Limitations for Data Collection Practice management software Staff resources

Develop 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 computers• Patient satisfaction surveys

Clinics are never identified in external reportingAll data is confidentialFully 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 impact• Change 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

[email protected]

312 440-2751

mailto:[email protected]

envisioning a better future for oral health utilizing community dental health coordinators oral...

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