Section 3: Profiles and Audio from the Field

Features

Methods facilitating the University of Illinois’ partnership with Heartland Health Outreach include: Budgeting Community Outreach Regular Meetings Emails Medical and Dental Providers Share, Collaborate and Provide Clinical Information Memoranda of Agreement Scheduling

Partners

University of Illinois at Chicago College of Dentistry Heartland Health Outreach

Illinois
University of Illinois at Chicago, College of Dentistry

Close Partnership, Continuous Feedback

An affiliation is like dating, but a partnership is like marriage. That’s how the dental project team at the University of Illinois sums up their Ryan White dental partnership with Heartland Health Outreach. The point, of course, is not about who has to cook dinner or clean the dishes. It’s about the level of effort it takes to make things work.

This marriage involves two very substantial service agencies. The University of Illinois at Chicago College of Dentistry is the State’s largest provider of dental care to PLWH. Their HIV/AIDS dental practice started in 1989 with 60 patients and now has over 2,600. The community partner, Heartland Health Outreach, is a multi-site human service agency that got its start in 1888. This close partnership works because of joint involvement in multiple activities (see Features).

The following methods facilitate the University of Illinois’ partnership with Heartland Health Outreach:

• Budgeting. Each partner provides input on budget issues, aiding buy-in to the overall project as all partners have a financial stake and obligation in the Partnership’s ongoing success. This also helps ensure that plans that are proposed are actually doable.
• Community Outreach. The University urges community-based preceptors to represent the project at local and national meetings.
• Regular Meetings. Monthly meetings are held at various partner facilities to discuss program status (especially with regard to students, patients, and preceptors). By rotating locations and lead roles, there is a lessened perception of one partner as the lead agency.
• Emails. Communication is ongoing via email and typically covers budgets, student scheduling, and other issues that come up at talk-back sessions (e.g., how to handle needle-stick reimbursement).
• Medical and Dental Providers Share, Collaborate and Provide Clinical Information. This is accomplished via telephone, letters, and consult requests that specify medical information needed by the medical provider or the dentist.
• Memoranda of Agreement. This document helps clarify partners’ understanding of the bylaws and responsibilities of each entity.
• Scheduling. Student scheduling ensures that students are scheduled when they are needed and available (e.g., not during spring break). It also ensures that preceptors are available to supervise students during these times (i.e. not during staff meetings).

Services: Steps Taken to Address No Shows

Three dental clinics provide care to patients with HIV in the Illinois program (two dental clinics at the community partner site and one HIV-specific clinic at the University). Sites can provide dental care on an emergency walk-in basis; regular patients are seen within 24 hours.

The current broken appointment rate is quite high, 30-40 percent, at the two community dental clinics. Typical reasons given for no-shows are weather. Steps take in response include:

• The appointment staff regularly checks for potential conflicts with medical care appointments at other health care clinics. This is done by simply calling providers listed on dental patient charts to check on appointment times. The providers at the medical agencies share the same parent organization, and patients give consent for this cross-checking before entering into the health-delivery system.
• Dental appointment staff members confirm telephone numbers and addresses of patients at each visit.
• Patients with specialty care needs in periodontics, orthodontics, endodontics and oral surgery are referred to the University dental clinic. These referrals are tracked by a paper check-in process that includes notations in charts.

Provider Education and Training: Rotation Time Expanded

Students used to be on-site at the Heartland community site for just one week—not nearly enough time to gain an appreciation of community dentistry and the rapid pace of seeing varied clients with many needs. The rotation was expanded to 20 days to provide students with a richer learning experience and more comfort treating PLWH. Student training includes the following:

• Students receive formal instruction and supervised clinic experience in: (1) HIV medical risk assessment including taking records and interpreting a medical history and physical evaluation as performed by a physician; (2) understanding the indications of and interpretation of laboratory studies, and (3) understanding the relationship of oral health care and HIV disease.
• Students engage in structured reflection activities, using a service-learning methodology. Students are asked to undertake a critical analysis about their experience working with HIV positive patients by completing a “Significant Moment Report” that poses three questions about an incident (of the students’ choosing) that happened during the clerkship. The intent is to turn conflicts into learning opportunities. (See the TARGET Center’s TA Library for a copy of this form.)
• Students are directed to examine a key policy issue they have identified and describe their experience in advocating for change.
• Students and residents engage in monthly “talk-back” sessions to share feedback on experiences.

Retention and Recruitment of Clients

The University of Illinois serves as a resource to other health care providers in the community regarding HIV related oral health. This is done via presentations to dentists in such settings as the AIDS Education and Training Center (AETC) Dental Study Club and the University’s UIC Extramural Site Conference. Up to eight of these presentations are held each year and are conducted by the community clinic’s dental director, principle investigator, and/or AETC-sponsored speakers. Additionally, University dentists are available to community dentists for regular consults about their private patients.