Care Delivery Systems: Community-based Approaches Michelle M. Henshaw, DDS, MPH Boston University School of Dental Medicine

Current environment Dental care segregated Dental schools provide inadequate training in elder care Non-dental health professionals have limited to no training in oral health Low oral health literacy As disability increases, focus on prevention decreases and acute care increases (oral health not valued) Lack of financing

What we need Integration in existing care delivery systems Additional training for dentists Training for non-dental health professionals Focus on social marketing PREVENTION, PREVENTION Partnerships, Partnerships, Partnerships

Community-based Models Volunteer dental clinics/dentists Physician based (pediatricians) Community-based service delivery Preventive services Comprehensive care

Oral Health Equity Project (OHEP) Partners Boston Public Health Commission Boston University School of Dental Medicine Harvard School of Dental Medicine Tufts University School of Dental Medicine Massachusetts College of Pharmacy and Health Sciences, Forsyth School of Dental Hygiene Boston Housing Authority Boston City Commission on Affairs of the Elderly

OHEP Enhance dental school curriculum Provide preventive services to elders living in public housing Develop network of CHCs, dental schools, private practices for treatment needs Partner with Social Service Agencies Train non-dental health providers Web based tool kit (under development) Social marketing - Watch Your Mouth Advocacy

Lessons Learned Service learning/experiential education works in dental education Triaging and education in community settings increases demand Case management is vital – partnerships important

Lessons Learned Primary care MDs not ready to connect the mouth with the body Social marketing is necessary but not sufficient Advocacy is essential – even when Medicaid covers adult services, preventive component is not adequate for elders