Service Learning Collaboration: Integration of Lutheran Medical Center Residency Programs in Community Health Centers

1. Service Learning Collaboration &The Integration of Lutheran Medical CenterPostdoctoral Residency Training Programs in Community Health Centers Neal Demby, DMD, MPH Director, Dept of Dental Medicine Anna D’Emilio, DDS Director, AEGD Program Bernard Tolpin, DDS, MPH Associate Director, Dept of Dental Medicine Susan Dietrich, DDS Director, Graduate Dental Education

2. Lutheran Medical Center • 476 + bed  teaching hospital • Level 1 Trauma Center • Only hospital-based CHC (Federally qualified health center) in the country • 600,000+ encounters at main site • 75,000+ dental encounters at main site • 120,000+ dental encounters at extramural partnership sites • Culturally Diverse Populations

4. Service Learning Mission • Recruitment & retention of oral health providers remains a critical and chronic problem in assuring access to care; centers face challenges with workforce and budgets. • Through the establishment of creative, collaborative partnerships between LMC dental education programs and community health centers, a major workforce initiative has been put in place to develop a cost effective means for centers to ameliorate access issues for the most vulnerable . • Health centers have the resources to provide the learning/educational environment to new dentists.

5. Collaboration Advantages • LMC pays resident salary & benefits • LMC provides financial reimbursement to sites for administrative time • Site retains all income generated by the resident • LMC consultant faculty appointment • CE opportunities; faculty development • ADA accreditation of clinical training site • Recruitment and retention of providers “Win-win situation”

6. Community Health Centers (FQHCs) Public Health Departments Indian Health Services Group practices (profit & non-profit) Health Science Centers Managed Care Organizations Veterans Administration Community Hospitals Health Departments AHEC Prison Health Systems Collaborative Partnerships

8. AEGD Program 1988 1 resident; 1 site 2008 73 residents; 61 sites PEDS Program 1994 2 residents; 1 site 2008 26 residents; 3 sites LMC Program & Partnership Evolution

9. Lutheran Medical Center Dental Residency Network Current States: Alaska, Arizona, California, Colorado, Hawaii, Massachusetts, Maryland, Michigan, Mississippi, New Mexico, New York, Rhode Island, Tennessee Future: New Jersey, Oregon, Connecticut, New Hampshire

10. ALASKA Yukon-Kuskokwin Health Bethel, Alaska

11. Winslow Indian Health Center Winslow, Arizona AEGD Residents North Country CHC Flagstaff, Arizona AEGD Residents ARIZONA Dental Net 5905 W Bell Road Glendale, Arizona 85308 AEGD Residents Dental Net 4747 N 7th Street Phoenix, Arizona AEGD Residents El Rio Health Center Northwest 4009 N Flowing Wells Tucson, Arizona 86705 AEGD Residents Mountain Park Health Center 635 East Baseline Road Phoenix, Arizona 85042 AEGD Residents Sun Life Family HC 865 N Arizona Road Casa Grande, AZ 85222 AEGD Residents Pascua Yaqui Tribal Dental Center 7490 S. Camino De Oeste Tucson, Arizona 85746 AEGD Residents Dental Net 1057 N Kolb Road Tucson Arizona 85710 AEGD Residents Sells Indian Health Service AEGD Residents Mariposa Community Health Center 1852 N Mastick Way Nogales, Arizona 85621 AEGD Residents EL Rio Health Center Downtown 639 W Congress Street Tucson, Arizona 85745 AEGD Residents El Rio Health Center Southwest 1530 Commerce Street Tucson, Arizona 85746 AEGD Residents

12. COLORADO Marillac Clinic Grand Junction, Colorado AEGD Residents Valley Wide Health Center 186 Hurt Street Center. Colorado AEGD Residents Valley Health Center 204 Carson Avenue Alamosa, Colorado 81101 AEGD Residents Valley Health Center 375 East Park Avenue Durango, Colorado 81301 AEGD Residents

13. Kaua’I Community Health Center 4643 Waimea Canyon Drive Waimea, Hawaii 96796 AEGD Residents Kokua Kalihi Valley 2239 N School Street Honolulu, Hawaii 96819 AEGD Residents Kalhi-Palama HC 915 N King Street Honolulu, HI 96817 AEGD Residents HAWAIIAN ISLANDS Maui Oral Health Initiative 310 W Kaahumanu Avenue Kahuliu, Hawaii 96732 AEGD Residents Waianae Coast Comprehensive HC 86-260 Farrington Highway Waianae, Oahu, Hawaii 96792 AEGD Residents Keaau Family Health Center Dental Clinic 16-192 Pilimua Street Keaau, Hawaii 96749 AEGD Residents

14. South Cove Community HC 885 Washington Street Boston, MA 02111 AEGD Residents Joseph M Smith Family Health Center 287 Western Avenue Alston, MA 02134 AEGD Residents Whittier Street HC 1125 Tremont Street Roxbury, MA 02120 AEGD Residents Boston Public Oral Health 774 Albany Street Roxbury, MA 02118 AEGD Residents Dimock Community Health Center 55 Dimock Street Roxbury, MA 02119 AEGD Residents BOSTON MASSACHUSETTS Dorchester House Health Center 1353 Dorchester Avenue Dorchester, MA 02122 AEGD Residents Harvard Street Health Center Blue Hill Avenue Dorchester, MA 02124 AEGD Residents Codman Square Health Cener Washington Street Dorchester, MA 02124 AEGD Residents South Cove Quincy 275 Hancock Street Quincy, MA 02171 AEGD Residents

15. Santa Fe Indian Health Service Hospital 1700 Cerrillos Road Santa Fe, NM 87505 AEGD Residents NEW MEXICO Acomo-Canoncito-Laguna Indian Health Service Grants, NM AEGD Residents Indian Health Service Dental Clinic Albuquerque, NM AEGD Residents

16. Peekskill/Hudson River Health Center 1037 Main Street Peekskill, NY 10566 AEGD Residents Morris Heights Health Center 85 W Burnside Avenue Bronx, NY 10453 AEGD Residents METROPOLITAN NY AREA Callen Lorde Community Health Center 356 W 18 Street New York, NY 10011 AEGD Residents Bedford-Stuyvesant Family Health Center 1413 Fulton Street Brooklyn, NY 11216 AEGD Residents Park Ridge Family Health Center 6317 4th Avenue Brooklyn, NY 11220 AEGD Residents Joseph P Addabbo Family Health Center 67 Rockaway Beach Blve. Arverne, NY 11692 AEGD Residents Brooklyn Chinese Family Health Center 812 54th Street Brooklyn, NY 11220 AEGD Residents Sunset Park Family Health Center 150 55th Street Brooklyn NY 11220 AEGD Residents

17. Schenectady FHS 602 Craig St. Schenectady, NY 12307 AEGD Residents 1st Advantage Dental 1202 Troy, Schenectady Rd, Latham, NY 12110 AEGD Residents CAPITAL DISTRICT UPSTATE NY Whitney Young FHC Lark Dr. & Arbor Dr. Albany, NY 12210 AEGD Residents

18. St. Joseph Hospital 21 Peace Street Providence, RI Pediatric Residency Program PROVIDENCE RHODE ISLAND

19. TENNESSEE

20. Implementing an LMC Program at a Clinical Training Site • Site complies with ADA standards & program curriculum, including but not limited to: • Identify dentists who will provide clinical supervision of residents • Provide practice resources (auxiliaries, supplies, room, etc.) • Provide the required clinical experiences* • Evaluate clinical competency** • Provide support for didactic curriculum (resident schedule, cases, internet access, work space, etc.) • Include resident in QA program (chart audits, meetings, etc.) Sites can collaborate together to share resident(s) or provide additional rotations/experiences

21. Comprehensive multidisciplinary dental care Patient assessment and diagnosis Obtaining informed consent Promoting disease prevention Control of pain & anxiety (behavior & pharmacological) Restoration of teeth (including single crowns) Replacement of teeth (fixed partial dentures, removable partial dentures and complete dentures Periodontal therapy (including surgery) Endodontic therapy (including molar endo) Hard and soft tissue surgery Management of medical and dental emergencies Medical risk assessment *Required Clinical Experiences

22. **Online Evaluation/Outcomes Assessment Applications

23. Didactic Curriculum • Provided by LMC • Applications of distance learning within post doctoral dental education • Synchronous Learning via Video teleconferencing • Asynchronous Learning via web-based applications • Regional Education

24. Growth of distance learning via video teleconferencing 1994 20 residents, 2 didactic sites (14 years later) 2008 118 residents, 24 didactic sites, 64 CHCs

25. Requirements for Distance Learning • Identify a didactic site for the region or islands • Purchase equipment or utilize a local network site • LMC uses a bridging service – Expedite • Expedite • Performs test calls with new didactic site • Connects all sites for VTC sessions • Weekly confirmation of connection times • Facilitator – one or more dentists at each didactic site for weekly didactic sessions (assistant director + site faculty)

26. Video Teleconferencing Sites Brooklyn NY Bethel AK Albany NY Winslow AZ Jackson MI Anchorage AK Juneau, AK Redding CA Holyoke MA Boston MA Maui HI Oakland CA Providence RI Keaau HI Eastern Shore MD Mesa AZ Honolulu HI Memphis TN Tucson AZ Ocala FL Alamosa CO Meridian MS Gallup NM San Juan PR

28. Telecommunication Network Columbia University School of Dental Medicine AT Still University/ ASDOH University of the Pacific Boston University University of Arizona Northern Arizona University University of Rochester/ Eastman Dental Center University of Missouri – Kansas City Hawaii Primary Care Association Penn State University – Hershey Idaho State University – Pocatello New York State OMRDD Marquette University Kaiser-Permanente Syracuse Medical Center

29. Typical Week of a Resident Resident assignment to Saturday sessions are permitted with faculty supervision. Creative scheduling allowed providing there’s supervision and resident has minimum 40 hours devoted to the entire program. VTC based on EST; therefore allow for different starting times in other time zones – lecture may start in AM session

30. Conclusion • These pivotal elements describe how vision, health policy, innovative ideas, can be translated to a major workforce program that increases access to services for the underserved, while maintaining an educational commitment to equity and service learning in postdoctoral education.

31. Contacts Susan Dietrich, DDS Director, Graduate Dental Education Phone: 646. 413. 8846 Email: sue.dietrich@gmail.com Anna D’ Emilio, DDS Director, AEGD Program Phone: 718. 630. 7213 Email: ademilio@lmcmc.com