Student Training. Extensive 9-month rotation training is
used, under a community-focused curriculum.
Strategic Response Plan. The plan outlines a vision and
work plan for expanding access to dental care. It identifies desired outcomes in
such areas as customers, financials, internal processes, and learning and
growth.
Referral Network. An enhanced referral network realized
a 179 percent increase in referrals with a nearly 70 percent kept-appointment
rate.
Ryan White Program Grant Administration Manual. This
document is used by the grantee to monitor quality, identify leadership and
accountability mechanisms, and develop data and measurable outcomes to measure
progress.
Partners
UMDNJ-New Jersey Dental School
Access One
AETC of New York/New Jersey Region
New Jersey
University of Medicine and Dentistry of New Jersey - Dental School
Crafting a Network of Dental Care in the Southern Counties
Community-based dental services for underserved and uninsured residents have
been in place in New Jersey since 1989, long before Ryan White oral health
funding came along. That’s quite a foundation to build upon, which New Jersey
did in creating the first-ever HIV-specific dental services for patients living
in a 7-county area in Southern New Jersey that includes multiple areas with high
HIV caseloads—two of which qualify as AIDS epicenters.
As with other grantees, the connection to the University dental school—the only
such school in the State—elevated the quality of dental training as well as
employment opportunities for students to keep working in HIV care and other
community areas upon graduation.
Services: Community-Based Partnerships
Ryan White funding enabled the University of Medicine and
Dentistry of New Jersey-New Jersey Dental School to create a network of HIV
dental care for Southern New Jersey. The network includes:
University. Components include skilled dental faculty
and staff, a student population primed for clinic rotations, and a specialty
dental clinic.
Community Dental Clinics. Three community dental clinics
deliver the bulk of dental care and are located in Galloway, Northfield and
Somerdale. Dental assistants conduct outreach one-day per week with primary care
sites in order to inform them about the availability of dental services so that
clinics know where to refer clients for dental care. Dental clinics also
communicate regularly with primary care providers in working with dental
patients, such as accessing medical information that dental providers need in
conducting oral health procedures, like current laboratory test values. Each
dental clinic also works closely with the University’s dental clinic in securing
students to conduct onsite work as part of their training rotations.
Collaboration is also conducted in linking clients to specialty oral health
services available via the University site.
Referral Partners. Fourteen agencies that deliver
primary medical care are partners in that they refer their patients to clinics
to receive dental services. Staff of these agencies (both medical staff and case
managers) receives education from University dentists or dental assistants on
oral health issues. Education covers HIV/AIDS and oral health considerations as
well as information on navigating the health care system in order to facilitate
patient access to oral health services.
Agency relationships under the Ryan White dental project
are clearly delineated in letters of agreement, which cover the role of the
agency and the University.
The project has performed well as the number of referrals
from primary care to dental care increased 179 percent during 2006. A number of
factors made this happen:
Coordination of Referrals, Appointments, and
Transportation. One agency, Access One, provides an array of medical and support
services, and thus plays a special role in coordinating appointments and
maximizing good network relationships with other partner sites. All dental
referrals are processed by Access One, which then makes appointments at the
dental clinic sites. Travel to dental clinics is difficult in this area, so bus
tokens for transportation are available through Access One.
Outreach by Dental Assistants. Dental assistants play a
particularly positive role in increasing the number of referrals by attending
patient education workshops, conveying the importance of oral health to
patients, and answering their questions and concerns, such as dental phobia.
During patient workshops, dental assistants work with patients to schedule
appointments and encourage patients to attend appointments. Dental assistants
visit an early intervention program and AIDS service organization a half a day a
week.
Outreach information covers the basics of good oral heath
and also provides clients with information on how to access services. A standard
outreach package of information is used to enhance both the consistency and
quality of outreach work.
Provider Education and Training: Intense Rotations Among Many Features
New Jersey’s student training includes 9-month rotations
for students at community clinic sites—the longest rotation of any Ryan White
community dental project. Many of the dentists at the community sites are
full-time faculty. In addition to providing a high level of training, faculty
members are also involved in direct patient care. Dental student training in HIV
care occurs under the University’s broader Community Oriented Dental Education
program.
The training experience at the New Jersey dental school
includes several parts but not limited to:
A continuing dental education lecture series includes a
seminar on cultural competency. The project director observed: “Through one of
our cultural competency trainings, for example, we were able to work with a
student who had very defined notions of people who were homosexuals since his
religion and background had told him it was wrong,” reported York.
“Communicating and talking about these issues allowed him to examine biases so
that his treatment of those living with HIV would not be compromised.”
A new feature as of 2007 is an externship program for
dental students to participate in during summer break. As of early 2008, there
were three undergraduate dental student participants.
In July 2008 a new program was added to the dental
school’s curriculum, all fourth year students will receive a training experience
that includes a two-week rotation at community clinic sites.
Provider Recruitment and Retention: Faculty and Students Targeted
Multiple efforts are conducted by New Jersey to recruit and
retain dental staff based in community clinics that target underserved
populations, including those living with HIV. They are targeted to both faculty
and dental students.
The University’s extramural dental education program
trains 11 senior dental students per year. They spend 28 hours per week during
the 30-week senior year in direct client care in a community-based dental
clinic. The training occurs at designated Ryan White funded sites, and provides
students with an opportunity to be educated in an excellent facility, under the
direction of experienced and respected dentists who are recognized as experts in
the field of oral health care for HIV positive clients.
In July 2006, a faculty/provider recruitment program was
launched to encourage students to seek employment with the University upon
graduation. To date, the dental school has secured four 2007 graduates to work
in the University’s community-based sites and two additional graduates to serve
as faculty in the clinics.
The University-based project team has a “big picture”
approach to carrying out a recruitment plan for their workforce. Their guide is
the Strategic Response Plan—specifically, to enhance dentists’ commitment and
engagement and develop adaptive and diverse leaders. The plan outlines some
important considerations when recruiting dentists, such as what salaries and
other incentives can be offered to get them to accept employment and to stay
over time.
