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Advanced Dental Hygiene Practitioner: The North American Model

Advanced Dental Hygiene Practitioner: The North American Model. Cindy Fletcher Executive Director British Columbia Dental Hygienists’ Association. American Dental Hygienists Association. Ann Battrell, RDH, MSDH(c) ADHA Executive Director National Oral Health Conference April 30, 2006.

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Advanced Dental Hygiene Practitioner: The North American Model

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  1. Advanced Dental Hygiene Practitioner: The North American Model Cindy Fletcher Executive Director British Columbia Dental Hygienists’ Association

  2. American Dental Hygienists Association Ann Battrell, RDH, MSDH(c) ADHA Executive Director National Oral Health Conference April 30, 2006

  3. MISSION STATEMENT To improve the public's total health, the mission of the American Dental Hygienists' Association is to advance the art and science of dental hygiene by ensuring access to quality oral health care, increasing awareness of the cost-effective benefits of prevention, promoting the highest standards of dental hygiene education, licensure, practice and research and representing and promoting the interests of dental hygienists.

  4. Dental Hygiene Projections • U.S. Department of Labor, Bureau of Labor Statistics: • Occupational Outlook Handbook • Dental hygienists noted within the top 10 fastest growing occupations and occupations having the largest numerical job growth from 2004-2014 • Noted by level of education and training • http://www.bls.gov/oco/ocotjt1.htm • (retrieved 12.21.05)

  5. Oral Health Workforce U.S. Dept. of Labor, Bureau of Labor Statistics: DENTISTS (general) http://data.bls.gov/ Retrieved 12.21.05

  6. Oral Health Workforce U.S. Dept. of Labor, Bureau of Labor Statistics: DENTAL HYGIENISTS http://data.bls.gov/ Retrieved 12.21.05

  7. Dental Health Professional Shortage Areas (D-HPSAs) • Critical issue • Distribution of dental workforce • Eliminating oral health disparities • Pockets of underserved areas • Rural • Inner city • DHPSAs increased to: • 3296 (792 in 1993) • 45,620,457 people affected *SOURCE:03/06/06, Shortage Designation Branch, National Center for Health Workforce Analysis, Bureau of Health Professions, Health Resources and Services Administration

  8. ADVANCED DENTAL HYGIENE PRACTITIONER

  9. ADHA HOD RESOLUTIONS, June 2004 • That the ADHA advocates the creation of an advanced dental hygiene practitioner who provides diagnostic, preventive, restorative and therapeutic services directly to the public. • That the ADHA supports a standardized educational curriculum developed by the American Dental Hygienists’ Association, for the advanced dental hygiene practitioner.

  10. ADHA HOD RESOLUTIONS, June 2004 • That the following definition of Advanced Dental Hygiene Practitioner be adopted: • A dental hygienist who has graduated from an accredited dental hygiene program and has completed an advanced educational curriculum, approved by the American Dental Hygienists’ Association, which prepares the dental hygienist to provide diagnostic, preventive, restorative and therapeutic services directly to the public.

  11. ADHP Vision Statement • The advanced dental hygiene practitioner will improve the underserved public’s health and access to quality, cost-effective oral health care and appropriate referrals within multidisciplinary healthcare teams.

  12. Historical Perspective Why is ADHA pursuing this? • Access to oral health care crisis in the U.S. • Heightened awareness for the need for a “mid-level practitioner” • Compliments the ADHA’s commitment to resolve health care disparities • Workforce Supply, Demand and Distribution

  13. Advanced Dental Hygiene Practitioner • Why Dental Hygienists? • Projected growth in workforce • Projected growth in educational programs • Market forces creating advanced practice • Advanced education already in place • 15 MSDH Graduate programs in place • Avoid duplication in education and training • Potential for cost-savings in cross training • Opportunity to revise efficiency in delivery of oral health care

  14. The ADHP … • Follows the Rapid Practice Changes in the DH Profession: • Affiliated Practice (AZ) • Registered Dental Hygienist in Alternative Practice (CA) • Extended Care Permit RDH (KS) • Public Health Permit (ME) • Collaborative Practice RDH (MN) • Limited Access Permit with Public Health Supervision (MT) • Public Health Supervision (NH) • Collaborative Practice RDH (NM) • Public Health Endorsement (NV) • Public Health Supervision (IA) • Limited Access Permit (OR) • School Sealant Programs (WA)

  15. The ADHP would … • Provide primary oral health care. • Be competent in working with populations with special needs: • children • medically compromised • adolescents and geriatric populations.  • Be able to evaluate oral health needs of populations with limited access to care. • Develop, implement and monitor dental hygiene care programs for these populations. • Participate as a member of a comprehensive health care team.

  16. The ADHP… • From the clinical perspective: • Including but not limited to: • cavity preparation, performing pulpotomies and competency in atraumatic restorative therapy (a temporary filling) among other preventive and restorative therapies.  • From the health promotion perspective: • Including but not limited to: • Designing nutritional interventions, implement and evaluate smoking cessation programs and evaluate health promotion and disease prevention programs for specific populations.   

  17. Advanced Dental Hygiene Practitioner (ADHP) Draft Curriculum

  18. ADHP Draft Curriculum DOMAINS: I. Provision of Primary Oral Health Care II. Healthcare Policy and Advocacy III. Management of Oral Care Delivery IV. Translational Research V. Professionalism and Ethics

  19. DOMAIN I: Provision of Primary Oral Health Care The advanced dental hygiene practitioner demonstrates competence in providing primary oral health care and case management in diverse populations. Practitioners use the process of care and target the underserved including those with special needs using a multidisciplinary approach.

  20. DOMAIN II: Healthcare Policy and Advocacy The advanced dental hygiene practitioner contributes to health policies that address disparities in oral health and access to care for the underserved. The practitioner supports and applies health policy at the institutional, local, state, regional, and national levels.

  21. DOMAIN III: Management of Oral Care Delivery The advanced dental hygiene practitioner integrates practice management, finance principles, and health regulations to analyze, design and develop initiatives that will improve clinical outcomes, the quality of care and patient safety. The practitioner demonstrates effective leadership for changing healthcare and practice environments.

  22. Domain IV: Translational Research The advanced dental hygiene practitioner uses sound scientific methods and accesses evidence-based information when making decisions and providing client care.

  23. Domain V: Professionalism and Ethics The advanced dental hygiene practitioner demonstrates professional behavior and clinical decision-making skills consistent with dental hygiene parameters of care, legal regulations and the ADHA Code of Ethics. The advanced dental hygiene practitioner possesses the values and behaviors which promote service to the public, professional involvement, and lifelong learning.

  24. Hospitals Nursing homes Public health settings Community Health Centers Federally Qualified Health Centers Homebound Elementary and Secondary Schools Other… In what settings will the ADHP work?

  25. What level of education and credential will be necessary for the ADHP? • Point of entry for all • Flexibility • Potential exists for distance education • Proven success in dental hygiene education • Currently 58 degree-completion programs (35 designated with some/all distance education) • Master’s Degree • Credentialing process

  26. How will the ADHP differ from the dental therapist or dental aide positions available elsewhere? • ADHA has and will continue to examine related models • Unique in design • Oral health needs and U.S. health care delivery system

  27. Will this replace the entry-level position for the registered dental hygienist? • No. • Answering an unmet public health need. • Intended to go beyond entry-level education.

  28. Where will the classes be taught? • Curriculum development in process. • Educational collaboration with universities. • Credential offered through the ADHA.

  29. What would it mean for an ADHP to serve as a collaborative partner? • Working with public health, allied health, and medical professionals. • Variety of practice settings. • Patients to receive a well-rounded approach to health services.

  30. “The idea that got the broadest support was expansion of scope of practice to include simple restorative procedures for dental hygienists.” --Policy Issues in Dental Workforce Diversity and Community-Based Dental Education, November 2004

  31. Legislative Success… • 19 states without overly restrictive supervision requirements • 10 States with Medicaid provider status • 43 States with general supervision • 38 States that allow dental hygienists to administer local anesthesia

  32. ADHP Legislative Success • July 2005:  ADHP language is inserted into HR 3010, the Fiscal Year 2006 Appropriations Bill for the Labor, Health and Human Services.  • The language is considered ‘report language’ – it does not carry the weight or law or appropriate any federal funding.  It is encouragement to the lead health agency, HRSA, to explore development of the ADHP.  • July 2005:  HR 3010 is passed by the Senate Appropriations Committee.  • October 2005:  HR 3010 passes the full Senate.

  33. Canadian Dental Therapists • Dental therapists work mainly for the federal government and the provincial and territorial governments to provide services in rural and remote communities. • Dental therapists complete the two year diploma program offered by First Nations University of Canada at the National School of Dental Therapy in Prince Albert, Saskatchewan.

  34. “Dental therapists are primary oral health care professionals who are trained to perform basic clinical dental treatment and preventive services within a variety of practice settings. As members of a multidisciplinary team, dental therapists provide restorative dental treatment services, disease prevention and oral health promotion programs to maintain and improve health. Dental therapists also advocate for the needs of clients, assist them in accessing care and refer them to other health professionals for services beyond the scope of the dental therapist’s practice.” Canadian Dental Therapists Association www.dentaltherapists.ca • Dental therapists who have completed post-graduate orthodontic modules approved by the regulatory bodies may also provide basic orthodontic procedures.

  35. Dental therapists practice in both private and public health settings within a general consultative/referral relationship with a dentist. Dental therapists practice in private dental clinics, government health programs, public health agencies, training institutions, First Nations organizations and other practice settings, in varying capacities as clinicians, educators, health promoters, administrators or dental consultants.

  36. Dental therapists are competent to provide the full range of professional services within their scope of practice. However, their practice may vary, depending upon health care legislation or employment policy that may exist within different settings or jurisdictions in Canada. • Upon graduation dental therapists will demonstrate competency and provide the full range of professional care in the following four broad categories: • Diagnostic Dentistry • Operative Dentistry • Community and Preventive Dentistry • Practice Management, Principles of Professionalism and Ethics.

  37. Legislative Changes to Dental Hygiene Legislation Canada • Alberta • Ontario

  38. What role can Canadian/BC dental hygienists play in meeting the oral health needs of ALL Canadians/British Columbians?

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