Patients Help Personalize and De-Stigmatize HIV.
Students are trained in small groups of 5-6 weekly, with time for a face-to-face
interview with a patient who puts a human face on HIV to help break down stigma.
Memorandum of Agreement (MOA) Put Into Action. The MOA
guides work among various parties and specifies responsibilities in program
operations, evaluation, and future planning. (See the TARGET Center’s TA Library for a copy.) Staff spend considerable time implementing tasks outlined
in the MOA—scheduling over 150 students for training and scheduling patients for
their treatments as well as their participation in student trainings.
Partners
Loma Linda University, School of Dentistry
Social Action Community Health System
San Bernardino County Department of Public Health
California
Loma Linda University, School of Dentistry
University’s Ethic of Service Embraces HIV Dental Care
Loma Linda University was founded over 100 years ago by missionaries with a zeal
for service to the community. Their vision is very much alive in expectations of
today’s students. Notably, the mission to serve also impacts HIV-positive
patients, who are asked to play a role in student training to help personalize
living with HIV and de-stigmatize care for infected patients.
Services: Central Dental Clinic as Focal Point
Loma Linda University is located on the far eastern reaches of the Los Angeles
metropolitan area, close to Riverside and San Bernardino. Ryan White-supported
dental services are primarily delivered out of the area’s large community
clinic, called Social Action Community Health System (SACHS), with over 32,000
patient visits annually in their various clinics. SACHS dental clinic serves as
the area’s central place to obtain routine HIV dental care and is readily
accessible via buses that run hourly. SACHS gets client referrals from numerous
private providers and Ryan White agencies in the area (including the other
community-based partner, the San Bernardino County Department of Public Health).
Specialty dental care is provided by the School of Dentistry and comprises just
a small part (probably no more than 5 percent) of dental services typically
needed by patients with HIV.
The routine at SACHS is for patients to check in for appointments at the main
registration area/waiting room. For patients living with HIV, SACHS offers a
patient-friendly option of waiting in a separate waiting room. Many patients
prefer this choice, particularly those experiencing difficulties.
Provider Education and Training: Patients and Students Make
the Most of Limited Time
Loma Linda dental trainees are drawn from fourth year senior dental students,
senior International Dentist Program students, and dental hygiene students.
Dental students complete the HIV-oriented training under a broader
service-oriented curriculum that requires 120 hours of service-learning during
an academic career.
In 2007, 113 senior dental students and international students as well as 43
senior dental hygiene students rotated through the SACHS clinic for 8 hours each
for a total of 1,184 hours of education. Dental students assigned to SACHS get
good training because their dental clinicians are University faculty members.
Faculty members bring the hard-to-replicate touch of deep experience to their
training.
Training is only two days long—two four-hour sessions held on two consecutive
days. The format reportedly works because the lecture component builds on the
materials students received in earlier classes and the mix of standard lectures
and handout materials, such as a CD-ROM and monograph describing oral
manifestations of HIV infection; role playing to illustrate how a dental
provider could respond to different situations; the actual provision of patient
treatment; and interviews with patients to put a human face on this stigmatizing
disease.
Patient interviews involve discussions between small groups of 5 to 6 students
and a volunteer patient. Patients are recruited by SACHS staff from among that
day’s scheduled patients, although there have been cases when HIV-positive
clients volunteered to come in just for the interview.
On the first day of training, the student group receives
one hour of didactic training. A 15-minute video covers psychosocial issues
often faced by HIV-positive patients and difficulties people face in obtaining
health care services, including dental care.
Students then meet face-to-face for 30-45 minutes to
talk to a patient with HIV. Students are instructed ahead of time not to ask
personally intrusive questions.
Conversations are free form. Patients can discuss
whatever they want. Students typically ask patients about any difficulties they
encounter getting good dental care, the effects of HIV disease and medications,
and how they want to be treated by providers.
Students report that the discussions are frank and emotional and allow patients
and students to take discussions out of the textbook and put a human face on the
disease. Training reportedly helps students overcome hesitation or nervousness
about treating HIV-positive clients.
Patient Education and Involvement: Materials, Appointment-Based Learning, Feedback
Getting patients informed about their dental care occurs through two channels:
Dentists and dental students provide education during
dental appointments and cover such topics as preventive care, smoking cessation,
maintaining a current medical and dental record, and the importance of staying
on medication schedules.
Patient educational materials are provided in English
and Spanish and cover home care instructions for periodontal conditions,
dentures and partial dentures, brushing and flossing, treatment descriptions for
procedures, and disease-related materials for AIDS and diabetes.
Client input is obtained via satisfaction surveys, direct day-to day input from
clients to help meet their service needs, and consumer involvement in training
sessions.
