Into the Future: Addressing Interprofessional Education and Oral Health Equity

IntroductionTheUCLACenterforChildren’sOralHealth(UCCOH)isamultidisciplinaryinitiativeutilizingevidence-basedresearchtranslatedtoclinicalcareinordertoachievepolicydevelopmentsandadvocacyforimprovingchildren’soralhealthinLosAngeles,California,theUnitedStates,andtheworld.ThegoalofUCCOHistriple-fold:

1. Research:Toidentifybestpracticesandevidence-basedresearchtranslatedtoenhancedpatientcare.

2. Training:Toadvancecollaboration,education,andservicethroughtheutilizationofinnovativeinterprofessionaltrainingcurriculaandasystems-changeapproach. Figure1.TripleaimofUCCOH.

3. Policy&Advocacy:Toimprovechildren’soralhealthlocallyandgloballythroughleadershipofpolicyandadvocacydevelopmentefforts,targetingmedical-dentalintegration.

Oralhealthisanessentialpartofstayinghealthy.Goodoralhealthallowsachildtospeak,smile,smell,taste,touch,chew,swallow,andmakefacialexpressionstoshowfeelingsandemotions.Poororalhealthhasseriousconsequences,includingpainful,disabling,andcostlyoraldiseases.EarlyChildhoodCaries(ECC)isthemostchronicdiseaseinchildren,yetitisentirelypreventable.HealthequityistheattainmentofthehighestlevelofhealthforallpeopleandinaccordancewiththatthefouroverarchinggoalsoftheHealthyPeople2020areto:

1. Attainhigh-quality,longerlivesfreeofpreventabledisease,disability,injury,andprematuredeath.

2. Achievehealthequity,eliminatedisparities,andimprovethehealthofallgroups.3. Createsocialandphysicalenvironmentsthatpromotegoodhealthforall.4. Promotequalityoflife,healthydevelopment,andhealthybehaviorsacrossalllifestages.1

Viewingoptimaloralhealthandaccesstoeffectiveandaffordableoralhealthcareasarightratherthanaprivilegeresultsinsystemicchangesthatleadtosocialjusticeandcontributestohealthequity.Throughthedeliveryofpreventiveoralhealtheducation,identificationofbestpracticesandevidence-basedresearch,utilizationofinnovativetrainingcurricula,andleadershipofpolicyandadvocacydevelopmentefforts,UCCOHaimstocreateaparadigmshiftwithinthelandscapeofpediatricdentalcarefromreactivetoproactive.ThemissionofUCCOHistoimproveoralhealthforunderservedchildrenandcommunitiesthroughtheutilizationofinterprofessionalpartnerships,expansionofpreventiveoralhealtheducationandcareforvulnerablepopulations,aswellaspioneeringnecessaryqualityimprovementprotocolsandoralhealthpoliciesforlong-lastingsystemchanges.UCCOHvaluesinclude:

● OralHealthasaSocialEquity&HumanRightsissue● Datadrivenresearchtoinform:bestpractices,workforceinnovation,andpolicydevelopment● Interprofessionaltrainingtosupportdiseasemanagement&prevention● Supporttheparadigmshiftindentistryforindividual,personalizedhealthcare(i.e.,“Precision

Dentistry”)..

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Background EarlyChildhoodcariesisacomplexmultifactorialdiseaseencompassingvarioussocialdeterminantsofhealth.Focusingonoralhealthasanimportantandintegralpartofsystemichealthwillhaveanimpactoneliminatingdisparitiesandcreatinghealthequity.

Figure2:FactorsaffectingECCWeaimtocreateabroadrangingECCpreventionframeworkthatcouldpotentiallybeusedworldwide.Thisframeworkwillprovidehealthofficials,schools,caregivers,andotherstakeholderswithpreventativeeducationandadvocacystrategiesregardingECCandhowtoattenuatethesehighratesofECCinchildren0-6yearsofage.ECCisconcentrateddisproportionatelyinchildrenofcolorandfromlowsocioeconomicfamilieswith73%ofschoolchildrenhavinguntreatedcariesamongpopulationsoflow-income,migrant,minorityfamiliesinLosAngeles.2Manyemergencydentaladmissionsbecomeprolongedhospitalizationswithsignificantcosts.Thisframeworkwillprovidehealthofficials,communityorganizations,schools,andhealthcareprofessionalswiththenecessaryknowledgeandskillstoprovideeffectivepreventativedentaleducationandtrainingtocaregiversandultimately,reduceECC. Weaimtoexpandtheroleofexistingoralhealthcareprofessionalstoprimarycareprovidersandservicesofpublichealth.Ayoungchildwillvisitthepediatricianapproximately10timesbythetimetheyreachage3years,andeachvisitisanexcellentopportunitytocombatthesilentdiseaseofdentalcaries.BoththeAmericanAcademyofPediatricsandtheUSPreventativeServicesTaskForcestatethat

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primarycareproviders(PCPs)shouldbeknowledgeableonthemanagementandpreventionofdentalcaries.3,4WeaimtocreateaframeworkforinterprofessionaltrainingbetweendentalprofessionalsandPCPsthatwilldirectlytargetaknowndeficitinoralhealthtrainingandimproveknowledge,confidence,andclinicalperformanceinthepreventionofchildhoodcaries. Wealsoaimtocreateaframeworktodeliveroralhealtheducationtocaregiversofyoungchildrenwithineducationalsettings,suchasatcaregiverorientationsessionswithinHeadStartandWICandBack-to-SchoolNightprogramsatpublicschools.Toensureattendanceanddeliveryofouroralhealtheducationalprogram,theorientationsessionswillalsobeofferedonline(i.e.,distancelearning).Wealsoaimtoimplementcaregivereducationwithintheirworkplaceaspartofwork-sitewellnessprograms.Byexpandingthedeliveryoforalhealtheducationtolocationsoutsideofthedentaloffice,weaimtoincreaseawarenessofECC,theimpactofpoororalhealthonoverallhealth,andtheimportanceoftheestablishmentofadentalhomebyage1year.Specifically,weaimtotargethighpriority,underservedareas,asECCisconcentrateddisproportionatelyinthosecommunities.andusingoutreachandeducationtothosefamiliestoclosethedentalcareawarenessgap.Additionally,weaimtoadvocateforexistingpolicies,createandintroduceneworalhealthpromotingpoliciesthatwillforexampleallowforbetterreimbursementratesforpreventivecareandeducation,suchasfluoridevarnishapplications,anticipatoryguidance,motivationalinterviewing,andpatienteducationtoimprovepatientoutcomes.Byencouragingandincentivizingdentalprofessionalstomaintainpatientsconsistentlyforpreventivecareandrecallvisits,itisourhopethattheseserviceswillbeutilizedmorefrequentlyandeffectively. TheU.S.ChamberofCommerceandPartnershipforPreventionhavedevelopedaguidethroughtheLeadingbyExampleCEORoundtableinitiative,whichsharestheexperienceandknowledgeofCEOswhohaveincorporatednew,successfulapproachestoemployeehealthandproductivity.Manyoftheworksitewellnessprogramsmentionedwithinthisinitiative,suchasSafewayInc.,IntelCorporation,andWal-MartStores,Inc.,includestrongpreventivecareprogramswithincentivesfortobaccocessation,weightloss,stressreduction,andpositivehealthybehaviors.5However,minimaleducationandfocusisprovidedfororalhealth.Weaimtointroducelegislationandbillstoexpandthescopeofworksitewellnessprogramstoprovidemorecomprehensivecarebyincludingoralhealtheducationandtheimportanceofpreventiveoralhealthservicesforemployeesandtheirfamilies.Insummary,UCCOHStrategicPrioritiesinclude:1.Datadrivenresearchtosupportclinicalandnon-clinicalstrategiestoaddressECC.2.Interprofessionalcollaborationtoexpandaccess3.Community-basedoralhealthservicesinpartnershipwithlocalagencies4.Children’soralhealtheconomicforecastofbenefitstoinformontrendsimpactingdentalproviders5.Policydevelopmenttosupportevidence-based Figure3:StepstoImproveChildren’sOralHealth

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protocols&systemsofcare6.WorkforceInnovationsthatsupportcommunity-basedcaremodels(i.ecreateanetworkofCommunityOralHealthWorkers).ProposalTheOralHealthInnovationLabwilltakeamultidimensionalandmultidisciplinaryapproachtowardsamelioratingoraldiseaseinchildrenandthelastingconsequencesonthechild’squalityoflife,aswellastowardsachievingoralhealthequity,andmitigatingoralhealthdisparities.Byspearheadingnewandnecessarypartnerships,ourOralHealthInnovationLabwillcollaborativelyapproachthisever-presentproblemthroughdatadrivenresearchtosupportclinicalandnon-clinicalstrategiestoaddressECC,anintegratedoralhealthcurriculumforPCPs,andthroughworkforceinnovationefforts.Figure4:OralHealthasaSocialJusticeIssue

1. EstablishanadvisorynetworkthatwillhelpmoveforwardUCCOH’sstrategicinitiatives.Wewillalsofosternewandnecessarypartnershipswithinthecommunity(i.e.,HeadStart,WIC,othercommunityagencies)andwithotherUCLAdepartments(SchoolsofMedicine,Nursing,PublicHealthandPublicAffairs).Wewillcreateanetworkmapandacommunityadvisoryboardwithmembersofthemostrelevantcommunityagenciesthatrepresentthemostunderservedcommunities.AllourpartnerswillcollaborativelyhelpusmovethestrategicprioritiesofourOralHealthInnovationLabforward.

a. Buildinterprofessionalcommitteestocollaborate,learn,anddevisenewstrategiesthatwillbecomprehensiveandhaveawide-reachingimpact.

b. Conductinterprofessionalcommitteemeetingstodevelopnovelsystemsandapproachestoincreasequalityofcareandaccesstoservices.

2. Analyzethekeyfactorsincludingtheprominentsocialdeterminantsoforalhealthinthedevelopmentoforaldiseaseandbuildatargetedplanaddressingeachfactor.

3. ConductaLosAngelesCountyneedsassessmentusinglatestGIStechnologythatincludesidentificationofcurrentresourcesinthecommunities.ThiswillallowustomapcommunityneedswithavailableresourcesinordertocreateeffectiveinterventionstoenhancecurrentpreventionidentificationandearlytreatmentofECC.

4. Developalongterm(10-year)roadmaptoimprovechildoralhealthinAmerica.Theroad-mappingandstrategypathwaydevelopmentprovidesthefieldwithavisualdepictionandcommonframeworktoguide,monitor,andevaluateimprovementandprogress.

a. Developshort-termandlong-termannualgoalsandmeasurableobjectivestoensureimprovementofchildren’soralhealthatbothlocalandnationallevels.

b. Establishbaselinesandcreatemeasurablemetricspartofacomprehensiveevaluationframeworktoanalyzethesuccessofoutcomes.

5. Conductdesignlabssessionsfocusedondesigningservicesandsystemstobettermeettheneedsofchildrenandtheirfamilies.Usingperson-centereddesignandecologymodeling,we

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willbetterunderstandtheneedsofchildrenandfamiliesandwaysofcreatingmorecoherentandfunctionalservicepathwaysandsystemsconnectionsthatsupportoptimaloralhealthdevelopment

a. Createopportunitiesforadvisorynetworkmemberorganizationstotestspecificstrategiesandlearntogethertoassessidentifiedgoalsandobjectives.

b. Holdatwo-dayInterprofessionalSymposium(October5th&6th,2018)tokickoffthisinitiative:”IntotheFuture:AddressingInterprofessionalEducationandOralHealthEquity”.

6. Explorecurrent,analyzeandcreatenewpreventionorientedoralhealthpoliciesthatfocusonqualityofcare,innovativepaymentsystems,andimprovingexistingservicesandsystems.

Wewillbefurtherexploringthefollowing5trackswithinourtwo-daySymposium,“IntotheFuture:AddressingInterprofessionalEducationandOralHealthEquity”:

1. FinancialissuesregardingECCprevention:a. ToincludedataandresearchonCHIPb. Value-based/risk-basedinsurancereimbursement,QualityImprovementOutcomes,etc.

2. PolicydevelopmentswithafocusonECCprevention:a. Waterfluoridationb. Sodataxbillsc. Mattersofsocialjusticeandhealthequity

i. Immigrantoralhealthissuesii. Globalpediatricoralhealthissues

d. Others…3. Diversityissuesinthedentalworkforce:

a. ToincludeissuesrelatedtohighcostofobtainingUSlicensureforforeigntraineddentists,etc.

b. Changesindentalpracticei. UseofDentalTherapistsandCommunityOralHealthWorkers(COHWs)

4. Accesstocareissuesandbarrierstocare:a. Immigrantoralhealthissuesb. Interprofessionaleducation,universalIPEcurriculumdevelopment,…

5. Whatprovidersneedtoknowforpatientcareinthefuturewithemergingtechnology:a. TechnologyandTeledentistryb. Roboticsc. Laserused. PrecisionDentistrye. AppsprovidingOralHealthf. Newdentalmaterialsresemblingnaturaltoothstructure

i. Useofstemcells

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ForalistoforalhealthpolicyopportunitiesseeFigure3below

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References

1. https://www.cdc.gov/oralhealth/about/healthy-people.htmlerences 2. Mulliganetal.,DentalCariesinunderprivilegedchildrenofLosAngeles.JHealthCarePoor

Underserved2011;22(2):648-62. 3. MoyerVA;USPreventiveServicesTaskForce.Preventionofdentalcariesinchildrenfrombirth

throughage5years:USPreventiveServicesTaskForcerecommendationstatement.Pediatrics(2014)133(6):1102–11.doi:10.1542/peds.2014-0483

4. HaganJF,ShawJS,DuncanPM,editors.BrightFuturesGuidelinesforHealthSupervisionofInfants,Children,andAdolescents.ElkGroveVillage,IL:AmericanAcademyofPediatrics(2017).

5. PartnershipforPrevention.(2005).LeadingbyExample:ImprovingtheBottomLineThroughaHighPerformance,LessCostlyWorkforce.Retrievedfromhttp://www.prevent.org/data/files/initiatives/leadingbyexample2005report.pdf

6. Ramos-Gomez,F.,Askaryar,H.,Garell,C.,&Ogren,J.(2017).PioneeringandInterprofessionalPediatricDentistryProgramsAimedatReducingOralHealthDisparities.FrontiersinPublicHealth,5,207.http://doi.org/10.3389/fpubh.2017.00207

7. Ramos-Gomez,F.J.,Gansky,S.A.,Featherstone,J.D.B.,Jue,B.,Gonzalez-Beristain,R.,Santo,W.,…Weintraub,J.A.(2012).MotherandYouthAccess(MAYA)MaternalChlorhexidine,CounselingandPediatricFluorideVarnishRandomizedClinicalTrialtoPreventEarlyChildhoodCaries.InternationalJournalofPaediatricDentistry,22(3),169–179.http://doi.org/10.1111/j.1365-263X.2011.01188.x

8. Ramos-Gomez,F.,&Ng,M.-W.(2011).IntotheFuture:KeepingHealthyTeethCariesFree:PediatricCAMBRAProtocols.JournaloftheCaliforniaDentalAssociation,39(10),723–733.