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
Today’s discussion
• ADA Basics
• The CDHC Pilot Program
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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
© 2012 American Dental Association, All Rights Reserved
3
ADA Strategic Plan Goals: 2011-2014
• 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
© 2012 American Dental Association, All Rights Reserved
4
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.
© 2012 American Dental Association, All Rights Reserved
5
© 2009 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)
© 2012 American Dental Association, All Rights Reserved
7
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.
© 2012 American Dental Association, All Rights Reserved
8
ADA Members
Chief Legal
Counsel
Officers:
President
President Elect
First Vice
President
Second Vice
President
Speaker of
House
Secretary
ADA HOD
Legislative/Governing Body
501(c)6
Makes Policy
Enacts Ame4nds Appeals Constitution and
By Laws
Grant, Amend, Suspend Revoke
Constituents
Creates Special Committees
Elects Officers Including Treasurer
Elects Board of Trustees
Receives and Acts on Reports
Adopts Annual Budget
Court of Appeal
Transfers Powers to BOT in Emergency
Council on
Membership
Council on
Dental Practice
Council on
Ethics Bylaws
Judicial Affairs
CAPIR
Council on Members
Insurance and
Retirement
Council on
Communication
Council on
Scientific Affairs
Council on
Dental Benefit
Programs
Council on
Government Affairs
Code Revision
Conmmittee
Council on
Dental
Education and
Licensure
Councils of the House of Delegates
Board of Trustees
Managing Body
Conducts Business
Establishes Rules and Regulations
Calls Special Session
Publish or Omit from ADA Publications
Prepare Budget, Reports for HOD
Elects Associate Members
Makes Nominations for Councils
Oversees Investments
Interim Policy
Removes Council Members
Elects Honorary Members
Appoints Committees
Interim Supervision, Monitors, Guides activities of Councils / Special Committees
Transacts business by unanimous consent by mail ballot
Appoints agents to supervise, manage and conduct business
Chief Legal
Counsel
EHR
Council Annual
Session
Future of
ADABEI
ADAF
PRC
501(c)3
Sole Corporate
Member is ADA
ADABEI
For Profit wholly
owned ADA
Subsidiary
ADPAC
Commission
on Dental
Accreditation
29 members
4 ADA
4ADExA
4ADEA
1ADHHA
1ADAA
1NADL
1ASDA
1Each Spec.
1 Post Doc
4 Consumers
Joint
Commission
on National
Dental
Examinations
15 Members
3 HOD
6 AADE
3 ADEA
1 ADHA
1 ASDA
1 Public
Commissions of ADA
Treasurer
PRC
State Gov
Affiars
Board Rules
Review
ADAidm
Advisory
Committee on
International
Programs and
Development
New Dentist
Committee
Finance
Committee
Compensation
Committee
Audit Committee
Compliance
Officer
Strategic
Planning
Diversity
Committee
Work Groups of the Board
FDI Delegation
Special
Committee’on
Financial Affairs
IT Committee
Pension
Committee
Executive Director, Chief Operating Officer
Preserve and Protect Constitution and By Laws
Facilitate activities of Officers and Trustees
Engage the staff, direct and coordinate activities
Provide leadership in formulation and recommendation of new policies to BOT
Oversee management of policies adopted by BOT/HOD
Assist BOT in supervising, monitoring and guiding Councils, Commissions and
Committees
Systematize preparation of reports for BOT/HOD
Encourage the exchange of information
Maintain effective internal and external relationships
Perform other duties per the By Laws
9
Committees of the Board
Management Committees of the Board of Trustees
ADA Organization and Operations
Executive Director
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
© 2012 American Dental Association, All Rights Reserved
10
CDHC Background
• ADA 2004/5 Workforce Models Taskforces
– Define, recommend training and certification
process for proposed new dental team members
• ADA 2006-2008 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
In the community
promoting
healthy living
Based in a community clinic
and providing care
A community health worker with dental skills and a member
of the dental team
© 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.
2.
3.
4.
Bridging/cultural mediation
Providing health education and information
Assuring people get services they need
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: http://bhpr.hrsa.gov/healthworkforce/chw/default.htm.
• 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?
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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 110th Congress in the 2nd
session
© 2012 American Dental Association, All Rights Reserved
ADA VISION
Patient Navigation
Prevention of Dental/
Oral Diseases
Reduce oral health disparities
Improve access to dental care
Health Promotion
Community Engagement
Palliative
Care
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
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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:
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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 2009 -- September of 2010
 2 cohorts; total 12 trainees; 10 graduated
• Cohort 2 March 2010 -- 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
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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:
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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
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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.
© 2012 American Dental Association, All Rights Reserved
Questions?
Lewis N. Lampiris DDS, MPH
LampirisL@ada.org
312 440-2751