Arizona | Arkansas | Colorado
| Delaware | District of Columbia
| Florida | Georgia | Louisiana
| Maine | Massachusetts | Michigan
| Mississippi | North Carolina
| Puerto Rico | Rhode Island
| Vermont | Washington | Wisconsin
Arizona
T12HP07705
Joyce Flieger B.S.D.H., M.P.H.
Arizona Department of Health Services, Office of Oral Health
1740 W. Adams #205
Phoenix, AZ 85007
602-542-1866
fliegej@azdhs.gov
Currently there are weaknesses in the dental workforce infrastructure
in meeting the dental needs of underserved, vulnerable, and/or special
needs persons in Arizona. While private providers and safety-net
dental programs provide dental treatment, the explosive population
growth in Arizona, large rural areas, and the maldistribution of
too few dental providers means that the dental needs of the population
as a whole are not being adequately met.
The expected outcomes of this project include an increase in the
proportion of Medicaid and SCHIP beneficiaries who receive dental
care each year, and an increase in the number of dental hygienist
FTEs employed in rural Arizona. Both of these outcomes would be
the result of full and successful implementation of the existing
affiliated practice act, and expansion of capabilities in teledentistry
as a diagnostic tool. This implementation will be documented in
a “how to” manual to smooth the way for future growth in affiliated
practice (and consequent increase in the number of people served
in outlying areas). Another expected outcome is an increase in the
number of general dentists trained in serving children with special
health care needs. The project has four main components:
- Chiricahua Community Health Center will be hiring a dental hygienist
to staff their recently acquired mobile dental van. OOH will facilitate
an affiliated practice agreement (newly legislated expanded practice
capability) between this dental hygienist and a dentist. This
arrangement, coupled with a teledentistry model for off-site diagnosis
by the dentist, will accelerate referral to the main federally
qualified health center in Elfrida, Arizona.
- Scottsdale Health Center and its school-based dental clinic
is currently the only model in the state using the affiliated
practice agreement for dental care. This project will utilize
the teledentistry model to accelerate the diagnosis by the off-site
dentist to approve further continued care for the children in
the most need.
- While Northern Arizona has one of the highest statewide levels
of dental decay and the greatest number of dental hygienists,
currently there are no dental hygienists working in a Head Start
center. This project will demonstrate non-traditional settings
for affiliated-practice hygienists by providing preventive dental
services to this population. OOH will provide the portable equipment
and hire and train an affiliated practice dental hygienist.
- OOH, the Arizona Dental Association, and A.T. Still University’s
Arizona School of Dentistry and Oral Health propose to develop
an intensive distance-learning training model, targeted at dental
students and general dental offices, on dental care for those
with disabilities.
Arkansas
T12HP07715
Lynn Douglas Mouden, DDS, MPH
Arkansas Department of Health and Human Services
PO Box 1437, H41
Little Rock, Arkansas 72203-1437
501-661-2595
Lynn.Mouden@arkansas.gov
Arkansas dentistry is often overwhelmed when addressing the needs
of special populations – those with developmental disabilities,
survivors of family violence, individuals with language barriers
or the geographically isolated.
Fewer than 10% of Arkansas dentists substantially participate in
ARKIDS FIRST, the state Medicaid and SCHIP waiver programs, and
few dentists practice in the Delta area of the state and other more
remote locations.
The major goals of the AR Oral Health Workforce Development project
are to increase the number of dental professionals practicing in
underserved areas, to promote dental careers especially in minority
populations, to train dental professionals to address special populations
and to address language barriers.
Objectives to reach those goals are: (1) to work with the primary
care association to recruit dental professionals to practice in
underserved areas, (2) to work with secondary schools and colleges
to promote dental careers, (3) to train dental professionals to
better communicate with and treat special populations, and (4) to
promote available interpretation services to minority populations.
Populations to be served include dentally underserved patients
of all ages, secondary school and college students (especially minority
students), patients with developmental disabilities, survivors of
family violence, and patients with language barriers.
The Arkansas Office of Oral Health will coordinate grant-funded
activities with the Arkansas Oral Health Coalition, Inc; Community
Health Centers of Arkansas, Inc; Partners for Inclusive Communities;
Philander Smith College; the University of Arkansas at Pine Bluff;
Delta Dental Plan of Arkansas, Inc; the Arkansas Farm Bureau; and
the Arkansas Department of Education.
Colorado
T12HP07716
Ms. Diane Brunson
Oral Health Program, Colorado Dept of Public Health and Environment
4300 Cherry Creek Drive South, A4-OH-7400
Denver, CO 80246-1530
(303) 692-2428
diane.brunson@state.co.us
The Colorado Rural Oral Workforce Project addresses the disparities
in access to oral health services in the rural areas of Colorado.
Colorado is primarily a rural state, with 47 of 64 counties designated
as rural or frontier (less than six people per square mile). Currently,
there are 8 counties without a dentist and an additional 18 without
a dental Medicaid provider. Eighty-four percent of Colorado dentists
practice along the Front Range in primarily urban areas. There
are significant oral health disparities among the residents in Colorado.
In the 2004 Impact of Oral Disease on the Health of Coloradans,
it was reported that 27% of kindergarten and third grade children
had untreated dental decay, yet only 35% had protective sealants.
Nearly 10% of Head Start children had urgent dental needs, characterized
by reports of pain or visible abcesses.
This project will address the needs in three ways: 1) Increasing
the number of participants in the State Dental Loan Repayment Program.
Currently funded by state tobacco settlement funds, the program
receives four applications for every loan repayment slot. This
will allow 2-3 additional providers to participate, with emphasis
on the recruitment and retention of rural providers. 2) Collaborating
with the University Of Colorado School Of Dentistry to develop a
“rural track” for new dental students. The School of Dentistry
will work jointly with the Department of Family Medicine, who already
has a rural track for medical students, to add dental students.
Medical and dental students will take rural health seminars together
and participate in a joint rural rotation during the summer months.
A mobile van, Colorado Smile makers, will also ferry dental and
dental hygiene students to rural areas to provide assessments, preventive,
and restorative services. This project will support the faculty
preceptor on the van. 3) The Colorado Health Institute will assist
in assessing the oral health workforce through provider surveys
and analysis to quantify and qualify the changes this project will
have.
Through all of these strategies, the primary population groups
to be served will be the residents of Colorado living in rural areas.
Also benefiting will be the dental providers who will receive assistance
with their educational loans by participating in the State Dental
Loan Repayment Program and serving underserved populations. Dental
students will benefit as they will be exposed to rural practice
and the need to collaborate with their physician colleagues if a
reduction in health disparities, including oral health disparities,
is to be realized.
Delaware
T12HP07718
Dr. Greg McClure
Delaware Health and Social Services; Division of Public Health
417 Federal St.
Dover, DE 19901
302-741-2960
Greg.McClure@state.de.us
Recent evidence indicates that there continues to be an insufficient
supply of dentists to treat children who are traditionally underserved.
This gap exists, despite the fact that the Medicaid program provides
one of the highest reimbursement rates in the country. The purpose
of this project is to improve the oral health infrastructure so
as to support an increase in the availability and competency of
the dental workforce, and to improve the oral health status of rural
and other underserved families in Delaware. The project encompasses
four major objectives:
- A mobile dentistry program will be established and implemented
for treating underserved children and families in Delaware.
- A Case-Management Referral system will be available for increasing
the number of dentists who treat underserved children.
- Dental residents and dental hygienists will receive enhanced
education in treating patients in community and mobile dentistry
programs.
- Underserved families will have increased awareness of oral health
and greater information for seeking oral health services.
The Delaware Division of Public Health (DPH) manages a school sealant
program. A significant limitation is the difficulty in scheduling
schools because of limited school space for portable equipment.
Urgent care needs are referred to private dentists, but routine
referrals are provided only upon request because of limited dentist
availability and uncertainty of ability to pay for services. A case
management system does not exist to link these services to children.
The proposed objectives and activities of this grant will complete
a circuit for the identification of children with untreated dental
needs, assessment of financial need, and either immediate treatment
or referral to a dental provider for comprehensive treatment. The
acquisition of a mobile dental van with funding from this grant
will replace the use of portable equipment, thus allowing for an
expanded and increased array of dental services. The case management
system will enable children to be referred as appropriate to dentists
who are not currently seeing a significant number of children.
Dental residents will have rotations on the dental van in rural
Delaware, thus increasing their experience in treating high-risk
children and exposing them to practicing in the underserved rural
area of Delaware. The dental hygiene students will be able to gain
additional experience both in public health dental programs, and
the treatment of children. The project will increase the number
of children receiving dental care by overcoming the structural barriers
of availability of dentists, costs, and incomplete information.
District of Columbia
T12HP07712
Karen S. Owens, D.D.S.
Department of Mental Health Saint Elizabeths Hospital
Department of Health Oral Health Division
202-645-7466
Karen.owens@dc.gov
In support of developing a State Oral Health Plan in the District
of Columbia, the Department of Mental Health and the Department
of Health are collaborating in an effort to address the oral health
workforce needs in the District of Columbia. The Department of
Mental Health (DMH), the only government agency addressing the oral
health needs of adults in the District of Columbia with acquired
disabilities, will take the lead on the collaborative effort.
Despite numerous findings indicating the importance of good oral
health and the need for timely unhindered access to dental services,
many vulnerable, low-income residents in the District of Columbia
(DC) are still adversely affected by needless dental complications.
This may oftentimes be attributed to the fact that: there are insufficient
dental professionals in areas where they are most needed; oftentimes,
quality of care and cultural competency from dental professionals
are low; health care workforce does not represent the population
it serves (nationwide, less than 7% of dentists are African American,
Hispanic or American Indian); and increased promotion of oral health
and dental public health is needed.
The District of Columbia (DC) realizes that the best way to address
these issues is to work collaboratively to develop initiatives to
support oral health workforce activities that:
Increase recruitment and retention efforts; Increase the number
of general dentistry residents program completers; Increase dental
services in areas that have been identified as dental health professional
shortage areas; Enhance continued dental education; Encourage children
within DC Public Schools to enter professions related to oral health
or science; Enhance faculty recruitment programs; and Augment the
DC Department of Health (DOH) Oral Health Division.
The General Practice Residency Training Program in General Dentistry
sponsored by the District of Columbia Department of Mental Health
(DMH) Saint Elizabeth Hospital (SEH) provides advanced general practice
residency training in dental specialties to five (5) recent dental
graduates, with emphasis on management and treatment of the adults
with acquired (mental health) disabilities who are wards of the
District of Columbia. These patient populations receive very little
attention and have difficulty locating community resources to provide
appropriate, necessary and affordable dental care.
In support of this collaboration to improve workforce activities
and address the global oral health needs of adults and children
within the District of Columbia, we are requesting HRSA support
for program expansion.
Florida
T12HP07706
Frank Catalanotto, DMD
University of Florida
Department of Community Dentistry and Behavioral Science
PO BOX 103628
Gainesville, Florida 32608
352-273-5970
fcatalanotto@dental.ufl.edu
Early Childhood Caries (ECC) is a significant national and local
problem. ECC disproportionately affects children in low-income
households, i.e. Medicaid recipients. Current Florida data suggest
that less than 12% of Medicaid children under age 6 years receive
preventive dental care and less than 10% of Florida dentists see
Medicaid children. One strategy suggested by Florida’s State Oral
Health Improvement Plan (SOHIP) and consistent with the HRSA Program
Guidance to expand the oral health workforce to reach underserved
populations, is to utilize non-dental health providers, for example,
physicians. This proposal addresses this strategy by implementing
demonstration projects of physician-implemented oral health services
in Duval County, an urban area with 18,000 Medicaid eligible 0-3
year old children, and in Collier, Lee and Charlotte counties, a
rural area with 16,500 similar children. The percentage of licensed
dentists in four counties that have submitted preventive Medicaid
claims ranged from 1.8% to 8.1% in 2003. Both locations contain
numerous Dental Health Professional Shortage Areas with a projected
shortfall of 61 dentists. The project will involve primarily educational
interventions with pediatricians (and residents in years 2 and 3)
to increase their competence in detecting and preventing ECC and
making appropriate referrals of high risk children to private dentists
and safety net providers for treatment.
We will form a statewide Advisory Committee composed of key stakeholders
from the Florida Department of Health, Florida’s Agency for Health
Care Administration, Florida Pediatric Society (FPS), Florida Academy
of Pediatric Dentistry, Florida Dental Association, and others including
appropriate safety net providers. In addition, three consultants
from states where such programs have been successfully implemented
will assist in program development, implementation and evaluation.
The overall plan would be to form the Advisory Committee, develop
the educational materials, conduct a pre-education evaluation survey
of physicians in the two sites, implement the educational program,
wait an appropriate length of time, and then implement post-educational
evaluation procedures. Following potential modifications of the
educational and implementation plan as recommended by the Advisory
Committee after review of evaluation outcomes, and the availability
of additional years of funding by HRSA, the program would be implemented
statewide in the second and third year; the FPS has achieve several
HRSA and SOHIP goals, i.e., enlarge the oral heath workforce, better
integrate oral health into general health, and provide a long term,
significant oral health intervention to underserved children, hopefully
reducing ECC in this population, both improving their overall oral
health and reducing long term costs to the state Medicaid system.
Georgia
T12HP07717
Dr. Carole Hanes
Medical College of Georgia
1120 15 Street
Augusta, GA 30912
706-721-2813
chanes@mcg.edu
The purpose of this project is to improve access to oral health
care for underserved citizens in the state of Georgia by improving
the current and future dental workforce treating these patients.
Georgia is generally a rural state with a few major population
centers. Census Bureau figures indicate nearly 1.8 million people
lived in rural counties in 2002. There are 108 counties with fewer
than 35,000 people. Georgia has a poverty rate of 12%, which is
the 18th highest poverty rate in the nation. In Georgia,
poor children are 80% more likely to have dental disease and 30%
of tooth decay remains untreated. There are 36 single county and
low income DHPSAs in Georgia. There are approximately 38 dentists/100,000
population in Georgia, ranking the state 45th out of
50. In summary, Georgia has a large rural population that does
not have ready access to the dental treatment needed for this population
The Medical College of Georgia School of Dentistry will collaborate
with the Division of Dental Public Health, private charitable dental
clinics and Area Health Education Centers, to place students in
dental clinics to care for underserved patients. All sites were
chosen to serve designated Dental Health Profession Shortage Areas
(DHPSAs). Identified locations in Georgia include 7 clinics in
5 urban and rural areas: Atlanta, Columbus, Dalton, Dublin and Rome.
Each student will provide oral health education and dental services
on a rotating basis for two weeks. Loan forgiveness funds totaling
$50,000 annually will be provided for two dentists who agree to
serve in a DHPSA. This one year commitment will be renewable for
2 additional years with a ceiling of $75,000 loan repayment per
dentist. The third aspect of this application involves rotating
Pediatric Dentistry residents from MCG to the Children’s Hospital
at Scottish Rite Dental Clinic in Atlanta. This rotation would
improve the residents’ educational experience by treating the very
vulnerable and medically compromised patients seen in that facility
and would benefit the patients. To maintain the quality of didactic
education for students and residents on rotations, computer technology
will be used to allow offsite students to view live or recorded
presentations.
This grant will help fulfill the mission of the Medical College
of Georgia School of Dentistry by educating our students to be excellent,
compassionate clinicians who are prepared to provide oral health
care to the citizens of the state, regardless of their socioeconomic
status, or medical condition. The short term benefit for the selected
communities is increased availability of oral health care. If the
program is successful the long term benefits will include sensitizing
students to the oral health needs in rural Georgia and the development
of local and state mechanisms to encourage development of loan forgiveness
programs and community efforts to address care for underserved citizens.
Louisiana
T12HP07700
Joan H. Wightkin, Dr.P.H.
Louisiana Department of Health and Hospitals
Office of Public Health
Maternal and Child Health Program
Bienville Building
628 N. 4th Street
Baton Rouge, LA 70802
(225) 342-7981
JWIGHTKI@dhh.la.gov
Access to oral health care and improving the dental health of Louisiana
residents is greatly needed, particularly following the devastating
hurricanes. Dental health clinics are overwhelmed by the oral health
needs of residents living in the affected areas. As a result of
vast reduction in the number of dentists in the areas that were
most devastated by the storm, the HRSA Bureau of Health Professionals
has designated 34 of the 64 parishes in Louisiana as health professional
shortage areas. The insufficient dental health workforce creates
more of an access problem for individuals seeking oral health care.
Although fluoridation is the safest, most cost-effective way to
reduce caries prevalence, fluoridation is underutilized in Louisiana.
In Louisiana, less than 46% of the population is served by public
water systems containing optimal fluoride. A study of Louisiana
Medicaid data by the CDC showed that the average dental treatment
costs for Medicaid eligible children living in non-fluoridated areas
were twice as high as the average treatment costs for Medicaid-eligible
children living in fluoridated areas. Dental sealants seem to be
an underutilized treatment option for many of the children as well.
Louisiana’s sealant rate is 18% of 3rd grade children.
A school-based dental sealant program would improve our rate of
sealants utilization for 3rd graders. This effort would
help meet the goals set in this performance measure and the Healthy
People 2010 sealant goal. Educating communities on the importance
of water fluoridation, and providing preventive services and access
to oral health care are critical to reduce and eliminate oral health
disparities existing in disadvantaged populations.
The goals of the grant are to: 1) augment the Oral Health Program
to coordinate oral health and access issues in the State 2) and
develop or enhance community-based prevention services including
water fluoridation and dental sealant programs. These steps are
needed toexpand the existing Oral Health Program office to enhance
our ability to coordinate oral health services and address access
to care issues caused by our diminished dental workforce.
Maine
T12HP07719
Judith Feinstein
Maine Department of Health & Human Services
11 State House Station
221 State St.
Augusta, ME 04333-0011
207-287-3267
judith.a.feinstein@maine.gov
The Maine Oral Health Workforce Initiatives Project consists of
three coordinated but distinct strategies that complement work currently
occurring within the state while increasing the breadth and depth
of that work. The purpose of the Project is to develop initiatives
that will address oral health workforce issues in our state, with
a focus on strategies to improve access to dental services and accessibility
of the oral health workforce for underserved geographic areas and
populations. In Maine, a largely rural state, a significant proportion
of the population has difficulty in accessing needed dental services,
and the distribution of dental professionals, particularly dentists,
is a matter of increasing concern.
The first strategy aims to coordinate current and develop new recruitment
and retention activities; the second aim is to increase the capacity
of current providers; and the third will ensure that young people
across the state are exposed to dental careers and offered a path
into higher education and training in a dental profession. These
are envisioned as follows.
- The Collaborative Dental Recruitment Initiative describes a
three-year plan to develop a model for a collaborative and coordinated
recruitment and retention function or system for dental professionals
in Maine. Year One will be largely devoted to planning, the second
year will include initial implementation of the model and of collaborative
marketing activities, and the third year will include additional
implementation, evaluation & sustainability planning.
- The Continuing Professional Education and Development Initiative
includes several training initiatives designed to increase the
effectiveness of practicing dental professionals, particularly
for general practitioners and dental hygienists in pediatric and
geriatric concerns, and to integrate the provision of oral health
promotion and early dental disease interventions into medical
settings by involving primary medical providers in oral health
trainings. An additional element of this component will be the
facilitation of relationships between registered dental hygienists
and pediatric medical practices.
- The Dental Careers Pipeline Initiative describes a plan for
the coordination and implementation of a dental careers curriculum
in collaboration with the Health Science Career Education program
at Maine’s Career and Technical Education high schools, in cooperation
and coordination with Maine’s Area Health Education Centers and
their efforts to encourage Maine youth, especially those from
rural or disadvantaged backgrounds, to pursue health professions
careers.
Massachusetts
T12HP07701
Sally Fogerty, BSN, Med
Commonwealth of Massachusetts
250 Washington Street
Boston MA 02108
617-624-6090
Sally.fogerty@state.ma.us
Massachusetts has overwhelming unmet oral health and workforce
needs. Fifty percent of 3rd graders have experienced
dental decay and 50% of low income 3rd graders have untreated
decay and only 8% of the state’s school nurses report having a school
dental prevention program. About 1 million of the state’s residents
are considered disabled. Over 100 communities do not have a dentist,
and another 100 communities do not have a dentist that accepts Medicaid.
The state’s only dental program for the developmentally disabled
recently lost 7 of 8 its’ AEGD residents and the 4 state public
health hospitals dental programs are overwhelmed. To respond to
these issues MA OH WINS was developed.
The primary purpose of the grant is to improve the oral health
of underserved residents by increasing the dental workforce and
expanding community based prevention programs. The project is
comprised of three different, but complementary initiatives: (1)
Address the oral health needs of underserved populations and communities
by identifying and assessing oral health needs, and workforce and
prevention resources with the expansion of the Office of Oral Health’s
(OOH) infrastructure; (2) Promote, develop and implement school
prevention dental (sealant) programs in federally qualified dental
health professional shortage areas and other underserved and rural
areas of the state, and support other effective community prevention
programs; and(3) Recruit culturally and linguistically competent
practitioners to care for the oral health of underserved populations,
including the 4 state public health hospitals and 7 dental clinics
for the developmentally disabled and other underserved and rural
areas.
The populations served include rural, underserved and/or DHPSA
communities; the 4 state public health hospitals that care for the
chronically ill and the 7 dental clinics for the developmentally
disabled.
The OOH will create a Dental Workforce/Data Consultant position
to develop, implement and monitor a data collection system for oral
health and workforce assessments, prevention programs and community
water fluoridation; as well as, apply for new DHPSA designations.
It also will hire a Community Prevention Oral Health Consultant
to develop, implement and promote statewide school preventive dental
(sealant) programs (grades 2 and 7), in DHPSA, rural and underserved
areas, replicating a successful model in Boston; and support fluoridation
and school fluoride mouth rinse programs. An assessment of the
oral health needs of the 4 state public health hospitals will be
done in partnership with the Tufts Dental School; and the development
of a faculty recruitment campaign to increase the dental workforce
in the 4 state hospitals and 7 facilities for the developmentally
disabled, as well as loan repayment and limited licensed dentists
program for underserved populations.
An Advisory Committee made up of key stakeholders such as the state
dental society, primary care association, dental and dental hygiene
schools, several offices within MDPH, and 2 dentists board certified
in dental public health will oversee this proposal by planning,
monitoring and evaluating the progress of the objectives and activities
of each initiative.
Michigan
T12HO07702
Sheila Semler, Ph.D
Michigan Department of Community Health
320 S Walnut Street
Lansing, MI 48933
517-335-8388
semlers@michigan.gov
Michigan continues to rank among the lowest in the country for
dental care access. Despite recent steps to alleviate oral health
disparity such as reinstating adult dental Medicaid in October 2005,
the positive step of mandating dental care through Community Health
Centers and developing an oral health infrastructure, the demand
for services far exceeds the resources available. The ailing economy,
aging workforce and increasing areas of oral health disparity exacerbate
the existing problem. Over 65 of Michigan’s 83 counties are designated
as full or partial health provider shortage areas for services.
This grant will address two critical workforce issues that can
significantly improve access to care to some of Michigan’s most
vulnerable populations. First, establishing a community-based
dental facility in an area of high poverty with an underserved population
will significantly improve access to care for a broad population
base. When State funding has allowed, developing dental clinics
within the safety-net network has been very successful in increasing
access to oral health services, especially for the Medicaid population.
The collaborative support of Michigan Primary Care Association,
Community Health Centers, the Michigan Association of Local Public
Health, the Oral Health Coalition, the Michigan Department of Community
Health, the Michigan Dental Association, local public health clinics
and other stakeholders is in place to ensure success of this endeavor.
The second workforce issue will address access to preventive services.
Establishing a pilot project for a community dental hygiene coordinator
in an area or areas of high decay incidence, low sealant placement,
lack of community water fluoridation and limited access should result
in a model that can be utilized state-wide to greatly improve oral
health and health care systems by eliminating barriers to oral health
access.
Both projects have components that address the four goals listed
in the grant:
- Improve the knowledge, skills and competencies of the workforce
in dealing with health disparities and in particular, persons
with disabilities.
- Each project is a critical piece to building the oral health
infrastructure for long-term sustainability of an effective and
efficient workforce.
- Health barriers will be removed in the target areas by providing
a distribution of dental care providers in health professional
shortages areas.
- Health disparities will be reduced by providing preventive and
restorative services and the establishment of a dental home for
the most underserved populations.
Mississippi
T12HP07709
Dr. Nicholas Mosca
Mississippi State Department of Health
570 East Woodrow Wilson
Jackson, MS 39215
601-576-6500
Nicholas.mosca@msdh.state.ms.us
Mississippi is a predominately rural state with approximately three-quarters
of the 2.9 million state residents living in non-metropolitan areas.
The states three largest populated areas have sufficient supplies
of dentists; however a majority of Mississippians live in rural
areas, and face tremendous shortages, particularly in dentists who
specialize in pediatric dentistry and periodontics. In 2005, the
Mississippi State Board of Dental Examiners reported 1,197 active
and 208 inactive dentists in the state, with 42 new dentists licensed
during 2004. Based on Mississippi’s 2010 projected population of
3.1 million people, the state will have one active dentist for every
2,605 people. In FY 2005, only 472 dental providers participated
in the Medicaid dental program. This proposal seeks to improve the
distribution of dentists in rural Mississippi by increasing the
agency’s capacity to identify dental workforce supply and demand,
and facilitate partnerships to provide a rich dental public health
education experience that encourages dentists to practice in rural
areas. The key objectives of this proposal are:
- To establish a GIS workforce analysis model based on previous
collaborative work between the Mississippi Department of Health
and the University of Mississippi School of Dentistry; and
- To facilitate the School of Dentistry to revise its curriculum
to develop a multi-year student externship in a community partner
clinic to serve culturally diverse communities and understand
the population-level factors that impact the community’s utilization
of dental care services.
North Carolina
T12HP07711
Rebecca S. King, DDS, MPH
North Carolina Department of Health and Human services
1910 MSC, Raleigh, NC 27699-1910
919-707-5487
Rebecca.King@ncmail.net
The prevalence of early childhood caries is increasing in low-income
children in North Carolina. A stable number of dentists combined
with the rapid growth of the child population, particularly poor
Latino immigrants, contribute to much of this dental disease going
untreated. A demonstration project, referred to throughout the
application as the Carolina Dental Home initiative, is proposed
in which we address disparities in oral health for preschool-aged
children by targeting Medicaid enrolled children from birth to 5
years of age.
The overall goal of the proposed demonstration is to develop and
pilot test a collaborative, coordinated and comprehensive community-based
system that provides access to dental homes for preschool-age Medicaid
children. It will build on successful efforts that already have
engaged more than 400 medical offices in the delivery of preventive
oral health services for young children and those children who are
enrolled in all 18 Early Head Start (EHS) programs in the state.
The objectives of this project are to: (1) enhance the ability of
medical providers participating in the ongoing dental initiative
to provide risk-based dental referrals; (2) improve the availability
and adequacy of the dental workforce to meet the dental needs of
preschool-age children enrolled in Medicaid; and (3) increase the
value that primary caregivers of preschool-age Medicaid children
place on early and regular dental visits.
Physicians, dentists and other community providers for pre-school
children and their families located in a pilot site will be enrolled
in a learning collaborative to develop risk-based guidelines for
coordinated care for children 0-5 years of age. We anticipate that
guidelines will recommend that children who are at high risk for
dental disease or develop obvious disease before 3 years of age
will be referred by physicians to a pediatric dentist, while low
risk patients will remain under the care of physicians and subsequently
referred to a general dentist at 3 years of age, the age at which
the dental benefit in medical offices ends. This risk-based approach
leaves most 0-2-year-old children under the care of physicians.
General dentists will be trained to provide dental services according
to the level of care agreed upon by collaborative participants through
enhanced continuing education and in-office collaboration among
pediatric and general dentists. Dental practices agreeing to provide
a dental home for children will receive an access improvement grant
tied to the number of children enrolled in their practices. Case
managers employed by Health Choice (NC’s EPSDT program) or other
social service programs will coordinate and integrate the delivery
of dental services. Physician counseling of parents of young children
will be enhanced to include the importance of dental homes for young
children.
Medicaid claims for reimbursement filed by physicians and dentists
in the demonstration site compared to the remainder of the state
will be used to monitor changes in access to dental care and the
quality of that care. We anticipate that the project will increase
access to dental care for low-income children through a comprehensive
system of evidence-based care.
Puerto Rico
T12HP07703
Ramon F. Gonzalez, DDS, MPH
University of Puerto Rico School of Dentistry (UPRSD)
Medical Sciences Campus
P.O. Box 365067
San Juan, PR 00936-5067
(787) 758-2525 ext. 1121 or 2509
rfgonzalez@rcm.upr.edu
Cantera Peninsula children suffer from oral health disparities
as a result of many factors such as the dietary and hygiene habits,
the attitudes of parents towards oral health, lack of knowledge
of the right time to take their children to their first dental visit,
not having a health insurance, limitations in health coverage, health
professional discriminating attitudes toward low-income families
and lack of confidence in the health system, among others. On the
other hand, studies in Puerto Rico indicate that HIV patients also
suffer from oral health disparities as a consequence of lack of
knowledge and willingness to treat from dental providers. To reduce
these inequalities not only proper oral health care is necessary
but also adequate training of medical/dental provider, patients
and families regarding oral health. The propose project intend to
reduce these disparities.
The proposed project has the following goals:
- To assure access to quality oral health care for infants and
children between 0 and 6 years from the Cantera Peninsula (Quality
oral health care is timely, appropriate and effective).
- To strengthen and increase the effectiveness of the Community
Network for Oral Health of the Cantera Peninsula.
- To assure access to quality and culturally competent oral health
care for HIV individuals enrolled at the Puerto Rico Community
Network for Clinical Research on AIDS (Quality oral health care
is timely, appropriate and effective).
To accomplish these goals the University of Puerto Rico will initiate
three new components to increase and improve the oral health services
provided to underserved communities:
- UPRSD will establish a Dental Hometo work more closely with
the families and empower them to take control of their oral health
needs and confront complex multifactorial access related problems.
This will be done though the facilities of the Cantera Peninsula
Dental Clinic, a community-based clinic administrated by the UPRSD.
- We will expand the Cantera Peninsula community partnershipthrough
a network of Puerto Rican organizations that attend the health
of infants, children and their families. In addition, we will
work strategically with Pediatricians and other Pediatric health
professionals to reduce the incidence of early childhood dental
caries in this community.
- The UPRSD will provide culturally competent comprehensive oral
health care services to HIV patients at the PR CoNCRA while providing
didactic and clinical training to dental residents and students.
The training will include seminars and workshops in stigma and
cultural competence issues in addition to the medical/dental management
of HIV. The proposed project will allow us to continue offering
and improving our services to this special target populations.
Rhode Island
T12HP07708
MaryAnne Miller, RN, MPH
Rhode Island Department of Health
3 Capitol Hill, Room 408
Providence, RI 02908-5097
401-222-7625
MaryAnne Miller@health.ri.gov
In recent years, RI has received federal and foundation funds to
support a variety of oral health initiatives. As a result, the Oral
Health Program, RI Department of Health has been revitalized, the
dental Medicaid program through the RI Department of Human Services
has undergone significant reform, community health centers have
started new or expanded dental clinics, and extensive oral health
partnerships have been developed. Despite these accomplishments,
RI is facing significant oral health workforce challenges. Nearly
half of actively practicing dentists are approaching retirement
and the state has a less than optimal supply of dental hygienists,
dental assistants, dental laboratory technicians and/or the expert
faculty to train students seeking entry to these professions. These
shortages will likely impact the state’s most vulnerable populations
– children from families with low-income, children with special
health care needs, disabled adults, elders in nursing facilities,
and those of minority race/ethnicity.
RI does not have a dental school and currently only eight Rhode
Islanders are enrolled in out-of-state dental schools. In addition,
the baccalaureate degree program for dental hygienists at the University
of RI has been eliminated and the Community College of RI remains
the only accredited program for dental hygiene [associate degree]
and certified dental assistant training. Only 14% of currently licensed
dentists are women and people of minority race/ethnicity are underrepresented
in the state’s oral health professions and existing training programs.
The proposed project seeks to further advance and implement strategies
identified by key RI coalitions including the RI Senate Commission
on Oral Health, Early Childhood Oral Health Coalition, Oral Health
Access Project Advisory Committee, Oral Health Professional Advisory
Council, and Dental Care in Nursing Homes Workgroup and by stakeholders
participating in the 1st Annual RI Oral Health Summit.
The proposed activities will help to enhance the clinical/ cultural
competency of currently practicing oral health professionals and
promote recruitment of diverse, qualified students to oral health
professions.
Project Objectives/Actions include: 1) Establishing an interdisciplinary
Steering Committee to guide implementation/evaluation; 2) Conducting
mini-residency programs for general practice dentists, dental
hygienists, and dental assistants in 3 focal areas [Pediatric,
Special Care, and Geriatric Dentistry]; 3) Increasing the cultural/linguistic
competency of the oral health workforce serving disadvantaged populations
through training in CLAS standards; 4) Increasing recruitment/ retention
of oral health professionals to RI and science/community-minded
students, particularly those of minority race/ethnicity to careers
in dentistry; and 5) Developing legislation and leveraging funds
to assure a highly trained/culturally sensitive oral health workforce
able to meet the needs of underserved populations.
Vermont
T12HP07710
Dr. Steve Arthur
State of Vermont, Department of Health
108 Cherry Street, P.O. Box 70
Burlington, VT 05402-0070
(802) 863-7497
sarthur@vdh.state.vt.us
Success and commitment in developing programs for oral health access,
clearly reflects Vermont’s ability to effectively collaborate with
key constituents to improve access to oral health services for its
citizens. However, given the improvements in policy and insurance
coverage which have increased access to oral health services, Vermont
continues to be challenged to retain and develop an oral health
workforce adequate in size and distribution to provide the types
of services and care promoted and supported by these system and
policy initiatives. Over the past several months a group of stakeholders
has met regularly to develop a plan for improving the coordination
and breadth of activities related to training and recruiting dentists.
This stakeholder group has included the Vermont State Dental Society
(both the Executive Director as well as individual members), University
of Vermont Area Health Education Centers Program, Vermont Department
of Health, Bi-State Primary Care Association, Vermont Dental Residency
Program and staff from the office of U. S. Senator James Jeffords.
This group has identified a number of consensus key activities and
initiatives which will advance the state and its training and recruitment
activities. These key activities have a high level of support across
the oral health, university and public health sectors. Vermont is
proposing to expand its existing workforce development infrastructure
to generate and support an oral health workforce adequate to meet
the expanding needs of the state. In order to do this, Vermont
will concentrate on the following goals:
- Establish systems and opportunities to recruit dental students
to Vermont with special interest in and attention to Vermont students
attending dental schools throughout the United States.
- Encouraging youth and college students to consider careers
in oral health through enhancement of the oral health educational
pipeline.
- Expand and develop educational programs through studying the
feasibility of both expanding the residency training program and
developing an externship program.
These goals will be accomplished through a collaborative process
monitored by an Oversight Committee of stakeholders which will act
as a subcommittee to the existing oral health recruitment and retention
working group. Subcommittee participants will include the Department
of Health, Vermont Dental Society, Vermont Residency Training Program
and UVM Area Health Education Center Program.
Washington
T12HP077
Riley Peters
Washington State Department of Health
Office of Community and Rural Health
P.O. Box 47850
Olympia, WA 98504-7850
(360) 236-3553
Riley.Peters@DOH.WA.GOV
The 2005 Washington State Smile Survey, conducted by the Washington
State Department of Health, indicated that, “There are significant
oral health disparities in Washington with minority, low-income,
and non-English speaking children having the highest levels of dental
decay, rampant decay, untreated decay, and urgent need for dental
care and the lowest level of dental sealants.” The proposed project
will target low-income and minority populations in Yakima County,
Walla Walla, and Seattle. The Yakima County and Walla Walla target
communities are in rural areas of the state, and the Seattle target
community is an underserved urban area of the state. These communities
experience substantial oral health disparities and lack of access
to adequate oral health care and dentist workforce s hortages.
The purpose of the project is to plan and implement innovative
programming to improve access to oral healthcare through a needs-based
program that increases the number of trained and culturally competent
dentists and other dental health professionals practicing in rural
and urban underserved areas of Washington State. This will be accomplished
through a partnership among the Washington State Department of Health
Office of Community & Rural Health, the Maternal and Child Health
Oral Health Program, the Washington State Healthcare Authority,
the Yakima Valley Farm Workers Clinic, Puget Sound Neighborhood
Health Centers, University of Washington School of Dentistry, the
Washington Dental Service Foundation and the Washington State Dental
Association that will accomplish an expansion of the newly-established
Northwest Dental Residency Program and support pipeline programs
to assist young people of color and those from dental shortage areas
of the state to enter dental health professions. These partners
have a strong history of partnership activities specific to oral
health workforce development and access to dental services.
The project will expand the Northwest Dental Residency by 4 additional
resident slots, 1 in Yakima County, 1 in Walla Walla and 2 in Seattle.
The project will provide for dental profession pipeline activities
to occur in Yakima County and Seattle. In addition, the project
will establish a unique interagency Evaluation/Technical Assistance
team, made up of staff from each of the partner organizations. Formalization
of this partnership will be important to future expansion efforts
for the community-based dental residency program.
Wisconsin
T12HP07707
Warren R. LeMay
One West Wilson Street - PO Box 7850
Madison, WI 53707-7850
(608) 266-5152
lemaywr@dhfs.state.wi.us
In many areas across Wisconsin, families and individuals have a
difficult time obtaining adequate access to dental care services.
A variety of obstacles may deter individuals from obtaining the
care they need. These barriers may be financial, geographic, perceptual,
educational, linguistic, cultural, or provider-related. Substantial
oral health disparities between populations of different income
levels, ages, and cultures also exist. Increased resources targeted
to high risk populations for the prevention of oral disease could
improve the oral health of Wisconsin children.
The purpose of the project is to improve access to oral health
care by increasing the number of oral health providers providing
evidence-based preventive services to targeted populations. Specifically,
the project will expand Wisconsin’s Seal a Smile initiative. Based
on a systemic review of the evidence on the effectiveness of population-based
interventions to prevent and control tooth decay, the Task Force
on Community Preventive Services strongly recommended school-based
or school-linked pit-and-fissure sealant delivery programs.
The Wisconsin Department of Health and Family Services (DHFS) will
contract with the Children’s Health Alliance of Wisconsin to administer
mini-grants for school-based and school-linked dental sealant programs.
The Seal a Smile program will assure that children receive a highly
effective but underutilized dental prevention service through a
proven community-based approach. The program will support infrastructure
workforce capacity by increasing funding support to local public
health departments for the increased utilization of dental hygienists
for community-based activities. Seal a Smile will maximize effectiveness
by targeting high risk children. High risk children include vulnerable
populations less likely to receive private dental care, such as
children eligible for free or reduced-cost lunch programs. The
primary grades to be targeted are the second and sixth grades.
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