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1 The RDHAP and the Virtual Dental Home: California Workforce Models for Underserved Populations Paul Glassman DDS, MA, MBA Professor of Dental Practice Director of Community Oral Health University of the Pacific School of Dentistry

2 Total Health: How Long and How Well We Live Environment, Public Health Health Care Delivery (procedures) 10% 20% 40% Behaviors (alcohol, tobacco, diet, exercise, preventive dental procedures?) 30% Genetics McGinnis JM & Foege WH. Actual Causes of Death in the United States. JAMA 1993; 270(18): (Nov 10). McGinnis JM, Williams-Russo P, Knickman JR. The case for more active policy attention to health promotion. Health Affairs 2002; 21(2):78-93 (Mar).

3 Population Categories 70% 30% Well Served Underserved 192 million 82 million Complex medical, physical, and social conditions Culturally diverse Institutionalized Economically disadvantaged Rural

4 The RDHAP RDHAP a California Workforce Model RDHAP = Registered it ddental tlhygienist itin Alternative Practice

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6 (29) January 2009

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8 The RDHAP in California 1980s HMPP RDHAP Pilot Project 1997 AB 560 Created RDHAP License 1998 RDHAP License Available st non-grandmothered license 2004 On-line training program 2008 over 200 RDHAPs

9 RDHAP Requirements Bachelors degree or its equivalent 2000 clinical i l hours in previous 36 months Current California Dental Hygiene license Completion of a 150 hour Dental Board approved course with specific content

10 Pacific RDHAP On Line Training i Program Started Fall 2004 Focus on care for people with complex medical, physical, social conditions 2 in-person days, 12 weeks of on-line modules ~ 150 graduates

11 RDHAP Practice Sites Residences of the homebound Schools Residential facilities and other institutions Dental health professional shortage areas

12 RDHAP Practice

13 California Dental Association Journal August/September 2005

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15 Oral Health Care Delivery System Services delivered in locations where people live, work, play, go to school, receive social services screening, triage, prevention education Prevention services - Fl varnish, sealants, medical model treatments minor dental procedures Complex dental procedures Dental office Sf Safety net clinic Hospital

16 Evolution of Community-Based Care Success and need for community-based care management models Evolution of direct access hygiene practice Fragmented care Collaborative systems Teledentistry systems

17 The Medical Home care management over time; health promotion activities; iti access to technical medical services when needed; in pediatric medical home models, there is also an emphasis on early intervention services.

18 Promotoras RDHAP ADHP CDHC DHAT CDA/CDHA Virtual Dental Home Project Community Oral Health Providers

19 Promotoras CDHC DHAT RDHAP ADHP Community Oral Health Providers

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21

22 The Virtual Dental Home in Action

23 The Virtual Dental Home in Action

24 The Virtual Dental Home in Action

25 The Virtual Dental Home in Action

26 Perform Procedures in the Community Care management over time Preventive education Prevention procedures o o o Teeth cleaning Medical treatments Temporary bonded restorations

27 The Virtual Dental Home in Action

28 Opportunity The Virtual Dental Home Emphasize health promotion in effective settings Connect dentists with community-based oral health professionals (dental hygienists and dental assistants) Develop workable collaborative systems Win-win for: Dentists Community-based oral health professionals Underserved d populations

29 Steps The Virtual Dental Home Infrastucture, t training, i agreements Expand the duties of existing providers OSHPD HWPP bonded glass ionomer temporary restorations Current: proof of concept demonstration Next: measure health improvement, economic modeling, regulatory reform, stabilize and spread

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31 We do not yet know which workforce models will work best to improve oral health for various underserved d populations Multiple models and collaborative arrangements will be needed for various locations and populations Oral health activities must be integrated into social service and general health systems We need to support experimentation, data collection, and reform to support new systems

32 California Dental Association California Dental Association Foundation American Dental Hygienists Association California Dental Hygienists Association The California Health Care Foundation The California Department of Developmental Services ADHA Institute for Oral Health The California Endowment The Verizon Foundation

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