San Francisco Department of Public Health CHC Research: Innovation Will be Built on Experience The CHC Perspective Irene V. Hilton DDS, MPH San Francisco Department of Public Health UCSF CANDO Center November 3, 2009

University of California San Francisco- CANDO Original cohort of 5 Centers to Reduce Oral Health Disparities Initial community partners San Francisco Department of Public Health San Ysidro Community Health Center

The HC Conumdrum Populations with the poorest health status Populations that could benefit most from results of research, the fastest Populations that have traditionally not been represented in research

HC 2007 Demographics 2,808,418 dental users 28% of all HC populations African American 34% of all HC populations Hispanic 1% of all HC populations AI/AN 70% of all HC populations under 100% of FPL 21% between 100-200% FPL

The HC Concondrum Research activities NOT the primary mission of HC The least infrastructure to support research Knowledge Data Mistrust

Support for Successful Collaboration Money Time Respect Academic Institution Health Center

Institution-Health Center Relationships Innovators are those that already have relationships Time & resources to initiate and maintain Long-term/permanent to create trust

Health Center Infrastructure Innovators have existing personnel familiar with research methodologies Innovators have IT systems that can accommodate research data collection Time & resources to initiate and maintain

Finding Common Ground Issues HC & community identifies as important and of interest What the institution has already been funded for and/or is interested in pursuing Areas of expertise

Type of Research Basic initial research i.e. disease prevalence, risk factors, cultural determinants Retrospective Qualitative Clinical interventions Effectiveness studies Translation/ implementation studies RCT very difficult

Translation/Implementation Activities HC are already very good at this Long history of exposure & adoption of new paradigms & clinical interventions 1996- ECC risk assessment & fluoride varnish 1998- Diabetes & oral health 2006- Medical-Dental integration No data

What Health Centers Need Resources/Money Appropriate staffing/expertise Supplies/Equipment Clear well-thought-out protocols that work within or complementary to the existing clinic systems

Current Reality Only a few HC could currently conduct any type of research activity If desired by both partners, collaboration could be explored Should be pursued because HC populations are most in need Must be done in the right way or will fail

Conclusion RESEARCHER