Enhancing the Dental Public Health Workforce and Infrastructure Discussion Notes



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Enhancing the Dental Public Health Workforce

and Infrastructure
Discussion Notes


TASK #1: What are the 3-4 most critical objectives for improving the dental public health (DPH) workforce? For each of these critical objectives, identify which organization(s) should be invited to help implement them. Criteria for their involvement would include but not be limited to providing expertise and capability, leveraging financial and political support, and demonstrating leadership.
Note: Time did not permit finishing the list of organizations. This will be finished by the workgroups. See the Lunch notes for additional organizational suggestions.
WORK SESSION PRODUCTS

EDUCATION Objectives


  1. Review, update and implement essential public health standards for accreditation of dental and dental hygiene programs.




  • CODA, AAPHD, AAMC, ASPH, CHC, ADHA, ADEA, ADA, AAHC, Amer Pharm Assn, Insurance companies and Chamber of Commerce, Civic orgs, CHC board members, NGA, AARP, AAPHD, dental and dental hygiene schools, APHA




  1. Facilitate the integration of an oral health component into the education curricula of: public health, medicine, nursing, physician assistant, dietetics, social work and other health professions programs.




  • AAPHD, NDA, HispDA, ADEA, NACHC, NAC, NACC (community colleges), graduate business schools, ADA, minority communities, urban league, Congressional Black/Hispanic Caucuses, NNOHA, , media, Amer Assn. of Advisors for Health Professions




  1. Develop, implement, and evaluate models to increase diversity (in all its dimensions) in schools of dentistry, dental hygiene, and public health

  • WICHE programs, NCSL, NDA, ADEA, HispDA, AAPHD, NACHC, AAPHD




  1. Create mechanisms to reduce the costs of postgraduate education for individuals interested in dental public health by resolving their debt and paying them during Masters of Public Health (MPH) and residency programs.




  • AAPHD, NCSL, ADA, NACCHO, ADEA, Council of Foundation Regional Grantmakers, Grantmakers in Health, NACHC, DMA, ADTA, CDHP


Full List of Brainstorming Ideas with Votes





  1. Provide more public health education in dental, dental hygiene and allied health programs and assure through accreditation; Provide oral health training in Schools of Public Health and other health professions schools (19)

  2. Clarify what dental public health is to help various communities understand what a career pathway might be (11)

  3. Increase the number of dental/dental hygiene faculty teaching public health/community health subjects that have a public health degree (e.g., MPH, DrPH)(4)

  4. Convince institutions and individuals that they have an obligation to improve the oral health of the public, and ways to do that in the public health arena (8)

  5. Develop broad competencies in community organization (assessments, analyses, work with other org) (4)

  6. Teach public health as a career option in public schools (3)

  7. Recruit a diverse group into public health and provide incentives for those with community service background (14)

  8. Provide incentives for dental public health professionals, e.g., mechanism so people interested in public health can deal with debt and get paid during MPH & DPH residency programs (13)

  9. Create training and certification beyond MPH for dental hygienists (also includes RDH completion programs) (10)

  10. Create flexible training (e.g., distance learning) with mentoring and technical assistance to newcomers (8)

  11. Create transdisciplinary training opportunities and selection process (1)

  12. Integrate externships into more dental schools (3)

  13. Build state/federal support for dental public health education and importance of oral health (17)

  14. Develop competencies in determinates of health care (4)

  15. Create demand for dental public health workers (16)

  16. Include public health as a part of all subjects in dental/dental hygiene education (4)



RESEARCH Objectives



  1. Research the characteristics of those currently in the dental public health workforce to develop a profile (e.g., what keeps them in public health, what contributes to their leaving, and what are their training needs.)




  1. Conduct studies of dental public health workforce impact, especially in relation to implementation of community interventions, health outcomes, economics, and other variable (e.g., do we make a difference.)




  1. Integrate research and evaluation as essential components of public health practice to demonstrate quality and health outcome measures



Full List of Brainstorming Ideas with Votes





  1. Integrate research and evaluation as essential components of public health practice to show quality and health outcome measures (16)

  2. Explore innovative approaches to fund prevention for entitlement programs (demonstration programs in Medicaid, SCHIP) (9)

  3. Accelerate application of science into dental public health practice (8)

  4. Improve community education and ethics of research to increase community trust (1)

  5. Research the characteristics of those currently in dental public health to develop a profile: What keeps them in public health, what contributes to their leaving, and what training needs do they have (25)

  6. Conduct studies of dental public health workforce impact, especially in relation to implementation of community interventions, health outcomes, economics, etc. (Do we make a difference?) (25)

  7. Facilitate collaboration for research and science; involve communities as partners in research (Call to Action page 21) (4)

  8. Define what dental public health workforce should be to more effectively improve health of the community (12)

  9. Create uniform and comparable data sets on dental public health workforce to be able to argue for and support issues (2)

  10. Conduct education research to enhance capabilities of dental public health workforce (10)

  11. Develop and evaluate models to integrate dental public health into overall public health efforts (9)

12.Evaluate ways to supplement dental public health workforce (e.g., midlevel providers) (3)

PRACTICE Objectives



  1. Know, use, and apply essential public health functions, core competencies, and evidence-based approaches in public health practice.




  1. Explore ways to provide training in oral health to other health professionals.




  1. Upgrade the value of the dental public health profession (e.g., encourage officials who hire professionals to set higher standards for training and experience)



Full List of Brainstorming Ideas with Votes





  1. Know, use, and apply essential PH functions, core competencies, and evidence-based approaches in public health practice (19)

  2. Explore ways to provide training in oral health to other health professionals (22)

  3. Advocate for local/state/federal programs that need dental public health workers (11)

  4. Create more service-learning opportunities for students (e.g., extend RWJ pipeline projects to other dental schools) (8)

  5. Create opportunities to practice with other health practitioners (5)

  6. Develop continuing education programs on dental public health through alumni (1)

  7. Enhance the dental public health skills of the entire dental health team (3)

  8. Create public health and dental public health career development support structure(s) (8)

  9. Upgrade the value of the dental public health profession (e.g., encourage hiring officials to set higher standards for training and experience) (24)

  10. Look for ways to maximize public health internships (0)

  11. Assure a dental public health workforce that mirrors the populations served (7)

  12. Expand dental hygiene/dental/dental assistant practice acts through additional education in public health (12)

  13. Integrate research and evaluation as essential components of public health practice to show quality and health outcome measures (10)

  14. Strengthen ties between local providers and professionals at local/state health departments to leverage resources to help meet health care delivery needs (3)

  15. Explore ways to leverage resources to support all levels of dental public health workforce (5)


OVERARCHING and OTHER Objectives



  1. Review the American Board of Dental Public Health certification process.




  1. Build local, state, federal, foundation and private support for dental public health education, the value of dental public health workers, and the impact they have on oral health (e.g., elimination of oral health disparities).




  1. Create additional funding for dental pubic health residencies.




  1. Raise the profile of the dental public health workforce and create a demand for dental public health workers.




  1. Promote the public health roles of dental hygienists and develop career paths in public health.




  1. Include more public health information in graduate dental education.




  1. Ensure oral health inclusion in public health workforce legislative efforts.




  1. Create national resource center/network on dental public health to provide technical assistance/consultation for state and local oral health programs.




  1. Institute tax on health insurance to raise funding to support dental public health.


NETWORKING LUNCH

TASK #2: To build awareness and support for each of the EDUCATION, RESEARCH, and PRACTICE objectives, identify groups you consider to be important participants.
Note: Summary is based on handwritten notes turned in after lunch


  • Organizations and resources external to public health

AARP, NDA, HispDA, Faith-based orgs, Social services agencies, dental and other health practitioners, business groups, ADTA, DMA, health care insurers, business schools, Am Pharm Assn., AHA, Benefits Managers Assn, State Employee Benefits Managers, Unions—AFSCME, Chambers of commerce, Civic groups such as Rotarians, Lions Clubs, Friends of NIDCR, 4-H groups, Agricultural Extension agencies, allied health professions assns, Jr. League, AMA


  • Organizations and resources external to dentistry

AARP, Families USA, NACHC, NACCHO, ASTHO, Nat. Assn of Community Action Programs, Head Start, Family Voices, NEA, NTA, Child care programs, PTA, MCH orgs, AMCHP, Chronic Disease Directors, APHA


  • Organizations not present at this meeting

Organizations listed in other questions, including AARP, ASPH, AAHC, ASPH, ACPM, school nurses, other minority orgs, advocacy orgs, NALBOH, AAHC


  • Institutional policymakers

American Hospital Assn, Grantmakers in Health, AAMC, Federal Oral Health Caucus, Legacy Foundation, Deans, Federal/state/local agencies, CHC Boards, County commissioners, Urban League, La Raza, NAACP, ADEA, ADA, ADHA, ASTDD


  • Public policymakers

ASTHO, NGA, NCSL, NACCHO, Leadership Council of Aging Organizations, Natl Conf of Mayors, Congressional caucuses-- Black Caucus, Hispanic Caucus, NASMD, Health Care for All, Children’s Defense Fund, Congress

TRANSLATING OBJECTIVES INTO

AN ACTION PLAN





WHERE DO WE WANT TO BE IN FIVE YEARS?

TASK #3. Develop action steps, timelines and other components of an action plan for all of the objectives.

Note: The group only started this process. A sample grid is provided. The grid has been simplified from the one presented at the workshop and will need to be completed for each objective by the workgroups that are convening.

EDUCATION OBJECTIVES




  1. Define and implement new, essential public health standards for accreditation of dental and dental hygiene programs.


Action Steps and Timelines:


  • Define the new, essential public health standards (need to add

Timeline to each step)

  • Develop coalition for advocacy

  • Submit to Council on Dental Accreditation to adopt the standards
  • Develop model curriculum

  • Prepare faculty to teach curriculum




Action Plan




Key Organizations





AAPHD, ADEA, ABDPH

Other Stakeholders


ASPH, ADA, ASTDD, State Dental Boards, CODA, ADHA, AACDP

Resources Needed


RWJ Demonstration Projects, HRSA Curriculum Development, $$

Measurable Outcomes











  1. Facilitate the integration of an oral health component/education into the curricula of: MPH programs, public health schools, medical schools, medical residency programs, nursing schools, physician assistant programs, social work schools, and other professional programs.


Action Steps and Timelines:


  • Define the problem and collect evidence for change
  • Assess any models currently available


  • Create interface for change by getting involved with other professional organizations

  • Define, implement, test competencies



  1. Develop, implement, and evaluate models to increase diversity (in all its dimensions) in schools of dentistry, dental hygiene, and public health


Action Steps and Timelines:


  • Contact a business school that has successfully attracted minorities to share approaches that might attract minorities to public health

  • Get institutional buy-in to implement new models

  • Educate target populations about professional opportunities in these fields

  • Increase diversity of Admissions Committees

  • Improve current legislation to decrease disparities (S 1833—Daschle’s Democratic bill “Health Equity & Accountability Act” and S 2091—Frist’s Republican bill “Closing the Health Care Gap”)

  • Organizations conduct self-assessment to see if they have diverse leadership that will attract others into the organization


  1. Create mechanisms to reduce the costs of postgraduate education for

those who are interested in dental public health by resolving their debt

and paying them during MPH & residency programs
Action Steps and Timelines:


  • Revisit public health traineeships for dental public health workforce

  • Advocate for appropriations for programs already authorized for training PH workforce (National Health Service Corps, PL 107—Dental Health Improvement Act from the Health Care Safety Net Amendments of 2003)

  • Give credit for field practices in public health school

  • Explore mechanism to use Medicaid/Medicare Graduate Medical Education (GME) funding for dental public health education

  • Explore opportunities and incentives through branches of the military to train the dental public health workforce

  • Create educational opportunities for midlevel dental public health staff



RESEARCH OBJECTIVES


  1. Research the characteristics of those currently in the dental public health workforce to develop a profile: What keeps them in public health, what contributes to their leaving, and what training needs do they have.



Action Steps and Timelines:


  • Develop proposal to do survey

  • Perform literature review, including unpublished documents

  • Compile inventory of professionals who work in public health (define

  • population and locate them)

  • Design survey(s) (e.g., look at differences in positions, job titles, skills

  • inventory) with self-assessment to identify gaps in knowledge

  • Develop research questions and contact researchers

  • Assess training programs and identify gaps

  • Conduct survey online and analyze data

  • Review career path matrix and moments of transition in career life


  1. Conduct studies of dental public health workforce impact, especially in relation to implementation of community interventions, health outcomes, economics, and other variable—e.g., do we make a difference.


Action Steps and Timelines:





  • Develop description of the problem

  • Advocate for funding organizations to release a Request For

Proposals

  • Contact experts on workforce studies

  • Inventory existing efforts

  • Review current state of research and align with other research

(qualitative researchers)

  • Develop proposals and pursue funding:

      1. Look at trained and untrained dental public health

professionals and impact on services and health

      1. Do ecologic assessment in states and look at outcomes

      2. Determine what the effect of the workforce is on delivery of

services, then look at the impact of these services on oral

health outcomes



      1. Research on public health/oral health coalitions (what

works/what doesn’t)

project

  • Invest in evaluation of community-based programs that include dental

public health workers

  • Disseminate research findings to policy makers


  1. Integrate research and evaluation as essential components of public health practice to show quality and health outcome measures


Action Steps and Timelines:


  • Create interdisciplinary consultation teams on designing and

evaluating community interventions

  • Educate potential funding sources to require appropriate, evidence-

based community interventions and evaluation in proposals

  • Provide data to funders to enable translation of science into action

  • Make technical assistance available to improve knowledge and skills in

integrating research and evaluation into practice

  • Establish technology centers to conduct research, disseminate and

evaluate Research findings

training for practitioners
PRACTICE OBJECTIVES


  1. Know, use, and apply essential public health functions, core competencies, and evidence-based approaches in public health practice.



Action Steps and Timelines:




    • Review and possibly revise current competencies

    • Define specific competencies by job classifications for dental public health workers

    • Create a subset of critical public health competencies for community health providers by level

    • Assess the capacity of the current professional education system to teach the competencies

    • Assess current curricula to identify ideal content and effective training methods

    • Review and adapt current training modules available through a variety of media (e.g., online)

    • Teach professionals to understand evidence based reviews, access them, and use them

    • Identify a pool of mentors and faculty

    • Develop relationships with communities to establish settings for students and practitioners to apply public health functions in practice.(expand community based integrated education opportunities)

    • Evaluate effectiveness of newly developed training curricula

    • Disseminate information included in ASTDD Best Practices website and in the Guide to Community Preventive Services

    • Adapt American Board of Dental Public Health competencies for other public health workers

    • Disseminate competencies at national meetings, e.g., National Oral Health Conference, Association of State and Territorial Health Officials affiliate meetings



  1. Explore ways to provide training in oral health to other health professionals.


Action Steps and Timelines:


  • Identify target audiences (e.g., Women, Infant and Children program (WIC) staff, nurses and physicians in long-term care facilities)

  • Incorporate oral health skills as requirement for maintaining credentials

  • Develop curriculum in collaboration with other health professions

organizations

  • Use existing public health regional training institutes

  • Include oral health in all health professions education

  • Influence leaders in non-dental groups to be advocates for oral health

  • Offer continuing education on oral health to all health provider groups

  • Strengthen linkages between oral health providers, pediatricians, and

other child health care providers around prevention and treatment

  • Provide national leadership to bring together health professions to

discuss integration of oral health into general health care practice

  • Strengthen linkages in practice and education between oral health

providers and medical providers around chronic health problems

  • Establish reimbursement methods and incentives for continuing

education in oral health topics

  • Evaluate the effectiveness of training/continuing education, as well as

the impact on the populations served


  1. Upgrade the value of the dental public health profession (e.g., encourage hiring officials to set higher standards for training and experience).


Action Steps and Timelines:


  • Define the problem (oral health needs vs # of oral health providers)

  • Conduct comparison of salaries

  • Establish salary ranges and norms

  • Develop a template Scope of Work

  • Distribute information to hiring officials; by partnering with others,

advocate for filling positions at adequate salaries

  • Demonstrate that dental public health trained professionals can make

a difference

  • Influence federal, state and local personnel systems

  • Influence the National Governors Association to recognize the

importance of formal public health training
OTHER OBJECTIVES



    1. Review the American Board of Dental Public Health certification

process
Action Steps and Timelines:


  • Request that the Board investigate possibilities to get more individuals

certified

  • Investigate how American Public Health Associaiton accredits

programs rather than just having accreditation through Council On

Dental Accreditation




  1. Build local/state/federal/foundation and private support for dental

public health education, the value of DPH workers, and the impact they

have on oral health (elimination of oral health disparities).
Action Steps and Timelines:


  • Ask other public health professionals to advocate within the other dental professions

  • Develop coalitions to lobby for oral health

  • Work with Assoc. of State and Territorial Health Officials and National Assoc. of Community Health Organizations on funding and legislative efforts (public health workforce not just dental public health workforce)

  • Educate the general public on the issues so they really understand

  • Raise awareness of community oral health needs to better market oral health to potential new support organizations

  • Create State legislative commissions on oral health to increase visibility and improve funding

  • Make oral health linkage to education

  • Attempt to identify foundations that may have demonstrated interest in oral health or related topics.

  • Collaborate with others who are working on public health and workforce issues (e.g., bioterrorism)

  • Review restrictions on scholarships

  • Identify highly visible champions for oral health

  • Explore opportunities through corporations (e.g, pharmaceuticals, McDonalds) to get funding and visibility



3. Create additional funding for dental pubic health residencies
Action Steps and Timelines:


  • Refer to previous action step

  • Investigate why funding for current residency programs and new programs is inadequate

  • Identify problems with recruiting residents (e.g., debt and salaries) and establish strategies to increase the pool

  • Work with communities upfront (Home Town Program at Arizona with community health center)


  1. Raise the profile of the dental public health workforce and create a demand for dental public health workers


Action Steps and Timelines:


  • Identify practitioners who don’t participate in community service and

provide opportunities for “change of heart”

  • Create ways to capture inspiration from community dental health

instructors and dental public health workers

  • Create ways to stimulate demand for positions and increase salary

schedules

  • Connect dental and dental hygiene schools with community service

opportunities (Volunteers in Health Care model), community service

model (Community-Campus Partnerships for Health)



  • Create student placements for community based experience beyond

the clinical rotations

  • Invite, involve and provide incentives to local dentists to come to

community health centers as mentors, clinicians, instructors

  • Identify ways that State Practice Acts can promote more

dentist/hygienist involvement in community programs

  • Partner with other organizations that work with students




  1. Promote roles of dental hygienists and develop career paths in public

health
Action Steps and Timelines:


  • Insure training and opportunities; create demand, support and

mentoring

  • Engage in public relations to educate public and others on role of

dental hygienists, particularly in public health

  • Include public health track in 4-year programs

  • Look at public health nursing model to design career pathway

possibilities for dental hygienists

  • Create and use different certificate programs (e.g., Wisconsin

community health online program) to address knowledge and skill sets

needed for public health



  • Promote existing training opportunities in program development and

management skills to dental hygienists and dental public health

workers


  • Enlist help from non-dental groups in changing practice acts (e.g.,

American Associaiton of Retired Persons and American School Health

Association)




6. Include more public health information in graduate dental education



Action Steps and Timelines:


  • Include public health information in other dental specialty training and

in other residencies (General Practice Residency, Advanced

Education in General Dentistry)



  • Offer continuing education or certificate programs to clinicians who

work in community health centers but have no public health training



  1. Ensure oral health inclusion in public health workforce legislative

efforts.
8. Institute tax on health insurance to raise resources to support

dental public health
9. Create national resource center/network on dental public health to

provide TA/consultation for state and local oral health programs.


  • No action steps created for these yet








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