Envisioning a Better Future for Oral Health Utilizing Community Dental Health Coordinators Oral Health Florida 2012 National & State Best Practices Conference Lewis N. Lampiris DDS, MPH Director, Council on Access, Prevention and Interprofessional Relations

© 2012 American Dental Association, All Rights Reserved Today’s discussion ADA Basics The CDHC Pilot Program –Background –Education and training –Current status of the pilot program –Evaluation update Potentials for CDHCs

© 2012 American Dental Association, All Rights Reserved ADA Vision and Mission The ADA: To be the recognized leader on oral health The ADA is the professional association of dentists that fosters the success of a diverse membership and advances the oral health of the public 3

© 2012 American Dental Association, All Rights Reserved ADA Strategic Plan Goals: Goal: Provide support to dentists so they may succeed and excel throughout their careers Goal: Be the trusted resource for oral health information that will help people be good stewards of their own oral health Goal: Improve public health outcomes through a strong collaborative profession, and through effective collaboration across the spectrum of our external stakeholders Goal: Ensure that the ADA is a financially stable organization that provides appropriate resources to enable strategic and operational initiatives 4

© 2012 American Dental Association, All Rights Reserved Governance The House of Delegates is the legislative and policy making body of the Association. The supreme authority. The Councils are Standing Committees of the House and report to the ADA House of Delegates. The Councils submit recommendations to the House through the ADA Board of Trustees. The Board of Trustees is the managing or administrative body of the ADA. They are responsible for implementing policy and overseeing the day to day business of the ADA. 5

© 2009 American Dental Association. All rights reserved.

© 2012 American Dental Association, All Rights Reserved ADA Councils and Commissions Council on Access, Prevention and Interprofessional Relations (CAPIR) (19 members including AMA & AHA representatives) Council on Communications (CC) Council on Dental Benefit Programs (CDBP) Council on Dental Education and Licensure (CDEL) Council on Dental Practice (CDP) Council on ADA Sessions (CAS) 7

© 2012 American Dental Association, All Rights Reserved ADA Councils and Commissions Council on Ethics, Bylaws and Judicial Affairs (CEBJA) Council on Government Affairs (CGA) Council on Membership (CM) Council on Members Insurance and Retirement Programs (CMIRP) Council on Scientific Affairs (CSA) There are two Commissions which operate at an arm’s length: Commission on Dental Accreditation and the Joint Commission on Education and Testing. Their membership includes outside stakeholders. ADA sponsors, but does not control Commissions. 8

9 ADA Members

© 2012 American Dental Association, All Rights Reserved CAPIR Mission CAPIR is the primary agency dedicated to providing leadership, vision, and coordination of the ADA’s activities to: advance oral health care within the health delivery system promote prevention as the cornerstone of oral health improve access to oral health services for underserved populations 10

© 2012 American Dental Association, All Rights Reserved CDHC Background ADA 2004/5 Workforce Models Taskforces –Define, recommend training and certification process for proposed new dental team members ADA National Coordinating and Development Committee –develop the CDHC model training program pilot, including curriculum, with implementation and evaluation guidelines, identify pilot sites.

© 2012 American Dental Association, All Rights Reserved CDHC………………….a new perspective Working remotely with teledentistry Based in a community clinic and providing care A community health worker with dental skills and a member of the dental team In the community promoting healthy living

© 2012 American Dental Association, All Rights Reserved Program Philosophy: Educate students who Will work in communities where residents have no or limited access to dental care Will come from the community in which they will serve Will understand the culture, language, barriers to care because they are members of the community

© 2012 American Dental Association, All Rights Reserved The CDHC Focus The CDHC’s focus is on reducing the oral health disparities by targeting social determinants of oral disease and improving access to dental care PRIMARY PREVENTION

© 2012 American Dental Association, All Rights Reserved Seven Roles of Community Health Workers 1.Bridging/cultural mediation 2.Providing health education and information 3.Assuring people get services they need 4.Providing informal counseling and social support 5.Advocating for individual and community needs 6.Providing direct services 7.Building individual and community capacity

© 2012 American Dental Association, All Rights Reserved 2006 – From the APHA CHW Special Primary Interest Group definition Frontline public health workers Trusted members of the community Serve as a liaison/link/intermediary between health/social services and the community Facilitate access to services and improve the quality and cultural competence of service delivery Build individual and community capacity through a range of activities such as: outreach, community education, informal counseling, social support and advocacy.

© 2012 American Dental Association, All Rights Reserved Facts about CHWs Approximately 120,000 CHWs working in the U.S. Source: Health Resources and Services Administration. Community Health Workers National Workforce Study. HRSA 2007; Available at URL: For every dollar spent on the CHW, there is a reduction in health care cost of $2.28 Source: Journal of Health Care for the Poor & Underserved 2006 by Elizabeth Whitley & others

© 2012 American Dental Association, All Rights Reserved Facts about CHWs Who receives services from a CHW?  71% of uninsured individuals  49 % of immigrants  41% of homeless individuals  31% of isolated rural residents and migrant workers Source: Background, resolution recognizing and supporting the work of Community Health Workers which is before the 110 th Congress in the 2 nd session

Reduce oral health disparities Improve access to dental care Health Promotion Community Engagement ADA VISION Patient Navigation Palliative Care Prevention of Dental/ Oral Diseases

© 2012 American Dental Association, All Rights Reserved Patient Navigation Coordinate dental care – manage all aspects of appointment behaviors Register for Medicaid or other appropriate dental care programs Arrange transportation Provide support for other potential personal access barriers: language, fear/anxiety, etc.

© 2012 American Dental Association, All Rights Reserved Health Promotion/Community Engagement Community Organization  Assessing community needs  Partnership/leadership development Health Promotion  Motivational Interviewing  Stages of Change  Health Literacy  Nutritional guidance  Tobacco cessation

© 2012 American Dental Association, All Rights Reserved Primary and Secondary Prevention Under supervision of dentist per state statute:  Caries risk assessment  Oral hygiene services  Fluoride -- topical application  Scaling (type 1 gingivitis)  Sealants  Clinical and radiographic screening  Temporary restoration placement

© 2012 American Dental Association, All Rights Reserved Scope of training program Online - 12 Month Didactic Training  Dental Skills Modules  CHW Skills Module Community-based internship - 6 months Certificate of Completion – College credits

© 2012 American Dental Association, All Rights Reserved Current Training Sites Temple University Kornberg School of Dental Medicine University of Oklahoma Arizona School of Dentistry and Oral Health Rio Salado College

© 2012 American Dental Association, All Rights Reserved CDHC Curriculum Community health worker & health promotion modules Interviewing Skills for Dental Health Advocate Oral health Communication Dental Health Legal and Ethical Issues Dental Health Advocacy and outreach

© 2012 American Dental Association, All Rights Reserved CDHC Curriculum Dental Skills Modules  Introduction to dentistry  Screening & classification  Prevention of dental caries  Prevention of periodontal diseases  Prevention of oral cancer  Palliative care  Financing and payment for dental care Community-based internship (6 months)

© 2012 American Dental Association, All Rights Reserved CDHC trainee status Cohort 1 March September of 2010  2 cohorts; total 12 trainees; 10 graduated Cohort 2 March September 2011  3 cohorts; total 18 trainees; 8 graduated Cohort 3 kick March 2011 – September of 12  3 cohorts: total 20 trainees; 16 still in training Evaluation continues through September 2013

© 2012 American Dental Association, All Rights Reserved Evaluation of the Project: Goals  To evaluate a new dental team provider model through a thorough review of the pilot training program and field internship.  To determine the value of the new dental team provider in a variety of practice settings.

© 2012 American Dental Association, All Rights Reserved Evaluation Questions Does the program contribute to improvements in access to oral health care? Has the program positively impacted oral health outcomes? Has the program impacted the financial sustainability of the dental health clinic sites? How can the CDHC initiative be improved post pilot?

© 2012 American Dental Association, All Rights Reserved Access and Patient Outcomes: Data Analysis Clinic Variation:  Rural  Urban  Indian Health Limitations for Data Collection  Practice management software  Staff resources Develop metrics for the evaluation  Core indicators  Site-specific indicators

© 2012 American Dental Association, All Rights Reserved Types of Data Collection Clinical profile Community profile Feedback from community stakeholders Outreach activity data Encounter data captured by clinic computers Patient satisfaction surveys Clinics are never identified in external reporting All data is confidential Fully HIPAA compliant and secure database

© 2012 American Dental Association, All Rights Reserved Patient Access and Outcome Metrics Implement school-based programs to improve access for children Improve access for a disease specific population Improve access to underserved populations Change in dentist productivity Assess clinic revenue impact Change in active patient rates

© 2012 American Dental Association, All Rights Reserved The Future: CDHC as a Career Ladder Residents of the community who are:  High school graduates  Dental assistants  Dental hygienists  Other health care/health service providers  Community health care workers without dental skills

© 2012 American Dental Association, All Rights Reserved CDHCs can reach into the community  Schools  WIC  Head Start  LTC facilities and other institutional settings  Social Service agencies  Community dentists

© 2012 American Dental Association, All Rights Reserved Summary The ADA has committed substantial resources to developing and evaluating the CDHC as a new member of the dental team. We believe the CDHC is an ADA legacy program that dentists will be proud of for generations to come.

Questions? Lewis N. Lampiris DDS, MPH