DHA Program

Ron Nagel DDS MPHAlaska Native Tribal Health Consortiumwww.ANTHC.org

Newtok Clinic, Yukon-Kuskokwim

AFHCAN CartAlaska Federal Health Care Access Network

Wireless Networking Touchscreen ECG / Video Dental

Camera and Otoscope / Scanner / Digital Camera

Mobile – Customized Patient safe

WWW. AFHCAN.ORG

Crisis in access to dental care in Alaska

AK Native children have 21/2 times the disease of U.S. all races

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.

91% of AI/AN, age 15-19, have a history of caries. 68% are untreated.

Dietary changes An aging population A growing population (over 60% increase since 1970) Substantially higher costs of providing services in small

isolated rural communities

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

Community Health Aide History

Developed by physicians some 38 years ago Competency based credentialing (similar to

hospital privileging) Today about 550 CHAs provide primary health

care in rural Alaska (350,000 patient encounters annually)

Their training starts with EMT or ETT training They are an integrated part of the delivery system

working with Doctors, Nurses, and PAs. They are not a second level of care.

Competency Based Credentialing - QA

Each Dental Health Aide is assigned to a dentist/s

After training DHAs must practice their newly learned skills under direct supervision for a prescribed minimum time/encounter period. 400 hours for Therapists

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

Competency - QA continued

DHAs must demonstrate competency to maintain their certification and to change their scope

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

These administrative controls help to assure quality and that a single standard of care is met in tribal programs

Competency vs. licensure

Changes in DHAs’ skills are measured over their entire career

We look directly at the services that they provide day to day

Each DHAs’ scope of practice is individually assigned based on competence through standing orders

Community Health Aide Program Certification Board

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

There are provisions in the standards for Discipline, Suspension or Revocation of a certificate

Primary Dental Health Aide

Village based Provides education Provides topical fluoride applications Places Sealants Exposes radiographs Performs prophylaxis Performs Atraumatic Restorative

Treatment (caries control) Manages emergencies Assistant when dentist is in village

Expanded FunctionsDental Health Aide

Clinic based Functions as dental assistant Performs expanded functions

Places filling materials in prepared teeth Perform prophylaxis SSCs Lab and prosthetics

Dental Health Aide Hygienist 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

General supervision Local Anesthetic ART

Dental Therapists

W.H.O. cites 42 countries that utilize Dental Therapists

Functions as part of the dental team under the supervision of a dentist

New Zealand has 87 yrs experience and Canada has over 37.

Exceptional safety record under general supervision for children and adults

They are equipped to help us provide the educational, preventive and safety net services that are most needed.

Gambell Clinic, Norton Sound