Volume 58, Supplement 1, 1998



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JOURNAL OF
PUBLIC HEALTH
DENTISTRY


Volume 58, Supplement 1, 1998

Official Journal
of the American Association
of Public Health Dentistry

114 Journal of Public Health Dentistry

The Development of Competencies for Specialists in Dental Public Health

Jane A. Weintraub, DDS, MPH
Abstract

This paper describes the process of developing new competency statements and performance indicators for the specialty of dental public health. These competencies help define the specialty and provide a base for educational curricula and the specialty board examination. The process included a survey of four target groups: all board members, all directors or co-directors of advanced education programs in dental public health, people who had become diplomates in the last three years, and all students currently enrolled in dental public health programs. Many constituencies were represented at the workshop, conducted in May 1997, to develop the competency document. After the workshop, the docu­ment underwent a series of review activities. [J Public Health Dent 1998; 58 (Suppl 1):114-18]

Key Words: dental public health, dental education, dental specialty, curriculum, competency-based education.



Rationale for Developing New and Revised Competencies

At the 1997 annual meeting of the American Association of Public Health Dentistry (AAPHD), partici­pants celebrated the organization's 60th birthday. Many goals and mis­sions of the specialty of dental public health have remained the same during these 60 years; however, disease pat­terns, health care delivery systems and resources change, and the advance­ment of science and technology con­tinues. The desire of our specialty to keep pace with these changes and ad­vances also continues. In 1974 the first set of "behavioral objectives" for the specialty of dental public health was developed at a workshop in Boone, NC (1). These objectives helped define our specialty and provided a base for educational curricula and the spe­cialty board examination. These objec­tives served well for 14 years. In 1988, these objectives were revised at a workshop in Bethesda, MD, and be­came "competency objectives" (2). As intended, they helped guide the prac­tice of dental public health in the

1990s. In 1996, the impetus for revising the competency objectives came from several sources. The American Board of Dental Public Health (ABDPH) listed the following reasons in its rec­ommendation to the American Asso­ciation of Public Health Dentistry to initiate this process:

1. The last revision of the compe­tency objectives was completed in 1988 and the board perceived the ob­jectives to be out of date.

2. The proliferation of knowledge is placing an increasing burden on our educational programs. It is becoming more difficult for programs to pro­vide, and for students to gain, suffi­cient expertise in all of the existing 165 objectives, as well as in new and emerging areas.

3. Educational programs have changed, so there are differences be­tween programs that primarily edu­cate researchers and those that edu­cate public health practitioners.

4. The accreditation standards were last substantially revised in 1985, with minor revisions in 1988. The US Department of Education, one of the accrediting bodies for the American Dental Association's (ADA) Commis­sion on Dental Accreditation, has new requirements. The ADA has requested all specialties to revise their standards to come into compliance. Although the standards used for accreditation are contained in a document separate from the competency objectives, it is appropriate for the curriculum section of the standards to reflect what the profession recommends as its core set of competencies.

The ADA does not require the spe­cialties to have a set of competency objectives. Dental public health has taken a leadership role in this activity. It is the only dental specialty with this type of document. As Mecklenburg described in his keynote address at the 1988 workshop, the document was particularly useful in the mid-1980s when preparing the application to the ADA for the re-recognition of dental public health as a specialty (3).

Dr. Weintraub is project director and Lee Hysan Professor of Oral Epidemiology and Dental Public Health, University of California at San Francisco, School of Dentistry, Department of Dental Public Health and Hygiene, 707 Parnassus Avenue, PO Box 0754, San Francisco, CA 941430754. E-mail: janew@itsa.ucsf.edu. Planning Committee: Drs. Eric Bothwell, Brian Burt, Joseph Doherty, Judith Jones, Jayanth Kumar, Reginald Louie, Linda Niessen, Gary Rozier, and Steven Silverstein. Reprints will be available from the AAPHD National Office. This project was supported by the US Department of Health and Human Services, Public Health Service, Health Resources and Services Administration, Bureau of Health Professions, and the AAPHD.

Vol. 58, Suppl. 1, 1998



Planning Process

In the spring of 1996, Dr. Robert (Skip) Collins, president of the AAPHD, asked me to direct this proc­ess. I did so with assistance from col­leagues and staff at the University of California, San Francisco School of Dentistry (UCSF), the AAPHD na­tional office, and an AAPHD planning committee. In addition to AAPHD's own financial contributions, the AAPHD was awarded a $50,000 pro­curement from US Health Resources and Services Administration, Bureau of Health Professions. Government Project Officer Dr. Kathy Hayes pro­vided invaluable assistance through­out this process. This report will de­scribe the process of developing these new competency statements.

The government contract required that at least four members of the plan­ning committee be board certified as specialists in dental public health. A planning committee was appointed in consultation with the government project officer. The planning commit­tee consisted of Drs. Eric Bothwell, Brian Burt, Joseph Doherty, Judith Jones, Jayanth Kumar, Reginald Louie, Linda Niessen, Gary Rozier, and Steven Silverstein. Dr. Collins also took an active role in this process. An electronic mail list for our group was established at the University of Michi­gan by Dr. Burt to facilitate communi­cation. Dr. Bothwell served as the liai­son to the Public Health Functions Steering Committee and Working Group Subcommittee on Workforce, Training, and Education Competency ­based Curriculum Group, which was meeting monthly in the Washington, DC, area.

During the 1996 AAPHD annual meeting in Orlando, several meetings were conducted to discuss the devel­opment of this process. I met with the planning committee, with the resi­dency directors, and with anyone who wanted to attend a round table discus­sion on this topic. These meetings helped clarify needed preworkshop activities. We discussed philosophical and logistical issues, and agreed that a preworkshop survey of specific tar­geted groups should be conducted. A subgroup of the planning committee





Seated, 1 to r: Rebecca King, Kathy Hayes (HRSA project officer), Myron Allukian, Jane Weintraub (project director), Brian Burt, Alex White. Diagonally, back to front, l to r: Stuart Lockwood, Skip Collins, James Leake, Linda Kaste, Scott Tomar, Stephen Corbin (partially hidden), Barbara Gooch, John King, Steven Levy (partially hidden), Aljernon Bolden, Robert Dumbaugh (partially hidden), Scott Navarro, David Alexander, Catherine Horan (ADA speaker, partially hidden), Jayanth Kumar (mostly hidden), Reginald Louie, Ray Kuthy, James Sutherland (mostly hidden), Gary Rozier, Chester Douglass, Jed Hand, Sena Narendran, Bruce Brehm, Ira Parker, Steven Silverstein, Barbara Gerbert, Joseph Doherty.



Project Director Jane Weintraub leads a dis­cussion during the workshop.

met during another meeting in Atlanta and selected participants for the work­shop. Selecting participants was not an easy task because our specialty is blessed with a wealth of talent. Our contract specified that certain organi­zations and constituencies be repre­sented, including: dental public health educators; members of the ABDPH; practitioners of dental public health national, state, and local programs; practitioners of allied dental health fields; experts in managed care issues, dental public health residents; com­munity representatives, particularly from settings with large numbers of vulnerable populations; and a public health practitioner(s) from a nonden­tal field. Not all participants initially selected were able to attend. The list of participants is shown in the Appendix.

Prior to the workshop, a survey (to be described) was conducted among four target groups and homework as­signments were given to workshop participants. For homework, each par­ticipant was asked to review the com­petency objectives in the topical area to which he or she had been assigned, and indicate which items should be kept, deleted, or revised. Respondents were also asked to list the skills cur­rently needed by an entry-level practi­tioner. Responses to the homework and survey were collated in advance and distributed to the workshop group leaders. Results of the survey were presented during the first ple­nary session of the workshop.

Preworkshop Survey Methods

The purpose of the survey was to evaluate the current competency ob­jectives and to assess the need for changing the objectives and related as­pects of the educational and certifica­tion process. The survey instrument was pretested in part at the residency directors' meeting in Orlando, and in more complete form among local den­tal public health and UCSF colleagues. The survey instrument was e-mailed or faxed to four target groups: all board members, all directors or codi­rectors of advanced education pro­grams in dental public health, people who had become diplomates in the last three years, and all students currently enrolled in dental public health pro­grams either part time or full time. My staff assistant removed the identifiers before giving me the surveys. Two mailings were conducted. After the second mailing, the members of the planning committee were each as­signed several nonrespondents to per­sonally contact to increase the re­sponse rate.



Survey Results

The overall response rate was 48 of 68 (71%). Although there are only six board members, seven respondents indicated that they were board mem­bers. Thus, the response rate for this category could be considered either 100 percent or 117 percent. Surveys were sent to 23 program directors, of whom three are also board members. Of the 20 not already counted, the re­sponse rate was 65 percent. If the three

Journal of Public Health Dentistry



Group 1-Health Policy, Program Management and Administration (1 to r, first row): John King, Rebecca King, Robert Dumbaugh, Reginald Louie; second row: Bruce Brehm, Stephen Corbin. Not pictured: Rhys Jones.

Group II-Research Methods (1 to r, first row): Barbara Gooch, Linda Kaste, Barbara Gerbert, Gary Rozier; second row: Scott Tomar, Ray Kuthy, Jayanth Kumar. Not pictured: Stuart Gansky, John Stamm.

board members are included, the re­sponse rate was 74 percent. The survey was sent to 21 new diplomates, of whom five are program directors. Of the 16 not already counted, the re­sponse rate was 63 percent, but 71 per­cent if the program directors are in­cluded. Of the 26 current students con­tacted, 69 percent responded. There were 19 workshop participants who met the criteria for one or more of the target groups and were sent surveys. The response rate among this group was 100 percent. Unfortunately, peo­ple not invited to the workshop were less likely to respond.

Some of the highlights of the survey results were:

• All board members favored the current mix of general and specific competency objectives, compared with 40-46 percent of the other three target groups.

• All groups favored the current format of four topical areas, overall 79 percent.

• Only 43 percent of board mem­bers favored separating minimum core competencies from more ad­vanced skills, compared with 70-89 percent of the other groups.

• All board members favored hav­ing the same objectives for everyone without special focus tracks, com­pared with 17-50 percent of the other groups.

• Program directors (92%) were

most likely to support changing the eligibility criteria for certification; stu­dents, least likely (47%).

• The responses presented in Fig­ure 1 were culled from two questions. Responses were not prioritized. The question from the survey asked about the skills, knowledge, or abilities re­spondents thought will be most needed by dental public health practi­tioners in the future. The homework question asked respondents to list the skills needed by an entry-level practi­tioner today. Many of the skills needed are difficult to teach. Students need mentors and field experiences where they can observe appropriate role models demonstrating many of these skills and abilities.

• The program directors were asked, "How do you use the compe­tency objectives in guiding and devel­oping the curriculum for your resi­dents?" My favorite response was: "They are the Bible." Examples of other responses were: "as a self-test to determine what the resident knows;' "as a diagnostic tool for developing the residency plan," and "part of cur­riculum development."

• The good news was that most students (89%) reported they were very likely or likely to take the board exam in the future. Only one person indicated that he or she was unlikely and one person did not answer the question.



FIGURE 1
Skills, Knowledge, or Abilities Most Needed by Dental Public Health Practitioners

Knowledge of clinical dentistry and public health

Leadership abilities Communication skills, both oral and written

Interpersonal skills

Ability to work effectively with a multidisciplinary team

Coalition and constituency building Advocacy skills

Negotiation abilities Political savvy Problem solving Computers, technology, informatics Marketing

Use of media in health promotion Research skills

Administrative skills Assessment, policy development, assurance

Delivery systems, financing mechanisms Evidence-based dentistry Grantsmanship Fundraising

Ethics

Passion and integrity



Vol. 58, Suppl. 1, 1998

Competency Workshop

The workshop was conducted May 3-6, 1997, in San Mateo, CA, a commu­nity near the San Francisco airport. To lay the foundation for the meeting, several speakers addressed the par­ticipants at the first plenary session. After Dr. Skip Collins provided the welcome and introductions, I de­scribed the rationale for the workshop, the workshop planning process, re­sults of the preworkshop survey, and presented my recommendations. Dr. Catherine Horan, manager, Advanced Specialty Education Programs for the ADA, presented background informa­tion regarding the new Department of Education requirements. These re­quirements provide the impetus for all specialties to revise their accreditation standards. The new standards will fo­cus on outcomes assessment.

Dr. Bruno Petruccelli, chair, Council of Residency Directors, represented the American College of Preventive Medicine (ACPM). The ACPM has de­veloped competency statements and performance indicators for their spe­cialties. He described the process used by the ACPM to develop their compe­tencies and the issues and challenges that they faced. The issues were all very relevant to dental public health and the document developed sub­sequently became a model for our de­liberations. Dr. David Chambers, asso­ciate dean, University of the Pacific School of Dentistry, led the workshop participants through a discussion of what competencies are and how they can be evaluated, described the stages in professional growth from novice to expert, and showed us how to write competencies in a standardized for­mat. After some lively discussion, the group agreed that we would develop competencies expected of a beginning practitioner after completing a two-year advanced education program in dental public health. The next two days were spent alternating between small work groups led by the work group chairs (Rebecca King, Gary Roz­ier, Brian Burt, Linda Niessen, and Alex White) and plenary sessions. In­itially, the 43 participants were di­vided among four work groups that corresponded to the four topical areas of the 1988 competency objectives (see Appendix).

Some reconfiguring of the work groups took place, as it became evi­dent that the final document was going to differ substantially from the list of 1988 objectives. The 1988 set lists 165 items that are primarily knowledge based and will continue to serve as a useful document, especially for pro­gram directors and residents. The new version provides a relatively short list of 10 competencies in behavioral terms that integrate skill, understanding and values and describe what a graduate of a dental public health program can (and preferably get paid to) do! The competency statements are presented in general terms with specific per­formance indicators to illustrate the range and depth expected in the com­petency.

Most of the 1988 competency objec­tives begin with one of the following eight verbs: describe, define, discuss, explain, identify, list, compare, or un­derstand. The new competency state­ments all begin with more action-ori­ented verbs. The new statements place more emphasis on collaboration, ad­vocacy, and monitoring and surveil­lance activities than did the prior ob­jectives. Both documents emphasize program planning, implementation, evaluation and management, health promotion and disease prevention ac­tivities, critical evaluation of the scien­tific literature, and research methods. The competency development process forced the group to concentrate on the goals in the previous document listing competency objectives and to focus on stating what specialists in public health dentistry should be able to do after completing an advanced educa­tion program in dental public health. Although the product that emerged was different from what might have been anticipated given the results of the preworkshop survey, a consensus was reached by participants before the end of the workshop.



Group III-Oral Health Promotion and Disease Prevention (I to r, first row): James Leake, Maritza Cabezas, Brian Burt, Jed Hand; second row: Steven Levy, Bruno Petrucelli, David Alexander, Stuart Lockwood. Not pictured: Candace Jones.

Group IV-Oral Health Services Delivery System (I to r, first row): Steven Silverstein, Skip Collins, Alex White, Chester Douglass; sec­ond row: Aljernon Bolden, Scott Navarro, Myron Allukian, Sena Narendran, James Sutherland, Ira Parker. Not pictured: Linda Nies­sen.

Journal of Public Health Dentistry



Postworkshop Activities

The draft report was distributed in sequential phases to the planning committee, workshop participants, and key stake holders-such as resi­dency directors-for feedback and comments. Revisions, edits, and com­ments were incorporated at each phase. An announcement was placed on the electronic mail dental public health list server and referred readers to the AAPHD homepage on the In­ternet. A final draft was presented to the AAPHD Executive Council at the 1997 annual meeting in Washington, DC. After a few minor edits, the docu­ment was approved. Additional infor­mation was provided during a round table discussion at the meeting. The document is on the AAPHD homepage. Reprints will be dissemi­nated to key dental and public health organizations and other colleagues.



Summary

The new competency statements are a consensus of what is expected of graduates of two- year advanced edu­cation programs in dental public health. It is recognized that all stu­dents may not have the opportunity to achieve all of these competencies while in training. Consequently, these competencies are not identical to ac­creditation curriculum standards. Practitioners are expected to develop these skills after graduation as part of a lifelong learning process. These con­temporary competency statements help us define the specialty of dental public health and will serve as a guide

to colleagues in other fields, educators, policy makers, employers, and future specialists.

References

1. Hughes JT. Behavioral objectives for den­tal public health. J Public Health Dent 1978; 38:100-7.

2. Competency objectives for dental public health. J Public Health Dent 1990; 50:338­44.

3. Mecklenburg R Keynote address. Creat­ing a future for dental public health. J Public Health Dent 1990; 50:334-7.



Appendix: Dental Public Health Competency Objectives Workshop Participants
Jane Weintraub, project director
Joseph Doherty, AAPHD National Office

Helen Doherty, AAPHD National Office

Kathy Hayes, HRSA project officer
Catherine Horan, ADA, speaker
David Chambers, University of the Pacific, speaker

Cynthia Klock, Marin County Head Start, community representative


Ricardo Salinas, UCSF staff

Group I: Health Policy, Program Management and Administration
Rebecca King, Chair

Bruce Brehm, recorder, dental public health resident


Stephen Corbin

Robert Dumbaugh


Rhys Jones

John King


Reginald Louie


Group II: Research Methods
Gary Rozier, chair

Barbara Gooch, recorder, dental public health resident

Stuart Gansky
Barbara Gerbert
Linda Kaste
Jayanth Kumar
Ray Kuthy
John Stamm
Scott Tomar

Group III: Oral Health Promotion and Disease Prevention

Brian Burt, chair


Maritza Cabezas, recorder, dental public health resident

David Alexander


Jed Hand
Candace Jones
James Leake
Steven Levy
Stuart Lockwood
Bruno Petrucelli, Preventive Medicine Representative

Group IV: Oral Health Services Delivery System

Linda Niessen, co-chair Alex White, co-chair


James Sutherland, recorder, dental public health resident

Myron Allukian


Aljernon Bolden
Robert (Skip) Collins
Chester Douglass
Sena Narendran
Scott Navarro

Ira Parker


Steven Silverstein

Vol. 58, Suppl. 1, 1998 119


Preamble to the Competency Statements for Dental Public Health


Competency statements for dental public health, and the performance in­dicators by which they can be meas­ured, were developed at a workshop in San Mateo, CA, on May 4-6, 1997. This is the third in a series of such workshops conducted by the Ameri­can Association of Public Health Den­tistry and the American Board of Den­tal Public Health, which set up the knowledge and practice base by which the specialty is recognized. The first such workshop was held at Boone, NC, in 1974 (1), and the second at Be­thesda, MD, in 1988 (2). Social and technological change and the evolu­tion of the specialty make periodic re­visions essential.

Dental public health is defined by the American Board of Dental Public Health as:

... the science and art of preventing and controlling dental diseases and promoting dental health through organized community ef­forts. It is that form of dental prac­tice which serves the community as a patient rather than the indi­vidual. It is concerned with the dental health education of the public, with applied dental re­search, and with the administra­tion of group dental care pro­grams, as well as the prevention and control of dental diseases on a community basis.

This population-based approach to professional practice is quite different from the approach required for indi­vidual patient care in private practice, though both forms of practice are inte­gral parts of the dental profession. Ac­cordingly, dental public health prac­tice demands an additional body of knowledge and a set of skills beyond those obtained in an undergraduate dental education.

Some fundamental aspects of dental public health practice are not readily encompassed in a competency state­ment, and these can be considered part of the framework in which the compe­tency statements are set. These funda­mental attributes of the dental public health specialist include:

• Being a dentist. The scientific background and clinical skills to diag­nose, prevent, and manage oral dis­eases and conditions inherent in a den­tal education provide the underlying foundation for advanced knowledge of dental public health.

• Demonstration of public health values, which essentially means a view of health issues as they affect a population rather than an individual, with particular emphasis on preven­tion, the environment in its broadest sense, and service to the community. Public health dentists usually work collaboratively as part of a multidisci­plinary team of public health profes­sionals and community repre­sentatives.

• Leadership characteristics, e.g., influencing health policies and prac­tice through research, education, and advocacy; articulating a vision for the organization; negotiating and resolv­ing conflicts; and preparing the next generation of public health dentists.

• Subscribing to the code of ethics set down by the American Dental As­sociation and the American Public Health Association. [A code of ethics for the American Association of Public Health Dentistry is being developed. An interim association policy was approved at the 1997 annual meeting and is included in this issue of the JPHD, pp 123-4.1

The format for these competency statements is based on those devel­oped by the American College of Pre­ventive Medicine for residents in Pre­ventive Medicine (3). As such, the competency statements are presented in general terms with accompanying specific performance indicators to il­lustrate the range and depth expected in the competency.

Competency means being able to function in context, and the term is used most often to describe the skills, understanding, and professional val­ues of the beginning practitioner (4). Competency is a level reached by the person who is initially a novice, and who, after training and experience, reaches the level where he or she can

be certified as competent. It is a major landmark in professional develop­ment, but not the final point in the journey. That comes with proficiency, and the ultimate status of expert after many years of experience and profes­sional growth. Competency in most areas of dental public health is seen as the point reached after students in ad­vanced dental education programs complete two years of postgraduate education in the specialty require­ments of dental public health. In that sense, these expectations comprise a "floor" rather than a "ceiling," a basic collection of the minimum knowledge, skills, and values needed for an entry level specialist to practice dental pub­lic health. It is understood that new practitioners may not have performed every competency at the level indi­cated while in training. However, it is expected that the practitioner will pro­gress beyond the status of competency as his or her career continues, at least in certain areas.

The previous set of competency ob­jectives (2) for dental public health specialty certification developed at the Bethesda workshop looks quite differ­ent from this current set. The previous objectives are essentially areas of knowledge that comprehensively cover just about everything that a pub­lic health dentist needs to know, but are not all "competencies" per se. By no means are they outdated, and they will continue to be used by advanced education directors as a guide for cur­riculum development. Many of those areas of knowledge have been incor­porated into the current document.

There are two principal changes be­tween the new competency state­ments and the previous set. First, the new competencies are stated in behav­ioral terms; they are intended to define what dental public health practition­ers can do as opposed to what they know or understand. These competen­cies describe skills or abilities that are measurable or observable. Second, performance indicators have been added. Performance indicators are ex­amples of the types of outcomes or categories of evidence to be collected and are used as a basis for judging competency attainment (3).

The competencies are the result of an attempt to achieve a consensus on the level of performance to be ex­pected of all dental public health spe­cialists at the completion of their edu­cational program. They can help de­fine the specialty to potential employers, to potential applicants for specialty certification, and to col­leagues in the health professions. These competency statements form the basis by which the curriculum con­tent of the "Standards for Advanced Specialty Education Programs" can be developed and applied. Specialty edu­cation programs in dental public health are accredited by the American Dental Associations Commission on Dental Accreditation in accordance with their degree of adherence to standards. The standards specify as­pects of program administration, evaluation, facilities, and resources, as well as curriculum required for ac­creditation. The competencies are used by educational and residency program directors, faculty, and stu­dents to establish curricula, and by graduates of these programs as they prepare to take their examinations leading to specialty certification ac­corded by the American Board of Den­tal Public Health.
References

1. Hughes JT. Behavioral objectives for den­tal public health. J Public Health Dent 1978; 38:100-7.

2. Competency objectives for dental public health. J Public Health Dent 1990; 50:338­44.

3. Lane DS, Ross V. Final report. Improving training of preventive medicine resi­dents through the development and evaluation of competencies. Washing­ton, DC: US Department of Health and Human Services, Public Health Service, Health Resources and Services Admini­stration, Bureau of Health Professions, 1993, HRSA contract f192-468(P).

4. Chambers DW, Gerrow JD. Manual for developing and formatting competency statements. J Dent Educ 1994; 58:361-6.


121


Vol. 58, Suppl. 1, 1998

Dental Public Health Competencies




A specialist in dental public health will:

I. Plan oral health programs for populations.
Planning reflects:

  1. Establishing goals and setting priorities.

  2. Assessing oral health status, needs, and demands, and their determinants in a community (see Com­petencies VI, IX, X).

    1. Understanding the natural history of oral dis­eases and conditions.

    2. Assembling, reviewing, analyzing, and inter­preting existing data, including census, vital statistics, scientific literature, oral health care/public health, and relevant legal docu­ments (see IX).

    3. Assessing quality of data, noting strengths and limitations (see IX).

  3. Compiling all types of resource inventories (e.g., economic, personnel, legal, political, social).

  4. Developing program plans (such as for prevention and service delivery, etc.).

a. Identifying problem or potential problem.

b. Setting goals, objectives, and priorities.

c. Identifying target population.

d. Assessing current system (public and private components), incl. organizational structure and its relevance to decision-making process.

e. Determining demand for program.

f. Analyzing alternative interventions (see IX).

g. Selecting best practices and interventions that take into account cultural differences (see 11, VII-6, IX).

h. Determining procedures, policies, and imple­mentation plans.

i. Identifying and analyzing liability issues and developing risk-reduction strategies.

j. Developing budget and financing to ensure ac­cess for needed services.

k. Determining timeline.

l. Developing plans for monitoring and evalu­ation (see V, VI).



  1. Collaborating with community partners and con­stituency building (see 11-4, 11-9, III-1, VII, VIII-4). II.


II.Select interventions and strategies for the prevention and control of oral diseases and promotion of oral health

This competency reflects:

1. Using a comprehensive knowledge of the efficacy, effectiveness, and efficiency of the various inter­ventions to select interventions and strategies to prevent and control oral diseases. Balancing costs and possible risks against benefits of potential in­terventions (see V, IX).

2. Understanding national, state, local health objec­tives.

3. Integrating knowledge of health determinants when selecting interventions.

4. Identifying the role of cultural, social, and behavioral factors, practices, and issues in determining disease initiation and progression, disease preven­tion, health promoting behavior, and oral health service organization and delivery.

5. Advocating for oral health policies (see VIII).

6. Providing information on maintaining and im­proving oral health at the community and individ­ual level (see VII).

7. Communicating with groups and individuals on oral health issues (see VII).

8. Serving as a resource for professional and commu­nity groups concerning evidence for the effective­ness of preventive and treatment interventions and the rationale for their use (see VII).

9. Collaborating with other health professionals, agencies, and private groups in disease prevention and health promotion activities. Examples include tobacco cessation, community water fluoridation, and early childhood caries prevention programs (see 1-5,114, III-1, VII, VIII4).



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