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ADA House to consider CDHC resolution

Long-term commitment sought for piloting, evaluating of training programs

The development of the Community Dental Health Coordinator has been in the works since 2006, with pilot training programs set to start early next year. The House of Delegates will consider a resolution to provide long-term financial support for the program.

"The Community Dental Health Coordinator is designed to assist dentists in improving dental care for patients with limited and no care," said Dr. Bob Brandjord, chair of the ADA Workforce Models National Coordinating and Development Committee. "Working with other dental team members under the remote supervision of a dentist, CDHCs will increase access for underserved people by coordinating their dental needs, triaging care based on emergent or urgent needs, and organizing transportation and other logistical or social support as needed."

After providing an update on the CDHC to the Board of Trustees Aug. 12, Dr. Brandjord took the opportunity to address some misconceptions regarding the workforce model. He emphasized that the CDHC:

  • is not intended to substitute for dentists in providing clinical care;
  • performs no irreversible procedures;
  • does not diagnose;
  • is part of the dental team;
  • screens patients for emergent, urgent or routine dental care;
  • places temporary restorations after consulting with the supervising dentist.

"The development of the CDHC has been in keeping with the ADA's commitment to the public's oral health," said Dr. Brandjord, also an ADA past president (2005-06).

"CDHCs will be recruited from distinct communities to work and build trust at the grassroots level and play an important role in bridging the gap between local cultures and dental health care systems," he said. "They will navigate community members through the health care delivery system, helping diverse populations overcome barriers that prevent them from accessing and benefiting from dental health services. Their overall goal will be empowering community members, communities and the dental health care systems to achieve positive outcomes and to reach the optimal level of wellness for everyone.

"This is not the only solution to dental access problems, nor is it the only solution proposed by the ADA," he added, citing improvements in funding and organization of Medicaid, promotion of the expansion of the State Children's Health Insurance Program and support for Federally Qualified Health Centers as a few examples.

"This is different than any other new, proposed workforce model in that the CDHC's focus is on the prevention of dental disease," said Dr. Brandjord.

CDHCs will work under a dentist's supervision in health and community settings such as schools, churches, senior citizen centers, Head Start programs and other public health settings with people similar to their own ethnic and cultural background. CDHCs will be trained to promote oral health and provide preventive services including screenings, fluoride treatments, placement of sealants, placement of temporary fillings and simple teeth cleanings (selective scaling for plaque-induced gingivitis, i.e., removing gross debris, stains and calculus using anterior and posterior sickle hand scalers) until the patient can receive comprehensive preventive services from a dentist or dental hygienist.

CDHCs will not excavate caries, but temporary restorations in caries will be placed (as well as sealant and fluoride application) by the CDHC after approval from a supervising dentist after the dentist has made a diagnosis.

"Temporization will stop the caries from progressing, increase secondary dentin formation and in some cases cause remineralization," said Dr. Brandjord. "Temporary restorations will eventually be replaced by the supervising dentist when he or she completes the patient's care. In cases like these, the CDHC will be instrumental in ensuring that the patient follows up in a timely manner with definitive care by the dentist."

Aside from working in health and community settings, the CDHC will collect information to assist the dentist in patient triage and address the social, environmental and health literacy issues facing the community. Linking patients to oral health care will also be an important role for the CDHC in working with underserved populations going through the maze of the health and dental care systems.

Dr. Brandjord has delivered presentations on the CDHC at 27 dental organization meetings in the last two years and to key staff of U.S. Senate and House of Representatives committees associated with health care. The ADA Board of Trustees in August reiterated its strong support for the CDHC program and adopted resolutions approving next steps for program implementation and evaluation. The Board reviewed the program's current funding, as well as anticipated additional financial implications for the ongoing operations and evaluation of the pilot sites, and recommended that the ADA commit to the program's long-term financial support.

The Board also directed that a similar presentation be made available to ADA members during annual session. "Presentation on the CDHC Pilot" takes place Friday, Oct. 17, from 11 a.m. to noon at the Henry B. Gonzalez Convention Center (Ballroom C).

Dr. Brandjord will also be available for state caucuses during annual session, and the CDHC curriculum will be on display in the Delegates Registration Area.

The 2008 House of Delegates will consider Resolution 39, recommended by the Board, which calls for the ADA to commit to up to $5 million to support the CDHC model. The funding would include the three pilot sites, management of the online curriculum, evaluation of the program, project support, and equipment and supplies. Board Report 10 states: "Because the program evaluation will be a multi-year endeavor with a formal agreement, the Board believed that the ADA should formally commit to long-term support for the program while continuing aggressive efforts to seek external funding."

"The ADA Foundation has helped us to identify potential funding sources that may be interested in providing financial support for the CDHC and we are aggressively pursuing those options," said Dr. Brandjord. More than 100 foundations and federal grant-making agencies have been contacted, and local funding support for the CDHC pilot programs has also been encouraged.

"Potential support from funding sources is more likely if there is clear support—including a financial commitment—from the ADA," said Dr. Brandjord.

The Community Dental Health Coordinator workforce model has been in development for several years. Dating back to 2004, the House of Delegates has directed three different workgroups to study workforce issues as part of a broad Association effort to evaluate workforce and oral health access. In 2006, the House of Delegates passed two resolutions calling for an expanded dental workforce team, as proposed by the ADA Workforce Task Force.

The 2007 House passed Resolution 54H-2007, which, among other things, encouraged the National Coordinating and Development Committee to complete the CDHC curriculum, begin piloting and evaluating the model training program at three sites, and allocated up to $2 million from reserves to fund pilot programs over a three-year period. That $2 million has been allocated to support the overall management of the online curriculum, initiate the training program and develop the comprehensive evaluation component in 2008-09. By early 2010, those funds will be fully allocated.

Each of the three pilot sites will cost a minimum of $1.5 million to operate for three years. The evaluation component, including a clinical care data management system, will be about $1 million. To date, approximately $170,000 in project administrative costs have been paid from the $2 million granted by the ADA to run the project. That figure is expected to increase to $250,000 by the end of the year.

Total funding for the CDHC pilot program will be almost $8 million, including project support costs for temporary staff, volunteer meetings, and promotion and evaluation of the pilot programs' overall success. Financial support of $5 million over the next five years is requested if external funding cannot be achieved.

"Report 10 of the Board of Trustees to the House of Delegates: Update on the Community Dental Health Coordinator Pilot Programs" is on ADA.org in members-only content.

To view the report and the "CDHC Curriculum: Community Health Worker and Health Promotion Skills and Dental Skills," visit www.ada.org/goto/hod and click on "2008 Reports and Resolutions."