AACDP Symposium

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AACDP Symposium

• Local Dental Programs Wear Your Wetsuit!

National Oral Health Conference April 30, 2006
Ann Battrell, RDH, MSDH(c) ADHA Executive Director
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(No Transcript)
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ADHA Mission Statement

• To improve the public's total health, the
  mission of the American Dental Hygienists'
  Association is to advance the art and science of
  dental hygiene by ensuring access to quality oral
  health care, increasing awareness of the
  cost-effective benefits of prevention, promoting
  the highest standards of dental hygiene
  education, licensure, practice and research and
  representing and promoting the interests of
  dental hygienists.

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Dental Hygiene Projections

• U.S. Department of Labor, Bureau of Labor
  Statistics
• Occupational Outlook Handbook
• Dental hygienists noted within the top 10 fastest
  growing occupations and occupations having the
  largest numerical job growth from 2004-2014
• Noted by level of education and training
• http//www.bls.gov/oco/ocotjt1.htm
• (retrieved 12.21.05)

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Oral Health Workforce
U.S. Dept. of Labor, Bureau of Labor Statistics
DENTISTS (general)
Industry 2004 employment Projected 2014 employment Change, 2004-2014 Change, 2004-2014
Industry Number Number Number
Total employment, all workers 128,000          145,000 17,000 13.5   
http//data.bls.gov/ Retrieved 12.21.05
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Oral Health Workforce
U.S. Dept. of Labor, Bureau of Labor Statistics
DENTAL HYGIENISTS
Industry 2004 employment Projected 2014 employment Change, 2004-2014 Change, 2004-2014
Industry Number Number Number Percent
Total employment, all workers 158,000     226,000         68,000 43.3    
http//data.bls.gov/ Retrieved 12.21.05
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Dental Health Professional Shortage Areas
(D-HPSAs)

• Critical issue
• Distribution of dental workforce
• Eliminating oral health disparities
• Pockets of underserved areas
• Rural
• Inner city
• DHPSAs increased to
• 3296 (792 in 1993)
• 45,620,457 people affected

SOURCE03/06/06, Shortage Designation Branch,
National Center for Health Workforce Analysis,
Bureau of Health Professions, Health Resources
and Services Administration
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ADVANCED DENTAL HYGIENE PRACTITIONER
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ADHA HOD RESOLUTIONS, June 2004

• That the ADHA advocates the creation of an
  advanced dental hygiene practitioner who provides
  diagnostic, preventive, restorative and
  therapeutic services directly to the public.
• That the ADHA supports a standardized educational
  curriculum developed by the American Dental
  Hygienists Association, for the advanced dental
  hygiene practitioner.

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ADHA HOD RESOLUTIONS, June 2004

• That the following definition of Advanced Dental
  Hygiene Practitioner be adopted
• A dental hygienist who has graduated from an
  accredited dental hygiene program and has
  completed an advanced educational curriculum,
  approved by the American Dental Hygienists
  Association, which prepares the dental hygienist
  to provide diagnostic, preventive, restorative
  and therapeutic services directly to the public.

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ADHP Vision Statement

• The advanced dental hygiene practitioner will
  improve the underserved publics health and
  access to quality, cost-effective oral health
  care and appropriate referrals within
  multidisciplinary healthcare teams.

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Historical Perspective

• Why is ADHA pursuing this?
• Access to oral health care crisis in the U.S.
• Heightened awareness for the need for a
  mid-level practitioner
• Compliments the ADHAs commitment to resolve
  health care disparities
• Workforce Supply, Demand and Distribution

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Advanced Dental Hygiene Practitioner

• Why Dental Hygienists?
• Projected growth in workforce
• Projected growth in educational programs
• Market forces creating advanced practice
• Advanced education already in place
• 15 MSDH Graduate programs in place
• Avoid duplication in education and training
• Potential for cost-savings in cross training
• Opportunity to revise efficiency in delivery of
  oral health care

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The ADHP

• Follows the Rapid Practice Changes in the DH
  Profession
• Affiliated Practice (AZ)
• Registered Dental Hygienist in Alternative
  Practice (CA)
• Extended Care Permit RDH (KS)
• Public Health Permit (ME)
• Collaborative Practice RDH (MN)
• Limited Access Permit with Public Health
  Supervision (MT)
• Public Health Supervision (NH)
• Collaborative Practice RDH (NM)
• Public Health Endorsement (NV)
• Public Health Supervision (IA)
• Limited Access Permit (OR)
• School Sealant Programs (WA)

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The ADHP would

• Provide primary oral health care.
• Be competent in working with populations with
  special needs
• children
• medically compromised
• adolescents and geriatric populations. 
• Be able to evaluate oral health needs of
  populations with limited access to care.
• Develop, implement and monitor dental hygiene
  care programs for these populations.
• Participate as a member of a comprehensive health
  care team.

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The ADHP

• From the clinical perspective
• Including but not limited to
• cavity preparation, performing pulpotomies and
  competency in atraumatic restorative therapy (a
  temporary filling) among other preventive and
  restorative therapies. 
• From the health promotion perspective
• Including but not limited to
• Designing nutritional interventions, implement
  and evaluate smoking cessation programs and
  evaluate health promotion and disease prevention
  programs for specific populations.   

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Advanced Dental Hygiene Practitioner (ADHP) Draft
Curriculum
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Educators Forum Wednesday, June 22,
400-600 p.m. Association Activities Forum
Friday, June 24, 1030-1230 p.m.
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ADHP Draft Curriculum

• DOMAINS
• I. Provision of Primary Oral Health Care
• II. Healthcare Policy and Advocacy
• III. Management of Oral Care Delivery
• IV. Translational Research
• V. Professionalism and Ethics

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DOMAIN I Provision of Primary Oral Health Care

• The advanced dental hygiene practitioner
  demonstrates competence in providing primary oral
  health care and case management in diverse
  populations. Practitioners use the process of
  care and target the underserved including those
  with special needs using a multidisciplinary
  approach.

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DOMAIN II Healthcare Policy and Advocacy

• The advanced dental hygiene practitioner
  contributes to health policies that address
  disparities in oral health and access to care for
  the underserved. The practitioner supports and
  applies health policy at the institutional,
  local, state, regional, and national levels.

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DOMAIN III Management of Oral Care Delivery

• The advanced dental hygiene practitioner
  integrates practice management, finance
  principles, and health regulations to analyze,
  design and develop initiatives that will improve
  clinical outcomes, the quality of care and
  patient safety. The practitioner demonstrates
  effective leadership for changing healthcare and
  practice environments.

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Domain IV Translational Research

• The advanced dental hygiene practitioner uses
  sound scientific methods and accesses
  evidence-based information when making decisions
  and providing client care.

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Domain V Professionalism and Ethics

• The advanced dental hygiene practitioner
  demonstrates professional behavior and clinical
  decision-making skills consistent with dental
  hygiene parameters of care, legal regulations and
  the ADHA Code of Ethics. The advanced dental
  hygiene practitioner possesses the values and
  behaviors which promote service to the public,
  professional involvement, and lifelong learning.

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In what settings do you expect the ADHP to work?

• Hospitals
• Nursing homes
• Public health settings
• Community Health Centers

• Federally Qualified Health Centers
• Homebound
• Elementary and Secondary Schools
• Other

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What level of education and credential will be
necessary for the ADHP?

• Point of entry for all
• Flexibility
• Potential exists for distance education
• Proven success in dental hygiene education
• Currently 58 degree-completion programs (35
  designated with some/all distance education)
• Masters Degree
• Credentialing process

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How will the ADHP differ from the dental
therapist or dental aide positions available
elsewhere?

• ADHA has and will continue to examine related
  models
• Unique in design
• Oral health needs and U.S. health care delivery
  system

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Will this replace the entry-level position for
the registered dental hygienist?

• No.
• Answering an unmet public health need.
• Intended to go beyond entry-level education.

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Where will the classes be taught?

• Curriculum development in process.
• Educational collaboration with universities.
• Credential offered through the ADHA.

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What would it mean for an ADHP to serve as a
collaborative partner?

• Working with public health, allied health, and
  medical professionals.
• Variety of practice settings.
• Patients to receive a well-rounded approach to
  health services.

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Coalition Building

• National Rural Health Association
• National Rural Education Association
• American Oral Health Association /Oral Health
  Section
• Special Care Dentistry

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ADHP Commentary

• Additional flexibility and capacity of the oral
  heath care workforce is sorely needed.
• A National Call to Action to Promote Oral
  Health, Office of the Surgeon General, June 2000
• The APHA actively supports innovative programs
  and practices to help alleviate the great unmet
  oral health need
• American Public Health Association, December
  2005

• The ADHP, a role comparable to the nurse
  practitioner, presents a timely and appropriate
  way to explore new approaches to oral health care
  delivery
• Oral Health Section, American Public Health
  Association, March 2006
• It is time to find a new way to deliver oral
  health care services it is time to test the
  feasibility of the ADHP concept.
• National Rural Health Association, January 2005

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• The idea that got the broadest support was
  expansion of scope of practice to include simple
  restorative procedures for dental hygienists.
• --Policy Issues in Dental Workforce Diversity and
  Community-Based Dental Education, November 2004

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Legislative Success

• 19 states without overly restrictive supervision
  requirements
• 10 States with Medicaid provider status
• 43 States with general supervision
• 38 States that allow dental hygienists to
  administer local anesthesia

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ADHP Legislative Success

• July 2005  ADHP language is inserted into HR
  3010, the Fiscal Year 2006 Appropriations Bill
  for the Labor, Health and Human Services. 
• The language is considered report language it
  does not carry the weight or law or appropriate
  any federal funding.  It is encouragement to the
  lead health agency, HRSA, to explore development
  of the ADHP. 
• July 2005  HR 3010 is passed by the Senate
  Appropriations Committee. 
• October 2005  HR 3010 passes the full Senate. 

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ADHP Legislative Success

• December 2005 
• HR 3010 passes the House after passage in a
  conference committee.  (The ADHP language was not
  in the Houses appropriations bill, so the 2
  bills went into a conference committee to
  negotiate differences in the 2 bills.) 
• December 2005 
• President Bush signs HR 3010 into law. 
  Specifically, the final bill language directs
  Departments and agencies to be guided by the
  language and instructions set forth therein.. 

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ADHP Report Language
The Committee is aware that dental disease
disproportionately affects our nations most
vulnerable populations, including many in rural
America. New ways of bringing oral health care
to rural and underserved populations are needed.
The Committee encourages HRSA to explore
alternative methods of delivering preventive and
restorative oral health services in rural
America. Specifically, the Committee encourages
HRSA to explore development of an advanced dental
hygiene practitioner who would be a graduate of
an accredited dental hygiene program and complete
an advanced educational curriculum, which
prepares the dental hygienist to provide
diagnostic, preventive, restorative and
therapeutic services directly to the public in
rural and underserved areas.
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• No single oral health care profession, by
  itself, can meet the needs of the public. Only
  through collaborative effort of all of us will
  the American public receive the oral care it
  needs and deserves.

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Next Steps

• ADHP Task Force
• November 2005
• January 2006
• March 2006
• 3 meetings for 2006-2007
• Pilot project funding
• Advisory Committee
• ADEA Allied Education Working Group
• June 2006
• Your continued input!