Benefits and Challenges Valerie A. Fatta, LMSW, University at Buffalo Clarener Moultrie, MSW, Columbia University Heather Marks, MSW, University of Washington
Benefits
Improved Access to Care Facilitated Insurance Enrollment Financial Literacy & Education Transportation Caregiving Resources Health/Mental Health Referrals Other Accommodations By Retaining Patients We Increase Clinic Revenues
Interprofessional Education Dental Students Identifying and removing barriers to care for patients Improved understanding of available resources Communication and behavior management Social Work Students Understanding the importance of Oral Health Care Assessment Advocacy Linking patients to appropriate resources
Multidisciplinary Teams Evaluation and Assessment Chair-side if needed Pilot Programs/Projects Research Interprofessional Community Outreach Practice
Behavioral Needs TMD Smoking Cessation Substance Use Nutrition Oral Hygiene HIV Screening Dental Anxiety
Research Opportunities Educational Student perspectives Interdisciplinary education Clinical Interprofessional practice Attitudes Outcomes Dental Journals Social Work Journals Conferences Others?
Team Approach To Crisis Management Child Welfare Domestic Violence Suicide Elder Abuse Prescription Drug Abuse Consent to treatment Social Worker Patient Dental Provider
Challenges
Establishing Need To hire a social work for your clinic takes capital (salary, supplies, etc). It would be difficult to justify this expense without evidence that this is a needed service which will improve your clinic. Surveys distributed in the clinic/waiting rooms can help determine the needs of your local population, and if there would be an interest in social work services. Students can distribute the survey as part of research course work.
Finding Funding Once need is established, finding the funding to support this might be another barrier. Keep in mind your social worker or team will need office space and supplies. Grants University at Buffalo Office of the Dean University of Washington ABCD Access to Baby and Child Dentistry funding from state Interns to assist
Hiring Social Work Staff Many dental educators and dental school administrators have never had the need to hire a social worker before. Knowing what to look for and who to hire can be challenging. What are realistic expectations of the social worker hired? Determine your school s specific needs/wants Partner with a School of Social Work if possible Resources: NASW State s Office of Professions United States Department of Labor, Bureau of Labor and Statistics UB CARES Program
Education of Providers Social workers are still new to the dental team. Dental providers need to be educated on how to utilize social workers in the dental setting Social workers need education on dental terminology and oral health care. Orientations Courses Clinic News Letters Meetings (Lunch and Learns) Brochures/Websites/ Information Patience
Lack of Support Emerging and small programs need Champions who can assist in the program development and provide support for continuation of the program Can faculty and administrators (both dental and social work) be identified who have passion for community access to care that are willing to take on a project Program advisory boards
Record Keeping How will the social work team keep records? Will they be separate from the dental records? Where will they be stored? What assessment tools will be used? Consent forms? Each program/team will need to decide what is best for them HIPAA laws Shared information Electronic Records
Program Limitations Case Loads? Hours? Treatment limitations? Intern limitations? Projects? How many patients do you expect your social workers to assist at one time? When should they be available to students/patients? Is there any treatment limitations determined by your school or state? If you plan to have interns, what will their limitations be? Will there be a limit to the amount of projects you have your social workers take on? Minimum requirement?
History of The CARES Program The University at Buffalo A top down initiative
Idea Development Need at the School of Dental Medicine to retain patients Students losing clinic time to no-shows and cancellations, discharges Need at the School of Social Work for field placements Students must complete two internships prior to graduation Community driven mindset Interested Faculty
Grant from Community Foundation of Buffalo $30,000 Initial Funding Paid for waiting room survey, and part time social worker One year duration After grant competition, SDM saw continued need, adopted CARES Program as part of the Office of the Dean
Waiting Room Survey Results showed the strongest need was Medical 928 patients were administered a two page survey in SDM waiting rooms. Ranked concerns: Health problems (32%) Financial problems (25%) Medical bills (16%) Family problems (14%) End of life (12%) Living will (11%) Transportation (11%) Housing (9%) Health care proxy (8%) Caregiving (5%) Power of attorney (4%) Raising a grandchild (3%) Other concerns (2%) Based on current referrals strongest need is financial 2011-2012 showed 67% of referrals for financial assistance
Referrals At first, the social work utilized the surveys to contact patients and set up a client base Dental Students began to bring patients to meet with the social worker Referrals now come only from Dental Students, faculty, staff and word of mouth Last year, the CARES Program received 288 patient referrals
Staffing Started with 1 part time social worker Currently 2 full time social workers, hiring one part time & 5 interns Another social worker is being hired by Oral Bio to work with TMD Grants to expand One full time social worker plus 7 interns Two full time social workers, one part time, 5 interns One part time social worker Two full time social workers plus 4 interns
Interprofessional Education and Practice: Social workers are available during clinic hours to provide consolation and assistance to dental students This past semester social workers have assisted patients with domestic violence concerns (1), suicidal ideation (2), and consent to treatment concerns (2) CARES Staff is currently teaching a section of a clinic rotation course for sophomores CARES Interns and Staff interact with dental students on a regular basis to consult about treatment needs and best practices for patient care
Awards American Dental Association Geriatric Oral Health Award American Dental Education Association Dr. Henrie Treadwell Dental Award Partner of the Year Award Partners for Prevention Cancer Screening Services of Erie County Invited Presentations ADEA Conferences, CSWE Conferences, SUNY Upstate Medical University, University at Buffalo, Buffalo State College, Community Agencies Grants Community Foundation of Greater Buffalo - $33,000 Dental Trade Alliance - $25,000 Josephine Goodyear Grant - $5,000 New York State Dental Foundation - $7,000 Health Foundation of Western New York Grant to 8 th District Dental Society Shared with CARES Program - $7,500 Publications (5 total) Accomplishments Social Work in Health Care Journal of Dental Education Gerontology and Geriatrics Education Collaboration between the schools has brought positive attention to UB
Student Reviews: I had a patient who had some emotional problems that I felt I was unprepared to deal with on my own and the CARES program was really helpful with this matter. They took over the situation but still let me be involved and I learned a lot from it. One student indicated that the school was doing much better in integrating the behavioral sciences into the clinic, especially with the CARES program. There are kinks in it, but it s very necessary and important. CARES is a good idea.
Continued: I think it s a nice program if it comes up in your patient family. It was nice that they came down to check every week to see if you need anything. It s one of the best things here- keeps patients here. just the fact that we have the program and I can tell the patients that we have this program to help them with any (problems) is wonderful. It s a good program to have to refer people to. Personally, I think I didn t really utilize it fully but it s great to have it.
Network of Social Work in Dentistry Grants in progress to fund idea TMD Program Research Opportunities Assistance in the Development of New Programs Consultation Services Next Steps Other Grant Opportunities
History of Social Work in the Center for Pediatric Dentistry University at Washington
UW Pediatric Dentistry The University of Washington pediatric dental residency program is committed to treating underserved populations including Medicaidinsured patients with complex health challenges who may have obstacles to obtaining dental care from more conventional practices as noted in the Washington State s Oral Health Workforce 2009 Final Report.
Idea Development UW Pediatric Dentistry focus on underserved Long-standing pediatric residency program 1979: Chair Dr. Pete Domoto denied funding for social worker in pediatric dentistry 2003-7: Part-time MSW student joins staff as Pedo alumni newsletter editor MSW student researches ABCD & EPSDT = pedo patient profile 2007: Co-existent concerns supports need for UW social work position in pediatric dentistry
Funding 2007: Oral Health for Vulnerable Children: An Integrated Approach GHC grant funds pediatric dentistry social worker project 2008-Current: Access to Baby & Child Dentistry (ABCD) contract with State of Washington Medicaid program funds one social worker position Medicaid patient enrollment assistance Medicaid patient transportation assistance 2012: Added Social Work assistant (half time) Funded by Floyd & Delores Jones Foundation
Pew Center on the States Pew s recent report on the Children s Dental Campaign showed 80 percent of dental disease in children is concentrated in 25 percent of kids and children from poor families face disproportionately high barriers to getting care. The report continues that we need to ensure that Medicaid and the Children s Health Insurance Program the programs that serve low-income children work better for kids and for providers so that insurance coverage translates into real access to needed care.
Demographics From the Pacific to the Palouse Patients from 30 of 39 counties in Washington 35 of 39 counties lacked sufficient dentists for population* *Pew Center on the States
Focus: Barriers to Care Social work focus is overcoming barriers to care for pediatric patients Patient population almost 80% low-income Patients from 30 of 39 counties in Washington Major barriers to dental care for pediatric patients Children uninsured or underinsured Families lack transportation to appointments
Social Work Team Social work is integral to oral health care delivery team and contributes to the triple bottom lines of: Patient access to care - extending oral health care to more children in the service area by overcoming barriers to care, identifying red flags and responding to the overall situations of patients in their environment. Improved departmental reimbursement through Medicaid enrollment and the Domoto Fund financial assistance. Faculty and staff satisfaction from smoother interactions and better outcomes (no-shows, cultural and language barriers, mistrust of dentistry by patients and their parent/caregivers, etc.).
History of Social Work at Columbia Columbia College of Dentistry
Valerie A. Fatta, LMSW University at Buffalo (716) 829-2698 vafatta@buffalo.edu