Medical-Dental Integration: "Collaborative, Competent Care and Health Equity For All"

This toolkit supports medical-dental integration through three important components: 1) Inter-professional collaboration/partnerships and “collective impact"; 2) Health Equity/Cultural Competency/Health Literacy teaching and learning activities; and 3) the Community Health Worker/Navigators’ active role in medical-dental integration. 

Collaboration and Partnership: "Collective Impact"

Collective Impact 

Minnesotans of all ages and places in life are becoming more connected to one another as they seek healthy lives. The oral health care system must be responsive by forming partnerships with diverse organizations who coordinate care and provide equitable opportunities for prevention of disease and promotion of total health. This collaboration results in collective impact (illustrated here as interlocking puzzle pieces) that creates a synergistic result. (photos used with permission)

 

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Collective Impact: Diverse organizations coming together

Click HERE for Collective Impact video

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"The nature of the problem really must lend itself to be driven by factors that no one actor can solve in that community. It must require multiple ...sectors to be acting simultaneously in different but coordinated ways to move the needle on that social problem." - Admas Kanyagia (FSG, Inc., Is Collective Impact the Right Approach for You?).

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Click the image to hear Joseph P. Lally, Executive Director, Delta Dental of Minnesota Foundation, discuss access to care and Delta Dental's collaboration with Normandale Community College.

Joe Lally

    
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Medical – Dental Integration in Minnesota Would Benefit from Changes in Law and Policy: Oral Health Issue Brief (2019)  Click HERE  

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The Quadruple Aim 

The 21st Century Dental Team is a partnership between a team of health providers and clients using a collaborative and coordinated approach to shared decision making around health and social issues. Restructure of the traditional oral health care team will result in increased access to oral healthcare, with health equity as the goal. In the future, the formation of an interprofessional team of dental, medical, and other providers will further enhance this goal.

For years, the The Triple Aim of health equity—enhancing patient experience, improving population health, and reducing costs—was widely accepted as a compass to optimize health system performance.  

The Quadruple Aim of health care was developed by the Institute for Healthcare Improvement in October of 2007, adding the goal of improving the work life of health care providers, including clinicians and staff.

The framework was designed to help health care organizations:

  • Improve the patient experience of care (including quality and satisfaction);
  • Improve the health of populations; and
  • Reduce the per capita cost of health care
  • Increase provider satisfaction (professional wellness)
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4226781/ 

Image source: https://cloudblogs.microsoft.com/industry-blog/en-gb/
health/2019/07/04/virtual-consultations-healthcare/

  

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Minnesota pediatrician a hero for kids' dental health  
 

Click HERE to read the Star Tribune article featuring Dr. Amos Deinard, one of Minnesota's biggest champions for children. (November 18, 2015)

Interprofessional Collaboration

Integration and coordination of medical and dental health approaches to reach optimal/total health. 

Inter-professional collaboration is a driving force behind state-of-the art health care delivery. (Fried, 2014). "Restructuring the oral health delivery system to accommodate the medically underserved will require reconfiguration of the dental team.  To a large extent, increasing access to oral healthcare will depend upon developing inter-professional relations." 

When "professional teams work collaboratively, they value one another's perspectives and contributions, they understand and appreciate true teamwork, they communicate effectively, and share an ethical code that is premised on just and high-quality care."

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Click HERE to access 'Interprofessional Collaboration: If Not Now, When?' by Jackie Fried, RDH, MS, University of Maryland School of Dentistry, who makes a case for community centered, integrated health care.

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Dental Hygienists in Coordinated Care

See how Colorado is utilizing dental hygienists in medical settings: "Improving Oral Health by Integrating Medical and Dental Care"

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A document describing the contributions of medical and dental professionals to "collaborative, competent care and health equity for all" can be found HERE.  


Medical-Dental Collaboration: Minnesota Examples


   Image result for hennepin healthcare

Hennepin County Medical Center Dental and Oral Surgery Clinic, Minneapolis/Hennepin County, Minnesota; a safety net and teaching hospital providing care for low-income, uninsured and vulnerable populations, from pediatrics through geriatrics.

Dental hygienists can effectively provide "coordinated care" to under-resourced populations in non-traditional health care settings (shown above). Collaborative practice authorization in community settings (Minnesota Statutes 150A.10, subd. 1a) authorizes dental hygienists to practice within a community-focused model resulting in more people with access to preventive services and in finding a dental home.

 

Eva Romero - Forging Change as a Collaborative Practice Dental Hygienist
-Whittier Clinic and Hennepin Healthcare

Eva Romero video link



 

HealthFinders, A model for the "21st Century Dental Team" presents at the second annual Minnesota Oral Health Summit

Click HERE to read the article featuring HealthFinders Collaborative

A Minnesota Dental-Medical Integration Example

Emily Carroll, a Certified Nurse Practitioner, is the Director of Clinical Care at HealthFinders Collaborative.  In her videos, Emily discussed the HealthFinders model of integrating medical in to dental, her roles in the organization, and the relationship with the dental staff.  In two of the videos Emily mentions Renae, who is a collaborative practice dental hygienist, as well as Jenny, a dental hygienist and advanced dental therapist.  

How Dental fits into the Medical Team-  Video

Advice to others wanting to adopt this model-  Video

Day in the life of Emily-  Video

How do you manage all your roles-  Video

How do you interact with your team-  Video



 

  Image result for carris health centracare

Click HERE to learn about Carris Health Dental Clinic, Willmar Minnesota--  a collaborative effort between Carris Health and the University of Minnesota School of Dentistry. Dental, dental hygiene and dental therapy students: 
 
* provide dental care to underserved patients in a rural setting
* encourage parents to begin regular dental visits for their children by age one



Click the link below to learn more about progress being made in Minnesota around Coordinated Care:

Blending Behavioral Health into Health Care Homes: MN Association of Community Health Centers and Cherokee Health Systems (2014)-  Video



Oral Health Summit II- August 3, 2017

Minnesota 21st Century Dental Team: Toward Access for All


Normandale Community College, in collaboration with Delta Dental of Minnesota Foundation, hosted an event on August 3, 2017 intended to move thinking about provision of oral health care in an interprofessional direction. Speakers described their vision and experiences in development of a "Minnesota 21st Century Dental Team" to improve access to care and reduce health disparities.  

Click HERE to see the full day's video of the event

Click HERE for Summit II Agenda


Summit II speakers featured in the video:

  • Keynote
    The Big Picture -Bob Russell, DDS, MPH
    Video (21:19) Click HERE 

  • Legal Strategies to Advance Oral Health - Jill Krueger, JD

  • Collective Impact PanelKey Stakeholder Groups

  • Collective Impact to Address Access to Care - Joseph P. Lally, JD
    Video (17:36) Click HERE

  • MN Health Equity Lens - Commissioner Ed Ehlinger, MD

  • MN Older Adults Basic Screening Survey -Megan Clare Craig-Kuhn, BA and Peggy Running, BSDH, GDH

  • Moving Towards Value Based Care - Margaret Langelier, MSHSA
    Video (50:15) Click HERE

  • 21st Century Dental Team - HealthFinders Collaborative




Health Equity; Health Literacy; Cultural Competency: Addressing Health Disparities

Health Equity is the attainment of the highest possible level of health, regardless of sex, gender identity, race/ethnicity, religion, culture, language, disability, or socioeconomic status.

We must unite our inter-professional ethical values, be grounded in principles of justice and human rights and be knowledgeable and competent to create an absence of health disparities.

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The 21st Century Dental and inter-professional teams must embrace and embody the provision of 'equitable care'.  The illustration below contrasts the value of equity over equality.

Equality/Equity Visual

Infographic credit:  Visualizing Health Equity: One Size Does Not Fit All 
https://www.rwjf.org/en/library/infographics/visualizing-health-equity.html

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Health Literacy is the degree to which individuals have the ability to obtain, process and understand basic health information and services needed to make good health decisions.  Health care professionals have a duty to provide information in simple, clear and plain language and to check that patients have understood the information before ending the conversation. (Source: Minnesota Health Literacy Partnership Plain Language Campaign Talking Points & Key Messages)                                                                                  

Minnesota Health Literacy Best Practices Conference
August 16, 2019   Click HERE to access the 2019 conference video.

 

Minnesota Health Literacy Best Practices Conference
July 27, 2018   Click HERE to access the 2018 conference video.

 

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Effective Communication and Health Literacy

Health Literacy Training, Minnesota Health Literacy Partnership Training and presentation materials to educate individuals and health care professionals about the importance of health literacy, health numeracy and teach back strategies. Click HERE


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Administration and Management Practice

Organizations can use the Cultural and Linguistic Competence Policy Assessment to determine the needs and gaps in knowledge on cultural diversity. This tool is free to use, although the data from the survey cannot be used for research purposes. Click HERE

 

 

 

Health Equity Educators’ Teaching Resources/Learning Activities And Related Competencies

     Integrating Health Equity into the Dental Curriculum

Overview Video:
Navigating the Educators' Teaching/Learning Resource Library  

Health equity is the attainment of the highest possible level of health, regardless of sex, gender identity, race/ethnicity, religion, culture, language, disability or socioeconomic status. Barriers to achieving health equity such as difficulty accessing oral health services, limited patient-provider health literacy and culture and language differences can result in poor patient health outcomes, increased healthcare spending and worsening oral health disparities.

 

A Minnesota 21st Century Dental Team must meet the needs of a growing diverse patient population by providing accessible, and culturally and linguistically appropriate oral health services to improve the oral health of all Minnesotans.  

 

Health equity competencies were developed in collaboration between Normandale Community College Dental Hygiene Program and Minnesota Department of Health Oral Health Program with funding from the Health Resources and Services Administration (HRSA). These competencies can be integrated into existing dental curricula, as well as other healthcare curricula and added to continuing education programs. Objectives are presented as intended outcomes in learner knowledge, skill, and attitude.

 

Associated with the health equity competencies and objectives, learning activities have been developed for your reference and implementation and can be accessed beneath the specific competency. 

 



Click the following for Competencies and Learning Objectives ...

             Integrating Health Equity into the Dental Curriculum



Competency 1: Health Equity and Cultural Competence in Health and Oral Healthcare

Click the following for Teaching and Learning Activities/Resources:

Concepts in Health Equity

Recognizing Aversive Racism: Bias Without Intention

Implications of Racism on Overall Health, Oral Health and Mental Health 

Racial Issues in Healthcare

Scarlet Letter Exercise: Have you experienced a social prejudice?

Self-Awareness in Racism

The Integrated Dental Workforce

History of Diverse Populations and Health

Cultural Competency for the Health Professional: Patti Rose Textbook Guide

Cultural Sensitivity in Healthcare

Connecting with Another Culture

Assessing Cross-Cultural Clinical Experiences with Competency Reference Checklist

Rubric for Patient Clinical Encounter Case



Competency 2Effective Communication and Health Literacy

Click the following for Teaching and Learning Activities/Resources:

Health Literacy

Plain Language

Accessibility

Numeracy

Prescription Literacy

Health Literacy Case Scenarios: How clear is your healthcare dialogue?

Evaluate Patient Health Education Materials

Take Action to Improve Health Literacy

Assessing Cross-Cultural Clinical Experiences with Competency Reference Checklist  

Rubric for Patient Clinical Encounter Case 

The Integrated Dental Workforce



Competency 3: Administration and Management Practice

Click the following for Teaching and Learning Activities/Resources:

Practice Management Strategies for Equitable Oral Healthcare Delivery 

The Integrated Dental Workforce

History of Diverse Populations and Health 

Health Literacy

Take Action to Improve Health Literacy

Community Health Worker/Navigator: Champions of Medical-Dental Integration

Dental Providers: How CHWs Help Dental Providers

CHWs can teach families about the value and practice of sound oral hygiene, acquaint them with a regular schedule of routine preventive dental care, and help prepare those patients ... with accurate and culturally-appropriate information.
  Minnesota Community Health Worker Alliance

 



The Minnesota Oral Health Project; March 23, 2020
 https://crushcavities.com/chw-and-mpls-schools/

Community Health Workers’ Fluoride Varnish Interventions in Minneapolis Schools

 

Nasra Budul, Community Health Worker (CHW), Ready Set SmileNasra Budul is an oral health educator and Community Health Worker in Minneapolis public and charter schools. As an educator of children age fourteen and younger, Nasra is keenly aware of oral health disparities within her Somali community. She educates school systems, helps get children to preventive dental visits twice each school year, and visits with parents at all school events and conferences. As a Community Health Worker for Ready Set Smile, a nonprofit in Minneapolis whose mission is to reduce oral health disparities and educate communities on best oral health practices, Nasra is a highly sought after advocate and groundbreaking champion with the Minneapolis Somali community.

Many children in public and charter school systems have never seen a dentist. They do not know what cavities are or how to prevent them. Most have loving, hard-working parents who do not know how to best care for their children’s teeth for life-long health. Since many parents have never learned sound oral health practices, their children are missing out on essential daily oral health preventive practices.

Nasra focuses on teaching best practices for caring for children’s teeth and oral health every time she visits school classrooms. She also teaches parents these practices at school events and conferences. “I meet with children and parents in so many environments. These include conferences and after school activities as well as in larger community settings. I also create flyers, provide consent forms, and organize all needed materials between schools and parents. This helps children to more easily receive the care they need. I also make certain children enrolled in Ready Set Smile receive two preventive oral health visits through onsite dental clinics in our partnering schools. An advanced dental therapist and collaborative dental hygienists provide exams, give fluoride varnishes, and help children understand how to care for their teeth as a life-long practice. We see more than 1,600 school-age children a year during clinic visits. And we provide oral health education for all children in those schools regardless of enrollment in the Ready Set Smile dental clinic.”

Nasra listens each day to what children say about their oral health. “Many children – and their parents – have myths about oral care. One 12 year-old recently told me that his mother gives him orange soda every day to drink. He told me this is because it is made from oranges and therefore has lots of vitamin C. When I explained the sugar content in soda to him and how it causes cavities to form, he was astounded. Another child recently told me that he brushes his teeth every morning because he learned if you brush in the morning, you will not need to brush again until the next day. After I explain the realities of good oral care to children, they are often shocked.”

Nasra completed her Minnesota Community Health Worker certificate program two years ago. She was a Somali interpreter in health care settings before she received her certification. “I am always startled to learn how little many parents and children know about the importance of oral health care. This is a practice that shapes our future health in so many ways. Many parents simply don’t have a lot of information about cavities or how to prevent them. We work alongside parents and educators to help students have access to preventative oral health care and education. I love working with children, their families, and school systems as an advocate. I help them to learn actual realities and myths about oral health care.”

As a Community Health Educator for Ready Set Smile, Nasra lives the organization’s two-fold mission: educating and providing preventive oral health services and then empowering children to care for their oral health. “I love what I do. Being an advocate for children and parents is the best way to live each day.”

For more information, see https://www.readysetsmile.org/aboutusrev.

 



 

 

Impoverished children and adults, people of color, immigrants and refugees, and many elders lack access to high-quality, affordable and culturally-competent oral care and suffer frequent, serious dental problems. Part of the solution to advancing health equity in Minnesota is integration of Community Health Workers (CHWs) into the oral health care system. 

Click HERE to view the "Success with CHWs: Oral Health Road Map", presented by the Minnesota Community Health Worker Alliance to address these challenges.

A Community Health Worker (CHW) is a frontline public health worker who has a close understanding of community needs and the persons they serve. This relationship enables the CHW to serve as a navigator or liaison between health and social services and the community to facilitate access to services and improve the quality and cultural competency of service delivery. 

A CHW builds individual and community capacity through a range of activities such as outreach, community education, informal counseling, social support and advocacy. 

 



Community Health Worker Alliance website

Wellshare International: Minnesota Community Health Worker Peer Network               

Minnesota Department of Health- Community Health Worker (CHW)

Minnesota Department of Health- Community Health Worker Toolkit

Minnesota Department of Human Services- Community Health Worker (CHW)

Community Health Worker Integration: Issues and Options for State Health Departments

 

Resources

3-14-2020
New Special Dentistry CE Podcast Series
The Colgate Oral Health Network is proud to partner with the distinguished faculty at the Arizona School of Dentistry & Oral Health, A.T. Still University (ATSU), to provide you with this 8 part- CE podcast series: TIPS FOR IMPLEMENTING SPECIAL CARE DENTISTRY INTO DAILY PRACTICE. Hosted by Dr. Ann Eshenaur Spolarich an internationally recognized author and speaker on the care of medically complex patients, this series covers a variety of topics including, but not limited to:
  • A broad overview of individuals who present with special needs
  • Risk reduction strategies to improve safety
  • Tips for staff training and skills and communication

Listen to each episode and complete the short CE quiz at the end of each to earn .25 CE credits per episode.

  • Click HERE to access the Colgate Oral Health Network Dental Podcast Series 


February 2020
Gender Identity and the Role of the Dental Hygienist 

Suzanne Hubbard, RDH; RDH magazine. January 7, 2020 
Click HERE  

People who are transgender, non-binary, or gender non-conforming face persecution, bias, and injustice in navigating medical systems, including when they are in the dental chair. This article provides practical and useful information on how to support a patient who is changing the way they express their gender to the world. As dental hygienists, it is our job to support the oral health as well as the overall health of our patients. It is our responsibility to educate ourselves about gender expression, to understand that it is different from sexual orientation, and to meet our patients where they are at without judgement. 

Click HERE for video from the Oral Health Summit II (August 2017- Normandale Community College) presented by Dr. Bob Russell, "The Big Picture: Achieving True Medical-Dental Integration to Meet the Needs of Unserved America".




Health Literacy in Dentistry, American Dental Association
Resources for increasing the dental team's knowledge about health literacy. Click HERE



Health Literacy and Patient Engagement, Health Resources and Services Administration (HRSA)  Click HERE
  • Advisory committee on training in primary care medicine and dentistry.
  • Recommendation to improve health literacy and patient engagement.



Journal of the California Dental Association, April 2012
This entire issue from the CDA focuses on oral health literacy.  Click HERE