BHPR -

Residency Training in General and Pediatric Dentistry > FY 2005 Grant Summaries

California

D59HP06492
Richard Udin, DDS
University of Southern California
837 W. Downey Way Ste 330
Los Angeles, CA 90098-1147
Tel: 213-740-2679
Email: scdental@hsc.usc.edu

The goal of this project is to expand access to pediatric dental care in Orange County, California to children in low-income families, to children with special healthcare needs and to children that are medically fragile. The goal of the Program closely mirrors the objectives of Healthy People 2010 on Oral Health of increasing prevention and control of oral and craniofacial diseases, conditions and injuries, and improving access to related services. The USC Advanced Pediatric Dentistry Program (USC) wishes to partner with Children’s Hospital of Orange County (CHOC) and Healthy Smiles for Kids of Orange County (Healthy Smiles), a non-profit entity formed with assistance from the Children and Families Commission of Orange County. Under this project, USC will establish a satellite hospital site for its Advanced Pediatric Dental Residency Program at CHOC, with outreach services through Healthy Smiles at their Children’s Health Dental Center. The USC Advanced Pediatric Dentistry Program will expand from 6 to 8 residency positions per year. The two added residents will complete their first year of didactic training at the USC campus, and their second year in Orange County at CHOC and Healthy Smiles. When in Orange County, the residents will become part of the CHOC residency program, completing the curriculum as defined and monitored by USC. CHOC will engage a full-time Dental Residency Director and two part-time faculty members to perform teaching. USC has successfully established similar programs at Long Beach Memorial Medical Center. CHOC currently does not provide dental care in their Specialty Care Center and does not have a pediatric dental residency program. USC, CHOC and Healthy Smiles believe that adding dental training and services will provide an immediate increase in access to care, as well as to provide a source of future pediatric dentists practicing in the County, providing care to the highest risk population of children.

D59HP06306
James J. Crall, DDS, ScD
UCLA School of Dentistry, Section of Pediatric Dentistry
10833 Le Conte Avenue, CHS 23-021A
Los Angeles, CA 90095
Tel: 310 - 206-3172
Email: jcrall@dent.ucla.edu

The proposed project seeks to initiate a new community-centered pediatric dentistry residency program at UCLA and to develop and implement a new, innovative curriculum that will enable all UCLA pediatric dentistry residents to acquire knowledge and skills necessary to more effectively meet the substantial and growing oral health needs of underserved children. The three primary objectives of the proposed project are to:

develop a new, comprehensive, competency-based Community Health and Advocacy Training for Pediatric Dentistry (CHAT-PD) residency curriculum in collaboration with faculty colleagues from the UCLA Department of Pediatrics who have developed the HRSA funded Community Health and Advocacy Training program (CHAT) for pediatrics residents;
initiate a new 27-month, UCLA CHAT for Pediatric Dentistry (CHAT-PD) residency program for 2 new residents each year based on the core and advanced components of the new CHAT-PD curriculum; and
integrate the core component of the CHAT-PD curriculum into the existing (traditional, health center-based) UCLA pediatric dentistry residency program curriculum and expand the quantity and quality of community-based training for residents in the traditional program.

The new CHAT-PD residency program and curriculum will be implemented through collaborative linkages with community organizations and primary care facilities in medically underserved communities of Venice and Mar Vista in West Los Angeles. CHAT-PD residents will receive the majority of their clinical pediatric dentistry training in these underserved communities at the UCLA Venice Dental Center, and participate in an extended set of learning experiences in local primary care and community settings linked to the Venice Family Clinic, a UCLA affiliate and the largest free clinic in the U.S. Integration of the core elements of the new CHAT-PD curriculum into the existing traditional residency will expand the amount of time that all UCLA pediatric dentistry residents spend providing comprehensive dental care in underserved communities. Implementation of the CHAT-PD curriculum will enhance residents' skills in delivering pediatric dental services and promoting oral health for children in underserved communities. Existing evaluation tools employing quantitative and qualitative measures will be modified and expanded to facilitate data collection and assessment of both the new CHAT-PD pediatric dentistry residency program and the curricular changes and related program outcomes in the CHAT-PD-modified traditional residency program.

D59HP05209
Donald Kohn, DDS
Pediatric Dentistry Center
Yale-New Haven Hospital (YNHH)
20 York Street
New Haven, CT 06504
Tel: 203-688-3033
Email: donald.kohn@yale.edu

The YNH Pediatric Dentistry Residency Program (PDRP) requests one funding preference as a new program located in a dental HPSA that expects to place graduates in medically underserved communities. It also requests one funding priority as a new program with more than 30% of its current trainees meeting the definition of having a "disadvantaged background."

The overall purpose of the proposed project is to build the infrastructure necessary to support the full implementation of the YNH PDRP. In doing so, YNHH will increase the number of dental providers serving in its medically underserved area; and, it expects to increase the number of graduates who either continue working with this population or who contribute to the field as educators and researchers. Ultimately, this project's purpose is to increase access for under and uninsured children and to increase awareness among other pediatric health care providers, families, and the community at-large. The proposed activities will fully implement the YNH PDRP by doubling the number of residents and bringing it to its full capacity of four residents. To accomplish this, YNH PDC seeks to expand its infrastructure and upgrade some of its existing facilities to accommodate increased providers and increased patient care. The launch of related activities will effectively lay the groundwork for YNH PDC to become a hub for continuing and multidisciplinary education, research and advocacy in pediatric dentistry, which will be expanded in years two and three of this grant project. At both the national and state level, there are repeated recommendations to overcome barriers by expanding awareness of oral health throughout the health care community; to review and update curricula to reflect the new research on oral health and the association of oral diseases to many chronic diseases; to diversify the dental workforce; and most importantly to create programs that increase access to care for the underserved. Guided by these recommendations and strategies, YNHH's new pediatric dentistry residency program will accomplish the following specific and measurable objectives:

Fully implement the program by building, upgrading, and expanding the infrastructure necessary to support two additional residents and additional patients.
Improve the oral health of children in southern Connecticut by increasing access to dental providers and improving continuity of care for this underinsured and uninsured pediatric population.

Disctrict of Columbia

D59HP05210
Karen S. Owens, DDS
Department of Mental Health
Saint Elizabeth Hospital
Tel: 202-645-7466
Email: Karen.owens@dc.gov

The General Practice Residency Training Program in General Dentistry provides advanced general practice residency training in dental specialties to five recent dental graduates at a public health hospital based training program. Over the past five years, HRSA support to our program provided an increase in the number of our minority program completers working in undeserved communities. In continuing with this effort, we are requesting HRSA support for another program expansion with program goals aimed at to increase the number of program graduates by one; increasing the number of program completers working in underserved special needs patients and cultural diverse patients; to improve access to preventive care for an underserved pediatric population; and develop and implement CQI indicators to capture and measure aspects of care not currently measured.

The General Practice Residency Training Program in General Dentistry is sponsored by Saint Elizabeth Hospital (SEH) a division of the District of Columbia Government Department of Mental Health. Our facilities include one main and two satellite dental clinics. Our program has trained new dentist while placing emphasis on dental health management and treatment of adults with acquired disabilities (mental health) who are wards of the District of Columbia. SHE ambulatory inpatient and outpatient dental faculty have performed for over 6500 encounters per year on a special needs population that includes minority and the most underserved population of mentally challenged, medically compromised, HIV/AIDS, and physically challenged patients in this HPSA designated dental shortage area. Over the past five years, the program has received HRSA support that increased our number of GPR minority program graduates to five.

The purpose of this project is to improve access to health care to special populations and undeserved populations through the achievement of the following goals: 1) to increase the number of program graduates to six per year; 2) to increase the number of program completers working in underserved communities; 3) to improve access to care for underserved special needs patients and culturally diverse patients by expanding the current curriculum to include educational experiences and practical experiences. Those experiences include distant learning technologies to train faculty and residents as qualified clinicians to treat persons with acquired (mental health) as well as and developmental (mental retardation) disabilities.

D30HP05271
George P. Thomas, DDS
Howard University College of Dentistry
Advanced Education Program in Pediatric Dentistry
600 W Street, N.W.
Washington, D.C. 20059
Tel: 202-806-0005
Email: gthomas@howard.edu

Howard University College of Dentistry has maintained an Advanced Education Program in Pediatric Dentistry (AEPPD) for the last 32 years at the highest level by graduating an average of three trainees each year. The program is fully accredited by the American Dental Association Commission on Dental Accreditation. The program has had some challenges in expansion of its recruiting efforts to meet the ever-present demand for underrepresented minorities in the dental community. The mission of the Howard University postdoctoral Pediatric Dentistry Program is to develop culturally competent oral health care professionals in Pediatric Dentistry who will in turn provide care to the underserved, uninsured and underinsured populations in the United States and the global community. The purpose of the proposed training grant is 1) to expand recruitment and enhance retention of underrepresented minority dentists in the practice of Pediatric Dentistry by offering tuition support and stipend funding; 2a) to enhance the training infrastructure by remodeling the existing recovery room to facilitate IV sedation which would allow postdoctoral Oral & Maxillofacial Surgery trainees to coordinate care in the Pediatric Dentistry Department and 2b) to add one support personnel position as a Care Manager to coordinate treatment for patients needing IV sedation and general anesthesia; and 3) to enhance the program to include an optional Master of Public Health (MPH) degree.

The overall objective of the AEPPD is to develop culturally competent oral health care professionals in Pediatric Dentistry who will in turn provide care to the underserved, uninsured and underinsured populations in the United States and the global community. The additional support will assist in achieving this ultimate objective. Therefore, the specific objectives of the proposed training grant are:

To expand recruitment and enhance retention of underrepresented minority dentists in the practice of Pediatric Dentistry by offering tuition support and stipend funding;
To enhance the training infrastructure by a) remodeling the existing recovery room to facilitate IV sedation room which would allow postdoctoral Oral & Maxillofacial Surgery trainees to coordinate care in the Pediatric Dentistry Department and (b) adding one support personnel position as a Care Manager to coordinate and facilitate treatment for patients needing IV sedation and general anesthesia;
To enhance the program to include an optional Master of Public Health degree.

Louisiana

D59HP05257
Janet Leigh, RDS, DMD
Louisiana State University School of Dentistry and Medical Center
1100 Florida Ave., Box 127
New Orleans, LA 70119
Tel: 504-619-8524
Email jleigh@isu.edu

Louisiana State University School of Dentistry (LSUSD) at the Medical Center of Louisiana, New Orleans (MCLNO) requests funding to expand the General Practice Residency Program (GPRP or "Program") through the addition of two dental resident positions, increasing the current number from 12 to 14 residents. Furthermore, LSUSD requests funding to implement a clinical and didactic curriculum in Geriatric Dentistry, to expand the clinical and didactic curriculum in Pediatric Dentistry, and to augment the dental academic and treatment program relating to infectious diseases (ID), specifically, HIV. Funding will facilitate the update and upgrade of the present MCLNO dental clinics to provide "state-of-the-art" medical treatment. The upgrade in clinical facilities and the expansion of the GPRP will allow for increased access to critical dental care for the large underprivileged and special care communities in the New Orleans metropolitan area and the state of Louisiana.

The LSUSD Program is the only full service public hospital dental service that provides care for these communities. In addition, MCLNO's Dental Clinic is the only referral center for complete general dental care for the indigent and medically compromised community throughout Louisiana. MCLNO is the focal point of Louisiana's public health system to address the dental needs of a very large group of underserved individuals with multiple health care needs.

Since the inception of the two-year program in 1973, the MCLNO GPRP has trained a "critical subgroup" of general dentists vital to the dental health care of the citizens of Louisiana. These professionals are specifically trained to care for a growing number of medically compromised patients, patients with special needs, geriatric patients, and the indigent population of Louisiana, largely comprised of racial minorities. These general dentists care for patients who would otherwise have no access to dental care. Six residents graduate annually from GPR's two year residency program. A total of 12 residents are currently enrolled in the Program. Since 1975, the MCLNO GPRP has trained 164 general dentists. During the past eight years, 70% of the graduates trained at MCLNO are practicing dentistry in Louisiana.

Massachusetts

D59HP06486
Man Wai Ng, DDS, MPH
Children's Hospital Boston
300 Longwood Avenue
Boston, MA 02115
Tel: 617-355-3375
Email: Manwai.ny@childrens.harvard.edu

The proposed project seeks to develop and implement an integrated; collaborative, oral health educational and training program for pediatricians, pediatric residents, pediatric dental residents and other health care providers at the Children's Hospital in Boston. This program will establish integrated pediatric resident-pediatric dental resident teams that will emphasize the preparation of medical and dental practitioners to care for underserved children and their oral health needs. Pediatric residents will benefit by having a pediatric dental resident on their continuity team in the primary care clinic to focus attention on the oral health issues of patients. Pediatric dental residents will benefit by learning about the social and medical concerns of children who possess high risk for early childhood caries and other health problems. Each year 70 pediatric residents and between six to eight dental residents will benefit from this program.

The program will emphasize three major components - education, integration, and access. Education will be provided to medical practitioners, pediatric and pediatric dental residents, and the underserved families and children in the communities serviced by the Children's Hospital. Integration will occur through the multidisciplinary teams providing training and service provision to the underserved communities. Access will be provided through increased scope of child check-ups to include oral health issues, increased awareness by practitioners and residents to the cultural and social concerns of the oral health needs of underserved communities, increased sensitivity of the community to the oral health issues important in total child wellness, and referrals by practitioners for oral health care in Pediatric Dentistry.

Dental caries continues to be a significant health problem for many American children.

Research from Oral Health in America: A Report of the Surgeon General brought to public attention the extent of oral and general health disparities faced by disadvantaged groups and the effects of these health problems on their general health. In Massachusetts, 70% of children on Medicaid do not receive any dental care (Oral Health and the Commonwealth's Most Vulnerable Children: A State of Decay, MSPCC, 2004). Additionally, only about 12% of the 5000 dental care providers in Massachusetts provide dental services to children on Medicaid.

Early childhood caries (ECC) is an entirely preventable disease, with effective prevention measures known to exist for use by families, practitioners and communities. Caries prevention measures are more cost effective than treatment measures.

D59HP05268
Robert A. Baldor, MD
David M. Matson, DMD
55 Lake Avenue. North
Worcester, MA 01655
Tel: 508-856-1509
Email: robert.baldor@umassmed.edu

The University of Massachusetts Medical School Department of Family Medicine and Community Health (The Department) is seeking funding to support the multi-faceted operations of a new residency training program in general and pediatric dentistry, with proposed program expansion in years 2 and 3. This application represents a unique opportunity to expand the oral health-general health interface by increasing interdisciplinary and coordinated care between primary care providers and dentists utilizing the medical school's extensive expertise in public health education resources and programs. It is estimated that in central Massachusetts, approximately 125,000 people suffer with oral diseases and have no access to dental care. Implementation of the dental residency program will utilize existing collaborative partnerships with three Worcester-county Federally Qualified 330 Community Health Centers currently providing dental services in federally designated dental health professional shortage areas. The overall goal of the residency program is to educate dentists about the special medical and oral health needs of underserved populations and to facilitate placement of graduates in facilities which provide care to medically underserved communities.

The Department has a commitment to the educational and clinical priorities which dovetail with HRSA/Bureau of Health Professions priorities. This grant proposal seeks funding for the implementation of a community health center-based dental residency combined with an educational experience to enhance the knowledge and clinical skills required to provide quality services to high-risk and vulnerable underserved populations.

To achieve these aims we have developed a proposal with 2 Goals: Goal 1 focuses on year 1 implementation of clinical placements at one collaborating community health center and expansion of placements in years 2 and 3 at two additional community health centers; Goal 2 is focused on curriculum development related to the oral health needs of medically compromised populations – i.e. those with diabetes, HIV/AIDS, the elderly, and developmental disabilities. The Department has had a long standing interest in serving the needs of underserved populations as reflected in our departmental mission statement:

Our Department provides leadership to achieve the highest standards of patient care, education and research in Family Medicine and Community Health, and is committed to improving the impact of this work on the health of populations, with special emphasis on those most vulnerable.

Mississippi

D59HP06497
Tracy Dellinger, DDS
University of Mississippi School of Dentistry
2500 North State Street
Jackson, MS 39216
Tel: 601-984-6028
Email: tdellinger@sod.umsmed.edu

The goal of this project is to add to the University of Mississippi Medical Center's (UMMC) hospitals and clinics an additional GPR resident, a dental assistant for chairside support, a fulltime dental hygienist, and a junior faculty member who is Hispanic and bi-lingual. The special needs dental clinic is located in the Jackson Medical Mall Dental clinic, a 10 chair operatory currently manned by 2 GPR residents and one AEGD resident routinely assigned on four days a week, an 2 dental hygiene students one day a week for an eight month period. Special needs patients routinely have a 2-3 month waiting period for appointments which adversely affect comprehensive care. Additionally, the growth of non-English speaking populations have let to barriers which limit the access-to-care for these patients. Translation services are becoming an increased need.

The Jackson Medical Mall (JMM) is located approximately one mile west from the UMMC campus. This facility was the first retail mall in Mississippi which fell into economic depression over the decades and was identified by a consortium of the JMM Foundation, UMMC, Jackson State University (JSU), and Tougaloo College to serve as a community outreach for medical care and social services to the under-served citizens living in the surrounding urban tracts. The facility evolved, with community support, to include elements of the State Health Department, county and city agencies, private entrepenuership associated with supporting health care, educational training and services through JSU and Tougaloo College (both historically African American institutions of higher learning), medical research, and delivery of health care.

The anchor tenant of JMM is UMMC, which houses many of its out-patient clinics in the facility. A broad range of primary and specialized health services, diagnostic laboratories, and pharmacy is available. Additionally, the Jackson Heart Study, the nation's largest ongoing longitudinal study of cardiovascular disease in Afro-Americans, is located at the mall as well as the Mississippi sub-set of the nation's Obstetrics and Periodontal Therapy (OPT) Study. UMMC is ongoing with its commitment to JMM by its anticipated completion of a comprehensive outpatient cancer center. The cancer center is currently serving patients and is an additional resource to the community.

New York

D59HP05269
Shannon H. McCarthy, DDS
Roswell Park Cancer Institute
Elm and Carlton Streets
Buffalo, NY 14263
Tel: 716-845-5970
Email: shannon.mccarthy@roswellpark.org

The primary objective of this three year project is to expand a general practice residency program to develop a continuing education program for practicing dentists in the United States (US) focusing on oral cancer prevention. The secondary objective will be eliminating oral health disparities among medically underserved communities in the Western New York region. Persons at high risk for oral disease are more likely to visit a physician than a dentist. Unfortunately, physicians do not often perform an oral cancer examination on such patients. General dentists must assume more responsibility for examining and counseling patients about behaviors that elevate risk for developing this cancer and referring patients to an appropriate specialist for management of a suspicious oral lesion.

The Roswell Park Cancer Institute (RPCI) General Practice Dental Residency program is the only one in the United States focusing on oral health of cancer patients. The program seeks to increase the number of dentists with expertise in diagnosing, detecting, treating and managing the special needs of these patients. Individuals who have completed chemotherapy, bone marrow transplants or radiation treatment for cancers have an increased need for sustaining adequate oral health.

Using the resources available at both Roswell Park Cancer Institute and the State University of New York University at Buffalo School of Dental Medicine, the General Practice Residency program will educate dental residents in the techniques necessary for improving oral health care of the medically underserved communities.

The proposal will allow expansion in size and improvement in quality of the GPR program with direct effect of expanding residents' knowledge and experience in treating cancer patients with special dental needs.

D59HP06498
James King, DDS
Department of Dentistry, Harlem Hospital Center
506 Lenox Avenue
New York, NY 10037
Tel. 212-939-2883
Email: Jking9659@aol.com

Harlem Hospital, a comprehensive health care institution in the Harlem Community, has long history of serving Harlem, a low income community, which is a MUA and a HPSA designated area. The Hospital also has a long tradition of training dentists and physicians from underrepresented groups who are disadvantaged.

The Hospital proposes to establish a pediatric dental residency Program. Year 1 will be a planning year with the goal to gain initial approval of the residency program. Each year, starting in year 2 the program will recruit and train 2 trainees from disadvantaged, underrepresented groups annually. It is our goal that we will graduate at least 50% of the trainees from low income underrepresented groups who will go on to provide primary care in Medically Underserved Areas. With the addition of the 2 residents in year 2 and an additional 2 residents in year 3, we anticipate that the program will increase the hospitals capacity to served children from our medically underserved community by 6000 patient visits. In addition we plan to develop a partnership with the Department of Pediatrics to provide coordinated care to children with HIV and special needs. A final component of the program is to develop cultural competency among the residents served.

Pennsylvania

D59HP05211
Mohammad Mazaheri, MDD, DDS, MsC
Lancaster Cleft Palate Clinic
223 North Lime Street
Lancaster, PA 17602
Tel: 717-394-3793
Email: MOMazahe@LancasterGeneral.org

The Lancaster Cleft Palate Clinic (LCPC) proposes to expand its Dental Residency Program and services provided for special needs and priority populations in the greater Lancaster regional area. The program will double enrollment in the residency program from one to two residents per year starting July 2005-June 2008. During this three-year-period, a total of six dental residents will be trained and complete the program, doubling LCPC's capacity to increase access for disadvantaged patient populations and decrease health disparities especially for underserved, priority, and special needs populations. The program will focus on: providing increased access to quality dental care for priority populations, increase residency opportunities for ethnic minorities and disadvantaged candidates, and innovatively provide diverse clinical experiences for residents by providing care for populations with craniofacial anomalies. This Advanced Education in General Dentistry (AEGD) Residency Program helps to address the national shortage of dental health professionals and promotes service to populations with DHPSA designations. This residency training program also addresses key Healthy People 2010 objectives by providing a program that gives extensive training in oral health within diverse populations including individuals with cleft lip and palate, mental and physical disabilities, individuals living with HIV/AIDS, and individuals who present conditions resulting from the lack of regular dental care. The number of patients currently served through the residency program exceeds 600. With grant funding, over 1200 patients will be served targeting HRSA priority populations. The Lancaster Cleft Palate Clinic is the largest provider of oral health and craniofacial services to patients between Philadelphia and Pittsburgh as reported by the American Cleft Palate Association. Over 56,400 residents (470,000 population/12% population without health/dental coverage) in this region have never had a dental examination. The LCPC AEGD residency training program has a primary focus on providing health care to dentally underserved communities. Our residency program is unique in that we are high-volume operators for treatment of patients with significant medical and developmentally compromising conditions. Dental care is provided to over 10,000 patients a year at our facilities. The proposed grant funds would increase LCPC's capacity to meet unmet dental needs for the Lancaster region as well as the unique needs of patients with craniofacial conditions.

Rhode Island

D59HP06496
Shirley Spater, DMD, MPH
General Practice Residency Program
Joseph Samuels Dental Center
Rhode Island Hospital
593 Eddy St.
Providence, RI 02903
Tel: 401-444-5995
E-Mail: sspater@lifespan.org

Since its foundation in 1931, Joseph Samuels Dental Center (JSDC) in Providence, RI has been dedicated to treating underserved populations, specifically children and special needs patients. JSDC is also an education site for dental hygiene and dental assistant students from Community College of Rhode Island and third year Brown medical students. The Joseph S. Sinclair General Practice Dental Residency Program is a natural extension of JSDC's mission and its role as a nucleus for oral health education.

The program will start in July 2005 with two residents. The core of the curriculum consists of treating patients at JSDC, rotations through other hospital departments such as Internal Medicine, Emergency Medicine, Pediatrics, and Anesthesiology, and attending didactic training sessions. They will receive a thorough education, especially targeting the needs of children and developmentally disabled patients, and they will be encouraged to involve themselves in local committees and organizations devoted to issues that ultimately affect their patients. Such in-depth involvement will encourage residents to remain in Rhode Island to practice and continue to work with underserved populations. Thus, the Sinclair Residency addresses a critical shortage of dentists in Rhode Island, particularly minority dentists and dentists who will treat underserved populations.

The Residency Program will allow more patients, particularly children and other underserved patient groups, to be seen at JSDC. The residents' involvement at JSDC, with other hospital departments, and with community dentists and organizations will increase the quality of patient care that is provided. Overall, the Sinclair Residency Program will be of great benefit, not only to JSDC, but also to Rhode Island Hospital and the community at large.

Washington

D59HP05270
Mark Koday, DDS
Yakima Valley Farm Workers Clinic (YVFWC)
518 West 1^stAvenue
P.O. Box 190
Toppenish, WA 98948
Tel: 509-865-5898, ext. 2244
Email: markk@yvfwc.org

YVFWC, a migrant/community health center, will implement the AEGD Residency Program to develop a culturally competent dental workforce that increases access to dental care and reduces disparities in dental outcomes for underserved populations. Didactic curriculum will include general dentistry seminars, public health dentistry seminars, practice management seminars, a quality assurance program, and literature review sessions. Clinical curriculum will include placements and rotations at the following training sites in underserved and rural areas: community-based clinics, mobile van, HIV/AIDS clinic, family practice residency program, children with special health care needs clinic, residential care facility, hospital, and private practices. YVFWC requests the Medically Underserved Community funding preference.

YVFWC will train seven residents, two of whom are underrepresented minority/disadvantaged, each year of the Program. Residents will receive training at four YVFWC community-based clinics in Yakima County, central Washington; one YVFWC community-based clinic in Spokane, eastern Washington; and one YVFWC mobile van, which provides care in central and eastern Washington. Residents will also receive training at community partner sites. The Children's Village provides integrated medical, dental, mental health, and social services for children with special health care needs, and the Selah School provides residential care for developmentally disabled adults. Yakima Valley Memorial Hospital provides inpatient acute care, outpatient treatment, rehabilitative services, home care services, skilled nursing services, and health education and wellness. The New Hope Clinic, a Ryan White Care Act program based in a YVFWC Yakima clinic, provides early intervention services for consumers with HIV/AIDS. Central Washington Family Medicine, a medical clinic and family practice residency program, provides primary medical care to underserved populations. Local general and specialist dentist private practices are located in underserved and rural areas.

In 2000, more than two-thirds of below poverty level children and Hispanic children, and three-quarters of children who spoke English as a second language (ESL) in Washington had decay experience in their primary and/or permanent teeth. In 2000, almost one-third of below poverty level children and Hispanic children, and more than one-third of ESL children in Washington had untreated decay. In 2002, almost one-third of below poverty level adults in Washington had lost six or more teeth due to decay or gum disease. In 1988, the YVFWC Dental Director and UW SOD faculty studied 216 migrant children age 6-12 in Yakima County. They found that migrant children had higher rates of decayed and filled surfaces for primary dentition and decayed, missing, and filled surfaces for permanent dentition than the 1986-87 rates for school children reported by the National Institute of Dental Research.