Post on 17-Dec-2015
S
Community Based Dental Partnership(CBDPP)
College of Dental MedicineColumbia University
Noreen Myers-Wright RDH, MA, CHES
Project STAYJoanna Pudil MA, LCSW
Program P.I. Burton Edelstein DDS, MPH
Supported by HRSA Ryan White HIV/AIDS Program Grant H65HA00014
CBDPP Partners
Harlem United A community AIDS center in Harlem, N.Y. Adults and Older Adults Community Service Learning for Advanced General Dentistry Residents (AEGD)
Dominican Sisters Provider of family health services in the South Bronx, N.Y. Women of young children Community Service Learning for Dental Public Health Residents
Project STAY Washington Heights, N.Y Adolescents and Young Adults Oral Health Education provided by Registered Dental Hygienist/Health
Educator
Comprehensive Health Program (CHP)
Established 1988, in New York Presbyterian Hospital
Multidisciplinary care
Patients living with HIV and other chronic conditions
Children, adolescent, young adults and adults
Project STAY(P.S.)(Service to Assist
Youth) Provides comprehensive care for young people 14
– 24 years Sexually high risk HIV Positive Adolescents & Young Adults
Community Outreach
Young Adult Health Clinic Farrell Community Health Center
Specialized Care Center New York Presbyterian/Columbia University Medical Center
Case Management Services
Nutritional Counselin
g
Medical
CDM’s Oral Health Educator
Mental Health
Services
Peer Support
Referred for Care to CDM
Project Stay
Patient
Patient Centered Collaborative Comprehensive Care
Project STAY Services Provided
Medical examinations
STI screenings
Medication management
Mental health services Individual, group & family therapy
Case management services Housing, transportation, educational support, employment, benefits
Nutritional counseling
Oral Health Education Services
Patient Concerns Assessed Pain Gingival Condition Appearance
Caries Risk Assessment Sugar sweetened beverage consumption Dietary Habits Home oral health habits
Motivational Interviewing Techniques Employed Home Oral Health Instruction Brief tobacco cessation counseling
Dental Exam Appointments Facilitated
Theory and Evidence
National Research Council & Institute Medicine Adolescent Health Services, Missing Opportunities Report
Healthy People 2020 objectives
Poor utilization of dental care by young adults
Ecological model
Principles of Motivational Interviewing
Triage Center Medical History Radiographs Referral for care supervised by dental faculty
Advanced General Dentistry & General Practice Residents Examination Treatment plan Prophylaxis, restorations
Oral & Maxillofacial Surgery Extractions
Prosthodontic Removable prosthetic appliances
College of Dental MedicineServices
Patient Oral Health Concerns
Gingival Health Bleeding Sensitivity
Tooth Decay
Tooth Loss
Appearance of Teeth
Privacy Regarding Health Information
Continuity of Provider Care
CDM Accommodations
Combined visits for P.S. patients Medical history& radiographs Examination, Treatment Planning & Dental Prophylaxis
CDM staff education Increased awareness of P.S. patient needs
Efforts to ensure privacy Change in electronic health record to conceal HIV
status
Efforts to accommodate minors not living with family Triage team huddle to strategize Routine engagement with CDM’s patient advocate
Trends & Outcomes
Reduction in dental phobia Detection of oral health issues P.S. providers have
missed Successful change in oral health habits Increased Oral Health Literacy 27% of patients referred for care kept appointment, July
– September 2014 35% increase in # of unduplicated patients referred for
care in 2014 80% of P.S. patients have received oral health
education and oral health products
Future Goals
Reduction in dental no show rate
Implement fluoride varnish program
Increase number of tobacco quit attempts
Change CDM culture of routine tooth extraction to tooth retention
Work with CDM to improve tracking of treatment plan completions
Implement incentive program for patient treatment completion
Program ReplicationPossibilities
Diabetes comprehensive centers
Cardiovascular care centers
Medical comprehensive care centers for older adults
Conclusions
References
Committee on Adolescent Health Care Services and Models of Care for Treatment, Prevention and Healthy Development (2009). Lawrence, R.S., Appleton Gootmand, J. & Sim, L.J.. (Eds). Adolescent Health Services:
Missing Opportunities. Washington D.C.: National Academic Press.
Hayden, J. (2009). Introduction to Health Behavior Theory. Sudbury, MA: Jones & Bartlett.
Viner, R. Ozer, E., Denny, S. Malmot, M. Reznick, M., Fatusi, A. & Currie, C. (2012). Adolescence and the social determinants of health. The Lancet, 379, 1641-52.
Vujicic, M. & Nasseh, K.( 2013). A decade of dental care utilization. Health Services Research, (1-21). Doi:10.1111/475-6773/12130