Delivering Dental Care to Rural DD Patients in Missouri – Elks Mobile Dental Program John Dane, DDS, FAAHD, DBSCD Dental Director Truman Medical Center Lakewood April 2014 SCDA Conference

MISSION To provide basic dental care to developmentally disabled and physically challenged persons in Missouri without regard to their ability to pay.

GOALS Provide dental services to a most under served dental population Work in cooperation with Missouri Bureau of Special Health Care Needs and Department of Mental Health Coordinate efforts with the MO. Elks Association (BPOE)

Breaking Down Barriers Financial Transportation Willing/trained dentist Equipment Appointment time

History Started in 1969 Missouri Department of Health and Missouri Elks Association (BPOE) Elks purchased equipment DOH supplied the operational funding. DOH operated program until 1977 – Contracted with Washington University SOD then added TMC/UMKC SOD in TMC became sole provider.

Public/Private Partnership Missouri Elks Benevolent Trust Major philanthropic effort Missouri Departments of Health and Mental Health UMKC/TMC educational and hospital support.

ELKS MOBILE DENTAL PROGRAM Patient Eligibility 1. Children and adults who have developmental disabilities or intellectual disabilities (DD/ID) as identified by the Department of Mental Health, Division of Developmental Disabilities. 2. Individuals, must be screened for their eligibility and their ability to receive treatment in a mobile clinic with the aid of local anesthesia when indicated. The Missouri Elks urge all eligible individuals currently under the care of a private dentist to continue treatment with him/her. Dane, J; Elks Mobile Dental Program

Staffing Dentist- Dental Assistant Staff takes on many roles. Patient care chair side reception administration unit repairs contact sponsors fund raising

Clinics in Operation Well designed coaches Instrument processing Supply storage Vacuum and compressors Wheelchair accessible 2 chairs minimum X-ray – digital or film based Patient records – EDR or paper

Mobile Dental Units Various Clinic configurations over the years Trailers Less expensive but required someone to move them More chairs (3) Self propelled units Winnebago type units International Harvesters Truck Commercial vehicles

Self Propelled Units Self propelled units Winnebago type units International Harvesters Truck Commercial vehicles

Patient Accessibility

Where to go? Best locations are where DD patients already have contacts for services! – Regional Centers for DD – State Schools for DD – Sheltered Workshops – Group homes – Elks Lodges

Missouri has several counties with 1 or no dentists.

Missouri Elks Lodges

Lodges are in rural locations

Qualified Locations Must have Electrical Connections – 220volt 50 amp service Must have water – usually a garden hose faucet will do Sanitary Sewers – grey water disposal.

Schedule Patients from every county in MO are seen (114) Stops are from 2-10 weeks in length 3 unit schedules, 41 locations in the State of Missouri Based on demand – 30 visits Moving units in a “circle” Certain stays based on weather and time of year.

Contacting Customers List from Mo Dept of MH Data base of patients seen Post cards, letters – parents/guardians Agency contacts Case Worker contacts Web page s Newspaper articles/radio spots

Where do the staff stay?

Financials 2013 Personnel - $209,658 (72%) Travel/per diem - $49,315 (17%) Supplies – $20,546 (7%) Repairs - $6,599 (2.2%) Office supplies $6,038 (2%) Total $290,276

Dane, J; Elks Mobile Dental Program State Funding

Dane, J; Elks Mobile Dental Program Medicaid cuts for adult dental services effected the Program

Financials YearPatient VisitsValue of Care $325, $416, *1781$280, $420, $707, $751, (decreased funding) 3507$425,113 Dane, J; Elks Mobile Dental Program

Fund Raising Direct Lobbying with State Legislature Funding from Local Board of Services for MR Grants from local philanthropy Hope Waivers

State Dental Board Missouri Dental Board has regulated Mobile Dental Units since the 1980’s – requiring that dentists delivering care in nursing homes have a plan for follow up services Complaints from local providers about school based programs Several hearings with dental board regarding mobile services

Pearls Keep mobile units simple Be sure your plumbing is warm or dry Dental equipment doesn’t like 20 miles of bad road Be clear about your mission. Work within the limitations of your practice Keep your sponsors and agencies happy Let people know about the value of the care you deliver On board restrooms are not worth the trouble