Advanced Dental Hygiene Advanced Dental Hygiene Practitioner: The North Practitioner: The North

American Model American Model

Cindy FletcherCindy FletcherExecutive DirectorExecutive Director

British Columbia Dental Hygienists’ AssociationBritish Columbia Dental Hygienists’ Association

American Dental Hygienists American Dental Hygienists AssociationAssociation

Ann Battrell, RDH, Ann Battrell, RDH, MSDH(c)MSDH(c)

ADHA Executive ADHA Executive Director Director

National Oral Health National Oral Health ConferenceConference

April 30, 2006April 30, 2006

MISSION STATEMENTMISSION STATEMENT

To improve the public's total health, the To improve the public's total health, the missionmission of the of the American Dental Hygienists' Association is to advance American Dental Hygienists' Association is to advance the art and science of dental hygiene by the art and science of dental hygiene by ensuring ensuring access to quality oral health care,access to quality oral health care, increasing awareness increasing awareness of the cost-effective benefits of prevention, promoting of the cost-effective benefits of prevention, promoting the highest standards of dental hygiene education, the highest standards of dental hygiene education, licensure, practice and research and representing and licensure, practice and research and representing and promoting the interests of dental hygienists. promoting the interests of dental hygienists.

Dental Hygiene ProjectionsDental Hygiene Projections

U.S. Department of Labor, Bureau of Labor Statistics:U.S. Department of Labor, Bureau of Labor Statistics: Occupational Outlook HandbookOccupational Outlook Handbook

Dental hygienistsDental hygienists noted within the noted within the top 10 fastest growing top 10 fastest growing occupationsoccupations and occupations having the largest numerical job and occupations having the largest numerical job growth from 2004-2014growth from 2004-2014

Noted by level of education and training Noted by level of education and training

http://www.bls.gov/oco/ocotjt1.htmhttp://www.bls.gov/oco/ocotjt1.htm (retrieved 12.21.05)(retrieved 12.21.05)

IndustryIndustry

2004 employment2004 employmentProjected 2014 Projected 2014

employmentemployment Change, 2004-2014Change, 2004-2014

Number Number NumberNumber NumberNumber %%

Total employment, Total employment, all workersall workers 128,000128,000

                145,000 145,000 17,000 17,000 13.513.5  

    

http://data.bls.gov/Retrieved 12.21.05

U.S. Dept. of Labor, Bureau of Labor Statistics: DENTISTS (general)

Oral Health Workforce

IndustryIndustry

2004 employment2004 employmentProjected 2014 Projected 2014

employmentemployment Change, 2004-2014Change, 2004-2014

Number Number NumberNumber NumberNumber PercentPercent

Total employment, all Total employment, all workersworkers 158,000158,000

      226,000226,000

              68,000 68,000

43.3   43.3     

http://data.bls.gov/Retrieved 12.21.05

U.S. Dept. of Labor, Bureau of Labor Statistics: DENTAL HYGIENISTS

Oral Health Workforce

Dental Health Professional Dental Health Professional Shortage Areas (D-HPSAs)Shortage Areas (D-HPSAs)

Critical issueCritical issue Distribution of dental workforceDistribution of dental workforce Eliminating oral health disparitiesEliminating oral health disparities

Pockets of underserved areasPockets of underserved areas RuralRural Inner cityInner city

DHPSAs increased to:DHPSAs increased to: 3296 (792 in 1993)3296 (792 in 1993) 45,620,457 people affected45,620,457 people affected*SOURCE:03/06/06, Shortage Designation Branch, National Center for Health Workforce

Analysis, Bureau of Health Professions, Health Resources and Services Administration

ADVANCED ADVANCED DENTAL HYGIENE DENTAL HYGIENE

PRACTITIONERPRACTITIONER

ADHA HOD RESOLUTIONS, ADHA HOD RESOLUTIONS, June 2004June 2004

That the ADHA advocates the creation of an advanced dental That the ADHA advocates the creation of an advanced dental hygiene practitioner who provides diagnostic, preventive, hygiene practitioner who provides diagnostic, preventive, restorative and therapeutic services directly to the public. restorative and therapeutic services directly to the public.

That the ADHA supports a standardized educational curriculum That the ADHA supports a standardized educational curriculum developed by the American Dental Hygienists’ Association, for developed by the American Dental Hygienists’ Association, for the advanced dental hygiene practitioner.the advanced dental hygiene practitioner.

ADHA HOD RESOLUTIONS, ADHA HOD RESOLUTIONS, June 2004June 2004

That the following definition of Advanced That the following definition of Advanced Dental Hygiene Practitioner be adopted:Dental Hygiene Practitioner be adopted: A dental hygienist who has graduated from an A dental hygienist who has graduated from an

accredited dental hygiene program and has accredited dental hygiene program and has completed an advanced educational curriculum, completed an advanced educational curriculum, approved by the American Dental Hygienists’ approved by the American Dental Hygienists’ Association, which prepares the dental hygienist Association, which prepares the dental hygienist to provide diagnostic, preventive, restorative and to provide diagnostic, preventive, restorative and therapeutic services directly to the public. therapeutic services directly to the public.

ADHP Vision StatementADHP Vision Statement

The advanced dental hygiene The advanced dental hygiene practitioner will improve the practitioner will improve the underserved public’s health and underserved public’s health and accessaccess to quality, cost-effective to quality, cost-effective oral health care and appropriate oral health care and appropriate referrals within multidisciplinary referrals within multidisciplinary healthcare teams.healthcare teams.

Historical PerspectiveHistorical PerspectiveWhy is ADHA pursuing this?Why is ADHA pursuing this?

Access to oral health care crisis in the U.S.Access to oral health care crisis in the U.S. Heightened awareness for the need for a “mid-Heightened awareness for the need for a “mid-

level practitioner”level practitioner” Compliments the ADHA’s commitment to resolve Compliments the ADHA’s commitment to resolve

health care disparitieshealth care disparities Workforce Supply, Demand and DistributionWorkforce Supply, Demand and Distribution

Advanced Dental Hygiene Advanced Dental Hygiene PractitionerPractitioner

Why Dental Hygienists?Why Dental Hygienists? Projected growth in workforceProjected growth in workforce Projected growth in educational programsProjected growth in educational programs Market forces creating advanced practiceMarket forces creating advanced practice Advanced education already in placeAdvanced education already in place

15 MSDH Graduate programs in place15 MSDH Graduate programs in place

Avoid duplication in education and trainingAvoid duplication in education and training Potential for cost-savings in cross trainingPotential for cost-savings in cross training Opportunity to revise efficiency in delivery of oral Opportunity to revise efficiency in delivery of oral

health care health care

The ADHP …The ADHP …

Follows the Rapid Practice Changes in the DH Follows the Rapid Practice Changes in the DH Profession:Profession:

Affiliated Practice (AZ)Affiliated Practice (AZ) Registered Dental Hygienist in Alternative Practice (CA)Registered Dental Hygienist in Alternative Practice (CA) Extended Care Permit RDH (KS)Extended Care Permit RDH (KS) Public Health Permit (ME)Public Health Permit (ME) Collaborative Practice RDH (MN)Collaborative Practice RDH (MN) Limited Access Permit with Public Health Supervision (MT)Limited Access Permit with Public Health Supervision (MT) Public Health Supervision (NH)Public Health Supervision (NH) Collaborative Practice RDH (NM)Collaborative Practice RDH (NM) Public Health Endorsement (NV)Public Health Endorsement (NV) Public Health Supervision (IA)Public Health Supervision (IA) Limited Access Permit (OR)Limited Access Permit (OR) School Sealant Programs (WA)School Sealant Programs (WA)

The ADHP would …The ADHP would … Provide primary oral health care.Provide primary oral health care.

Be competent in working with Be competent in working with populations with special needspopulations with special needs::

childrenchildren medically compromisedmedically compromised adolescents and geriatric populations. adolescents and geriatric populations.

Be able to evaluate oral health needs of Be able to evaluate oral health needs of populations with limited populations with limited access to care.access to care.

Develop, implement and monitor dental hygiene care programs for Develop, implement and monitor dental hygiene care programs for these populations.these populations.

Participate as a member of a comprehensive health care Participate as a member of a comprehensive health care teamteam. .

The ADHP…The ADHP…

From the From the clinicalclinical perspective: perspective:

Including but not limited to:Including but not limited to: cavity preparation, performing pulpotomies and competency in cavity preparation, performing pulpotomies and competency in

atraumatic restorative therapy (a temporary filling) among other atraumatic restorative therapy (a temporary filling) among other preventive and restorative therapies. preventive and restorative therapies.

From the From the health promotionhealth promotion perspective: perspective:

Including but not limited to:Including but not limited to: Designing nutritional interventions, implement and evaluate Designing nutritional interventions, implement and evaluate

smoking cessation programs and evaluate health promotion smoking cessation programs and evaluate health promotion and disease prevention programs for specific populations. and disease prevention programs for specific populations.

Advanced Dental Advanced Dental Hygiene Practitioner Hygiene Practitioner

(ADHP) Draft (ADHP) Draft CurriculumCurriculum

ADHP Draft CurriculumADHP Draft Curriculum

DOMAINS:DOMAINS:

I.I. Provision of Primary Oral Health CareProvision of Primary Oral Health Care

II.II. Healthcare Policy and AdvocacyHealthcare Policy and Advocacy

III.III. Management of Oral Care DeliveryManagement of Oral Care Delivery

IV.IV. Translational ResearchTranslational Research

V.V. Professionalism and Ethics Professionalism and Ethics

DOMAIN I: Provision of Primary DOMAIN I: Provision of Primary Oral Health CareOral Health Care

The advanced dental hygiene practitioner The advanced dental hygiene practitioner demonstrates competence in providing demonstrates competence in providing primary oral health care and case primary oral health care and case management in management in diverse populationsdiverse populations. . Practitioners use the process of care and Practitioners use the process of care and target the target the underservedunderserved including those including those with with special needsspecial needs using a using a multidisciplinary approach. multidisciplinary approach.

DOMAIN II: Healthcare Policy and DOMAIN II: Healthcare Policy and AdvocacyAdvocacy

The advanced dental hygiene practitioner The advanced dental hygiene practitioner contributes to health policies that address contributes to health policies that address disparities in oral health and access to disparities in oral health and access to care for the care for the underservedunderserved.. The The practitioner supports and applies health practitioner supports and applies health policy at the institutional, local, state, policy at the institutional, local, state, regional, and national levels.regional, and national levels.

DOMAIN III: Management of Oral DOMAIN III: Management of Oral Care Delivery Care Delivery

The advanced dental hygiene practitioner The advanced dental hygiene practitioner integrates practice management, finance integrates practice management, finance principles, and health regulations to analyze, principles, and health regulations to analyze, design and develop initiatives that will improve design and develop initiatives that will improve clinical outcomes, the quality of care and clinical outcomes, the quality of care and patient safety.patient safety. The practitioner demonstrates The practitioner demonstrates effective leadership for changing healthcare effective leadership for changing healthcare and practice environments. and practice environments.

Domain IV: Translational ResearchDomain IV: Translational Research

The advanced dental hygiene practitioner The advanced dental hygiene practitioner uses sound scientific methods and uses sound scientific methods and accesses evidence-based information accesses evidence-based information when making decisions and providing when making decisions and providing client care.client care.

Domain V: Professionalism and Domain V: Professionalism and EthicsEthics

The advanced dental hygiene practitioner The advanced dental hygiene practitioner demonstrates professional behavior and demonstrates professional behavior and clinical decision-making skills consistent with clinical decision-making skills consistent with dental hygiene parameters of care, legal dental hygiene parameters of care, legal regulations and the ADHA Code of Ethics. regulations and the ADHA Code of Ethics. The advanced dental hygiene practitioner The advanced dental hygiene practitioner possesses the values and behaviors which possesses the values and behaviors which promote service to the promote service to the publicpublic, professional , professional involvement, and lifelong learning.involvement, and lifelong learning.

In what settings will In what settings will the ADHP work?the ADHP work?

HospitalsHospitals

Nursing homesNursing homes

Public health settingsPublic health settings

Community Health Community Health CentersCenters

Federally Qualified Federally Qualified Health CentersHealth Centers

HomeboundHomebound

Elementary and Elementary and Secondary SchoolsSecondary Schools

Other…Other…

What level of education and What level of education and credential will be necessary for credential will be necessary for

the ADHP?the ADHP? Point of entry for allPoint of entry for all

FlexibilityFlexibility Potential exists for distance educationPotential exists for distance education

Proven success in dental hygiene education Proven success in dental hygiene education Currently 58 degree-completion programs (35 Currently 58 degree-completion programs (35

designated with some/all distance education)designated with some/all distance education)

Master’s DegreeMaster’s Degree

Credentialing processCredentialing process

How will the ADHP differ from How will the ADHP differ from the dental therapist or dental the dental therapist or dental

aide positions available aide positions available elsewhere?elsewhere?

ADHA has and will continue to examine ADHA has and will continue to examine related modelsrelated models

Unique in designUnique in design

Oral health needs and U.S. health care Oral health needs and U.S. health care delivery systemdelivery system

Will this replace the entry-level Will this replace the entry-level position for the registered dental position for the registered dental

hygienist?hygienist? No.No. Answering an unmet public health Answering an unmet public health

need.need. Intended to go beyond entry-level Intended to go beyond entry-level

education.education.

Where will the classes be taught?Where will the classes be taught?

Curriculum development in process.Curriculum development in process.

Educational collaboration with universities.Educational collaboration with universities.

Credential offered through the ADHA.Credential offered through the ADHA.

What would it mean for an What would it mean for an ADHP to serve as a ADHP to serve as a

collaborative partner?collaborative partner?

Working with public health, allied health, Working with public health, allied health, and medical professionals.and medical professionals.

Variety of practice settings.Variety of practice settings.

Patients to receive a well-rounded Patients to receive a well-rounded approach to health services.approach to health services.

““The idea that got the broadest The idea that got the broadest support was expansion of scope support was expansion of scope

of practice to include simple of practice to include simple restorative procedures for dental restorative procedures for dental

hygienists.”hygienists.”

--Policy Issues in Dental Workforce Diversity and Community---Policy Issues in Dental Workforce Diversity and Community-Based Dental Education, November 2004Based Dental Education, November 2004

Legislative Success…Legislative Success…

19 states without overly restrictive 19 states without overly restrictive supervision requirementssupervision requirements

10 States with Medicaid provider 10 States with Medicaid provider statusstatus

43 States with general supervision43 States with general supervision 38 States that allow dental hygienists 38 States that allow dental hygienists

to administer local anesthesiato administer local anesthesia

ADHP Legislative SuccessADHP Legislative Success July 2005:  July 2005:  ADHP language is inserted into HR 3010, ADHP language is inserted into HR 3010,

the Fiscal Year 2006 Appropriations Bill for the Labor, the Fiscal Year 2006 Appropriations Bill for the Labor, Health and Human Services.  Health and Human Services. 

The language is considered ‘report language’ – it does not carry The language is considered ‘report language’ – it does not carry the weight or law or appropriate any federal funding.  It is the weight or law or appropriate any federal funding.  It is encouragement to the lead health agency, HRSA, to explore encouragement to the lead health agency, HRSA, to explore development of the ADHP.  development of the ADHP. 

July 2005:  July 2005:  HR 3010 is passed by the Senate HR 3010 is passed by the Senate Appropriations Committee.  Appropriations Committee. 

October 2005:  October 2005:  HR 3010 passes the full Senate.HR 3010 passes the full Senate.  

Canadian Dental TherapistsCanadian Dental Therapists

Dental therapists work mainly for the Dental therapists work mainly for the federal government and the provincial and federal government and the provincial and territorial governments to provide services territorial governments to provide services in rural and remote communities.in rural and remote communities.

Dental therapists complete the two year Dental therapists complete the two year diploma program offered by diploma program offered by First Nations University of CanadaFirst Nations University of Canada at the at the National School of Dental TherapyNational School of Dental Therapy in in Prince Albert, Saskatchewan.Prince Albert, Saskatchewan.

““Dental therapists are primary oral health care Dental therapists are primary oral health care professionals who are trained to perform basic clinical professionals who are trained to perform basic clinical dental treatment and preventive services within a variety dental treatment and preventive services within a variety of practice settings. As members of a multidisciplinary of practice settings. As members of a multidisciplinary team, dental therapists provide restorative dental team, dental therapists provide restorative dental treatment services, disease prevention and oral health treatment services, disease prevention and oral health promotion programs to maintain and improve health. promotion programs to maintain and improve health. Dental therapists also advocate for the needs of clients, Dental therapists also advocate for the needs of clients, assist them in accessing care and refer them to other assist them in accessing care and refer them to other health professionals for services beyond the scope of the health professionals for services beyond the scope of the dental therapist’s practice.” dental therapist’s practice.” Canadian Dental Therapists Association Canadian Dental Therapists Association www.dentaltherapists.cawww.dentaltherapists.ca

Dental therapists who have completed post-graduate Dental therapists who have completed post-graduate orthodontic modules approved by the regulatory bodies orthodontic modules approved by the regulatory bodies may also provide basic orthodontic procedures.may also provide basic orthodontic procedures.

Dental therapists practice in both private Dental therapists practice in both private and public health settings within a general and public health settings within a general consultative/referral relationship with a consultative/referral relationship with a dentist. Dental therapists practice in dentist. Dental therapists practice in private dental clinics, government health private dental clinics, government health programs, public health agencies, training programs, public health agencies, training institutions, First Nations organizations institutions, First Nations organizations and other practice settings, in varying and other practice settings, in varying capacities as clinicians, educators, health capacities as clinicians, educators, health promoters, administrators or dental promoters, administrators or dental consultants.consultants.

Dental therapists are competent to provide the full range Dental therapists are competent to provide the full range of professional services within their scope of practice. of professional services within their scope of practice. However, their practice may vary, depending upon health However, their practice may vary, depending upon health care legislation or employment policy that may exist care legislation or employment policy that may exist within different settings or jurisdictions in Canada. within different settings or jurisdictions in Canada.

Upon graduation dental therapists will demonstrate Upon graduation dental therapists will demonstrate competency and provide the full range of professional competency and provide the full range of professional care in the following four broad categories:care in the following four broad categories:

Diagnostic DentistryDiagnostic Dentistry Operative DentistryOperative Dentistry Community and Preventive DentistryCommunity and Preventive Dentistry Practice Management, Principles of Professionalism andPractice Management, Principles of Professionalism and

Ethics Ethics..

Legislative Changes to Dental Legislative Changes to Dental Hygiene Legislation CanadaHygiene Legislation Canada

AlbertaAlberta OntarioOntario

What role can Canadian/BC What role can Canadian/BC dental hygienists play in dental hygienists play in meeting the oral health needs meeting the oral health needs of ALL Canadians/British of ALL Canadians/British Columbians?Columbians?