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