DHA Program

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DHA Program

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

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Newtok ClinicYukon Kuskokwim Health Corporation
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Newtok Clinic, Yukon-Kuskokwim
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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

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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

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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

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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.

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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

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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

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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

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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

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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

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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

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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

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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.

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Gambell Clinic, Norton Sound