Social work in dentistry: the CARES model for improving patient retention and access to care

The social determinants of health, social work, and dental patients: a case study

Oral health has been largely overlooked in conceptualizing health, and the workforce responsible for addressing the Social Determinants of Health (SDOH) within oral health settings has received little attention. While the role for social work in oral health has remained limited, there has been recent growth articulating its role in dental education. This paper presents a case study of how social work has been implemented into one school of dentistry in the U.S. to address SDOH and offers a roadmap for integration of social work into dental education, including opportunities for interprofessional health care experiences related to SDOH.

Challenges connecting emergency department patients with oral health care: A qualitative analysis of patients, emergency department clinicians, and dentists

BACKGROUND

Unmet dental need shares many risk factors with unmet health-related social needs (HRSN) such as housing and food security and are a common cause for seeking treatment at the emergency department (ED).

METHODS

The authors recruited a purposive sample of English-speaking and Spanish-speaking patients, ED clinicians at 3 urban EDs, and dentists from nearby communities to participate in qualitative interviews to explore barriers to and facilitators of screening for HRSN and unmet dental needs in the ED. Themes were identified from transcripts using a modified grounded theory approach.

RESULTS

Interviews were conducted with 25 ED patients, 19 ED clinicians, and 4 dentists. Four themes were identified: (1) a preference for formalized resources, which more frequently exist for HRSN than for oral health; (2) frequent use of ad hoc resources that are less reliable or structured, particularly for dental referral information; (3) limited knowledge of oral health care resources in the community; and (4) desire for more assistance with identifying and addressing resource needs for both HRSN and oral health. Patients were amenable to screening through a variety of modalities and felt it would be helpful, but clinicians emphasized the need for easier referral processes because of frequent failure to connect patients to oral health care.

CONCLUSIONS

More robust infrastructure and clinician support are needed to ensure successful referral and screening without undue provider burden for both medical and dental clinicians.

PRACTICAL IMPLICATIONS

Patients are amenable to screening for unmet oral health needs and HRSN in the ED, which may improve access to care.

Oral Health and Social Work Integration: Advancing Social Workers' Roles in Dental Education

Oral health remains underutilized within both integrated service delivery and educational settings. Advancing social workers' roles in the education of oral health providers is one strategic way to expand oral health and social work integration. Although the involvement of social workers in dental education is not new, fewer than 18 percent of the country's 68 accredited dental schools have active social work departments or services. This exploratory study sought to determine how, as of 2021, social work has been integrated into U.S. dental education programs (N = 13). Findings offer an overview of current social work programs in existence, roles social workers have in addressing social and behavioral health needs in dental education settings, and barriers to and facilitators in developing and sustaining integrated partnerships. This article discusses ways social work and oral health educational settings can mutually benefit from developing and/or strengthening their integrated collaborations. It also addresses a comparison of educational missions, clinical learning opportunities across both professions, and how patient care can be improved by expanding oral health and social work integration.

Promoting Whole Health in the Dental Setting: Steps Toward an Integrated Interprofessional Clinical Learning Environment Involving Pharmacy, Social Work, and Nursing

Introduction:

Dental settings have not traditionally functioned as access points to the health care system, however they can serve patients who may not otherwise seek routine health care. Millions of Americans annually visit either a dental or primary care provider, but not always both as recommended, even though multiple health co-morbidities can manifest in and impact oral health. Offering multidisciplinary health services in a dental setting has potential to reach unserved populations.

Description:

Innovative partnerships between schools of dentistry, pharmacy, social work, and nursing were designed to promote integrated service delivery in the emerging workforce and the purposeful inclusion of oral health in integrated care settings.

Discussion:

Oral complications of systemic disease and systemic complications of oral disease impose significant burdens on populations and the public health infrastructure in terms of economic cost, disability, and mortality. Exacerbated by the lack of integrated services, intersecting social, economic, and health issues perpetuate disparities and negative health outcomes. Care is often focused on reactive rather than preventive measures therefore addressing only the acute issue instead of the underlying, causative problem(s).

Conclusion:

We describe steps for integrated, whole-health services and lessons learned for other academic health institutions and interprofessional settings considering integrated clinical models.

Implementing care coordination in a large dental care organization in the United States by upskilling front office personnel

BACKGROUND

Care coordination is a key strategy used to improve health outcomes and efficiency, yet there are limited examples in dentistry. A large dental accountable care organization piloted care coordination by retraining existing administrative staff to coordinate the care of high-risk patients. Following the pilot's success, a formal "dental care advocate" (DCA) role was integrated system-wide. The goal of this new role is to improve care, patient engagement, and health outcomes while integrating staff into the clinical care team. We aim to describe the process of DCA role implementation and assess staff and clinician perceptions about the role pre- and post-implementation.

METHODS

Guided by the Consolidated Framework for Implementation Research, semi-structured interviews with clinical and operational administrative staff and observation at the company-wide training session were combined with pre- and post-implementation electronic surveys. Descriptive statistics and mean scores were tested for significance between each survey sample (t-tests), and qualitative data were thematically analyzed.

RESULTS

With preliminary evidence from the pilot and strong executive support, a dedicated leadership team executed a stepwise rollout of the DCA role over 6 months. Success was facilitated by an organizational culture of frequent interventions deployed rapidly through a centralized system, along with supportive buy-in from managerial teams and high staff acceptance and enthusiasm for the DCA role before implementation. Following implementation, significant changes in attitudes and beliefs about the role were measured, though managers held stronger positive impressions than DCAs. DCAs reported high confidence in new skills and dental knowledge post-implementation, including motivational interviewing and the ability to confidently answer patients' questions about their oral health. Overall, the fast-paced implementation of this new role was well received, although consistent and significant differences in mean attitudes between managers and DCAs indicate more work to fine-tune the role is needed.

CONCLUSIONS

Successful implementation of the new DCA role was facilitated by a strong organizational commitment to team-based dentistry and positive impressions of care coordination among staff and managers. Upskilling existing administrative staff with the necessary training to manage some high-risk patient needs is one method that can be used to implement care coordination efforts in dentistry.

Development and implementation of a patient assistance fund: a descriptive study

BACKGROUND

The purpose of this descriptive study is to outline the Roseman University of Health Sciences (RUHS) College of Dental Medicines' Patient Assistance Fund development, organization and outcomes. The description and reported results provide insight to others considering similar health professions programs.

METHODS

The Patient Assistance Fund (PAF) affords dental students an opportunity to petition for and obtain financial assistance for their most disadvantaged patients. In this study, two sources of data were collected and used with a quantitative analysis for data collected as part of the PAFs operation and a qualitative analysis to evaluate the patient experiences.

RESULTS

A total of 16 student advocates, consisting of 6 males and 10 females from the D3 and D4 classes made 26 presentations to the PAF board committee. The combined amount requested from the PAF was $47,428.00 ("Cost of Treatment Plan") representing an average request per patient of $1824.15 (range $324.00 to $4070.00). The approved procedures and treatment plans totaled $21,278.36 ("Cost of Approved Procedures") with an average of $818.40 (range $204.00 to $2434.00) per patient. Patients and students expressed a high degree of satisfaction with the program.

CONCLUSIONS

This study provides an overview of the structure, funding sources, expenditures and patient services supported by a dental student managed patient assistance fund. The experiences at RUHS College of Dental Medicine (CODM) suggest that other healthcare professions schools can develop similar type programs that yield benefit both to students and to patients in need.

The Children's Health and Maintenance Program (CHAMP): An innovative community outreach oral health promotion program: A randomized trial

OBJECTIVE

To describe CHAMP (Children's Oral Health Promotion Program) evaluating the impact of two motivational methods in increasing dental care access.

METHODS

CHAMP is a multi-dimensional oral health promotion programme that recruited and screened underprivileged children/families from community sites in Los Angeles County between 2012 and 2018. A randomized clinical trial (RCT) enrolled children/families into one or more motivational interventions (intra-oral camera and/or social work consultation) designed to impact subsequent scheduling of dental appointments.

RESULTS

CHAMP served 24 535 families. RCT had 418 families with 68.5% scheduling appointments by second follow-up (P < .001). Excluding children with scheduled appointments by first follow-up, children experiencing both interventions were 4.1 (95% CI 1.5-11.2) times more likely to schedule appointments by second follow-up than were the controls (P=<.01). When experiencing both interventions and had never previously been to the dentist, 68.3% scheduled dental appointments; this was significantly higher than the controls (46.7%) (P = .04). The best predictor for families to have scheduled appointments was a dental visit within the last six months [OR = 3.8 (95% CI 2.2-6.6), P < .001].

CONCLUSIONS

Outreach health promotion programmes are important and should consider utilizing various motivational techniques to encourage enrolment and treatment at dental homes.

The Barber Pole Might Have Been an Early Sign for Patient-Centered Care: What Do Interprofessional Education and Interprofessional Collaborative Practice Look Like Now?

In 2009, the Interprofessional Education Collaborative (IPEC) was initiated. Its release of interprofessional collaborative practice (ICP) core competencies in 2011 was pivotal for the engagement of health care professionals, including dentistry; in patient-centered, collaborative efforts for interprofessional education (IPE); and ICP. Thereby, IPEC is helping to put into application, in North America, the 2010 World Health Organization (WHO) Framework for Action on Interprofessional Education and Collaborative Practice. This article introduces IPE/ICP in 5 phases of evolution, emphasizing dental influence and inclusion, from historical perspectives through current applications that are expanded on in the accompanying articles elsewhere in this issue.

Problems and Solutions for Interprofessional Education in North American Dental Schools

Interprofessional education (IPE) is a relatively new part of dental education. Its implementation is mandated by accreditation standards, but it is also essential to good patient care. Diverse dental schools from various regions of North America outline problems they have faced in IPE and the solutions that they have found to surmount these problems. Commonalities and unique features of these problems and solutions are discussed.