1. DHA Program Ron Nagel DDS MPH Alaska Native Tribal Health Consortium www.ANTHC.org

2. Newtok Clinic Yukon Kuskokwim Health Corporation

4. Newtok Clinic, Yukon- Kuskokwim

5. AFHCAN Cart Alaska Federal Health Care Access Network n Wireless Networking n Touchscreen n ECG / Video Dental Camera and Otoscope / Scanner / Digital Camera n Mobile – Customized n Patient safe n WWW. AFHCAN.ORG

6. Crisis in access to dental care in Alaska n AK Native children have 21/2 times the disease of U.S. all races n 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. n 91% of AI/AN, age 15-19, have a history of caries. 68% are untreated. n Dietary changes n An aging population n A growing population (over 60% increase since 1970) n Substantially higher costs of providing services in small isolated rural communities

7. 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

8. Community Health Aide History n Developed by physicians some 38 years ago n Competency based credentialing (similar to hospital privileging) n Today about 550 CHAs provide primary health care in rural Alaska (350,000 patient encounters annually) n Their training starts with EMT or ETT training n They are an integrated part of the delivery system working with Doctors, Nurses, and PAs. They are not a second level of care.

9. Competency Based Credentialing - QA n Each Dental Health Aide is assigned to a dentist/s n After training DHAs must practice their newly learned skills under direct supervision for a prescribed minimum time/encounter period. 400 hours for Therapists n 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

10. Competency - QA continued n DHAs must demonstrate competency to maintain their certification and to change their scope n 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 n These administrative controls help to assure quality and that a single standard of care is met in tribal programs

11. Competency vs. licensure n Changes in DHAs skills are measured over their entire career n We look directly at the services that they provide day to day n Each DHAs scope of practice is individually assigned based on competence through standing orders

12. Community Health Aide Program Certification Board n 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 n There are provisions in the standards for Discipline, Suspension or Revocation of a certificate

13. Primary Dental Health Aide n Village based n Provides education n Provides topical fluoride applications n Places Sealants n Exposes radiographs n Performs prophylaxis n Performs Atraumatic Restorative Treatment (caries control) n Manages emergencies n Assistant when dentist is in village

14. Expanded Functions Dental Health Aide n Clinic based n Functions as dental assistant n Performs expanded functions u Places filling materials in prepared teeth u Perform prophylaxis u SSCs u Lab and prosthetics

15. Dental Health Aide Hygienist n 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 n General supervision n Local Anesthetic n ART

16. Dental Therapists n W.H.O. cites 42 countries that utilize Dental Therapists n Functions as part of the dental team under the supervision of a dentist n New Zealand has 87 yrs experience and Canada has over 37. n Exceptional safety record under general supervision for children and adults n They are equipped to help us provide the educational, preventive and safety net services that are most needed.

18. Gambell Clinic, Norton Sound