CHC Research Involvement: Developing a Mutually Beneficial Relationship CHC Networked Research To Address Oral Health Disparities Conference November 3 rd 2009 Mark Koday, DDS Dental Director- YVFWC

Yakima Valley Farm Workers Clinic Large community/migrant health center system Large community/migrant health center system Clinics in WA and OR Clinics in WA and OR Served >115,000 patients last year Served >115,000 patients last year 64% Hispanic 64% Hispanic 39% m/sfw + family members 39% m/sfw + family members

Initiating Research and the Formulation a Research Agenda Meeting with the U. of Washington School of Dentistry 1987 Meeting with the U. of Washington School of Dentistry 1987 Senior dental student rotation established in 1989 Senior dental student rotation established in 1989 Discussions of community oral health needs Discussions of community oral health needs Discussions/ development of a University/ CHC partnership Discussions/ development of a University/ CHC partnership

Context for Dental Research Opportunities-1990s Increased health profession student placement Increased health profession student placement Students and faculty interested in research opportunities with unique population Students and faculty interested in research opportunities with unique population Increased research interest (funding) from academic researchers Increased research interest (funding) from academic researchers Increased research interests on the part of our organization Increased research interests on the part of our organization

Examples of Early Collaborative Dental Research Studied dmfs data Studied community resources Studied dmfs data Studied community resources Baby Bottle Tooth Decay Baby Bottle Tooth Decay Behavioral: affecting tx and prevention issues Behavioral: affecting tx and prevention issues

Types of Research Beneficial to CHCs Epidemiology studies Epidemiology studies Efficacies of specific medications Efficacies of specific medications Behavioral research Behavioral research Prevention protocols Prevention protocols

Agency Tools implemented 1999 Policy on Research Involvement Policy on Research Involvement Application Elements and Process for prospective researchers Application Elements and Process for prospective researchers Principles of Community-Based Research Principles of Community-Based Research Research Review Committee/HIPAA Privacy Board Research Review Committee/HIPAA Privacy Board

Change in Orientation CHC as…. Proactive Proactive Responsible to identify needs Responsible to identify needs Asserting an equal relationship Asserting an equal relationship Introducing negotiation Introducing negotiation Taking risks Taking risks

Benefits From Research Transformation of our behavioral management practice Transformation of our behavioral management practice New clinic prevention strategies New clinic prevention strategies DSHS billing for fluoride varnish: win-win-win DSHS billing for fluoride varnish: win-win-win Helped to become a recognized leader in our region Helped to become a recognized leader in our region

Benefits From Research Developed a strong partnership leading to our residency programs Developed a strong partnership leading to our residency programs Personal/ professional growth Personal/ professional growth Use in funding requests Use in funding requestsBottom-line: Improved provider satisfaction and improved patient care

Considerations for Research Review Committee Costs and Benefits Costs and Benefits Alignment with agency priorities Alignment with agency priorities Confidentiality Confidentiality Sustainability Sustainability Equitable budget distribution Equitable budget distribution Pressures on key staff Pressures on key staff Balance of buy-in and pressure on clinic sponsor Balance of buy-in and pressure on clinic sponsor

Principles of Community-Based Research Opportunity for discussion: Early involvement Early involvement Real influence on project direction Real influence on project direction Process and outcome should benefit community Process and outcome should benefit community Part of analysis and interpretation Part of analysis and interpretation Relationship beyond specific project Relationship beyond specific project Empowered to initiate research Empowered to initiate research

Publication of Research Dental Caries Rates Among Children of Migrant Workers in Yakima, M. Koday, D. Rosenstien, G Lopez Public Health Reports, Sept- Oct. 1990, Vol. 105 No. 5, pp Dental Caries Rates Among Children of Migrant Workers in Yakima, M. Koday, D. Rosenstien, G Lopez Public Health Reports, Sept- Oct. 1990, Vol. 105 No. 5, pp Mexican American Parents With Children At Risk For BBTD: A Pilot Study At A Migrant Farm Workers Clinic Wienstien, Domoto, Leroux, Koday et al. Journal of Dentistry for Children, Sept./ Oct. 1992, pp Mexican American Parents With Children At Risk For BBTD: A Pilot Study At A Migrant Farm Workers Clinic Wienstien, Domoto, Leroux, Koday et al. Journal of Dentistry for Children, Sept./ Oct. 1992, pp White Spot Caries In Mexican American Toddlers And Parental Preferences For Various Strategies Domoto, Leroux, Koday et al. Journal of Dentistry for Children, Sept./ Oct. 1994, pp White Spot Caries In Mexican American Toddlers And Parental Preferences For Various Strategies Domoto, Leroux, Koday et al. Journal of Dentistry for Children, Sept./ Oct. 1994, pp

Publication of Research Results Of A Promising Open Trial To Prevent BBTD Wienstien, Domoto, Koday, Lore. Journal of Dentistry for Children, Sept./ Dec. 1994, pp Results Of A Promising Open Trial To Prevent BBTD Wienstien, Domoto, Koday, Lore. Journal of Dentistry for Children, Sept./ Dec. 1994, pp Addressing Disparities in Children’s Oral Health: A Dental- Medical Partnership to Train Family Practice Residents Mouridian, Scaad, Kim, Leggott Domoto, Maier, Stevens, Koday Journal of Education August 2003, pp Addressing Disparities in Children’s Oral Health: A Dental- Medical Partnership to Train Family Practice Residents Mouridian, Scaad, Kim, Leggott Domoto, Maier, Stevens, Koday Journal of Education August 2003, pp Situation-specific child control: a visit to the dentist. Weinstein P, Milgrom P, Hoskuldsson O, Golletz D, Jeffcott E, Koday M. Behav Res Ther Jan;34(1): Situation-specific child control: a visit to the dentist. Weinstein P, Milgrom P, Hoskuldsson O, Golletz D, Jeffcott E, Koday M. Behav Res Ther Jan;34(1): Situation-specific child control: a visit to the dentist. Situation-specific child control: a visit to the dentist.

Example of Recent Dental Research Involvement We are currently discussing a new prevention research project comparing the effects of fluoride varnish vs iodine + fluoride varnish We are currently discussing a new prevention research project comparing the effects of fluoride varnish vs iodine + fluoride varnish The funding would allow a 2 year project The funding would allow a 2 year project