2009 State Oral Health Workforce

 ARIZONA

Project Title: Improving Arizona’s Oral Health Workforce through the Promotion of Enhanced Dental Teams Utilizing Teledentistry Practice and/or Affiliated Practice
Arizona Department of Health Services
Address: 150 N. 18^thAvenue, Suite 320
Phoenix, Arizona   85007
Phone:  602-542-1866
Fax:  602-364-1494
Email: sjolans@azdhs.gov

The Arizona Department of Health Services, Bureau of Women’s and Children’s Health, Office of Oral Health (OOH) is submitting a 3-year program proposal entitled: Improving Arizona’s Oral Health Workforce through the Promotion of Enhanced Dental Teams Utilizing Teledentistry Practice and/or Affiliated Practice. The burden of oral disease in Arizona shows that 22% of 2-year-olds have experienced tooth decay (twice the Healthy People 2010 target); 62% of 6- to 8-year-olds have experienced tooth decay; and 30% of 3rd graders have untreated tooth decay (twice the HP target). Arizona’s oral health workforce is challenged by the high dental needs of the state’s children, especially in rural areas (80% of the state’s land). Workforce solutions are complex and require a multi-level approach for improving access to care. Recent initiatives to improve the oral health workforce have lead OOH and many partners to a readiness to promote strategies to enhance dental teams. These strategies include teledentistry practice and affiliated practice. Teledentistry practice utilizes offsite collaborating dentists to diagnose and plan/coordinate treatment using electronic and communication technologies. Affiliated practice utilizes qualified dental hygienists permitted by Arizona State law and regulations to provide dental hygiene and preventive oral health services, in limited settings to qualifying pediatric patients, subject to the practice parameters established by an agreement with an affiliated dentist.

The proposed program goal is to promote and develop enhanced dental teams utilizing teledentistry practice and/or affiliated practice to improve workforce capacity, diversity and flexibility for providing oral health services to underserved populations and underserved areas.

The program objectives are: (1) build and expand regional/local program development infrastructure; (2) train providers for enhanced dental teams and increase provider understanding and competencies for teledentistry practice and affiliated practice; (3) educate and increase awareness of program administrators, policymakers and funders about enhanced dental teams and how teledentistry practice and affiliated practice can increase workforce capacity and flexibility in community settings; (4) increase the number of enhanced dental teams at the state, regional and local levels; and (5) develop and gather resource materials, tools and lessons to support development of practice models, making this information accessible to providers, programs and communities.

Activities include developing advisory committees to address barriers/challenges for teledentistry practice and affiliated practice; building linkage with the state’s oral health coalition; training providers on teledentistry technology; and gaining the support of regional partnership councils for enhanced dental teams. Activities also include implementing three demonstration practice models striving for best practices to serve preschool/school-aged children and educate their parents/primary caregivers. The proposed program will use communications to develop support networks, provide resource information on a Website, and share lessons/successes at the national, state and local levels.

 ARKANSAS

Project Title: Arkansas Oral Health Workforce Development
Name: Lynn Douglas Mouden, DDS, MPH
Arkansas Department of Health Office of Oral Health
Address: 4815 W. Markham, Slot 41
Little Rock, Arkansas  72205
Phone:  501-661-2595
Fax:  501-661-2240
 

PROBLEM:
Arkansas dentistry is often overwhelmed when addressing the needs of special populations – survivors of family violence, individuals with language barriers or the geographically isolated. Only 25% of Arkansas dentists substantially participate in ARKIDS FIRST, the state Medicaid and SCHIP waiver programs, and few dentists practice in the Delta area of the state and other more remote locations.

GOALS AND OBJECTIVES:
The major goals of the AR Oral Health Workforce Development project are to increase the number of dental professionals practicing in underserved areas, to promote dental careers especially in minority populations, to train dental professionals to address special populations, to address language barriers, and to support dental and dental hygiene education.

Objectives to reach those goals are: (1) recruit dental professionals to practice in underserved areas, (2) to work with elementary schools, secondary schools and colleges to promote dental careers, (3) to train dental professionals to treat special populations, (4) to promote available interpretation services to minority populations, (5) to support dental hygiene and dental specialty training, and (6) to support the basis for a dental school in Arkansas.

POPULATIONS SERVED:
Dentally underserved patients of all ages, elementary, secondary school and college students (especially minority students), survivors of family violence, patients with language barriers and dental hygiene, dental and dental specialty students.

COORDINATION:
The Arkansas Office of Oral Health will coordinate grant-funded activities with the Arkansas Oral Health Coalition, Inc; the University of Arkansas at Pine Bluff; Delta Dental Plan of Arkansas, Inc; the Arkansas Farm Bureau; the Arkansas Coordinated School Health program, and the UAMS Center for Dental Education.

KEY WORDS:
Family violence prevention, language interpretation services, dental careers, dental education, dental hygiene education, dental specialty training.

 CALIFORNIA

California Oral Health Workforce Project
The California Department of Public Health’s Office of Oral Health
Name: Rosanna Jackson
Address: 1616 Capital Ave, Bldg. 174, Ste. 74.4.100
Sacramento, California  95814
Phone:  916-552-9896
Fax:  916-552-9910
 

Access to dental care for low-income Californians is quite limited. Addressing the oral health workforce needs of underserved Californians will require a multi-pronged approach. California’s safety net must brace itself for the potentially devastating loss of the adult Denti-Cal program. Given the historic economic crisis forecasted for years to come, even if this program is preserved in the current state budget, it will likely be up for elimination in subsequent fiscal years. The safety net needs systematic and objective information on the potential impact of the loss of this program on the current oral health workforce. Using that information, the safety net will need to come together to develop and implement strategies to mitigate the damaging effects that may ensue.  New and creative ways to build tomorrow’s oral health workforce must also be put in place.

The California Department of Public Health’s Office of Oral Health is pleased to present this proposal to HRSA’s Grants to Support State Oral Health Workforces program in partnership with the University of the Pacific’s California Dental Pipeline Project, the Oral Health Access Council (a collaborative of over 50 oral health stakeholder organizations co-facilitated by the Dental Health Foundation and the California Primary Care Association), and the University of California at San Francisco’s Center for Health Professions.  This public/private partnership has come together to develop an innovative, multi-pronged approach to addressing the dire workforce issues facing California’s safety net dental services.

Our broadly stated goals over the three years of the project include:

1. Expanding access to oral healthcare for traditionally difficult-to-reach patient populations, such as low-income children.
2. Expanding the pipeline of dental professionals who are interested in working in the safety net, in dental shortage areas, or in public health programs;
3. Maintaining or expanding the current workforce capacity of safety net providers to meet the needs of underserved populations.

We will achieve these goals through the following activities:  expanding the California Dental Pipeline’s Virtual Dental Home Demonstration project, a partnership of five California dental schools and several safety net providers, to expand training and residency programs in safety net settings. Specifically, we are proposing to develop two new and innovative training sites within Federally Qualified School-Based Health Centers utilizing the model of the Virtual Dental Home (Years 1-3).

• Working with the Oral Health Access Council (OHAC) and UCSF to conduct a systematic assessment of the potential impact of the loss of the adult dental Medicaid benefit in California on the current safety net workforce, while also identifying alternative models of financing to help maintain the current workforce (Year 1).
• Working with OHAC to utilize the results of that assessment to develop and implement strategies to preserve the current workforce in the face of this tremendous blow to access to oral health care for low-income Californians (Years 2-3).

 COLORADO

The Colorado Oral Health Workforce Project for the Underserved

Project Title: Oral Health Unit
Colorado Department of Public Health and Environment
Name: Theresa Anselmo
Address: 4300 Cherry Creek Drive South, PSD-OH-A4
Denver, Colorado  80246
Phone:  303-692-2569
Fax:  303-782-5576
 

The Colorado Oral Health Workforce Project for the Underserved addresses disparities in access to oral health services in rural areas and diverse populations. Eighty-six percent of Colorado’s population of 5 million resides in 17 counties along the Front Range. Conversely, 14% live in 47 rural and frontier counties. In some geographically isolated areas there is only 2 people per square mile. Additional challenges face people who are economically disadvantaged. Five rural counties have over 20% of their population below the federal poverty line, and 9 counties have 15-nearly 20% who are below poverty. Moreover, 18% of Colorado’s population is of Hispanic origin; the fastest growing population group in the state.

Disparities in the burden of oral disease are identified through data collected by the Colorado Oral Health Surveillance System. In 2007 prevalence of untreated decay showed that Hispanic third graders carried nearly twice the burden of untreated decay, 31%, compared to their white counterparts, 18%. Adults report similar oral health disparities. Whereas 71% of all Coloradans reported having a dental visit in the past year, only 53% of those earning less than $25,000 had a dental visit in the last year. In 2007 74% of whites reported a dental visit in the last year, compared to 56% of Hispanics. Access to oral health providers in rural areas is also limited by a lower patient-provider ratio, compared to urban areas. In 2008 there were 371 dentists practicing in 47 rural and frontier counties. Nine counties did not have a dental provider. Seventeen counties did not have dental providers that accepted Medicaid, and minority dental professionals were especially underrepresented throughout the state.

The Colorado Oral Health Workforce Project for the Underserved will address these disparities through the coordination of six program activities. 1) Strengthen capacity of the Oral Health Unit to coordinate oral health access statewide through additional dental health professional shortage designations, and the development of a dental workforce-forecasting model. The resulting information will lead to 2) corresponding provider recruitment and retention activities. 3) Collaborations with the University of Colorado School of Dental Medicine will facilitate the placement and support of dental students, residents, and advanced dentistry trainees in rural and public health settings to ensure new graduates are well-equipped to practice successfully in rural areas. 4) Implement programs that expand oral health services in health professional shortage areas through the Colorado Smilemakers mobile dental clinic. 5) Develop a Dental Ground Rounds to provide continuing dental education utilizing of the Colorado Area Health Education Centers distance-learning technology and ensure that existing dental and medical practitioners in rural areas are engaged in addressing community identified oral health needs according to the latest evidence-based practices. 6) Increase dental loan repayment slots to encourage dentists to agree to serve in designated shortage areas.

These strategies will address key outcomes identified in the Smart Mouths, Healthy Bodies: Oral Health Action Plan and move Colorado forward in improving the oral health of all its residents.

 DELAWARE

Oral Health Workforce Activities
Delaware Health and Social Services
Division of Public Health
Name: Greg McClure
Address: 417 Federal Street
Dover, Delaware  19901
Phone:  302-744-4554
Fax:  302-6617229
 

Delaware recognizes a critical need for immediate action to improve access to dental care, particularly in the underserved areas of Kent and Sussex County.  Therefore, the Division of Public Health is collaborating with key stakeholders to advance objectives that will establish dental services in southern Delaware during the next year; while also ensuring that Delaware is best positioned to move forward with long-term recommendations from its current planning grant.  The purpose of this project is to improve the oral health infrastructure so as to support an increase in the availability of the dental workforce, and to improve the oral health status of rural and other underserved families in Delaware.

This will be accomplished with three major objectives:

1. Establish oral health services for low-income, underserved populations in Sussex County by La Red Health Center and improve access to services for residents in Kent County, with a strong focus on outreach and prevention.
2. Support and enhance the State’s recently developed mobile dentistry program to provide dental services to children and adults through community outreach and recruitment of additional provider volunteers. 
3. Coordinate and manage a project to develop a multi-purpose clinic, including a dental residency program and auxiliary dental professional training in southern Delaware.

Delaware’s most striking need for dental services is in Sussex County, where there are no community dental clinics that provide dental services to underserved families.  Kent County is also federally designated as dental shortage area, and also demonstrates a need for increased access to dental care.  This grant will capitalize on a recent opportunity to initiate dental services at a community health center in Sussex County within months of receiving the grant.  Delaware’s mobile dentistry program will now be able to provide comprehensive dental services on its dental van with funding for a dentist, while continuing to operate its Seal-A-Smile program as a collaborative venture with key partners.  Immediate dental needs can be met on the dental van, while children can be referred to a dental home for continuing care.

The need for a dental clinic in Sussex County and a downstate dental residency program have been promoted for several years, but there have not been sufficient resources to organize efforts among key stakeholders until now.  Planning is underway to determine the feasibility of establishing a multipurpose dental clinic in Sussex County that could  provide clinic training for dental residents and auxiliary dental professionals, as well as serving as a focus of  dental care for those who have been traditionally underserved.  This grant will advance those plans by assuring that the recommendations from the feasibility study are championed to help address the strong need and demand for dental services in Kent and Sussex Counties.

 FLORIDA

Addressing Florida’s Oral Healthcare Workforce Needs
Name: Douglas T. Manning DMD, JD, MPH
Florida Department of Health
Public Health Dental Program
Address: 4052 Bald Cypress Way, Bin # A14
Tallahassee, Florida  32399-1724
Phone:  941-925-2906
Fax:  850-414-7552
 

In 2004, in response to the U.S. Surgeon General’s Report and Healthy People 2010, the Florida Department of Health’s (DOH) Public Health Dental Program (PHDP) established Oral Health Florida, a broad-based coalition that developed and continues to advance a State Oral Health Improvement Plan for Disadvantaged Persons (SOHIP). In early 2008, the State Surgeon General, concerned that many Floridians were not receiving necessary dental care due to provider availability, established an Oral Healthcare Workforce Ad Hoc Advisory Committee (Committee). The Committee provided recommendations on dental workforce and access to oral health care to the Governor’s office. In August of 2008, HRSA awarded a $200,000 grant to the DOH’s PHPD for the purpose of convening an Oral Healthcare Workforce Workgroup (Workgroup) and developing a strategic plan on dental workforce issues. Additionally, the project includes an independent needs assessment on oral health access and workforce in Florida. The Workgroup will complete its mission by the end of August 2009.

The proposed project will continue this process and focus upon the needs of Florida’s disadvantaged populations such as children; the poor; individuals with special health care needs; and isolated populations (e.g. rural populations, the elderly). The Project proposes to initiate recommendations of the Committee and Workgroup. This project will 1) build the PHPD’s infrastructure so that it can adequately lead oral health education and preventive programs in the state by creating a permanent oral health education and prevention specialist – the specialist will work upon integrations, oral health promotion and awareness (including messaging) projects; 2) advance recruitment and retention efforts in safety net dental programs (including supporting minority recruitment and loan forgiveness efforts; and investigating residencies or externships in County Health Department (CHD) dental facilities) and establishing best practice models for volunteerism and referral networks that can be replicated throughout the state by hiring a dental coordinator in the PHPD; 3) strengthen PHPD’s efforts as the state’s lead in community water fluoridation (CWF) by hiring a CWF project specialist who will work with local communities; 4) support the expansion of Miami-Dade CHD’s community dental sealant program; 5) collaborate with the University of Florida in developing and providing a continuing education (CE) course to enhance general dental provider skills in treating young and very young children (especially low-income children); and 6) provide funding to expand or establish community –based dental programs including CHDs.

 GEORGIA

Addressing the Oral Health Needs of Georgia’s Underserved:
Loan Forgiveness and Student Clerkships
Name: Dr. Carole Hanes
Medical College of Georgia
Augusta, Georgia  30912
Phone:  706-721-2813
 

The purpose of this project is to improve access to oral health care for underserved citizens in the state of Georgia by increasing the dental workforce treating these patients. 

METHODOLGY:
First, the Medical College of Georgia School of Dentistry (MCG SOD) will collaborate with the Division of Dental Public Health, private charitable dental clinics and Area Health Education Centers, to place students in dental clinics to care for underserved patients.  All clinics chosen serve Dental Health Profession Shortage Areas (DHPSAs).  Identified locations in Georgia include 12 clinics in 8 urban and rural areas including: Atlanta, Augusta, Columbus, Dalton, Dublin, Rome, and Savannah. Each student will provide oral health education and dental services in two weeks increments for a total of 6 weeks.  As part of this objective funds will be directed to three public health sites to support and expand services.

Second, loan forgiveness funds totaling $200,000 annually will be provided for 8 dentists who agree to serve in a DHPSA.  This one year commitment will be renewable for 2 additional years with a ceiling of $75,000 total loan repayment per dentist. 

The third aspect of this application involves rotating Pediatric Dentistry residents from MCG to the Children’s Hospital at Scottish Rite Dental Clinic in Atlanta.  This rotation would improve the residents’ educational experience by treating the very vulnerable and medically compromised patients seen in that facility and would benefit the patients.  To maintain the quality of didactic education for students and residents on rotations, computer technology will be used to allow offsite students to view live or recorded presentations.
Justification:

Georgia is generally a rural state with a few major population centers.  Census Bureau figures indicate nearly 1.8 million people currently live in rural counties.  There are 109 counties with fewer than 35,000 people.  Georgia has a poverty rate of 13.7%, which is higher than the national poverty rate. In Georgia, poor children are 80% more likely to have dental disease and 30% of tooth decay remains untreated.  There are 58 single county or low income DHPSAs in Georgia.  There are approximately 45 dentists/100,000 population in Georgia, compared to 54/100,000 in the U.S.  In summary, Georgia has large indigent and rural populations that do not have ready access to the dental treatment.
Outcomes:

This grant will help fulfill the mission of the MCG SOD by educating our students to be excellent, compassionate clinicians who are prepared to provide oral health care to the citizens of the state, regardless of their socioeconomic status, or medical condition. The short term benefit for the selected communities is increased availability of oral health care.  If the program is successful, the long term benefits will include sensitizing students to the oral health needs in rural Georgia and the development of local and state mechanisms to encourage development of loan forgiveness programs and community efforts to address care for underserved citizens.

 IOWA

Iowa’s Effort to Improve Oral Health Workforce
Name: Raymond A. Kuthy, D.D.S., M.P.H.
University of Iowa College of Dentistry
Address: 801 Newton Road
Iowa City, Iowa  52242
Phone:  319-335-7201
Fax:  319-335-7187
 

This project proposes two innovative approaches in addressing Iowa’s oral health workforce needs: developing a dental workforce model that substantially augments the traditional population to dentist ratio with numerous county-specific data to highlight locations with the most acute access problems; and, in conjunction with local community health centers, developing community-based, senior dental student clinical rotation sites in southern Iowa, a geographic tier with a paucity of dentists.

These approaches build on two Iowa strengths: an existing statewide dentist database that is constantly being monitored; and a long-standing and successful student extramural program, in which senior dental students provide care to traditionally underserved groups. Using an existing statewide dentist database (Iowa Dentist Tracking System) that was developed in 1996 and that includes such information as provider’s age, gender, type of practice, work address(es), specialty, and number of hours worked per week, this project will expand the database by collecting, inputting, and updating county-specific data concerning demographics, economics, health status and health care infrastructure. Moreover, pertinent data from two other existing statewide databases (physicians, pharmacists) will also be incorporated into this master database. Then, statistical models will be developed to assist with targeting geographic areas so that suitable approaches can be implemented to correct provider shortages.

The primary intent of the dental workforce model is to assist with developing a cohesive statewide plan for oral health workforce, with a special emphasis in the southern 33 counties, an area that has great difficulty in recruiting and retaining dentists and dental hygienists. Oral health findings via a needs assessment for these counties will be incorporated into the database to better understand the counties with the greatest need for oral health services. This project will also allow for expansion of the University of Iowa dental extramural program to community health centers in southern Iowa, an area where no sites currently exist. We are very hopeful that providing suitable educational programs in this geographic region will have direct and indirect impact on recruiting oral health providers there.

This project will rely on a collaborative effort among various state agencies (Public Health, Human Services), the only dental school in the state, oral health professional organizations, other health organizations (Iowa-Nebraska Primary Care Association, regional Area Health Education Centers [AHEC]), and two community health centers. This project also provides an opportunity for several cooperating groups to raise the visibility of oral health as a major health issue for the newly formed regional AHECS in southern Iowa.

 KANSAS

Name: Dr. Katherine Weno, Director
Kansas Office of Oral Health
Address: 1000 S.W. Jackson, Ste. 300
Topeka, Kansas  66612-1365
Phone:  785-296-5116
Fax:  785-291-3959
 

Many poor and rural Kansans lack access to dental care. In 2008 the Kansas Office of Oral Health received funding for a comprehensive workforce study and community planning on how to strengthen the professional workforce in underserved areas. The purpose of Kansas’ 2009 Dental Professional Workforce Grant proposal is implement evidence based recruitment strategies to increase the numbers of dental professionals serving underserved populations in Kansas.

Grant Objectives:

Objective 1: Increase Kansas Specific Oral Health Data to Develop Evidence Based Oral Health Programs
Strategies:

Kansas will develop a comprehensive unified dental recruitment program that will be located at the Office of Oral Health at KDH

 KENTUCKY

Access for Babies and Children to Dentistry (ABCD) Initiative
Cabinet for Helath and Fmaily Services
Department of Public Health
Address: 275 East Main Street, HS2C
Frankfort, Kentucky  40621
Phone:  502-564-3246 X3774 or 3820
Fax:  502-696-5159
Email: Juliew.mckee@ky.gov

Oral disease is a major health program for Kentuckians.  Kentucky can be justifiably proud that more than 90 percent of all Kentucky’s 4.2 million residents receive optimally fluoridated water and many of Kentucky children are recipients of fluoride varnish and dental sealants.  Still, oral disease still affects the quality of life of many citizens.  Or special concern for the Kentucky Oral Health Program (KOHP) is the lack of care for Kentucky’s Medicaid/KCHIP eligible children from the eruption of their first tooth through five years of age, or the Very Young Patient (VYP).

The purpose of the Grants to States to Support Oral Health Workforce Activities Program (‘Workforce Grant’) is to increase the services of general dentistry of Kentucky’s very young children through training of general dentists in effective pediatric technique for the treatment and management of the Very Young Patient.  Kentucky’s strategies will specifically address increasing the access for preventive and restorative dental care for Kentucky’s Medicaid/KCHIP very young eligible children.

Funding for the Workforce Grant will allow the KOHP to build upon the infrastructure developed during the four year of the State Oral Health Collaborative Systems grant and two years of the Targeted State MCH Oral Health Service Systems Grant Program.  Through these grants we have a state strategic plan, a children’s surveillance system, screening software, a dental workforce study, increase oral health awareness, electronic tracking systems development and a reporting system compatible with local health departments.  Kentucky is involved in statewide needs assessments and community forums for continued development of needed programs.  The goals of the grant will be addressed during the development of statewide capacity and infrastructure through the Kentucky ABCD Initiative (ABCD) and its partners, whereby model of the Washington State Program, which has been identified by the Association of State and Territorial Dental Directors as the Best Practice for State Oral Health Programs.  Three primary methods planned are: ABCD Workforce Group established, effective training of the participating dentists during several learning opportunities and sustainability through enhanced Medicaid reimbursements and a continuing consultation network electronically linking general dentists with consulting pediatric dentists.  The Initiative will be assessed per the Evaluation Plan protocols.

Two Memoranda of Agreements are anticipated to execute this Workforce Grant: 1) University of Kentucky College of Dentistry and 2) the University of Louisville School of Dentistry.  Their expertise in continuing dental education is key to the success of this Initiative.

Over the period of the Workforce Grants, Kentucky’s communities and partners will gain invaluable experience and knowledge to move Kentucky toward improved oral health status, specifically through the increased competency of the general dentists treating the Very Young Patient.

 LOUISIANA

Louisiana Seals Smiles
Name: Dionne J. Richardson, D.D.S., M.P.H.
Louisiana Oral Health Program
Louisiana Department of Health and Hospitals
Office of Public Health/Oral Health Program
Address: 628 N.4th Street
PO Box 3214
Baton Rouge, Louisiana  70821-3214
Phone:  225-342-9047
Fax:  225-342-2256
 

Target Population:
School-aged children in areas where access to care is poor is a challenge, especially in rural and hurricane affected areas.

Problem:
Access to oral health care in Louisiana has been severely compromised by a diminishing dental health workforce. Oral health workforce reports reveal that the state lost more than 100 dentists since hurricanes Katrina and Rita. Dental provider shortages coupled with poor access to oral health care has a tremendous impact on the oral health of children, especially in rural and hurricane affected areas. A 2002 survey of oral health revealed that only 18% of 3rd grade children had preventive dental sealants on permanent molar teeth. Moreover, Medicaid data reveal that less than 1/3 of children eligible to receive dental services were treated in the 2008 fiscal year. After hurricane Katrina the state experienced a remarkable upward shift in Dental Health Professional Shortage Area designations, from 8 parishes in 2003 to 49 in 2009. Oral health needs are also compounded by the lack of community water fluoridation. Only 40% of the population benefits from this public health intervention. Therefore, it has become increasingly important for the dental professional community, both public and private, to identify strategies to provide access to preventive health care for the state’s most vulnerable children.

Project Activities:
The goal of the project will be to expand the dental sealant program to provide access to preventive services to protect children from dental decay. In an effort to engage dentists and dental hygienist in the communities served, they will be recruited in each of the regions of the state to provide oral health screening and dental sealants in school-based settings. A final report will be submitted to the Health Research and Services Administration.

 MAINE

Maine Oral Health Access Partners Project
Maine Department of Health & Human Services
Address: 11 State House Station
221 State Street
Augusta, Maine  04333-0011
Judith Feinstein: 207-287-3267 (phone); 207-287-7213 (fax)
Charles Dwyer: 207-287-5503 (phone); 207-287-5431 (fax)
Web Sites: http://www.maine.gov/dhhs/boh/index.shtml

The Maine Oral Health Workforce Development Project will expand an existing dental loan education repayment program and develop a new, low-interest revolving loan program that will help providers who participate in the Medicaid program to establish or expand practices in designated dental health professional shortage areas by equipping dental offices or allowing them to replace and upgrade needed dental equipment. 

As Maine has worked to maintain its dental professional workforce over the past several years, the value of loan repayment options as a recruitment tool has been emphasized by both the private practice sector and community-based organizations.  Recruitment and retention efforts by safety net providers in Maine have been hampered by limited opportunities for loan repayment. Reports indicate that new dental school and residency graduates want practice settings where state-of-the art equipment similar to what they used during their training is available.  Newer equipment is more efficient and contributes to overall productivity as well as to quality of care. 

In order to assure maximum utilization of both programs, specific marketing activities will be undertaken to promote the expansion of the Loan Repayment Program, involving a range of community-based partners. For the new Dental Equipment Revolving Loan Program, a unified marketing strategy will be developed, also involving those partners.

 MASSACHUSETTS

Massachusetts Oral Health Workforce Initiative in New Sites II (MA OH WINS II)
Name: Lynn Bethel, RDH, MPH, Director   
Massachusetts Department of Public Health Office of Oral Health
Address: 250 Washington Street
Boston, Massachusetts  02108
Phone:  617-624-6074
Fax:  617-624-6062
 

The primary purpose of MASS OH WINS II is to improve the oral health of underserved populations by increasing the oral health workforce and expanding community-based prevention programs by three different, complementary initiatives: 1. Identify and assess oral health needs and resources in underserved communities including workforce and prevention programs with the expansion of the Office of Oral Health’s (OOH) infrastructure; 2. Promote, develop and implement school prevention dental (sealant) programs in federally qualified dental health professional shortage areas (DHPSAs) and other underserved and rural areas of the state in addition to supporting other effective community prevention programs; and 3. Recruit culturally and linguistically competent practitioners to serve underserved populations including the low income, children, minorities, seniors, nursing home residents, the homebound, and the developmentally disabled.
Population(s) Served:  Rural, underserved and/or DHPSA communities; the low income, minorities, high-risk children; homebound and nursing home seniors; and the developmentally disabled.

Needs Assessment:  Massachusetts has overwhelming unmet oral health and workforce needs.  More than one million residents live in DHPSAs.  Four counties have less than 20 MassHealth (Medicaid) dentists and just 12% of dentists statewide are actively treating MassHealth members. 58% of Hispanic 3rd graders have experienced dental disease compared to 36% of Non-Hispanic White 3rd graders.  Utilization of dental sealants is low with just 32% of 6-8 year olds with MassHealth receiving one sealant in FY 2008, and just 7% of school nurses reported hosting a school sealant program.  About 1 million of the state’s residents are considered disabled and more than 850,000 residents are over the age of 65, with just 6% having dental insurance.   To respond to these issues MA OH WINS II was developed.

Methodology:  Response 1:  The OOH will create a Dental Workforce/Dental Health Professional Shortage Area Specialist position to develop, implement and monitor a data collection system for oral health, workforce and prevention program needs and resources and new DHPSA designations.  Response 2:  The OOH will hire two public health dental hygienists and two community health workers to develop, implement and promote statewide school preventive dental (sealant) programs in DHPSAs, rural and underserved areas, and in communities where there are greater than 10,000 MassHealth children, and promote and support community water fluoridation.  Response 3:  Create one-time start-up grants to fund portable dental equipment and supplies for public health dental hygienists and dentists interested in work with high-risk children and elderly populations in public health settings.

Evaluation:  An Advisory Committee made up of key stakeholders such as the state’s dental and dental hygiene societies, primary care association, dental and dental hygiene schools, several offices within MDPH, and three dentists’ board certified in dental public health will oversee this proposal by planning, monitoring and evaluating the progress of the objectives and activities of each initiative.

 MINNESOTA

Minnesota Oral Health Workforce Innovation Project
Name: Mark Schoenbaum
Minnesota Department of Health
Address: P.O. Box 64882
St. Paul, Minnesota  55164-0882
Phone:  651-201-3584
Fax:  651-201-3830
 

Minnesota is re-energizing its oral public health effort. MDH held a well-attended Oral Health Summit in January, 2009, that attracted over 170 attendees from all stakeholder sectors. Plans are underway to develop a state oral health plan, conduct a state-wide open mouth screening survey, establish an ongoing oral health surveillance system, create a state oral health advisory committee, support a statewide oral health coalition and strengthen oral health partnerships both within the department of health and the overall community. However, funding is insufficient to address the urgent oral health workforce needs that have been identified. We propose to provide significant additional support for oral health workforce priorities that will both improve the impact and availability of Minnesota’s oral health workforce for underserved populations, and also increase the comprehensiveness of Minnesota’s oral health improvement effort. Over the past several months a group of stakeholders has met to develop a plan for improving the coordination and breadth of activities related to training and recruiting Minnesota oral health workforce. This stakeholder group has identified five different, but complementary elements for this proposal:

1. Improving infrastructure to support dental hygienists and dentists practicing under collaborative agreement, thereby increasing the capacity of current providers and encouraging new providers to enter into this practice arrangement.

2. Collaborating with the University of Minnesota School of Dentistry to develop an Early Decision Program for Rural Dentistry Track for first year college students in an effort to encourage more dentists to return to rural areas to practice

3. Ensuring that young people across the state are exposed to dental careers via the development of the “Careers in Oral Health Inter-active Website” in cooperation and coordination with the University of Minnesota’s Academic Health Center (AHC).

4. Expanding the externship program of the pediatric residency training program at Rice Memorial Hospital located in Willmar, Minnesota. The short term benefit for the community is increased availability of oral health care for its pediatric population. The long term benefits will include sensitizing pediatric residents to the oral health needs in rural Minnesota and encouraging the consideration of this practice option.

5. Promoting, developing and implementing school prevention dental (sealant) programs in federally qualified dental health professional shortage areas and other underserved and rural areas of the state.

6. Collect and analyze data on Minnesota’s Oral Health Workforce, with expanded capacity to document and analyze the effects of Minnesota’s launch of the midlevel dental provider.

Each element is a critical piece to building the oral health infrastructure for long-term sustainability of an effective and efficient workforce.

 MISSISSIPPI

Mississippi Community Water Fluoridation Program
Mississippi State Department of Health
Address: 570 East Woodrow Wilson Ave.
Jackson, Mississippi  39215-1700
Phone:  601-576-7500
Fax:  601-576-8190
Email:  Nicholas.mosca@msdh.state.ms.us 
 

Community water fluoridation is the adjustment of fluoride that occurs naturally in water to optimal levels to protect oral health. Water fluoridation is the single most effective public health measure to prevent dental decay. It is safe, cost-effective and beneficial for all income groups in a community. Over six decades of use shows that for most cities, every $1 invested in water fluoridation saves $38 in dental treatment costs.
In 2003, Oral Health America gave Mississippi an “F” because less than 48% of the state’s population on public water received water fluoridation. In 2006, Mississippi ranked 41st in the nation for proportion of population (50.9%) that received public water fluoridation. In 2005, statewide dental decay experience and untreated decay rates of third-grade children were reported at 69% and 39% respectively (Source: MSDH). In 2008, statewide dental decay experience and untreated decay of Head Start children were reported at 56% and 41% (Source: MSDH). Federal health objectives call for states to provide community water fluoridation to 75% of the proportion of population that receives public water by 2010.

With such high decay rates among children and at least 25 percentage points to gain before achieving national health objectives, Mississippi should pursue additional funding for communities to implement public water fluoridation programs statewide.

The Office of Oral Health at the Mississippi State Department of Health is requesting funding to improve capacity and support to plan and construct multiple community water fluoridation programs (an estimated six to 12 systems) to reduce the burden of dental decay for populations on public water systems. Funding for these systems will be matched using non-federal funds provided by the Bower Foundation, a private philanthropic organization.

 NEBRASKA

Attaining Optimal Overall Health through Improved Oral Health
Nebraska Department of Health and Human Services
Address: 301 Centennial Mall South, P.O. Box 95026
Lincoln, Nebraska  68509
Phone:  402-471-3485
Fax:  402-471-6446
E-mail: barbara.pearson@nebraska.gov
 

The project envisions unique solutions to existing disparities in oral health services access to oral health services among Nebraska's young children. The target populations includes children from birth through 7 years of age, with special attention to children from low income families, those who are members of racial and ethnic minority groups, as well as children with special health care needs. Emphasizing primary prevention reduces the need for restorative dental care. Focusing on young children creates new opportunities to protect oral health from starting with the eruption of the first primary teeth and positively influence the future oral health of the child as he/she grows up.

The project works to overcome the effects of uneven distribution of dentists in state designated dental health professional shortage areas by expanding the oral health care team, providing training, and building on existing oral health services in public settings. It capitalizes on the vital services already being carried out. Local health departments are tapped to lead the process of finding local solutions to the oral health access problems in their coverage areas.

A core process is enhancing the capacity of the NDHHS Office of Oral Health and Dentistry to coordinate and guide oral health services in the public arena; drawing together the many oral health stakeholders, actively seeking consultation with state-level oral health experts through an Advisory Panel, and facilitating collaboration across the state.

 NEW MEXICO

Improving Access to Oral Health Care through a Dental Support Center
Name: Mary Altenberg, MS, CHES
New Mexico Department of Health
Phone:  505-222-8671
Fax:  505-222-8675
 

The prevention and treatment of oral disease among vulnerable and underserved populations is of critical importance.  According to a report from the National Institute of Dental and Craniofacial Research (2002), one of three primary barriers that prevent many population groups from achieving optimum oral health is the availability of dental health professionals and the ratio of dentist to population. Unfortunately, in New Mexico there is a significant shortage of dental professionals.  The median number of dentist to population in this state is 1 to 3,297, compared to the federal standard of 1 to 1,050.  Many inner-city and rural communities struggle to recruit and retain an adequate supply of dental providers.

The goal of this proposal is to augment the New Mexico Department of Health’s (NMDOH) Office of Oral Health by establishing a dental preventive and clinical support center which is based on a successful model established by the Indian Health Service. The New Mexico Dental Support Center will sustain and enhance current efforts to increase the number of appropriately trained and culturally competent oral health providers through two primary mechanisms.  The first will develop and maintain a system of outreach to dental providers serving in rural areas and community health settings. Outreach will consist of providing continuing dental education opportunities and technical support, establishment of a continuous communication network, and establishment and coordination of a network of local dental disease prevention coordinators. The second mechanism will establish a network of dental educators in New Mexico for the purpose of connecting and aligning with statewide missions and strategies of educators of dental residents, dental hygienists and dental assistants.

Two primary goals have been developed for this proposal. Goal 1: Provide training and technical consultation for dental providers in rural areas and community health clinics; and, Goal 2: Provide a center of professional support and network of communication for dental educators throughout the state.

 OHIO

Ohio’s State Oral Health Workforce Proposal
Ohio Department of Health
Address: 246 N. High Street
Columbus, Ohio  43215
Phone:  614-466-4180
Fax:  614-564-2421
E-Mail:  Mark.Siegal@odh.ohio.gov
 

In Ohio, dental care is the number one unmet healthcare need. The greatest needs have been documented primarily for low- income populations, minorities and residents of the state’s 29-county Appalachian region. About 13% of Ohioans live in poverty and another 17% are near-poor (with incomes between 101% and 200% of the federal poverty level). Ohio’s unemployment rate jumped to 9.4% in February 2009 and is expected to be in double digits by year’s end. The 38% of the population found to lack dental coverage in a 2003-04 survey will soar with increased job loss and people in lower paying jobs that do not provide dental insurance. The bottom line will be a continued escalation of the number of Ohioans without access to dental care.

The dental care safety net, with its mission of serving patients who find it difficult to find care in the private sector, traditionally is stressed by demand for care that outstrips its resources. The increased need for care growing out of the current economic situation, combined with dwindling budgets of local governments and non-profit agencies that operate safety net clinics may overwhelm the system.  Dental OPTIONS, a long-standing referral and case management partnership between the Ohio Department of Health (ODH) and the Ohio Dental Association will be increasingly unable to meet the needs of high-risk Ohioans.

The purpose of this project is to enable ODH to leverage HRSA Dental Workforce Grant funding with
a nearly 4-fold state dollar overmatch of the 40% requirement to provide operational support to the dental care safety net through competitive sub-grants for serving primarily low-income uninsured individuals and Medicaid consumers.

This three-year proposal has two goals:

• Increase access to direct oral health care services for high-risk Ohioans through safety net dental clinics.
• Increase access to case management and direct oral health care services for high-risk Ohioans through the Dental OPTIONS program.

The objectives are:

1. During each funding year, 10,500 additional unduplicated patients will be served by dental clinics receiving ODH Safety Net Dental Care sub-grants as a result of HRSA Workforce Development grant dollars.

2. During each funding year, 2000 additional unduplicated patients will receive referral and case management services by regional Dental OPTIONS offices funded by ODH as a result of HRSA Workforce Development grant dollars.  Using a combination of data analysis and face-to-face contact with sub-grantee agencies, we will evaluate both process and impact measures to ensure accomplishment of our goals and objectives.

Monthly meetings of the state oral health program’s Access Team will serve to assess progress on accomplishing plan activities and addressing barriers that may arise.

 OREGON

First Tooth: A Pediatric Dental / Medical Provider Collaboration
for the Prevention of Early Childhood Caries
Department of Human Services
Office of Family Health
Address: 800 N.E. Oregon St., Suite 825
Portland, Oregon  97232
Phone:  971-673-0338
Fax:  971-673-0240

The Dental Care Health Professional Shortage Area (HPSA) is 55.6% in Oregon compared to 26.9% nationally. As only 20% of Oregon’s population has access to fluoridated water systems, children in these areas are at high risk of developing cavities. Recent Oregon Medicaid data shows that only 79% of children age 12-23 months received a preventive visit from a dentist and 36% of children between the ages of 2 and 5 received at least one preventive dental care service. More than a third of children in Oregon need treatment for tooth decay, yet an estimated 38 percent had not seen a dentist in the year previous to the survey.

The project goal is to expand the oral health workforce in Oregon by utilizing medical care providers to deliver early childhood caries prevention services to at-risk children ages birth to three years; develop and launch a web-based training/education curriculum and tools readily accessible to all professionals and others with a stake in early childhood caries prevention for all of Oregon’s children; and facilitate collaborative referral relationships between dentists and primary medical care providers in order that all Oregon children ages birth to three years have a dental home.

PROJECT OBJECTIVES:

1. Develop face to face and web-based curricula and schedule of education and outreach to dental and medical providers throughout a three-county region
2. Train at least 60 dental and family/pediatric health providers in the targeted region on early childhood caries prevention
3. Ensure that at least 4,000 infants and toddlers in the targeted region are identified as having a dental home
4. 80 dentists will provide early childhood caries prevention services to at least 4,000 infants and toddlers in the targeted region
5. At least 50 percent of participating dentists will report that they are collaborating with participating medical providers and vice versa

The First Tooth project is to be administered in two phases.

Phase I:

1. Target three counties in a regional area to serve as a pilot. Bring together partners to identify key learning objectives and create the framework for curriculum development.
2. Develop face-to-face and web-based curricula.
3. Develop outreach strategies to target providers.
4. Implement provider training as a method to field test curricula materials and content within the pilot.

Phase II:

1. Emphasize statewide training, as well as analysis of linkages to dental homes for the targeted children.
   

 PUERTO RICO

Accessibility of the Elderly Population to the Oral Health Workforce in Puerto Rico
Name: Ramón F. González, DDS, MPH
University of Puerto Rico School of Dental Medicine (SDM)
Address: PO Box 365067
San Juan, Puerto Rico  00936-5067
Phone:  787-758-2525 Ext 1121/2509
Fax:  787-751-5279

Studies show that the Puerto Rican elderly population experience unmet needs in oral health. Their low-income status and poor educational levels are some barriers that keep them from visiting the dentist. On the other hand, the numbers of providers that respond to their special requirements and that are culturally competent and willing to attend to their needs is low compared to the high numbers of people over 60 years. With studies predicting a larger population within this age group in future decades, it is necessary to improve the oral health workforce and service delivery infrastructure.

The SDM is committed to increase the accessibility of the oral health workforce for the geriatric population of Puerto Rico. A one-year planning grant in 2008, through the HRSA Grants to States to Support Oral Health Workforce Activities program, allowed us to convene a Strategic Planning Committee with stakeholders of the oral health community and representatives of the elderly population to develop a statewide strategic plan addressing goals in line with those of the Bureau of Health Professions.

These goals are:

• To improve the delivery of oral health care of the geriatric population by assuring that infrastructure exists to support an efficient and effective oral health professions workforce.
• To assure quality oral health care to the geriatric population in Puerto Rico by improving the knowledge, skills, competencies, and outcomes of the health provision of direct services and exposure of students, residents, and dentists to caring
• To increase the recruitment and retention of disadvantaged students at the Puerto Rico School of Dental Medicine
• To improve the oral health care delivery system of the geriatric population in Puerto Rico through changes in organizational practices and public policy

Strategies to accomplish these goals fall under three categories: practice environment strategies, dental education strategies and applicant pool strategies. Key activities in the plan are: a) the introduction of geriatric dentistry topics throughout the dental curriculum, b) the development of a Fellowship Program in Geriatric Dentistry, c) the provision of continuing dental education in geriatric dentistry to Puerto Rico’s dental community, d) the recruitment and retention of disadvantaged students, e) the collaborate to increase the role of hygienists in geriatric dentistry and f) the provision of comprehensive culturally competent geriatric oral health services

This is a new project with an innovative comprehensive approach to address the Puerto Rican oral health workforce supply and requirements; in collaboration with partners in the Network for Oral Health of the Geriatric Population in Puerto Rico, is committed to achieve its ambitious goals.

 RHODE ISLAND

Rhode Island Oral Health Workforce Partnerships Project
Name: Laurie Leonard, MS
Rhode Island Department of Health
Address: 3 Capitol Hill, Room 309
Providence, Rhode Island  02908-5097
Phone:  401-222-2433
Fax:  401-222-1442
 

In recent years, RI has received federal and foundation funds to support a variety of oral health initiatives. As
a result, RI stakeholders have worked collaboratively on a number of important oral health initiatives including, but not limited to: 1) publication/dissemination of the RI Oral Health Plan, 2006, RI Oral Health Surveillance Plan, 2006, and The Burden of Oral Diseases in RI, 2006; 2) completion of the first statewide oral health screening of third graders in partnership with schools and school dentists; 3) implementation of RIte Smiles, an enhanced dental Medicaid program for children ages 0-9 years; 4) expansion of dental capacity at community health centers and hospitals; 5) establishment of a general practice residency (GPR) program and pediatric dentistry residency (AEPD) program at inner-city hospitals; and 6) development of extensive and robust oral health partnerships.

Further, under the leadership of the RI Oral Health Program, a series of annual mini-residency programs in pediatric, special care, and geriatric dentistry were convened, and training on culturally and linguistically appropriate services (CLAS) standards was offered to dentists, dental hygienists, and dental assistants statewide. These efforts have contributed to improved access to oral health services for some underserved geographic areas and populations by increasing the number of appropriately trained and culturally competent oral health providers. Despite these accomplishments, RI is facing significant oral health workforce challenges. There is no in-state dental school and 56% of actively practicing dentists are of retirement age (50 years and over). With insufficient state funds for the RI Health Professional Loan Repayment Program, RI has not been able to leverage matching Federal dollars, and valuable support for oral health professional recruitment and retention initiatives has been lost. While RIte Smiles has improved access for young children in Medicaid, the persistent shortage of oral health professionals impacts the state’s most vulnerable populations – families with low-income, underserved perinatal women and adults, elders in nursing facilities, and those of minority race/ethnicity.

To address these current workforce and delivery systems gaps, priority areas have been identified by key RI coalitions and stakeholders in the 2006 RI Oral Health Plan. The proposed activities are complementary, built upon synergy and past partnership successes, and include: 1) Enhanced oral health infrastructure within the state health department; 2) Expanded services for underserved perinatal women and adults through creation of an Advanced Education in General Dentistry (AEGD) Residency Program in collaboration with St. Joseph
Health Services of RI; 3) Expanded mobile dental programs serving Medicaid elders in nursing homes; 4) Loan forgiveness funds ($50,000 annually) for two dental professionals working in dental health professional shortage areas; and 5) Oral disease risk assessment/disease management trainings for primary care providers (pediatricians, family practice physicians, and obstetricians), continued cultural competency training for oral health professionals that focuses on health literacy and communicating across cultures, and the integration of oral health topics/content with curricula for youth participating in health career exploration/work experience programs operated by the Central RI Area Health Education Center.

 SOUTH DAKOTA

Name: Julie Ellingson
Oral Health Coordinator
South Dakota Department of Health
Address: 615 East 4th Street
Pierre, South Dakota  57501-1700
Phone:  605-773-7150
Fax:  605-773-5509
 
The purpose of the Grant to Support Oral Health Workforce Activities in South Dakota is to improve the oral health of underserved residents through implementation of initiatives in the South Dakota State Oral Health Plan. The project is comprised of three complementary and interrelated goals: (1) ensuring an integrated, comprehensive oral health surveillance system for ongoing collection and assessment of the dental workforce and dental needs of the underserved; (2) implementing the state oral health strategic plan to increase dental workforce, service delivery, and access to care; and (3) collaborating with partners to increase the number of underserved, Medicaid/SCHIP enrolled, and Native American children receiving preventive and restorative dental services.

South Dakota has pressing unmet oral health and dental workforce needs. Sixty-six percent of 3rd grade students in South Dakota experience caries and 33% have untreated decay. For the Native American population, the problem is worse with 84% of 3rd graders experiencing caries and 51% with untreated decay. Only 14% of one-year-old children have been to a dentist and only 16% of children ages 0-3 enrolled in Early Head Start received a dental examination. For children aged 1-20 enrolled in Medicaid, only 32% has received dental treatment. There are 320 practicing general dentists in South Dakota, but nearly half the counties in the state, are designated as dental Health Professional Shortage Areas. There is no dental school or dental residency program in South Dakota which impacts the state's ability to increase the number of dentists in the state.

The goal of this proposal is to improve the oral health of underserved residents of South Dakota by increasing the dental workforce and expanding and supporting projects addressing access to care and community-based prevention programs. With limited resources, there is a need to revise the current disease-based repair system and promote prevention by developing and implementing an early prevention system. Thirty key oral health advocates and partners recently developed the State Oral Health Plan and will collaborate to implement the following initiatives proposed in the strategic plan:

• Objective 1: Improve the systematic assessment of the oral health needs in the state.

• Objective 2: Increase the number of dental professionals in the state and the proportion of dental professionals who provide services for the underserved populations.

• Objective 3: Develop, promote, and implement effective prevention programs including expansion of the traditional service delivery model.

Low income children and adults, particularly those residing in dental Health Professional Shortage Areas, including rural and high risk populations statewide and Native American children will be the focus to be served by this grant.

 VIRGINIA

Virginia State Oral Health Workforce Activities Grant
Name: Karen C. Day, DDS, MPH, MS
State Dental Director
Virginia Department of Health
Address: 109 Governor Street, 9th floor
Richmond, Virginia  23219
Phone:  804-864-7775
Fax:  804-864-7783
 

In spite of a long history of care and prevention in Virginia, dental disease remains the most common chronic disease of the state’s children with rates comparable to the national average. Approximately 34% of Virginia’s citizens do not have access to dental insurance, and according to a 2006 state manpower analysis, 80% of Virginia’s counties and independent cities qualify as dentist shortage areas. Although improvements have been made in the dental Medicaid program, there are still inadequate numbers of dental Medicaid providers, pediatric and general dentists in underserved areas, as well as safety net programs to meet the needs of low-income children and adults.

The purpose of this proposal from the Virginia Department of Health (VDH) is to improve the state's oral health workforce and service delivery infrastructure for underserved populations, focusing primarily on addressing the needs of three health districts (Cumberland Plateau, Lenowisco, and Southside). A multifocal approach, which includes prevention and treatment services, will be used to accomplish the ultimate goal of improved oral health for the residents of these areas. Activities that will be used to accomplish this goal include expansion of an existing program operated by the state dental society that provides services to individuals in need; establishing or expanding community-based prevention services including community water fluoridation, school based dental sealants, fluoride varnish, and home visitation/care coordination; establishing a loan repayment program for dentists practicing in dental Health Professional Shortage Areas; and working with entities that serve children with special health care needs to improve their access to care and preventive services.

State laws and regulations are often a barrier in access to care, by limiting the type of practice settings and imposing restrictive supervision requirements. Legislative changes made this year will allow dental hygienists employed by VDH to work under less restrictive supervision requirements in the three targeted health districts, selected because of their high oral health needs and limited availability of safety-net providers. This is a new concept for public health practice in Virginia and if successful, has potential for replication and dissemination to other underserved areas of the state, as well as sustainability through Medicaid billing.

 WASHINGTON

WA State Dental Network for Training and Coordination
Name: Joseli Alves-Dunkerson
Manager of State Oral Health Program
WA State Department of Health
Address: PO Box 47835
Olympia, Washington  98504-7835
Phone:  360-236-3524
Fax:  360-236-2323
 

Purpose of Proposed Project
Washington State seeks funding through this grant opportunity to enhance its oral health system capacity by: a) promoting needed workforce training and incentives, and b) developing a well-coordinated referral system network that effectively improves access to care for those most in need. The ultimate goal is to decrease the state’s oral health disparities, which are concentrated among those with low-income, from racial/ethnic groups, uninsured, eligible for Medicaid, with disabilities or special needs, and residing in rural and remote areas. These population groups affected by oral health disparities will be referred as “underserved population groups” in this grant proposal. Washington State will take a systems approach and pursue workforce efforts to both prevent dental disease as well as improve access to care in a way that is culturally competent to the populations it aims to reach.  

Population to be served:
This grant will allow Washington State to enhance workforce and referral activities in order to address the oral health needs of the underserved, which include those with low income, from minority groups, from special populations (such as children with special needs, individuals with disabilities, individuals with HIV/AIDS, seniors, pregnant women), and from rural areas.

Needs to be addressed:
Underserved populations harbor the greatest amount of oral diseases and least access care.
Workforce training initiatives for the underserved (dental pipeline) exist in the state but are being shrunk or discontinued due to the economic downturn. Private dental providers are not motivated to treat this population.
Public dental clinics do a great service and still could benefit from increased efficiencies and productivity especially with the newly created position of Expanded-function Dental Auxiliaries (EFDAs).

Local public oral health services do not always work together to address the needs of the underserved.
Several individual referral networks for the underserved exist in the state, but they are disconnected and often feel frustrated with their lack of success in making dental referrals. 

Proposed activities:
Through the Grants to States to Support Oral Health Workforce Activities (HRSA-09-109), Washington State will be able to collaborate with a myriad of public and private partners and take a systematic approach that includes:
 

By pursuing these objectives, this grant proposal will address all the 12 suggested activities listed in the grant guidance, plus three new activities that reflect the workforce and referral needs of Washington State.

 WISCONSIN

Oral Health Workforce Activities
Name: Warren R. LeMay
One West Wilson Street
Address: PO Box 7850
Madison, Wisconsin  53707-7850
Phone:  608-266-5152
Fax:  608-266-8925
 

In many areas across Wisconsin, families and individuals have a difficult time obtaining adequate access to dental care services.  A variety of obstacles may deter individuals from obtaining the care they need.  These barriers may be financial, geographic, perceptual, educational, linguistic, cultural, or provider-related.  Substantial oral health disparities between populations of different income levels, ages, and cultures also exist.  Increased resources targeted to high risk populations for the prevention of oral disease could improve the oral health of Wisconsin children.

The purpose of the program proposed in this grant application is two-fold: 1) to improve access to oral health care by increasing the number of oral health providers providing preventive based services to targeted populations, and 2) to enhance and expand a diverse and culturally competent dental public health workforce by engaging dental hygiene and dental assistant students from at least one Wisconsin Technical College and one Community Action Program.  The program will expand Wisconsin’s Seal-A-Smile school based sealant program, integrate a service learning component in the non-traditional care settings for students and provide a unique avenue to enhance knowledge and clinical skills.

The Wisconsin Department of Health Services (DHS) will contract with the Children’s Health Alliance of Wisconsin to administer mini-grants for school-based and school-linked dental sealant programs through the Seal-A-Smile Initiative.  DHS will additionally contract with one Wisconsin Technical College and one Community Action Program to expand and enhance their capacity by providing clinical training and support for school-based and school-linked dental sealant programs.  By optimizing these partnerships the program will assure that children receive a highly effective but underutilized dental prevention service through a proven community-based approach.  The program will support infrastructure workforce capacity by increasing funding support to local public health departments and organizations for the increased utilization of dental hygienists and dental assistants for community-based activities.  The program will maximize effectiveness by targeting high risk children, including vulnerable populations less likely to receive private dental care, such as children eligible for free or reduced-cost lunch programs.  The primary grades to be targeted are the second and sixth grades.