Alaska s Dental Health Aide Therapists

Transcription

1 Alaska s Dental Health Aide Therapists The American Academy of Dental Therapy, 2011 Mary E. Williard, DDS Community Colleges Advisory Group on Dental Therapy Educa?on Wednesday, January, 28, 2015, WDI,Santa Ana, CA

2 History of Dental Caries in Alaska Native People Archeological records show caries rate of ~1% Improved air transportation and dietary changes s Studies show lowest caries rate in the world Price, WA Nutrition and Physical Degeneration. 8 th ed. Lemon Grove, CA. Prevalence of dental caries in children 2x same aged U.S. children Vast majority of children have dental caries

3 Alaska Access and Workforce Issues n AN children dental disease rates n 2.5 <mes na<onal average n OR pediatric cases n Vacancies and annual turnover n 140,000Alaska Na<ve people n 85,000 live in the 200 villages n Few roads

4 Dental Therapists: A Definition Primary oral health care professionals Basic clinical dental treatment and preventive services Multidisciplinary team members Advocate for the needs of clients Refer for services beyond the scope of the dental therapist s practice.* *SASKATCHEWAN DENTAL THERAPISTS ASSOCIATION

5 Community Health Aide Program Structure Community Health Aide Program Certification Board Federally appointed Like a licensing board Diverse group Standards and Procedures Educational requirements Certification process Scope of practice Operated by the Alaska Tribal Health System

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7 Dental Health Aides: A local solution to a local problem Conan Murat, DHAT, standing his ground

8 Alaska s DHAT- A Local Solution to a Local Problem- National Implications Minnesota & Maine California American Dental Hygiene Association American Dental Association Individual states WA, NM, VT, OH, KS Health advocates

9 Different Providers DHAT DENTIST Different Education NEED TO KNOW Limited scope, 46 procedures NEED to know+ nice to know Large scope, 500+ Supervised Team leader Preven<on oriented team approach Accessible to students in target popula<ons Culturally competent Pa<ent centered Surgically oriented Educa<on is difficult to access, especially for minori<es Struggling to address cultural competency Prac<ce centered

10 Alaska DHAT Educational Program information: First year: 40 weeks Second year: 39 weeks Total: 79 weeks (3160 hours) Curriculum Break-down first year Biological Science: 30% Social Science: 10% Pre-clinic: 40% Clinic: 20% Curriculum Break-down second year Biological Science: 15% Social Science: 7% Pre-clinic: 0% Clinic: 78% (1215 hours) Combined: Biological Science: 22.5% Social Science: 8.5% Pre-clinic: 20% (632 hours) Clinic: 49% (1548 hours) DHAT Students Kate Kohl, Trisha Patton dissecting a cow heart

11 Curriculum DHAT curriculum adapted by AAPHD panel American Associa<on of Public Health Den<stry 11- person academic panel Model curriculum two- year, post- secondary Open access online: hzp://onlinelibrary.wiley.com/doi/ /jphd issue- s2/ issuetoc The Journal of Public Health Den?stry, Special Issue: Workforce Development in Den?stry: Addressing Access to Care Spring 2011 Volume 71, Issue Supplement S2

12 A Review of the Global Literature on Dental Therapists * Dental Therapists: Decrease cost of care Improve access to care Provide care safely Public values the role of dental therapists Tradi<onally 2 years educa<on *Prepared by: David A. Nash, Jay W. Friedman, Kavita R. Mathu- Muju, Peter G. Robinson, Julie Satur, Susan Moffat, Rosemary Kardos, Edward C.M. Lo, Anthony H.H. Wong, Nasruddin Jaafar, Jos van den Heuvel, Prathip Phantumvanit, Eu Oy Chu, Rahul Naidu, Lesley Naidoo, Irving McKenzie and Eshani Fernando Supported by the W.K. Kellogg Founda<on hzp:// and- media/ar<cle/2012/04/nash- report- is- evidence- that- dental- therapists- expand- access

13 Improved Access and Quality 25 certified DHAT 81 communities in rural AK Over 40,000 people have access Continuity of care Higher level of care possible Dentist working up to their licensure DHAT Aurora Johnson, NZ Educated

14 Medicaid and DHAT AK Medicaid pays for services provided by certified health aides DHAT services paid at same rate as dentists AK Medicaid was an early adopter of DHAT as provider because: tribal patients seen in tribal facilities = 100% Federal pass through $ treating disease earlier is usually cheaper savings on Medicaid travel with providers in communities

15 Tribal revenue as reported by dental directors with DHAT net annual revenue stream $125,000-$245,000 after costs Additional savings of ~ $40,000 in avoided travel 19 DHATs generate 76 jobs $9m economic activity in rural Alaska Scott and Co. Consulting, 2011

16 Dental Therapy Education: How much is enough? 2 years CODA Educational program standards multiple entry points and waivers Partnership with UW - opportunities to partner with community and tribal colleges

17 Keys to DHAT Success Not Mini Dentists 2 Year Education Competency based Cultural Competence General Supervision Appropriate Scope: Diagnosis and Treatment Planning Extractions Certification/ Recertification Community-based Trisha PaZon, DHAT student, taking x- rays

18 DHAT Educational Program Address: 4200 Lake Otis Parkway, Ste 204 Anchorage, AK Mary E. Williard, DDS DHAT training is ANTHCsmile on Facebook website: Div. of Community Health Services- DHAT education