AACDP Symposium Local Dental Programs: Wear Your Wetsuit! National Oral Health Conference April 30, 2006 Ann Battrell, RDH, MSDH (c) ADHA Executive Director

ADHA Mission Statement To improve the public's total health, the mission of the American Dental Hygienists' Association is to advance the art and science of dental hygiene by ensuring access to quality oral health care, increasing awareness of the cost-effective benefits of prevention, promoting the highest standards of dental hygiene education, licensure, practice and research and representing and promoting the interests of dental hygienists.

Dental Hygiene Projections U.S. Department of Labor, Bureau of Labor Statistics: –Occupational Outlook Handbook – Dental hygienists noted within the top 10 fastest growing occupations and occupations having the largest numerical job growth from –Noted by level of education and training – (retrieved )

Industry 2004 employment Projected 2014 employmentChange, Number % Total employment, all workers 128, ,00017, Retrieved U.S. Dept. of Labor, Bureau of Labor Statistics: DENTISTS (general) Oral Health Workforce

Industry 2004 employment Projected 2014 employmentChange, Number Percent Total employment, all workers 158, ,000 68, Retrieved U.S. Dept. of Labor, Bureau of Labor Statistics: DENTAL HYGIENISTS Oral Health Workforce

Dental Health Professional Shortage Areas (D-HPSAs) Critical issue –Distribution of dental workforce –Eliminating oral health disparities Pockets of underserved areas –Rural –Inner city DHPSAs increased to: –3296 (792 in 1993) –45,620,457 people affected *SOURCE:03/06/06, Shortage Designation Branch, National Center for Health Workforce Analysis, Bureau of Health Professions, Health Resources and Services Administration

ADVANCED DENTAL HYGIENE PRACTITIONER

ADHA HOD RESOLUTIONS, June 2004 That the ADHA advocates the creation of an advanced dental hygiene practitioner who provides diagnostic, preventive, restorative and therapeutic services directly to the public. That the ADHA supports a standardized educational curriculum developed by the American Dental Hygienists Association, for the advanced dental hygiene practitioner.

ADHA HOD RESOLUTIONS, June 2004 That the following definition of Advanced Dental Hygiene Practitioner be adopted: –A dental hygienist who has graduated from an accredited dental hygiene program and has completed an advanced educational curriculum, approved by the American Dental Hygienists Association, which prepares the dental hygienist to provide diagnostic, preventive, restorative and therapeutic services directly to the public.

ADHP Vision Statement accessThe advanced dental hygiene practitioner will improve the underserved publics health and access to quality, cost-effective oral health care and appropriate referrals within multidisciplinary healthcare teams.

Historical Perspective Why is ADHA pursuing this? –Access to oral health care crisis in the U.S. –Heightened awareness for the need for a mid- level practitioner –Compliments the ADHAs commitment to resolve health care disparities –Workforce Supply, Demand and Distribution

Advanced Dental Hygiene Practitioner Why Dental Hygienists? –Projected growth in workforce –Projected growth in educational programs –Market forces creating advanced practice –Advanced education already in place 15 MSDH Graduate programs in place –Avoid duplication in education and training –Potential for cost-savings in cross training –Opportunity to revise efficiency in delivery of oral health care

The ADHP … Follows the Rapid Practice Changes in the DH Profession: –Affiliated Practice (AZ) –Registered Dental Hygienist in Alternative Practice (CA) –Extended Care Permit RDH (KS) –Public Health Permit (ME) –Collaborative Practice RDH (MN) –Limited Access Permit with Public Health Supervision (MT) –Public Health Supervision (NH) –Collaborative Practice RDH (NM) –Public Health Endorsement (NV) –Public Health Supervision (IA) –Limited Access Permit (OR) –School Sealant Programs (WA)

The ADHP would … Provide primary oral health care. Be competent in working with populations with special needs: –children –medically compromised –adolescents and geriatric populations. Be able to evaluate oral health needs of populations with limited access to care. Develop, implement and monitor dental hygiene care programs for these populations. Participate as a member of a comprehensive health care team.

The ADHP… From the clinical perspective: –Including but not limited to: cavity preparation, performing pulpotomies and competency in atraumatic restorative therapy (a temporary filling) among other preventive and restorative therapies. From the health promotion perspective: –Including but not limited to: Designing nutritional interventions, implement and evaluate smoking cessation programs and evaluate health promotion and disease prevention programs for specific populations.

Advanced Dental Hygiene Practitioner (ADHP) Draft Curriculum

Educators Forum – Wednesday, June 22, 4:00-6:00 p.m. Association Activities Forum – Friday, June 24, 10:30-12:30 p.m.

ADHP Draft Curriculum DOMAINS: I.Provision of Primary Oral Health Care II.Healthcare Policy and Advocacy III.Management of Oral Care Delivery IV.Translational Research V.Professionalism and Ethics

DOMAIN I: Provision of Primary Oral Health Care diverse populations underserved special needs The advanced dental hygiene practitioner demonstrates competence in providing primary oral health care and case management in diverse populations. Practitioners use the process of care and target the underserved including those with special needs using a multidisciplinary approach.

DOMAIN II: Healthcare Policy and Advocacy underserved The advanced dental hygiene practitioner contributes to health policies that address disparities in oral health and access to care for the underserved. The practitioner supports and applies health policy at the institutional, local, state, regional, and national levels.

DOMAIN III: Management of Oral Care Delivery The advanced dental hygiene practitioner integrates practice management, finance principles, and health regulations to analyze, design and develop initiatives that will improve clinical outcomes, the quality of care and patient safety. The practitioner demonstrates effective leadership for changing healthcare and practice environments.

Domain IV: Translational Research The advanced dental hygiene practitioner uses sound scientific methods and accesses evidence-based information when making decisions and providing client care.

Domain V: Professionalism and Ethics public The advanced dental hygiene practitioner demonstrates professional behavior and clinical decision-making skills consistent with dental hygiene parameters of care, legal regulations and the ADHA Code of Ethics. The advanced dental hygiene practitioner possesses the values and behaviors which promote service to the public, professional involvement, and lifelong learning.

In what settings do you expect the ADHP to work? Hospitals Nursing homes Public health settings Community Health Centers Federally Qualified Health Centers Homebound Elementary and Secondary Schools Other…

What level of education and credential will be necessary for the ADHP? Point of entry for all Flexibility –Potential exists for distance education Proven success in dental hygiene education –Currently 58 degree-completion programs (35 designated with some/all distance education) Masters Degree Credentialing process

How will the ADHP differ from the dental therapist or dental aide positions available elsewhere? ADHA has and will continue to examine related models Unique in design Oral health needs and U.S. health care delivery system

Will this replace the entry-level position for the registered dental hygienist? No. Answering an unmet public health need. Intended to go beyond entry-level education.

Where will the classes be taught? Curriculum development in process. Educational collaboration with universities. Credential offered through the ADHA.

What would it mean for an ADHP to serve as a collaborative partner? Working with public health, allied health, and medical professionals. Variety of practice settings. Patients to receive a well-rounded approach to health services.

Coalition Building National Rural Health Association National Rural Education Association American Oral Health Association /Oral Health Section Special Care Dentistry

ADHP Commentary Additional flexibility and capacity of the oral heath care workforce is sorely needed. A National Call to Action to Promote Oral Health, Office of the Surgeon General, June 2000 The APHA actively supports innovative programs and practices to help alleviate the great unmet oral health need… American Public Health Association, December 2005 The ADHP, a role comparable to the nurse practitioner, presents a timely and appropriate way to explore new approaches to oral health care delivery… Oral Health Section, American Public Health Association, March 2006 It is time to find a new way to deliver oral health care services; it is time to test the feasibility of the ADHP concept. National Rural Health Association, January 2005

The idea that got the broadest support was expansion of scope of practice to include simple restorative procedures for dental hygienists. --Policy Issues in Dental Workforce Diversity and Community- Based Dental Education, November 2004

Legislative Success… 19 states without overly restrictive supervision requirements 10 States with Medicaid provider status 43 States with general supervision 38 States that allow dental hygienists to administer local anesthesia

ADHP Legislative Success July 2005: ADHP language is inserted into HR 3010, the Fiscal Year 2006 Appropriations Bill for the Labor, Health and Human Services. –The language is considered report language – it does not carry the weight or law or appropriate any federal funding. It is encouragement to the lead health agency, HRSA, to explore development of the ADHP. July 2005: HR 3010 is passed by the Senate Appropriations Committee. October 2005: HR 3010 passes the full Senate.

ADHP Legislative Success December 2005: –HR 3010 passes the House – after passage in a conference committee. (The ADHP language was not in the Houses appropriations bill, so the 2 bills went into a conference committee to negotiate differences in the 2 bills.) December 2005: –President Bush signs HR 3010 into law. Specifically, the final bill language directs Departments and agencies to be guided by the language and instructions set forth therein…..

advanced dental hygiene practitioner The Committee is aware that dental disease disproportionately affects our nations most vulnerable populations, including many in rural America. New ways of bringing oral health care to rural and underserved populations are needed. The Committee encourages HRSA to explore alternative methods of delivering preventive and restorative oral health services in rural America. Specifically, the Committee encourages HRSA to explore development of an advanced dental hygiene practitioner who would be a graduate of an accredited dental hygiene program and complete an advanced educational curriculum, which prepares the dental hygienist to provide diagnostic, preventive, restorative and therapeutic services directly to the public in rural and underserved areas. ADHP Report Language

No single oral health care profession, by itself, can meet the needs of the public. Only through collaborative effort of all of us will the American public receive the oral care it needs and deserves.

Next Steps … ADHP Task Force –November 2005 –January 2006 –March 2006 –3 meetings for Pilot project funding Advisory Committee ADEA Allied Education Working Group –June 2006 Your continued input!