Dental Health Aide Therapists

1. Dental Health Aide Therapists Bringing Oral Health Care into the 21st Century NPAIHB QBM wednesday, october 28, 2015 Pam johnson, Oral Health Project specialist

2. Oral Health is important to overall health yet millions of people living in tribal communities cannot get the dental care they need.

3. 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 remote • settings 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

4. 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

5. Dental Therapists in Action Alaska’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 • Created 76 full time jobs per year with total personal income of $4.4 million • Net economic effect of program is $9.7 million in Rural Alaska Swinomish Dentist Rachael Hogan observes DHAT Savannah Bonorden on a recent learning trip to Sitka, AK

6. 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…”

7. Swinomish Indian Tribal Community DHAT Initiative Swinomish Chairman and NCAI President Brian Cladoosby announcing the Swinomish DHAT Initiative, June 2105

8. Swinomish Current Political and Legal Solution -Swinomish Tribal Community worked for the past two legislative sessions with the Northwest Portland Area Indian Health Board and the Washington State House and Senate to craft a Tribal Specific DHAT Authorization Bill -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. -Swinomish has determined that it has the power and obligation to address oral health systems change under Tribal Sovereignty - http://apps.leg.wa.gov/documents/billdocs/2013-14/Pdf/Bill%20Reports/House/2466%20HBA%20CDHT%2014.pdf

9. Solutions for Swinomish Provided by DHAT • Procedure review for FY 2012, 2013 and 2014 for Swinomish Clinic showed that over 50% of procedures and services could have been provided by trained Dental Health Aide Therapist • Analysis shows that the same procedures could have been covered with 50% Personnel cost savings-replace Dentist time with DHAT time • DHAT Licensure Authorization would help I/T/U Clinics fill a huge gap in service demand across the Indian Health Service system for Native patients • Work Force Development strategy of a DHAT based in the Community assures longer term Community and Public Health benefits

10. Our Current Systems Solution -Swinomish has adopted 2 Tribal laws under its own regulatory framework: • It has created a Division of Licensing, roughly equivalent to the State of Washington’s and • It has adopted a Dental Health Provider Licensing Code under which Dentists, Dental Hygienists, and Dental Health Aide Therapists will be licensed

11. History being made! 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.

12. 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

13. DHAT 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!

14. Analysis of the Swinomish Solution -The Swinomish Solution is a huge step forward in advancing DHATs and dental therapists in the lower 48. -Swinomish Solution develops a “replicable Tribal Model” under Tribal Sovereignty -Unfortunately the Swinomish Model cannot be duplicated by all Tribes, especially resource poor tribes -State Legislatures still need to authorize DHATs, especially in Tribal settings under current IHCIA language!

15. Oregon Tribes DHAT Pilot Project

16. ackground Oregon Dental Pilot Projects were authorized by state legislation in 2011 to increase access and improve quality to oral health care by: • Teaching new skills to existing providers, • Developing new categories of dental providers, and • Accelerating and expanding the training to current providers.

17. This year, 2015, legislation was passed to: Extend the sunset date from 2018 to 2025--acknowledging the slow start and lack of funding to the program since 2011 Make sure new providers and services would be covered by Medicaid Oregon Health Authority funded for upcoming year to administer the program

18. 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.

19. Initial Pilot Sites • Confederated Tribes of Coos, Lower Umpqua and Siuslaw Indians • Coquille Indian Tribe

20. Pilot Project Application • First Pilot Project submitted to the state: Project 100! • The application includes a full summary of project, training program, employment options, patient notification, evaluation and monitoring plan, and costs • Last week it was deemed “complete” and sent to a Technical Review Board for a 30 day review. • Final decision rests with the OHA Dental Director

21. Next 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

22. 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

23. Northwest Portland Area Indian Health Board For more information please contact: Christina Peters, Oral Health Project Director cpeters@npaihb.org 206.349.4364 Pam Johnson, Oral Health Project Specialist pjohnson@npaihb.org 206.755.4309 Indian Leadership for Indian Health