DHA Program - PowerPoint PPT Presentation

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DHA Program

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Crisis in access to dental care in Alaska ... Why Dental Health Aides? ... Functions as part of the dental team under the supervision of a dentist ... – PowerPoint PPT presentation

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Title: DHA Program


1
DHA Program
  • Ron Nagel DDS MPH
  • Alaska Native Tribal Health Consortium
  • www.ANTHC.org

2
Newtok ClinicYukon Kuskokwim Health Corporation
3
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4
Newtok Clinic, Yukon-Kuskokwim
5
AFHCAN CartAlaska Federal Health Care Access
Network
  • Wireless Networking
  • Touchscreen
  • ECG / Video Dental Camera and Otoscope / Scanner
    / Digital Camera
  • Mobile Customized
  • Patient safe
  • WWW. AFHCAN.ORG

6
Crisis in access to dental care in Alaska
  • AK Native children have 21/2 times the disease of
    U.S. all races
  • 2-4 y/o AI/AN have the highest decay rate of any
    population cohort in the U.S. Five times the U.S.
    average.
  • 91 of AI/AN, age 15-19, have a history of
    caries. 68 are untreated.
  • Dietary changes
  • An aging population
  • A growing population (over 60 increase since
    1970)
  • Substantially higher costs of providing services
    in small isolated rural communities

7
Why Dental Health Aides?
  • To improve access to basic oral health services
    by developing local capacity
  • To remove barriers to training so that students
    come from underserved areas and return to live
    and practice
  • To provide the continuity of care needed to
    implement preventive and educational programs
  • To develop culturally competent providers
  • To help establish the social and behavioral
    changes needed for better oral health

8
Community Health Aide History
  • Developed by physicians some 38 years ago
  • Competency based credentialing (similar to
    hospital privileging)
  • Today about 550 CHAs provide primary health care
    in rural Alaska (350,000 patient encounters
    annually)
  • Their training starts with EMT or ETT training
  • They are an integrated part of the delivery
    system working with Doctors, Nurses, and PAs.
    They are not a second level of care.

9
Competency Based Credentialing - QA
  • Each Dental Health Aide is assigned to a
    dentist/s
  • After training DHAs must practice their newly
    learned skills under direct supervision for a
    prescribed minimum time/encounter period. 400
    hours for Therapists
  • Only after the dentist that oversees the
    procedure has determined that the DHA meets the
    standard of care are they considered to competent
    for that skill and eligible for certification

10
Competency - QA continued
  • DHAs must demonstrate competency to maintain
    their certification and to change their scope
  • Every two years each DHA must provide evidence
    that they completed the CE requirements (24 hrs)
    and they demonstrate the practical professional
    competencies for their level of certification
  • These administrative controls help to assure
    quality and that a single standard of care is met
    in tribal programs

11
Competency vs. licensure
  • Changes in DHAs skills are measured over their
    entire career
  • We look directly at the services that they
    provide day to day
  • Each DHAs scope of practice is individually
    assigned based on competence through standing
    orders

12
Community Health Aide Program Certification Board
  • The Community Health Aide Program Certification
    standards are administrated by a 12 member
    Federal board. They are MDs, DDS, PA, NP, CHAs
    from tribal programs in Alaska
  • There are provisions in the standards for
    Discipline, Suspension or Revocation of a
    certificate

13
Primary Dental Health Aide
  • Village based
  • Provides education
  • Provides topical fluoride applications
  • Places Sealants
  • Exposes radiographs
  • Performs prophylaxis
  • Performs Atraumatic Restorative Treatment (caries
    control)
  • Manages emergencies
  • Assistant when dentist is in village

14
Expanded FunctionsDental Health Aide
  • Clinic based
  • Functions as dental assistant
  • Performs expanded functions
  • Places filling materials in prepared teeth
  • Perform prophylaxis
  • SSCs
  • Lab and prosthetics

15
Dental Health Aide Hygienist
  • Screen for oral health problems develop and
    implement community-based oral health promotion
    programs temporize dental cavities in
    preparation for permanent care by a dentist and
    provide individual and community-wide preventive
    services
  • General supervision
  • Local Anesthetic
  • ART

16
Dental Therapists
  • W.H.O. cites 42 countries that utilize Dental
    Therapists
  • Functions as part of the dental team under the
    supervision of a dentist
  • New Zealand has 87 yrs experience and Canada has
    over 37.
  • Exceptional safety record under general
    supervision for children and adults
  • They are equipped to help us provide the
    educational, preventive and safety net services
    that are most needed.

17
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18
Gambell Clinic, Norton Sound
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