Dental Competency and Quality Assessment Tools. The
“Competencies Project” measures and monitors dental competency and includes a
set of competency statements relevant to providing high quality oral health care
to people living with HIV/AIDS. Each competency is expressed as a statement with
corresponding sub-competencies. In turn, statements are tied to cognitive,
affective and behavioral learning objectives and linked to a final set of
learning objectives to fellow-defined service objectives.
A Web blog site has been developed to allow participants
of the rotations to share their experiences with each other. The goal is to
foster a community of learners.
Partners
Columbia University, College of Dental Medicine
Harlem United Community AIDS Center
New York City
Columbia University, College of Dental Medicine
Harlem Project Delivers Dental Care in HIV/AIDS Clinic
Two strong institutions with a tremendous amount of buy-in define this Ryan
White dental partnership between Columbia University and an AIDS service agency
called Harlem United Community AIDS Center. Harlem United Community AIDS Center
delivers an array of “one-stop shop” primary care services exclusively for PLWH,
including routine dental care. Columbia’s College of Dental Medicine administers
the grant and devotes considerable attention to the learning experience for
dental students and Advanced Education in General Dentistry Program (AEGD) that
fellows get while at Harlem United. Columbia also delivers specialty and
surgical dental care to PLWH and has developed competency standards to measure
provider readiness to provide high quality dental care to PLWH.
Mechanisms that help the Columbia-Harlem partnership work smoothly include:
Formal documentation of the partnership through a
sub-contract that specifies responsibilities, financial arrangements, and shared
commitment to project goals.
Formal communications among partners through bi-weekly
meetings convened by the project director. Meetings track progress in reaching
project goals and objectives, address issues as they arise, and inform
participants in areas such as competencies and service learning.
Tracking of progress through monthly reports on clinical
and trainee performance.
Partner involvement in the planning and development of
the project proposal and work plan, which enhances buy-in.
Services: One-Stop Shop and Ample Communication
Harlem United was founded in 1988 to serve hard-to-reach
HIV clients with multiple health problems who are living in two poor underserved
inner-city communities, including Harlem and the South Bronx. Beyond medical
care, services include housing, substance abuse, mental health, and many other
areas, providing patients with the full gamut of care. In 2006, Harlem United
provided services to 2,430 unduplicated clients of which 450 received dental
care—a 27 percent increase from the prior year.
Dental care is well-integrated with other care at Harlem
United, in part, because they are in the same building but only a floor away.
Other facilitators of collaboration:
Clinical directors of the medical and dental departments
share philosophies about patient care (i.e. treating the total health of the
patient).
Multispecialty clinical care planning committees meet
weekly to address treatment planning and coordination across multiple services.
Dental trainees participate in these personalized care sessions.
Directors communicate informally on a daily basis, and
more formally through regular meetings with other staff at Harlem (e.g., case
managers, therapists).
Provider Education and Training: An Enhanced Identity as a Caring Professional
Prior to sending students on rotations at Harlem, Columbia
uses a didactic curriculum that reviews dental management and treatment of the
HIV-positive person. It can be used both as a guide for an experienced clinician
or as a primer for a novice. Rotations for residents entail two days a week for
a semester or more at Harlem’s dental department, while pre-doctoral dental
students participate in clinical care during variable-length short-term
rotations of 7 to 50 hours through their elective “Community Dentistry Area of
Concentration.”
Once on-site, Columbia takes steps to ensure that rotations
at Harlem United have a real impact on trainees. It’s called a strong service
learning component and is put into practice using multiple techniques:
The dental director at Harlem United carves out time at
the end of each clinical day to spend time with AEGD fellows and students on
rotation to discuss their experiences for the day and provide a forum for direct
feedback from them. These reflection sessions are structured through a series of
trigger questions that address trainees’ expectations and experiences, attitudes
and values, and understanding of their patients’ social, behavioral, and
environmental conditions.
A web blog site has been developed to allow participants
of the rotations to share their experiences with each other. The goal is to
foster a community of learners.
During academic year 2007-2008, training involved exposure
experiences for 13 undergraduate students of whom seven had intensive clinical
rotations and 22 AEGD fellows of which five had intensive experiences. Several
third-year undergraduate students have requested to return to Harlem United
during their fourth-year of school to fulfill their “Area of Concentration
Project”—a graduation requirement for students to spend four semesters exploring
a concentrated area of study.
Patient Education and Involvement: Feedback Sought—and Incorporated
A family-like atmosphere is reported to exist at Harlem
United, in part because of low staff turnover and the high level of familiarity
between staff and clients. In addition, Harlem takes the extra step to secure
formal and informal feedback via patient surveys, focus groups, a bi-weekly oral
health education group session (“Healthy Smile Dental Group”), a Client Advisory
Board, and institution-wide client meetings. In turn, efforts are made to
fulfill consumer-recommended service enhancements such as sedation therapy,
expanded hours of operations to include evening hours and Saturdays, and
in-house oral surgery that expands dental care available on site at Harlem.
Patient education activities include a day program, one of
many at Harlem, known as the “Healthy Smile Dental Group.” This group focuses on
the importance of oral health through oral hygiene instruction and education
dental care services at Harlem. Patient education is also incorporated into each
client’s visit to the dental department as well as visits to the medical
department, where educational materials are available in both English and
Spanish languages.
