BRINGING ORAL HEALTH CARE INTO THE 21ST CENTURY

NPAIHB QBMWEDNESDAY, OCTOBER 28, 2015

PAM JOHNSON, ORAL HEALTH PROJECT SPECIALIST

Dental Health Aide Therapists

YET MILLIONS OF PEOPLE LIVING IN TRIBAL COMMUNITIES CANNOT GET THE DENTAL CARE

THEY NEED.

Oral Health is important to overall health

A Solution: Dental Health Aide Therapists

Model began in the 1920s

Dental therapists practice in 54 countries, including the US, Canada, England, Australia, New Zealand and The Netherlands

Under supervision of dentists, dental therapists can practice in remotesettings where there is need for additional provider capacity

•Evidence shows care provided by dental therapists is high quality, cost effective and safe

•History of providing routine and preventive care in community settings

Dental Therapists

• Primary oral health care professionals• Basic clinical dental treatment and

preventive services • Multidisciplinary team members• Advocate for the needs of clients• Refer for

services beyond the scope of the DHAT’s practice

Alaska’s Dental TherapistsAlaska’s Dental Therapists

35 dental therapists increased access to care for over 45,000 Alaska Natives

Provide culturally competent care

Produce high patient satisfaction rates

Reduce amount of emergency care

Increase preventive care Create jobs and generate

economic impact o Created 76 full time jobs per

year with total personal income of $4.4 million

o Net economic effect of program is $9.7 million in Rural Alaska

Dental Therapists in Action

Swinomish Dentist Rachael Hogan observes DHAT Savannah Bonorden on a recent learning trip to Sitka, AK

Why no DHATs in lower 48???

After losing the battle in Alaska to prevent DHATs from expanding services to Tribal communities, the American Dental Association was successful in inserting the following language in the re-authorization of the Indian Health Care Improvement Act:

Expansion of the Community Health Aide Program “shall exclude dental health aide therapist services from services covered under the program…”

“…shall not apply in the case of an election made by an Indian tribe or tribal organization located in a State (other than Alaska) in which the use of dental health aide therapist services or midlevel dental health provider services is authorized under State law…”

Swinomish Chairman and NCAI President Brian Cladoosby announcing the Swinomish Chairman and NCAI President Brian Cladoosby announcing the Swinomish DHAT Initiative, June 2105Swinomish DHAT Initiative, June 2105

Swinomish Indian Tribal Community DHAT Initiative

Swinomish Current Political Swinomish Current Political and Legal Solution and Legal Solution

--Swinomish Tribal Community worked for the past two legislative sessions with Swinomish Tribal Community worked for the past two legislative sessions with the Northwest Portland Area Indian Health Board and the Washington State the Northwest Portland Area Indian Health Board and the Washington State House and Senate to craft a House and Senate to craft a Tribal Specific DHAT Authorization BillTribal Specific DHAT Authorization Bill

-Lobbied heavily by the WSDA, no DHAT Bill—tribal or otherwise--got out of -Lobbied heavily by the WSDA, no DHAT Bill—tribal or otherwise--got out of House or Senate Committees in Washington State for the past 10 years. House or Senate Committees in Washington State for the past 10 years.

-Swinomish has determined that it has the power and obligation to address oral -Swinomish has determined that it has the power and obligation to address oral health systems change under Tribal Sovereigntyhealth systems change under Tribal Sovereignty

--

http://apps.leg.wa.gov/documents/billdocs/2013-14/Pdf/Bill%20Reports/House/2466%20HBAhttp://apps.leg.wa.gov/documents/billdocs/2013-14/Pdf/Bill%20Reports/House/2466%20HBA%20CDHT%2014.pdf%20CDHT%2014.pdf

Solutions for Swinomish Solutions for Swinomish Provided by DHATProvided by DHAT

Procedure review for FY 2012, 2013 and 2014 for Swinomish Clinic Procedure review for FY 2012, 2013 and 2014 for Swinomish Clinic showed that over 50% of procedures and services could have been showed that over 50% of procedures and services could have been provided by trained Dental Health Aide Therapistprovided by trained Dental Health Aide Therapist

Analysis shows that the same procedures could have been covered Analysis shows that the same procedures could have been covered with 50% Personnel cost savings-replace Dentist time with DHAT with 50% Personnel cost savings-replace Dentist time with DHAT timetime

DHAT Licensure Authorization would help I/T/U Clinics fill a huge DHAT Licensure Authorization would help I/T/U Clinics fill a huge gap in service demand across the Indian Health Service system for gap in service demand across the Indian Health Service system for Native patientsNative patients

Work Force Development strategy of a DHAT based in the Work Force Development strategy of a DHAT based in the Community assures longer term Community and Public Health Community assures longer term Community and Public Health benefits benefits

Our Current Systems Solution Our Current Systems Solution

--Swinomish has adopted 2 Tribal laws under its Swinomish has adopted 2 Tribal laws under its own regulatory framework: own regulatory framework:

•It has created a Division of Licensing, roughly It has created a Division of Licensing, roughly equivalent to the State of Washingtonequivalent to the State of Washington’’s and s and

•It has adopted a Dental Health Provider Licensing It has adopted a Dental Health Provider Licensing Code under which Dentists, Dental Hygienists, and Code under which Dentists, Dental Hygienists, and Dental Health Aide Therapists will be licensedDental Health Aide Therapists will be licensed

Swinomish Dental Health Provider Licensing Board and Staff: Dr. Rachael Hogan, Board Member; Stephen LeCuyer, SITC Staff Attorney; Tara Satushek, SITC Associate Planner; Ed Knight, SITC Director Division of Licensing; John Stephens, SITC Programs Administrator; Dr. Louis Fiset, Board Member; Brian Wilbur, Board Member. Board members not pictured: Ruth Ballweg and Diane Vendiola.

History being made!

Building a 21st Century Dental Team!

Swinomish has entered in to a Interlocal Agreement with the Alaska Native Tribal Health Consortium to provide DHAT Training to Swinomish members accepted into the program. The first trainee started the program this July, and after graduating in 2017 will come back to serve her community.

Aiyana Guzman, SITC, Class of 2017

DHAT services begin in January 2016DHAT services begin in January 2016

Daniel Kennedy, experienced DHAT currently working for the Southeast Regional Health Consortium in Alaska will be joining the Swinomish Dental Clinic Team!

Analysis of the Swinomish SolutionAnalysis of the Swinomish Solution

-The Swinomish Solution is a huge step forward in -The Swinomish Solution is a huge step forward in advancing DHATs and dental therapists in the lower 48.advancing DHATs and dental therapists in the lower 48.

-Swinomish Solution develops a -Swinomish Solution develops a ““replicable Tribal Modelreplicable Tribal Model”” under Tribal Sovereigntyunder Tribal Sovereignty

-Unfortunately the Swinomish Model cannot be -Unfortunately the Swinomish Model cannot be duplicated by all Tribes, especially resource poor tribesduplicated by all Tribes, especially resource poor tribes

-State Legislatures still need to authorize DHATs, -State Legislatures still need to authorize DHATs, especially in Tribal settings under current IHCIA especially in Tribal settings under current IHCIA language!language!

Oregon Tribes DHAT Pilot Project

aacckkggrroouunndd

Oregon Dental Pilot Projects were Oregon Dental Pilot Projects were authorized by state legislation in 2011 to authorized by state legislation in 2011 to increase access and improve quality to oral increase access and improve quality to oral health care by:health care by:

Teaching new skills to existing providers,Teaching new skills to existing providers,

Developing new categories of dental Developing new categories of dental providers, and providers, and

Accelerating and expanding the training to Accelerating and expanding the training to current providers. current providers.

This year, 2015, legislation was passed to:This year, 2015, legislation was passed to:

Extend the sunset date from 2018 to 2025--Extend the sunset date from 2018 to 2025--acknowledging the slow start and lack of funding to acknowledging the slow start and lack of funding to the program since 2011the program since 2011

Make sure new providers and services would be Make sure new providers and services would be covered by Medicaid covered by Medicaid

Oregon Health Authority funded for upcoming Oregon Health Authority funded for upcoming year to administer the programyear to administer the program

The Northwest Portland Area Indian Health Board, working with Oregon tribes, has submitted a dental pilot project to the Oregon Health Authority to train and employ DHATs at Tribal Health and Dental Clinics. Proposed outcomes of the pilot are to:

•Expand access to consistent, routine, high quality oral health care in tribal communities;•Grow the number of AI/AN oral health care providers available to tribal communities;•Bring culturally competent care into tribal communities;•Create a more efficient and effective oral health team that can meet the needs of the tribal communities;•Establish cost effective solutions to oral health challenges in tribal communities;•Bring care where it is needed most.

Initial Pilot SitesInitial Pilot Sites

Confederated Tribes Confederated Tribes of Coos, Lower of Coos, Lower Umpqua and Siuslaw Umpqua and Siuslaw IndiansIndians

Coquille Indian Coquille Indian TribeTribe

Pilot Project ApplicationPilot Project Application

First Pilot Project submitted to the state: Project First Pilot Project submitted to the state: Project 100!100!

The application includes a full summary of The application includes a full summary of project, training program, employment options, project, training program, employment options, patient notification, evaluation and monitoring patient notification, evaluation and monitoring plan, and costsplan, and costs

Last week it was deemed “complete” and sent to Last week it was deemed “complete” and sent to a Technical Review Board for a 30 day review.a Technical Review Board for a 30 day review.

Final decision rests with the OHA Dental Final decision rests with the OHA Dental DirectorDirector

Next StepsNext Steps

• Work with pilot tribes to start informing and educating the tribal community about adding a DHAT to the dental team.

• Start recruiting 2nd DHAT student from CTCLUSI and 1st DHAT student from Coquille for July 2017 start of training

• Initiate training for the supervising dentist at CTCLUSI

• Start recruiting an experienced DHAT to begin providing services at dental clinic in mid-2017

• Explore setting up a regulatory structure/licensing code similar to Swinomish

Building a 21st Century Dental Team!

Confederated Tribes of Coos, Lower Umpqua and Siuslaw Indians has entered in to a Interlocal Agreement with the Alaska Native Tribal Health Consortium to provide DHAT Training to CTCLUSI members accepted into the program. The first trainee started the program this July, and after graduating in 2017 will come back to serve her community.

Naomi Petrie, CTCLUSI Class of 2017

2121 SW Broadway, Suite 300 Portland, Oregon 97201

Phone: (503) 228-4185 Fax: (503) 228-8182

Northwest Portland Area Indian Health BoardIndian Leadership for Indian Health

For more information please contact:

Christina Peters, Oral Health Project Director cpeters@npaihb.org206.349.4364

Pam Johnson, Oral Health Project Specialist pjohnson@npaihb.org206.755.4309