Dental care was front-and-center with 8 workshops (listed below), 20 posters, and additional coverage of oral health issues at the Clinical Conference (see Oral Health in HIV Infection in the Clinical Conference Syllabus). This focus is reflective of a HRSA-wide focus on oral health (driven by the fact that 20% of the U.S. lacks access to dental care) as well as long-standing Ryan White attention to oral health disease.
Poor oral health is a major problem among persons living with HIV/AIDS and is consistently reported as a top unmet need by consumers in formal needs assessments conducted by Ryan White programs around the country. While dental care is provided by all Ryan White Parts, several programs are focused solely on oral health care. As outlined in a presentation by HRSA/HAB’s Dr. Mahyar Mofidi (I-6, Expanding the Dental Safety Net for PLWHA):
- The Part F Dental Reimbursement Program, in operation since 1994, reimbursed dental care provided to over 35,000 people in 2008.
- The relatively newer Community Based Dental Partnership Program started operations in Fiscal Year 2002, delivering care to 5,300+ people in 2008 through the work of 1,485 providers—while adeptly spinning a plate and providing training to 824 dental students in that same year.
All Ryan White Parts deliver oral health care. In 2008, over 86,000 Ryan White clients received oral health care from Parts A through D. Additionally the SPNS Innovations in Oral Health Initiative is exploring models of care to deliver these services to PLWHA.
Oral Health Workshops: Highlights. Below are highlights from several oral health workshops, followed by a listing of all the oral health workshops at this year’s meeting. Check the TARGET Center, post-meeting, for an online listing of workshop slides and additional resources on this topic.
The Provision of Oral Health Care Services to Children in Ryan White Part D Programs
C-5, August 24, 2010
Dental disease is a critical public health issue whose impact is particularly heaving on children from poor minority households. Early oral diseases can lead to social and other health diseases. Although Medicaid covers dental services for children, this critical health care service is not being accessed by many of those who are eligible for this care.
In this workshop, two Ryan White grantees talked about their work in bringing oral health care services to children eligible for care under Ryan White Part D: the University of Colorado (UC) and the University of California of San Diego (UCSD). Presenters reported challenges faced in delivering dental services to children, such as cultural barriers, fear, transportation, dentists not taking Medicaid, and a shortage of dentists. They followed up by outlining various activities to address gaps in dental care for children:
- Both California and Colorado have developed public information-type campaigns. Colorado has two: Cavities Free by Three. Another campaign by their School of Dentistry focuses on forming partnerships with internal and family medicine resident programs to conduct dental assessments to reduce access barriers.
- It is one thing to provide dental services. Doing it well is another matter. To determine the impact of dental services to children enrolled in its Part D program, UCSD is using the HAB Performance Measure for Oral Health Care in designing a quality management initiative. The team of providers at UCSD, under the leadership of Dr. Stephen Specter, has developed a program to teach oral health care literacy to enrolled families and staff.
Maintain the Connection: Dental Case Management for the Multi-Diagnosed, Marginally Housed
Session Combined With: “If You Build It They Will Come” – Creating a Dental Home: Access to Care through a SPNS Initiative
D-7
Providing Comprehensive Dental Care: Getting Hard-to-Reach Populations to “Open Wide.” Not surprising to the “denta-phobes” among us, many people are reluctant to take advantage of dental services, even when provided comprehensive dental care free-of-charge. Two dental programs, one in downtown San Francisco and the other in suburban Chester County, Pennsylvania, shared tips for providing dental care to hard-to-reach populations. Both programs are funded through the SPNS Program Oral Health Care Initiative.
Both programs tried various approaches to make their dental services more accessible to their clients. Most daunting was how to overcome one of the most significant barriers to care: competing challenges faced by clients (e.g., unstable housing, need for food and clothing, lack of transportation). Dental care, even when desperately needed, was often a low priority for clients, many of whom would access available service when in pain but not return for necessary follow-up care.
- The San Francisco program, headed by Tenderloin Health in collaboration with the San Francisco Department of Public Health, Asian and Pacific Islander Wellness Center, and Positive Resource Center, initially hired an oral health coordinator—a mostly administrative position—to schedule appointments. A good number of patients failed to return for follow-up. Many had not been to the dentist in many years and may have been refused care due to stigma and discrimination.
- In response, the program decided to implement a more intensive model of support—the dental case manager (DCM). The DCM carried out eight critical roles, identified by Boston University (also a SPNS grantee). These include: patient recruitment; transportation; accompaniment on visits; explanation of visits (i.e., what to expect); referral and translation; retention support; patient education; and collaboration with HIV case managers. The critical aspect of the DCM is that he or she knows the clients and can help them get to appointments, understand the importance of dental care, and know what to expect.
- The AIDS Care Group had a similar experience in that once established, their services were not an instant draw for the target population. A strategy that worked for them was to reach out to other organizations offering services to PLWHA and take their services on the road. What started as information sessions evolved into on-site screenings. Once patients were identified through the screenings and committed to appointments, AIDS Care Group’s supportive services, especially transportation, became critical. Pick-up sites were established in four communities, and patients from those communities are scheduled for the same day. For some of the sites, the twice daily round trips to pick up and return patients required about 400 miles of driving for the shuttle driver (who recommends books on tape). The long drives were made more productive for patients, so to speak, given that AIDS Care Group provided them with access to other services while at the dental clinic.
Despite their different approaches, both programs emphasize the importance of building relationships with clients. While they may only be initially interested in eliminating their pain or receiving a bridge to dramatically improve smiles, over time clients may decide to take the steps necessary to address all their oral health needs. During that time, organizations can be working to meet other needs.
Learn more about HRSA’s Ryan White Dental Programs and access TA resources on dental care and HIV/AIDS from the TARGET Center.
Oral Health Workshops
- HRSA Oral Health Programs: Improving Access to Oral Health Care for Persons Living with HIV/AIDS, A-4
- A Grantee and Subgrantee Partnership for Implementing the HAB Oral Health Performance Measures, B-5
- Improving Oral Health Care: Information to Reduce Barriers to Accessing Care, B-6
- Implementing HIV Performance Measures into your Oral Health Program, B-7
- Developing a Successful Network for Endodontic Services for People with HIV/AIDS, C-4
- The Provision of Oral Health Care Services to Children in Ryan White Part D Programs, C-5
- Maintaining the Connection: Dental Case Management for the Multi-Diagnosed Marginally Housed, D-6
- “If You Build It They Will Come”: Creating a Dental Home, Access to Care Through a SPNS Initiative, D-7
- Expanding the Dental Safety Net for PLWA, I-6
- Stigma and the Provision of Dental Services to People Living with HIV/AIDS, I-13
- If You Build It, Will They Come? Increasing Access to HIV Oral Health Care, I-14
- Reducing the Burden on HIV Case Managers in Accessing Oral Health Care for HIV Patients, J-4