DHA Program - PowerPoint PPT Presentation

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DHA Program. Ron Nagel DDS MPH Alaska Native Tribal Health Consortium www.ANTHC.org. Newtok Clinic Yukon Kuskokwim Health Corporation. Newtok Clinic, Yukon-Kuskokwim. AFHCAN Cart Alaska Federal Health Care Access Network. Wireless Networking Touchscreen

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DHA Program

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DHA Program

Ron Nagel DDS MPH

Alaska Native Tribal Health Consortium


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Newtok ClinicYukon Kuskokwim Health Corporation

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Newtok Clinic, Yukon-Kuskokwim

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AFHCAN CartAlaska Federal Health Care Access Network

  • Wireless Networking

  • Touchscreen

  • ECG / Video Dental Camera and Otoscope / Scanner / Digital Camera

  • Mobile – Customized

  • Patient safe


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Crisis in access to dental care in Alaska

  • AK Native children have 21/2 times the disease of U.S. all races

  • 2-4 y/o AI/AN have the highest decay rate of any population cohort in the U.S. Five times the U.S. average.

  • 91% of AI/AN, age 15-19, have a history of caries. 68% are untreated.

  • Dietary changes

  • An aging population

  • A growing population (over 60% increase since 1970)

  • Substantially higher costs of providing services in small isolated rural communities

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Why Dental Health Aides?

  • To improve access to basic oral health services by developing local capacity

  • To remove barriers to training so that students come from underserved areas and return to live and practice

  • To provide the continuity of care needed to implement preventive and educational programs

  • To develop culturally competent providers

  • To help establish the social and behavioral changes needed for better oral health

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Community Health Aide History

  • Developed by physicians some 38 years ago

  • Competency based credentialing (similar to hospital privileging)

  • Today about 550 CHAs provide primary health care in rural Alaska (350,000 patient encounters annually)

  • Their training starts with EMT or ETT training

  • They are an integrated part of the delivery system working with Doctors, Nurses, and PAs. They are not a second level of care.

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Competency Based Credentialing - QA

  • Each Dental Health Aide is assigned to a dentist/s

  • After training DHAs must practice their newly learned skills under direct supervision for a prescribed minimum time/encounter period. 400 hours for Therapists

  • Only after the dentist that oversees the procedure has determined that the DHA meets the standard of care are they considered to competent for that skill and eligible for certification

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Competency - QA continued

  • DHAs must demonstrate competency to maintain their certification and to change their scope

  • Every two years each DHA must provide evidence that: they completed the CE requirements (24 hrs) and they demonstrate the practical professional competencies for their level of certification

  • These administrative controls help to assure quality and that a single standard of care is met in tribal programs

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Competency vs. licensure

  • Changes in DHAs’ skills are measured over their entire career

  • We look directly at the services that they provide day to day

  • Each DHAs’ scope of practice is individually assigned based on competence through standing orders

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Community Health Aide Program Certification Board

  • The Community Health Aide Program Certification standards are administrated by a 12 member Federal board. They are MDs, DDS, PA, NP, CHAs from tribal programs in Alaska

  • There are provisions in the standards for Discipline, Suspension or Revocation of a certificate

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Primary Dental Health Aide

  • Village based

  • Provides education

  • Provides topical fluoride applications

  • Places Sealants

  • Exposes radiographs

  • Performs prophylaxis

  • Performs Atraumatic Restorative Treatment (caries control)

  • Manages emergencies

  • Assistant when dentist is in village

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Expanded FunctionsDental Health Aide

  • Clinic based

  • Functions as dental assistant

  • Performs expanded functions

    • Places filling materials in prepared teeth

    • Perform prophylaxis

    • SSCs

    • Lab and prosthetics

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Dental Health Aide Hygienist

  • Screen for oral health problems; develop and implement community-based oral health promotion programs; temporize dental cavities in preparation for permanent care by a dentist; and provide individual and community-wide preventive services

  • General supervision

  • Local Anesthetic

  • ART

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Dental Therapists

  • W.H.O. cites 42 countries that utilize Dental Therapists

  • Functions as part of the dental team under the supervision of a dentist

  • New Zealand has 87 yrs experience and Canada has over 37.

  • Exceptional safety record under general supervision for children and adults

  • They are equipped to help us provide the educational, preventive and safety net services that are most needed.

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Gambell Clinic, Norton Sound

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