Vermont CDHCs shine; legislation to boost programs headed to White House

CDHC Tracy Towers teaching school children proper brushing technique.

Barriers to dental care are not created equally. Even when they spring from socioeconomic conditions, like low income and poverty, the particular array of challenges can be as diverse as the people. Still, the challenges often mean parents, children and other family members must deal with those challenges instead of having needed time in a dental chair.

But there are some impediments that are experienced enough so that trained health care professionals can run interference to assist the many patients who might otherwise miss out on care. Where these common and predictable problems exists is where community dental health coordinators (CDHCs) can make a huge difference. CDHCs typically receive specialized training which builds upon their already established dental skills that helps them to anticipate, recognize and ameliorate access to care barriers, particularly in underserved communities nationwide.

In Vermont, children benefit from uniquely prepared dental hygienists who work in some schools districts as dental care coordinators through The Tooth Tutors Dental Access Program – a Vermont Department of Health vehicle. Though not all “Tooth Tutors” have formal CDHC training, there is a lot of crossover in the work, said dental hygienist Tracy Towers, who is both a CDHC and Tooth Tutor.

“They’re still doing the same awesome job of connecting kids with dental care and acting as a liaison between school, home and the dental office,” said Towers, a dental hygienist for 27 years. “Hygienists have been working in the Tooth Tutors program for years in Vermont.”

CDHC Senada Sokocevic

Towers works in Dr. Charles “Chuck” Seleen’s two-office private practice in Winooski, Vermont. The practice serves a low-socioeconomic population, she said. In her roles as a CDHC/Tooth Tutor in Dr. Seleen’s office, Towers said she also encounters a high refugee and immigrant population.

“Where I feel that my CDHC training benefits me is in everything I’ve learned about cultural competency and motivational interviewing,” Towers said. “I feel like clinically and dental hygiene wise I know my skills, I know what I need to say, and, when I’m seeing a patient, I know what I need to do. But I think the CDHC for me has given more resources and more knowledge and information about taking that next step in being able to reach families in a way that’s culturally competent.”

Towers points to training in cultural competency as one of the biggest values she associates with CDHC training.

“Some cultures don’t like people looking in their mouths,” she said. “They’re offended by that. So that might come across as us trying to invade them. For me to be able to explain that in America, it’s not an invasion – just being more educated on the public health dental system and the cultural competence – that goes with reaching out to this patient population group.”

Through the Tooth Tutors program, she and other trained coordinators work with nurses in coordinating patients’ access to information and resources pertaining to their dental health and overall health. In the school populations the office serves, other big values Towers pointed to include helping to reduce school children’s missed appointments due to common challenges like transportation.

“In the Winooski School District, I probably have close to 200 kids that take advantage of the transportation program, meaning from September to May, they’re scheduled appointments, they get picked up from school and delivered to my dental office in Winooski for care and then returned to school. In Burlington, there’s a school-based dental clinic. So the students either go to that school and they just walk down to the dentist, or they are in one of the Burlington School District schools and it’s the same thing. Their nurse and their Tooth Tutor hygienist coordinate their visit. They get transported from their schools to the school-based clinic at another site. ”

In Dr. Seleen’s office, Tower’s colleague, Senada Sokocevic, performs separate functions as a CDHC/Tooth Tutor. Sokocevic is known for going the extra mile, Tower said. “She’s a dental assistant, a refugee from Bosnia. She survived the war in Bosnia, and is a passionate dental assistant. She has tirelessly educated patients on the importance of oral health.

Towers said there can be a lot of misconception about what CDHC’s do and it’s important to clarify that, “CDHCs are not replacing anybody. It’s just a dental liaison (role) for communication between schools, parents and dental offices – and the community.”

“I’m a liaison or a quarterback in getting kids into dental offices. I happen to work in two school districts that have offices locally that support these programs and see Medicaid kids routinely. I think that’s probably a challenge in other states, and I know it’s a challenge in other parts of our state.”

Aside from getting school children connected to primary dental care, the CDHCs and Tooth Tutors also coordinate referrals for dental specialist care. “I can’t just in good stead send a child that doesn’t speak good English home with a referral slip that says call this whole other office that they’re not even associated with and make an appointment for this special procedure,” Towers said. “It just doesn’t happen.”

“Translators are a huge piece of this in my school districts because they’re actually going to work with the parents, call the offices, and make sure that child gets scheduled. I’m constantly like, ‘Oh, my gosh, I wonder if John really did go to that appointment,’ and I call. There’s a lot of follow-up. There are a lot of steps and a lot of people to make these appointments happen. I’m just one piece of the puzzle.”

In October, the Senate passed The Action for Dental Health (ADH) Act, which underwent reconciliation in November before heading to the White House for final consideration. The ADA-supported bill is significant because it will allow organizations to qualify for oral health grants through Health and Human Services to support activities that improve oral health education for dental disease prevention.

These activities will also help develop and expand access to dental services by breaking down geographic and linguistic barriers. It will also help reduce use of emergency rooms by connecting individuals seeking dental services more appropriate for dental primary care settings, thus potentially improving patients’ oral health.

Grants from the ADH Act could support training and development of a nationwide supply of CDHCs. In the interim, some towns, cities, and states already employ CDHCs enthusiastically and effectively. There are currently 130 students enrolled in CDHC programs among 17 CDHC curriculum approved schools, with already 316 trained CDHC graduates. Residents of underserved communities, and every vulnerable population group, no matter where they reside, could benefit greatly from trained Community Dental Health Coordinators.

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