 Community Based Dental Partnership (CBDPP) College of Dental Medicine Columbia University Noreen Myers-Wright RDH, MA, CHES Project STAY Joanna Pudil MA, LCSW Program P.I. Burton Edelstein DDS, MPH Supported by HRSA Ryan White HIV/AIDS Program Grant H65HA00014

CBDPP Partners  Harlem United  A community AIDS center in Harlem, N.Y.  Adults and Older Adults  Community Service Learning for Advanced General Dentistry Residents (AEGD)  Dominican Sisters  Provider of family health services in the South Bronx, N.Y.  Women of young children  Community Service Learning for Dental Public Health Residents  Project STAY  Washington Heights, N.Y  Adolescents and Young Adults  Oral Health Education provided by Registered Dental Hygienist/Health Educator

Comprehensive Health Program (CHP)  Established 1988, in New York Presbyterian Hospital  Multidisciplinary care  Patients living with HIV and other chronic conditions  Children, adolescent, young adults and adults

Project STAY(P.S.) (Service to Assist Youth)  Provides comprehensive care for young people 14 – 24 years  Sexually high risk  HIV Positive Adolescents & Young Adults  Community Outreach  Young Adult Health Clinic  Farrell Community Health Center  Specialized Care Center  New York Presbyterian/Columbia University Medical Center

Case Management Services Nutritional Counseling Medical CDM’s Oral Health Educator Mental Health Services Peer Support Referred for Care to CDM Project Stay Patient Patient Centered Collaborative Comprehensive Care

Project STAY Services Provided  Medical examinations  STI screenings  Medication management  Mental health services  Individual, group & family therapy  Case management services  Housing, transportation, educational support, employment, benefits  Nutritional counseling

Oral Health Education Services  Patient Concerns Assessed  Pain  Gingival Condition  Appearance  Caries Risk Assessment  Sugar sweetened beverage consumption  Dietary Habits  Home oral health habits  Motivational Interviewing Techniques Employed  Home Oral Health Instruction  Brief tobacco cessation counseling  Dental Exam Appointments Facilitated

Theory and Evidence  National Research Council & Institute Medicine Adolescent Health Services, Missing Opportunities Report  Healthy People 2020 objectives  Poor utilization of dental care by young adults  Ecological model  Principles of Motivational Interviewing

 Triage Center  Medical History  Radiographs  Referral for care supervised by dental faculty  Advanced General Dentistry & General Practice Residents  Examination  Treatment plan  Prophylaxis, restorations  Oral & Maxillofacial Surgery  Extractions  Prosthodontic  Removable prosthetic appliances College of Dental Medicine Services

Patient Oral Health Concerns  Gingival Health  Bleeding  Sensitivity  Tooth Decay  Tooth Loss  Appearance of Teeth  Privacy Regarding Health Information  Continuity of Provider Care

CDM Accommodations  Combined visits for P.S. patients  Medical history& radiographs  Examination, Treatment Planning & Dental Prophylaxis  CDM staff education  Increased awareness of P.S. patient needs  Efforts to ensure privacy  Change in electronic health record to conceal HIV status  Efforts to accommodate minors not living with family  Triage team huddle to strategize  Routine engagement with CDM’s patient advocate

Trends & Outcomes  Reduction in dental phobia  Detection of oral health issues P.S. providers have missed  Successful change in oral health habits  Increased Oral Health Literacy  27% of patients referred for care kept appointment, July – September 2014  35% increase in # of unduplicated patients referred for care in 2014  80% of P.S. patients have received oral health education and oral health products

Future Goals  Reduction in dental no show rate  Implement fluoride varnish program  Increase number of tobacco quit attempts  Change CDM culture of routine tooth extraction to tooth retention  Work with CDM to improve tracking of treatment plan completions  Implement incentive program for patient treatment completion

Program Replication Possibilities  Diabetes comprehensive centers  Cardiovascular care centers  Medical comprehensive care centers for older adults

 Conclusions

References Committee on Adolescent Health Care Services and Models of Care for Treatment, Prevention and Healthy Development (2009). Lawrence, R.S., Appleton Gootmand, J. & Sim, L.J.. (Eds). Adolescent Health Services: Missing Opportunities. Washington D.C.: National Academic Press. Hayden, J. (2009). Introduction to Health Behavior Theory. Sudbury, MA: Jones & Bartlett. Viner, R. Ozer, E., Denny, S. Malmot, M. Reznick, M., Fatusi, A. & Currie, C. (2012). Adolescence and the social determinants of health. The Lancet, 379, Vujicic, M. & Nasseh, K.( 2013). A decade of dental care utilization. Health Services Research, (1-21). Doi: / /12130