Accepted Manuscript Are Dental Hygienists Prepared to Work in the Changing Public Health Environment? Beverly A. Isman, RDH, BS, MPH, ELS Christine M. Farrell, RDH, BSDH, MPA PII:
S1532-3382(14)00061-X
DOI:
10.1016/j.jebdp.2014.03.007
Reference:
YMED 948
To appear in:
The Journal of Evidence-Based Dental Practice
Please cite this article as: Isman BA, Farrell CM, Are Dental Hygienists Prepared to Work in the Changing Public Health Environment?, Indian Journal of Dentistry (2014), doi: 10.1016/ j.jebdp.2014.03.007. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
Are Dental Hygienists Prepared to Work in the Changing Public Health Environment?
RI PT
*Beverly A. Isman, RDH, BS, MPH, ELS Dental Public Health Consultant
SC
Association of State and Territorial Dental Directors
Oral Health Program Director
*Corresponding author 212 Huerta Place Davis, CA 95616
TE D
Michigan Department of Community Health
M AN U
Christine M. Farrell, RDH, BSDH, MPA
EP
Work/home phone: 530-758-1456
AC C
Cell phone: 530-902-7179 Fax: 530-759-7089
[email protected]
1
ACCEPTED MANUSCRIPT
Are Dental Hygienist Prepared to Work in the Changing Public Health Environment? Abstract Declarative Title: Healthcare reform, the changing public health environment, and a lack of clarity about
RI PT
what defines a ‘public health professional’ create challenges as well as opportunities for dental hygienists who wish to pursue positions or careers in public health.
Background: Although many studies have been conducted about dental hygienists in clinical practice,
SC
there are few describing dental hygienists working in public health positions, particularly in non-clinical roles, or how well their education and other resources prepared them for these roles. Competency
M AN U
statements and the 10 Essential Public Health Services to Promote Oral Health in the U.S. provide a public health framework to assess what skills will be required for future opportunities that may emerge for dental hygienists
Methods: Published literature, recent unpublished survey data, selected professional health care reform
TE D
documents, competency statements, accreditation standards, and the 10 Essential Public Health Services to Promote Oral Health in the U.S. were analyzed. Competencies in public health/dental public health provide an overview of skills needed by dental hygienists who will be seeking public health
EP
positions. Health reform statements describe the need for more leadership and workforce models in
AC C
public health, while the 10 Essential Services can serve as a framework for career preparation/transition. Conclusions: The literature does not provide a comprehensive historical review or current profile of dental hygienists who work in various public health positions or their various roles, especially nonclinical roles. More research is needed regarding current positions, degree and experience requirements, and role responsibilities. Additionally, the credentials and public health background of the faculty teaching community/public health courses in dental hygiene programs requires exploration. Follow-up studies of dental hygiene program graduates could help determine how well courses prepare
2
ACCEPTED MANUSCRIPT
students for public health activities or careers and what resources aid in transitioning from clinical to public health positions. Dental hygienists need more information about education, continuing education
RI PT
and employment opportunities related to pursuing a career in public health. Introduction
Many studies have been conducted regarding dental hygienists in clinical practice, but few have
SC
researched dental hygienists working in public health settings or positions, particularly in non-clinical roles. With increasing job competition in the private sector, changes in the U.S. health care/dental care
M AN U
systems, and new paradigms in the public health sector, are dental hygienists positioned to make significant contributions in public health roles? This article will 1) review what is known about dental hygienists in the public health workforce and where there are gaps; 2) analyze published standards, competencies and other guidelines from national groups to determine what skills are needed in the changing public health environment, 3) review current avenues for gaining public health knowledge and
TE D
experience, 4) use a public health framework for suggesting ways that dental hygienists can apply public health competencies, especially in non-clinical roles; and 5) suggest considerations for future research
Literature Review
EP
and education.
AC C
The terms ‘public health’ and ‘community health’ often are used interchangeably by the dental and dental hygiene professions. Yet public health really is a broader concept and a broader profession that is now structured around the core functions of assessment, policy development and assurance as recommended by a 1988 Institute of Medicine report.1 Community health uses public health concepts to assess and address problems in a particular community, and focuses more closely on health practices and health care. The 10 Essential Public Health Services document developed in 19942 provides the population health framework for many public health national standards and accreditation programs; 3
ACCEPTED MANUSCRIPT
they do not focus on the provision of individual healthcare. The Association of State and Territorial Dental Directors (ASTDD) adapted the 10 Essential Public Health Services in 1997 to create a Dental Public Health version, 10 Essential Public Health Services to Promote Oral Health in the U.S. (see Figure
RI PT
1), to use as the framework for the ASTDD Guidelines for State and Territorial Dental Programs, making slight revisions in 2010.3 The American Association for Community Dental Programs created Model Framework for Community Oral Health Programs4 in 2006 for local health agencies based on the 10
SC
Essential Public Health Services.
Provision of oral health care outside private practice settings such as in schools, correctional
M AN U
facilities, long-term-care facilities, community health centers or other community-based programs, has traditionally been referred to as practicing in public health settings, or more recently as alternative practice settings, even though they are not connected with public health agencies. States also have used the term public health in regulatory changes for dental hygienists practicing in alternative settings. The Commission on Dental Accreditation’s (CODA) 2013 document entitled Accreditation Standards for
TE D
Dental Hygiene Education Programs,5 however, refers to concepts and courses in community health, while the American Dental Education Association (ADEA)/American Dental Hygienists’ Association
EP
(ADHA) document called Competencies for Entry into the Profession of Dental Hygiene6 refers to community involvement. When mentioning career paths, most dental hygiene organizations refer to
AC C
careers in public health, not community health. In 2010 the ADHA Council on Public Health developed Career Opportunities in Public Health7 that highlights non-private practice potential career paths for dental hygienists and students. The document includes positions categorized under the five professional dental hygiene roles (see Figure 2.) Of the three textbooks designed for dental hygienists that primarily address public health issues, two include ‘Dental Public Health’ in the title and the other, ‘Community Oral Health Practice’.
4
ACCEPTED MANUSCRIPT
Inconsistent or interchangeable use of these terms has created long-standing debate about who is considered a ‘public health professional.’ Should someone who has no formal public health education and who practices clinically in an alternative practice setting be considered part of the public health
RI PT
workforce? Until there are clearer definitions around credentials, work settings, or the skills needed to perform specific scopes of work, confusion and disagreement still will exist and interfere with high quality evaluation studies or other public health research pertaining to the public health workforce.
SC
While the Career Opportunities in Public Health resource document provides a general description with education, licensure, training and experience suggestions, criteria for the positions are not clearly
M AN U
defined and can vary by state.
None of the literature provides a comprehensive historical review or studies of the various roles, particularly non-clinical roles, performed by dental hygienists who work in public health positions, not just in settings for underserved groups. The credentials and public health experience of faculty who
TE D
teach community health/public health courses in dental hygiene programs and who often serve as counselors or role models for students has not recently been examined. The literature also does not address how well community health/public health courses or experiences help prepare students for
AC C
Recent Studies
EP
positions or careers in public health.
ADHA National Surveys
A 2007 the ADHA Survey of Dental Hygienists in the United States8 found that about 3.8% of respondents primarily worked in sites considered in the ‘public health’ arena, while a slightly larger percent volunteered at such sites. The study did not differentiate clinical vs. non-clinical duties. The preliminary results of a large 2012 ADHA online study of dental hygienists in the U.S. showed that 14% of 6,723 respondents said their primary role was not clinical; 9% of those in non-clinical roles reported 5
ACCEPTED MANUSCRIPT
these roles were in public health. In addition, of the 5,529 respondents who classified themselves as clinical dental hygienists, 9% indicated public health/alternative practice sites as their primary setting for providing direct patient care. Many other respondents also provide occasional services or volunteer in
RI PT
those settings. Examples of such sites include federal government clinics and programs, health centers, long-term-care facilities, correctional facilities, school health service, mobile unit, Head Start, Indian Health Service, other public health/community health setting. When asked what other career paths they
SC
would be interested in pursuing, 30% (of 5,125 respondents) noted public health. Because some of the questionnaire items allowed more than one response, it is difficult to interpret the preliminary findings;
M AN U
release of the final study report may clarify how many dental hygienists consider themselves to be working in public health or public health settings. ASTDD Listserv Query
In September 2013 the authors posted a short, informal query for state oral health program
TE D
(SOHP) directors in state government in all 50 states and DC via the ASTDD dental directors’ listserv to assess the number of dental hygienists employed or contracted by SOHP and their roles within the programs. Thirty-nine states responded to the query. Some of the non-responding programs were in
EP
staffing transitions or had a director vacancy. Responses to the questions about employment vs
AC C
contractual arrangements are included in Figures 3a and 3b. States reported that 125 dental hygienists were employees and 72 contractors. Two states, Kentucky and California, reported having no dental hygienists in the SOHP, while a number of the non-responding states also may not have any dental hygiene staff.
The survey requested information on job titles, roles and responsibilities. Responses clearly demonstrated that dental hygienists employed by state oral health programs performed non-clinical or mixed duties and responsibilities. Contracted dental hygienist roles were mainly clinical; dental sealant 6
ACCEPTED MANUSCRIPT
coordinator was the main job responsibility. Civil service job titles were broad with generic titles such as public health coordinator or program consultant. Working titles for positions included fluoridation coordinator, education coordinator, dental sealant consultant, etc. Fourteen states indicated there were
RI PT
other dental hygienists who work in the health agency outside the SOHP program, some in high level positions and whose primary focus is not oral health. These findings demonstrate that dental hygienists perform a variety of roles within state oral health programs, as well as apply cross-cutting skills in other
SC
public health programs. While the SOHP responses demonstrate there are many dental hygienists in non-clinical roles within the programs, the query did not ask about specific duties and responsibilities
M AN U
within the roles or about education or degree requirements for the positions. Since many of the positions fall within the state civil service system, many states did note that the salaries and wages did not keep pace with private practice settings and were not competitive in the job marketplace. The responses are being used to begin to build a preliminary profile of dental hygienists in state government
TE D
positions. Further research is needed to build a more robust profile of dental hygienists at all levels of government.
Review of Health Reform Statements and Professional Competencies
EP
The American Public Health Association 2009 Agenda for Health Reform9 called for 1)
AC C
investments in population-based and community-based prevention, education and outreach programs that have been proven to prevent diseases and injury; and 2) expansion of the public health and primary care workforce especially through increasing resources for public health graduate education and incentives for state and local governments to hire credentialed professionals. An ASTDD Issue Brief on Health Reform10 recommended 1) a strong, well-trained, dental public health presence at all levels of government: federal, regional, state and local; 2) increased support for community-based oral disease prevention and oral health promotion programs; and 3) support for new models for an oral
7
ACCEPTED MANUSCRIPT
health/public health workforce that include a variety of professionals and career pathways with associated competencies, training, and leadership opportunities, incentives and continuing education. Both of these documents emphasize the need for skill development and increased investment in
RI PT
workforce development and a focus on disease prevention/health promotion activities in government and other public health programs at all levels.
Some public health positions rely on technical expertise in a subject area, e.g., oral health,
SC
cardiovascular disease, epidemiology, but may not require credentials in a specific profession. Other positions that are more general in nature require management, finance or leadership skills. To foster
M AN U
public health credentialing and accreditation, the Public Health Accreditation Board (PHAB) has developed a new voluntary accreditation program for health departments,11 while the National Board of Public Health Examiners (NBPHE) now offers a voluntary credentialing process for public health professionals who have public health degrees.12 A few professionals and health departments have
TE D
successfully completed these volunteer programs but it is too early to evaluate their effectiveness or impact.
Three sets of professional competencies13-15 developed through consensus relate most to skills
EP
that dental hygienists will need if working in public health positions or settings today or in the future.
AC C
The authors believe these competencies provide a comprehensive list of skills most needed in light of health reform and the realities of the public health environment. Due to space limitations, only the competency domains, not the competencies themselves, are listed in the figures to show categorical similarities. Figure 4 shows the broadest grouping, public health professionals (non-discipline specific), while Figure 5 highlights a subspecialty, Dental Public Health, and Figure 6 addresses a particular setting, State Oral Health Programs. Notation is made if there are different levels of attainment included (tiers). Program planning and policy development are common threads, as are using scientific (evidence-based)
8
ACCEPTED MANUSCRIPT
approaches and management/leadership skills. High-level communication and collaboration skills are implicit in all of the domains, while cultural competency is included in the newer general public health
RI PT
competencies and in the guiding principles for the SOHP competencies. The three sets of competency domains reflect non-clinical, cross-cutting skills that may not be taught at all or not in depth in some dental hygiene education programs. The most recent accreditation standards for curricula for dental hygiene programs focus only on community program needs of
SC
assessment, planning, implementation and evaluation, as well as communicating with diverse
population groups and other members of the health care team. Recently, through a Health Resources
M AN U
and Services Administration (HRSA) funded project, the American Association of Public Health Dentistry (AAPHD) developed, and is in the process of field testing, a preliminary set of eight core dental public health competencies for pre-doctoral dental and dental hygiene education and six teaching modules (see Figure 7).17 The competencies seem to have a mixed community health/public health focus, and the
TE D
modules were originally planned to be taught by public health professionals from an AAPHD Speakers’ Bureau, which may be impractical. CODA accreditation standards for dental hygiene education programs do not require public health credentials or experience for faculty in dental hygiene programs who teach
EP
community health courses or the other cross-cutting skills needed in public health positions or who
AC C
supervise community-based experiences. Preparing for Positions/Careers in Public Health The Association of Schools of Public Health (ASPH) has been holding a multi-phase national conversation called Framing the Future: The Second 100 Years of Education for Public Health.17 Its purpose is to rethink the continuum of education in public health through the various degree levels and from interdisciplinary and interprofessional perspectives. This may prove useful for better defining the public health workforce and the options for gaining public health knowledge and skills. In August 2013 9
ACCEPTED MANUSCRIPT
ASPH broadened its name to the Association of Schools and Programs of Public Health (ASPPH) to represent schools and programs accredited by the Council on Education for Public Health.
RI PT
Ways to transition directly from graduation from dental hygiene educational programs or from private practice to positions in public health currently are limited. Positions within public health agencies often require public health experience or a public health degree, preferably a graduate level degree. Textbooks provide personal profiles of selected dental hygienists who work in an array of settings and in
SC
different roles. The profiles include insights into their career paths, challenges and benefits of their paths; and thoughts for the future. Many of these profiles reflect innovative career paths and pioneering
M AN U
ways to create public health positions. ADHA’s Career Opportunities in Public Health describes core responsibilities, current education and experience requirements, and examples of dental hygienists functioning in those roles. In Table 1, using the 10 Essential Public Health Services framework, the authors provide examples of public health activities that dental hygienists are currently most apt to
advance the public’s oral health.
TE D
perform along with more advanced and collaborative activities they could perform in the future to
Currently there are limited formal transition options for dental hygienists who wish to work in
EP
non-clinical public health roles other than earning a baccalaureate degree, certificate or master’s degree
AC C
in public health. Master’s degree programs require at least a baccalaureate degree. The number of online degree programs in public health has increased exponentially, however, providing greater opportunities for dental hygienists to pursue a degree on a part-time basis without leaving home or a job. Most public health degree programs do not include much if any content specific to dental public health. Only a few degree programs still cater to dental hygienists and dentists with dental public health specific content. Eligibility for dental public health residency programs and board eligibility as a specialist is limited to dentists. Even if a dental hygienist earned an master’s degree in public health with a major
10
ACCEPTED MANUSCRIPT
in dental public health or a doctorate in public health, and has years of public health experience, there is no way to recognize that expertise in terms of a specialty designation. The development of mentored public health internships or fellowships for dental hygienists that include cross-cutting competencies at
RI PT
least would create a much needed opportunity for preparing for a public health career.
Dental hygienists who plan to pursue employment opportunities in public health need to find ways to learn new skills through formal educational programs, continuing education and public health
SC
experiences with good mentors. Until new avenues are developed, dental hygienists should take
advantage of community volunteer activities through component dental hygiene societies or other
M AN U
groups, online courses, workshops at professional conferences, study groups or other forms of networking to keep current with the public health literature, and correspond with hygienists who already work in public health positions. National and state organizations should continue to help create and disseminate information to assist dental hygienists who wish to pursue public health positions or
TE D
careers.
Conclusions: More research is needed on the current positions, degree/experience requirements, and role responsibilities of dental hygienists working in public health, particularly non-clinical roles. More
EP
research is also needed on the credentials and public health background of the faculty teaching
AC C
community/public health courses in dental hygiene programs, and whether the current accreditation standards and content for dental hygiene community health course work is adequate for the newer public health paradigms. Follow-up studies of dental hygiene graduates are indicated to determine how well the courses prepare students for public health activities or careers and what other resources helped them. Dental hygienists need more information about education, continuing education and employment opportunities related to pursuing a career in public health.
11
ACCEPTED MANUSCRIPT
References
1. Institute of Medicine. The Future of Public Health. Washington, DC: National Academy Press,
RI PT
1988. Accessed 12-25-13. http://www.nap.edu/openbook.php?isbn=0309038308 2. Public Health Functions Steering Committee. Public Health in America. Washington, DC: U.S. Public Health Services, 1994. Accessed 12-25-13. (see essential services piece at
SC
http://www.cdc.gov/od/ocphp/nphpsp/essentialphservices.htm)
3. Association of State and Territorial Dental Directors. 10 Essential Public Health Services to
M AN U
Promote Oral Health in the U.S. In Guidelines for State and Territorial Oral Health Programs. 2010, updated in 2013. Accessed 12-25-13. http://www.astdd.org/state-guidelines/ 4. The American Association for Community Dental Programs. Model Framework for Community Oral Health Programs. 2006. Accessed 12-25-13. http://www.aacdp.com/docs/Framework.pdf 5. Commission on Dental Accreditation (CODA). Accreditation Standards for Dental Hygiene
TE D
Education Programs. 2013. Accessed 12-25-13. http://www.ada.org/sections/educationAndCareers/pdfs/dh.pdf 6. American Dental Education Association (ADEA)/ADHA. Competencies for Entry into the
EP
Profession of Dental Hygiene. Accessed 12-25-13.
AC C
http://www.adea.org/about_adea/governance/Documents/Competencies.pdf 7. American Dental Hygienists’ Association. Career Opportunities in Public Health. 2010. Online access to members only. 8. American Dental Hygienists’ Association. Survey of Dental Hygienists in the United States, 2007: Executive Summary. 2009. Albany, NY: Center for Health Workforce Studies at the School of Public Health, University at Albany.
12
ACCEPTED MANUSCRIPT
9. American Public Health Association. 2009 Agenda for Health Reform. Accessed 12-25-13. http://www.apha.org/advocacy/Health+Reform/implementation/ 10. Association of State and Territorial Dental Directors. Issue Brief – Health Reform
RI PT
The Dental Public Health Infrastructure: Failing to Meet the Needs of the Underserved. 2009. Accessed 12-25-13. http://www.astdd.org/docs/hcr-issue-brief-final-4-1-2009-iinv-info.pdf 11. Public Health Accreditation Board (PHAB). Standards and Measures. Accessed 12-25-13.
SC
http://www.phaboard.org/accreditation-process/public-health-department-standards-andmeasures/
M AN U
12. Certified in Public Health by the National Board of Public Health Examiners (NBPHE). Accessed 12-25-13. http://www.nbphe.org/aboutthecph.cfm
13. The Council on Linkages between Academia and Public Health Practice. Core Competencies for Public Health Professionals. May 2010 revisions. Accessed 12-25-13.
TE D
http://www.phf.org/programs/corecompetencies
14. American Association of Public Health Dentistry and American Board of Dental Public Health. Competency Statements for Dental Public Health (DPH). 1998. Accessed 12-25-13.
EP
http://www.aaphd.org/docs/competencies.htm 15. Association of State and Territorial Dental Directors. Competencies for State Oral Health
AC C
Programs. September 2009. Accessed 12-25-13. http://www.astdd.org/state-oral-healthprogram-competencies-and-competecy-tools/ 16. Atchison, K et al. Implementing the Ready-to-Use AAPHD Dental Public Health Curriculum for Pre-Doctoral Dental and Dental Hygiene Students. Accessed 12-25-13. http://www.nationaloralhealthconference.com/docs/presentations/2013/0423/Implementing%20the%20Ready-to-Use%20AAPHD%20Curriculum%20for%20PreDoctoral%20Dental%20and%20Dental%20Hygiene%20Students.pdf
13
ACCEPTED MANUSCRIPT
17. Association of Schools of Public Health. Framing the Future: The Second 100 Years of Education for Public Health. Accessed 12-25-13. www.asph.org/UserFiles/TF-Roster_Current5.pdf
RI PT
LOE score: 3
AC C
EP
TE D
M AN U
SC
SORT score: C
14
ACCEPTED MANUSCRIPT
Figure 1. 10 Essential Public Health Services to Promote Oral Health in the U.S. ASTDD Guidelines. 2013. 3
Assessment
RI PT
1. Assess oral health status and implement an oral health surveillance system.
2. Analyze determinants of oral health and respond to health hazards in the community. 3. Assess public perceptions about oral health issues and educate/empower people to
M AN U
Policy Development
SC
achieve and maintain optimal oral health.
4. Mobilize community partners to leverage resources and advocate for/act on oral health issues.
5. Develop and implement policies and systematic plans that support state and community oral health efforts.
TE D
Assurance
6. Review, educate about and enforce laws and regulations that promote oral health and ensure safe oral health practices.
AC C
services.
EP
7. Reduce barriers to care and assure use of personal and population-based oral health
8. Assure an adequate and competent public and private oral health workforce. 9. Evaluate effectiveness, accessibility and quality of personal and population-based oral health promotion activities and oral health services.
10. Conduct and review research for new insights and innovative solutions to oral health problems.
ACCEPTED MANUSCRIPT
Figure 2. Career Opportunities in Public Health. ADHA7
Educator Role o Health Educator o Public Health/Dental Hygienist
•
Researcher Role o Epidemiologist o Research Administrator o Research Scientist
•
Administrator/Manager Role o State Oral Health Program Director o Local/County Oral Health Program Director o Program/Grant Administrator o Medicaid/Medicare Program Manager Specialist
•
Advocate Role o Oral Health Coordinator/Case Manager/Community Health Worker o Legislator/Law Maker
•
Clinical Role o Military and Federal Agencies i. US Public Health Service ii. National Health Service Corps iii. Public Health Dental Hygienist in a State Program iv. FQHC/Local Health Department Dental Hygienist v. RDH in Alternative Setting Contractor o Collaborative Practice Hygienist/Contractor
SC
M AN U
TE D
EP AC C
•
RI PT
•
ACCEPTED MANUSCRIPT
Figures 3a and 3b. Preliminary Results of 2013 ASTDD Listserv Query About Dental Hygienists in State Government
RI PT
Figure 3a
SC
Number of SOHP Employees
GA, NC, VA (54%)
58
26 States (46%)
M AN U
67
TE D
Figure 3b
EP
Number of Contract Employees
22
AC C
36
OR (31%) ID (17%) 10 States (51%)
12
ACCEPTED MANUSCRIPT
Figure 4. Core Competencies for Public Health Professionals. The Council on Linkages Between Academia and Public Health Practice. May 2010 revisions13
•
Policy Development/Program Planning
•
Communication
•
Cultural Competency
•
Community Dimensions of Practice
•
Public Health Science
•
Financial Planning and Management
•
Leadership and Systems Thinking
SC
Analytical/Assessment
M AN U
•
RI PT
Competency Domains
8 Domains, 74 competencies in tier 1 and in tier 2, 85 in tier 3
AC C
EP
TE D
Tiers: 1=entry level, 2=program management/supervisor, 3=senior management/executive
ACCEPTED MANUSCRIPT
Figure 5. Competency Statements for Dental Public Health (DPH). American Association of Public Health Dentistry and American Board of Dental Public Health. 1998.14
•
Program planning for Populations
RI PT
Competency Domains
Strategies for Prevention/Control of Oral Diseases and Promotion of Oral Health
•
Resources for and Management of DPH Programs
•
Ethical Standards
•
Evaluation and Monitoring of Dental Care Delivery Systems
•
Developing Oral Health Surveillance Systems
•
Communication and Collaboration
•
Public Health Policy, Legislation and Regulation
•
Scientific Literature Critique and Synthesis
•
Public Health Research
TE D
M AN U
SC
•
10 Domains with 60 competency performance indicators:
AC C
EP
No tier differentiation
ACCEPTED MANUSCRIPT
Figure 6. Competencies for State Oral Health Programs. Association of State and Territorial Dental Directors. September 2009.15
•
Plan and Evaluate Programs
•
Influence Policies and Systems Change
•
Manage People
•
Manage Programs and Resources
•
Use Public Health Science
•
Lead Strategically
SC
Build Support
M AN U
•
RI PT
Competency Domains
Guiding Principles
TE D
1. Integrating oral health and general health 2. Programming for all life stages
3. Recognizing/reducing oral health disparities
EP
4. Identifying, leveraging and using resources 5. Social responsibility to advocate for/serve underserved populations
AC C
6. Understanding and respecting other professions, their goals and roles 7. Respecting diversity/cultural competency/health literacy 8. Dedication to lifelong learning and quality improvement.
8 Guiding Principles, 7 Domains and 78 Competencies 4 tiers of examples to reflect more advanced skills
ACCEPTED MANUSCRIPT
Figure 7. AAPHD Proposed Pre-Doctoral DPH Competencies (Areas of Focus) and Curriculum Modules16 Competency Focus Areas Ethical reasoning
•
Synthesis, critique and analysis of scientific literature
•
Social and health care systems and determinants of health (individual and population)
•
Risk assessment and preventive interventions and health promotion strategies (individual and
SC
population)
Access and use population health data for health promotion, patient care and quality
M AN U
•
RI PT
•
improvement •
Communication and collaboration with stakeholders to advocate for oral and general health
•
Lifelong learning and professional growth to provide leadership in using principles of dental public health
Interdisciplinary care across the lifespan with diverse communities and cultures
TE D
•
Curriculum Modules
Principles of Dental Public Health
•
Evidence Based Dentistry
•
DPH Ethics
•
Policy and Advocacy
•
Prevention and Oral Health Promotion
•
Health Literacy and Communication
AC C
EP
•
ACCEPTED MANUSCRIPT
Legends Figure 1. 10 Essential Public Health Services to Promote Oral Health in the U.S. ASTDD Guidelines. 2013. 3
RI PT
Figure 2. Career Opportunities in Public Health. ADHA7 Figures 3a and b. Preliminary Results of 2013 ASTDD Listserv Query About Dental Hygienists in State Government
M AN U
and Public Health Practice. May 2010 revisions.13
SC
Figure 4. Core Competencies for Public Health Professionals. The Council on Linkages Between Academia
Figure 5. Competency Statements for Dental Public Health (DPH). American Association of Public Health Dentistry and American Board of Dental Public Health. 1998.14
Figure 6. Competencies for State Oral Health Programs. Association of State and Territorial Dental
TE D
Directors. September 2009.15
Figure 7. AAPHD Proposed Pre-Doctoral DPH Competencies (Areas of Focus) and Curriculum Modules16
EP
Table 1. Examples of Current and Future Public Health Activities for Dental Hygienists Using the 10
AC C
Essential PH Services to Promote Oral Health Framework
ACCEPTED MANUSCRIPT
Table 1. Examples of Current and Future Public Health Activities for Dental Hygienists in Using the 10 Essential PH Services to Promote Oral Health Framework
Policy Development 4. Participate in state/local coalitions to advocate for oral health improvements.
TE D
5. Develop a protocol and policy manual for a school-based oral health program.
Work with other disciplines to identify common risk factors for diseases and serve on response teams for infectious disease outbreaks. Work with public health educators, public health information offices and the media to create and evaluate tailored, culturally relevant materials using plain language for different groups.
M AN U
3. Conduct in-person community focus groups to field test materials.
Serve as liaison to community sites, gain consents, organize all logistics for surveys. Write reports or fact sheets reporting the findings of the studies.
RI PT
2.Conduct infection prevention and safety training and office assessment.
Future Opportunities
SC
Currently Most Apt to Do Assessment 1. Participate as screener in national, state or local surveys to collect oral status data.
EP
Assurance 6. Serve on public health councils or state dental /dental hygiene boards. 7. Serve as quality improvement staff at a community health center.
AC C
8. Design evaluation forms for conferences and workshops. 9. Conduct patient or consumer satisfaction surveys.
10. Work on a survey research project and write an abstract for presenting the findings at a research meeting.
Convene partners to write oral health policies for schools and school boards, nursing homes, town councils, Head Start, hospitals, associations and non-profit groups. Help develop state oral health plans and integrate oral health into other state education, health or Healthy People 2020 plans. Present or submit testimony on a proposed bill at a public hearing after researching the bill’s benefits and limitations. Write grants to support and evaluate community water fluoridation and school-based dental programs. Serve as faculty for a course on creating a comprehensive evaluation plan for public health programs and policies. Develop goals, objectives, activities and evaluation methods and measures for public health projects or plans. Review and summarize findings from research meetings to share with colleagues via a newsletter.
S1532-3382(14)00061-X
DOI:
10.1016/j.jebdp.2014.03.007
Reference:
YMED 948
To appear in:
The Journal of Evidence-Based Dental Practice
Please cite this article as: Isman BA, Farrell CM, Are Dental Hygienists Prepared to Work in the Changing Public Health Environment?, Indian Journal of Dentistry (2014), doi: 10.1016/ j.jebdp.2014.03.007. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
Are Dental Hygienists Prepared to Work in the Changing Public Health Environment?
RI PT
*Beverly A. Isman, RDH, BS, MPH, ELS Dental Public Health Consultant
SC
Association of State and Territorial Dental Directors
Oral Health Program Director
*Corresponding author 212 Huerta Place Davis, CA 95616
TE D
Michigan Department of Community Health
M AN U
Christine M. Farrell, RDH, BSDH, MPA
EP
Work/home phone: 530-758-1456
AC C
Cell phone: 530-902-7179 Fax: 530-759-7089
[email protected]
1
ACCEPTED MANUSCRIPT
Are Dental Hygienist Prepared to Work in the Changing Public Health Environment? Abstract Declarative Title: Healthcare reform, the changing public health environment, and a lack of clarity about
RI PT
what defines a ‘public health professional’ create challenges as well as opportunities for dental hygienists who wish to pursue positions or careers in public health.
Background: Although many studies have been conducted about dental hygienists in clinical practice,
SC
there are few describing dental hygienists working in public health positions, particularly in non-clinical roles, or how well their education and other resources prepared them for these roles. Competency
M AN U
statements and the 10 Essential Public Health Services to Promote Oral Health in the U.S. provide a public health framework to assess what skills will be required for future opportunities that may emerge for dental hygienists
Methods: Published literature, recent unpublished survey data, selected professional health care reform
TE D
documents, competency statements, accreditation standards, and the 10 Essential Public Health Services to Promote Oral Health in the U.S. were analyzed. Competencies in public health/dental public health provide an overview of skills needed by dental hygienists who will be seeking public health
EP
positions. Health reform statements describe the need for more leadership and workforce models in
AC C
public health, while the 10 Essential Services can serve as a framework for career preparation/transition. Conclusions: The literature does not provide a comprehensive historical review or current profile of dental hygienists who work in various public health positions or their various roles, especially nonclinical roles. More research is needed regarding current positions, degree and experience requirements, and role responsibilities. Additionally, the credentials and public health background of the faculty teaching community/public health courses in dental hygiene programs requires exploration. Follow-up studies of dental hygiene program graduates could help determine how well courses prepare
2
ACCEPTED MANUSCRIPT
students for public health activities or careers and what resources aid in transitioning from clinical to public health positions. Dental hygienists need more information about education, continuing education
RI PT
and employment opportunities related to pursuing a career in public health. Introduction
Many studies have been conducted regarding dental hygienists in clinical practice, but few have
SC
researched dental hygienists working in public health settings or positions, particularly in non-clinical roles. With increasing job competition in the private sector, changes in the U.S. health care/dental care
M AN U
systems, and new paradigms in the public health sector, are dental hygienists positioned to make significant contributions in public health roles? This article will 1) review what is known about dental hygienists in the public health workforce and where there are gaps; 2) analyze published standards, competencies and other guidelines from national groups to determine what skills are needed in the changing public health environment, 3) review current avenues for gaining public health knowledge and
TE D
experience, 4) use a public health framework for suggesting ways that dental hygienists can apply public health competencies, especially in non-clinical roles; and 5) suggest considerations for future research
Literature Review
EP
and education.
AC C
The terms ‘public health’ and ‘community health’ often are used interchangeably by the dental and dental hygiene professions. Yet public health really is a broader concept and a broader profession that is now structured around the core functions of assessment, policy development and assurance as recommended by a 1988 Institute of Medicine report.1 Community health uses public health concepts to assess and address problems in a particular community, and focuses more closely on health practices and health care. The 10 Essential Public Health Services document developed in 19942 provides the population health framework for many public health national standards and accreditation programs; 3
ACCEPTED MANUSCRIPT
they do not focus on the provision of individual healthcare. The Association of State and Territorial Dental Directors (ASTDD) adapted the 10 Essential Public Health Services in 1997 to create a Dental Public Health version, 10 Essential Public Health Services to Promote Oral Health in the U.S. (see Figure
RI PT
1), to use as the framework for the ASTDD Guidelines for State and Territorial Dental Programs, making slight revisions in 2010.3 The American Association for Community Dental Programs created Model Framework for Community Oral Health Programs4 in 2006 for local health agencies based on the 10
SC
Essential Public Health Services.
Provision of oral health care outside private practice settings such as in schools, correctional
M AN U
facilities, long-term-care facilities, community health centers or other community-based programs, has traditionally been referred to as practicing in public health settings, or more recently as alternative practice settings, even though they are not connected with public health agencies. States also have used the term public health in regulatory changes for dental hygienists practicing in alternative settings. The Commission on Dental Accreditation’s (CODA) 2013 document entitled Accreditation Standards for
TE D
Dental Hygiene Education Programs,5 however, refers to concepts and courses in community health, while the American Dental Education Association (ADEA)/American Dental Hygienists’ Association
EP
(ADHA) document called Competencies for Entry into the Profession of Dental Hygiene6 refers to community involvement. When mentioning career paths, most dental hygiene organizations refer to
AC C
careers in public health, not community health. In 2010 the ADHA Council on Public Health developed Career Opportunities in Public Health7 that highlights non-private practice potential career paths for dental hygienists and students. The document includes positions categorized under the five professional dental hygiene roles (see Figure 2.) Of the three textbooks designed for dental hygienists that primarily address public health issues, two include ‘Dental Public Health’ in the title and the other, ‘Community Oral Health Practice’.
4
ACCEPTED MANUSCRIPT
Inconsistent or interchangeable use of these terms has created long-standing debate about who is considered a ‘public health professional.’ Should someone who has no formal public health education and who practices clinically in an alternative practice setting be considered part of the public health
RI PT
workforce? Until there are clearer definitions around credentials, work settings, or the skills needed to perform specific scopes of work, confusion and disagreement still will exist and interfere with high quality evaluation studies or other public health research pertaining to the public health workforce.
SC
While the Career Opportunities in Public Health resource document provides a general description with education, licensure, training and experience suggestions, criteria for the positions are not clearly
M AN U
defined and can vary by state.
None of the literature provides a comprehensive historical review or studies of the various roles, particularly non-clinical roles, performed by dental hygienists who work in public health positions, not just in settings for underserved groups. The credentials and public health experience of faculty who
TE D
teach community health/public health courses in dental hygiene programs and who often serve as counselors or role models for students has not recently been examined. The literature also does not address how well community health/public health courses or experiences help prepare students for
AC C
Recent Studies
EP
positions or careers in public health.
ADHA National Surveys
A 2007 the ADHA Survey of Dental Hygienists in the United States8 found that about 3.8% of respondents primarily worked in sites considered in the ‘public health’ arena, while a slightly larger percent volunteered at such sites. The study did not differentiate clinical vs. non-clinical duties. The preliminary results of a large 2012 ADHA online study of dental hygienists in the U.S. showed that 14% of 6,723 respondents said their primary role was not clinical; 9% of those in non-clinical roles reported 5
ACCEPTED MANUSCRIPT
these roles were in public health. In addition, of the 5,529 respondents who classified themselves as clinical dental hygienists, 9% indicated public health/alternative practice sites as their primary setting for providing direct patient care. Many other respondents also provide occasional services or volunteer in
RI PT
those settings. Examples of such sites include federal government clinics and programs, health centers, long-term-care facilities, correctional facilities, school health service, mobile unit, Head Start, Indian Health Service, other public health/community health setting. When asked what other career paths they
SC
would be interested in pursuing, 30% (of 5,125 respondents) noted public health. Because some of the questionnaire items allowed more than one response, it is difficult to interpret the preliminary findings;
M AN U
release of the final study report may clarify how many dental hygienists consider themselves to be working in public health or public health settings. ASTDD Listserv Query
In September 2013 the authors posted a short, informal query for state oral health program
TE D
(SOHP) directors in state government in all 50 states and DC via the ASTDD dental directors’ listserv to assess the number of dental hygienists employed or contracted by SOHP and their roles within the programs. Thirty-nine states responded to the query. Some of the non-responding programs were in
EP
staffing transitions or had a director vacancy. Responses to the questions about employment vs
AC C
contractual arrangements are included in Figures 3a and 3b. States reported that 125 dental hygienists were employees and 72 contractors. Two states, Kentucky and California, reported having no dental hygienists in the SOHP, while a number of the non-responding states also may not have any dental hygiene staff.
The survey requested information on job titles, roles and responsibilities. Responses clearly demonstrated that dental hygienists employed by state oral health programs performed non-clinical or mixed duties and responsibilities. Contracted dental hygienist roles were mainly clinical; dental sealant 6
ACCEPTED MANUSCRIPT
coordinator was the main job responsibility. Civil service job titles were broad with generic titles such as public health coordinator or program consultant. Working titles for positions included fluoridation coordinator, education coordinator, dental sealant consultant, etc. Fourteen states indicated there were
RI PT
other dental hygienists who work in the health agency outside the SOHP program, some in high level positions and whose primary focus is not oral health. These findings demonstrate that dental hygienists perform a variety of roles within state oral health programs, as well as apply cross-cutting skills in other
SC
public health programs. While the SOHP responses demonstrate there are many dental hygienists in non-clinical roles within the programs, the query did not ask about specific duties and responsibilities
M AN U
within the roles or about education or degree requirements for the positions. Since many of the positions fall within the state civil service system, many states did note that the salaries and wages did not keep pace with private practice settings and were not competitive in the job marketplace. The responses are being used to begin to build a preliminary profile of dental hygienists in state government
TE D
positions. Further research is needed to build a more robust profile of dental hygienists at all levels of government.
Review of Health Reform Statements and Professional Competencies
EP
The American Public Health Association 2009 Agenda for Health Reform9 called for 1)
AC C
investments in population-based and community-based prevention, education and outreach programs that have been proven to prevent diseases and injury; and 2) expansion of the public health and primary care workforce especially through increasing resources for public health graduate education and incentives for state and local governments to hire credentialed professionals. An ASTDD Issue Brief on Health Reform10 recommended 1) a strong, well-trained, dental public health presence at all levels of government: federal, regional, state and local; 2) increased support for community-based oral disease prevention and oral health promotion programs; and 3) support for new models for an oral
7
ACCEPTED MANUSCRIPT
health/public health workforce that include a variety of professionals and career pathways with associated competencies, training, and leadership opportunities, incentives and continuing education. Both of these documents emphasize the need for skill development and increased investment in
RI PT
workforce development and a focus on disease prevention/health promotion activities in government and other public health programs at all levels.
Some public health positions rely on technical expertise in a subject area, e.g., oral health,
SC
cardiovascular disease, epidemiology, but may not require credentials in a specific profession. Other positions that are more general in nature require management, finance or leadership skills. To foster
M AN U
public health credentialing and accreditation, the Public Health Accreditation Board (PHAB) has developed a new voluntary accreditation program for health departments,11 while the National Board of Public Health Examiners (NBPHE) now offers a voluntary credentialing process for public health professionals who have public health degrees.12 A few professionals and health departments have
TE D
successfully completed these volunteer programs but it is too early to evaluate their effectiveness or impact.
Three sets of professional competencies13-15 developed through consensus relate most to skills
EP
that dental hygienists will need if working in public health positions or settings today or in the future.
AC C
The authors believe these competencies provide a comprehensive list of skills most needed in light of health reform and the realities of the public health environment. Due to space limitations, only the competency domains, not the competencies themselves, are listed in the figures to show categorical similarities. Figure 4 shows the broadest grouping, public health professionals (non-discipline specific), while Figure 5 highlights a subspecialty, Dental Public Health, and Figure 6 addresses a particular setting, State Oral Health Programs. Notation is made if there are different levels of attainment included (tiers). Program planning and policy development are common threads, as are using scientific (evidence-based)
8
ACCEPTED MANUSCRIPT
approaches and management/leadership skills. High-level communication and collaboration skills are implicit in all of the domains, while cultural competency is included in the newer general public health
RI PT
competencies and in the guiding principles for the SOHP competencies. The three sets of competency domains reflect non-clinical, cross-cutting skills that may not be taught at all or not in depth in some dental hygiene education programs. The most recent accreditation standards for curricula for dental hygiene programs focus only on community program needs of
SC
assessment, planning, implementation and evaluation, as well as communicating with diverse
population groups and other members of the health care team. Recently, through a Health Resources
M AN U
and Services Administration (HRSA) funded project, the American Association of Public Health Dentistry (AAPHD) developed, and is in the process of field testing, a preliminary set of eight core dental public health competencies for pre-doctoral dental and dental hygiene education and six teaching modules (see Figure 7).17 The competencies seem to have a mixed community health/public health focus, and the
TE D
modules were originally planned to be taught by public health professionals from an AAPHD Speakers’ Bureau, which may be impractical. CODA accreditation standards for dental hygiene education programs do not require public health credentials or experience for faculty in dental hygiene programs who teach
EP
community health courses or the other cross-cutting skills needed in public health positions or who
AC C
supervise community-based experiences. Preparing for Positions/Careers in Public Health The Association of Schools of Public Health (ASPH) has been holding a multi-phase national conversation called Framing the Future: The Second 100 Years of Education for Public Health.17 Its purpose is to rethink the continuum of education in public health through the various degree levels and from interdisciplinary and interprofessional perspectives. This may prove useful for better defining the public health workforce and the options for gaining public health knowledge and skills. In August 2013 9
ACCEPTED MANUSCRIPT
ASPH broadened its name to the Association of Schools and Programs of Public Health (ASPPH) to represent schools and programs accredited by the Council on Education for Public Health.
RI PT
Ways to transition directly from graduation from dental hygiene educational programs or from private practice to positions in public health currently are limited. Positions within public health agencies often require public health experience or a public health degree, preferably a graduate level degree. Textbooks provide personal profiles of selected dental hygienists who work in an array of settings and in
SC
different roles. The profiles include insights into their career paths, challenges and benefits of their paths; and thoughts for the future. Many of these profiles reflect innovative career paths and pioneering
M AN U
ways to create public health positions. ADHA’s Career Opportunities in Public Health describes core responsibilities, current education and experience requirements, and examples of dental hygienists functioning in those roles. In Table 1, using the 10 Essential Public Health Services framework, the authors provide examples of public health activities that dental hygienists are currently most apt to
advance the public’s oral health.
TE D
perform along with more advanced and collaborative activities they could perform in the future to
Currently there are limited formal transition options for dental hygienists who wish to work in
EP
non-clinical public health roles other than earning a baccalaureate degree, certificate or master’s degree
AC C
in public health. Master’s degree programs require at least a baccalaureate degree. The number of online degree programs in public health has increased exponentially, however, providing greater opportunities for dental hygienists to pursue a degree on a part-time basis without leaving home or a job. Most public health degree programs do not include much if any content specific to dental public health. Only a few degree programs still cater to dental hygienists and dentists with dental public health specific content. Eligibility for dental public health residency programs and board eligibility as a specialist is limited to dentists. Even if a dental hygienist earned an master’s degree in public health with a major
10
ACCEPTED MANUSCRIPT
in dental public health or a doctorate in public health, and has years of public health experience, there is no way to recognize that expertise in terms of a specialty designation. The development of mentored public health internships or fellowships for dental hygienists that include cross-cutting competencies at
RI PT
least would create a much needed opportunity for preparing for a public health career.
Dental hygienists who plan to pursue employment opportunities in public health need to find ways to learn new skills through formal educational programs, continuing education and public health
SC
experiences with good mentors. Until new avenues are developed, dental hygienists should take
advantage of community volunteer activities through component dental hygiene societies or other
M AN U
groups, online courses, workshops at professional conferences, study groups or other forms of networking to keep current with the public health literature, and correspond with hygienists who already work in public health positions. National and state organizations should continue to help create and disseminate information to assist dental hygienists who wish to pursue public health positions or
TE D
careers.
Conclusions: More research is needed on the current positions, degree/experience requirements, and role responsibilities of dental hygienists working in public health, particularly non-clinical roles. More
EP
research is also needed on the credentials and public health background of the faculty teaching
AC C
community/public health courses in dental hygiene programs, and whether the current accreditation standards and content for dental hygiene community health course work is adequate for the newer public health paradigms. Follow-up studies of dental hygiene graduates are indicated to determine how well the courses prepare students for public health activities or careers and what other resources helped them. Dental hygienists need more information about education, continuing education and employment opportunities related to pursuing a career in public health.
11
ACCEPTED MANUSCRIPT
References
1. Institute of Medicine. The Future of Public Health. Washington, DC: National Academy Press,
RI PT
1988. Accessed 12-25-13. http://www.nap.edu/openbook.php?isbn=0309038308 2. Public Health Functions Steering Committee. Public Health in America. Washington, DC: U.S. Public Health Services, 1994. Accessed 12-25-13. (see essential services piece at
SC
http://www.cdc.gov/od/ocphp/nphpsp/essentialphservices.htm)
3. Association of State and Territorial Dental Directors. 10 Essential Public Health Services to
M AN U
Promote Oral Health in the U.S. In Guidelines for State and Territorial Oral Health Programs. 2010, updated in 2013. Accessed 12-25-13. http://www.astdd.org/state-guidelines/ 4. The American Association for Community Dental Programs. Model Framework for Community Oral Health Programs. 2006. Accessed 12-25-13. http://www.aacdp.com/docs/Framework.pdf 5. Commission on Dental Accreditation (CODA). Accreditation Standards for Dental Hygiene
TE D
Education Programs. 2013. Accessed 12-25-13. http://www.ada.org/sections/educationAndCareers/pdfs/dh.pdf 6. American Dental Education Association (ADEA)/ADHA. Competencies for Entry into the
EP
Profession of Dental Hygiene. Accessed 12-25-13.
AC C
http://www.adea.org/about_adea/governance/Documents/Competencies.pdf 7. American Dental Hygienists’ Association. Career Opportunities in Public Health. 2010. Online access to members only. 8. American Dental Hygienists’ Association. Survey of Dental Hygienists in the United States, 2007: Executive Summary. 2009. Albany, NY: Center for Health Workforce Studies at the School of Public Health, University at Albany.
12
ACCEPTED MANUSCRIPT
9. American Public Health Association. 2009 Agenda for Health Reform. Accessed 12-25-13. http://www.apha.org/advocacy/Health+Reform/implementation/ 10. Association of State and Territorial Dental Directors. Issue Brief – Health Reform
RI PT
The Dental Public Health Infrastructure: Failing to Meet the Needs of the Underserved. 2009. Accessed 12-25-13. http://www.astdd.org/docs/hcr-issue-brief-final-4-1-2009-iinv-info.pdf 11. Public Health Accreditation Board (PHAB). Standards and Measures. Accessed 12-25-13.
SC
http://www.phaboard.org/accreditation-process/public-health-department-standards-andmeasures/
M AN U
12. Certified in Public Health by the National Board of Public Health Examiners (NBPHE). Accessed 12-25-13. http://www.nbphe.org/aboutthecph.cfm
13. The Council on Linkages between Academia and Public Health Practice. Core Competencies for Public Health Professionals. May 2010 revisions. Accessed 12-25-13.
TE D
http://www.phf.org/programs/corecompetencies
14. American Association of Public Health Dentistry and American Board of Dental Public Health. Competency Statements for Dental Public Health (DPH). 1998. Accessed 12-25-13.
EP
http://www.aaphd.org/docs/competencies.htm 15. Association of State and Territorial Dental Directors. Competencies for State Oral Health
AC C
Programs. September 2009. Accessed 12-25-13. http://www.astdd.org/state-oral-healthprogram-competencies-and-competecy-tools/ 16. Atchison, K et al. Implementing the Ready-to-Use AAPHD Dental Public Health Curriculum for Pre-Doctoral Dental and Dental Hygiene Students. Accessed 12-25-13. http://www.nationaloralhealthconference.com/docs/presentations/2013/0423/Implementing%20the%20Ready-to-Use%20AAPHD%20Curriculum%20for%20PreDoctoral%20Dental%20and%20Dental%20Hygiene%20Students.pdf
13
ACCEPTED MANUSCRIPT
17. Association of Schools of Public Health. Framing the Future: The Second 100 Years of Education for Public Health. Accessed 12-25-13. www.asph.org/UserFiles/TF-Roster_Current5.pdf
RI PT
LOE score: 3
AC C
EP
TE D
M AN U
SC
SORT score: C
14
ACCEPTED MANUSCRIPT
Figure 1. 10 Essential Public Health Services to Promote Oral Health in the U.S. ASTDD Guidelines. 2013. 3
Assessment
RI PT
1. Assess oral health status and implement an oral health surveillance system.
2. Analyze determinants of oral health and respond to health hazards in the community. 3. Assess public perceptions about oral health issues and educate/empower people to
M AN U
Policy Development
SC
achieve and maintain optimal oral health.
4. Mobilize community partners to leverage resources and advocate for/act on oral health issues.
5. Develop and implement policies and systematic plans that support state and community oral health efforts.
TE D
Assurance
6. Review, educate about and enforce laws and regulations that promote oral health and ensure safe oral health practices.
AC C
services.
EP
7. Reduce barriers to care and assure use of personal and population-based oral health
8. Assure an adequate and competent public and private oral health workforce. 9. Evaluate effectiveness, accessibility and quality of personal and population-based oral health promotion activities and oral health services.
10. Conduct and review research for new insights and innovative solutions to oral health problems.
ACCEPTED MANUSCRIPT
Figure 2. Career Opportunities in Public Health. ADHA7
Educator Role o Health Educator o Public Health/Dental Hygienist
•
Researcher Role o Epidemiologist o Research Administrator o Research Scientist
•
Administrator/Manager Role o State Oral Health Program Director o Local/County Oral Health Program Director o Program/Grant Administrator o Medicaid/Medicare Program Manager Specialist
•
Advocate Role o Oral Health Coordinator/Case Manager/Community Health Worker o Legislator/Law Maker
•
Clinical Role o Military and Federal Agencies i. US Public Health Service ii. National Health Service Corps iii. Public Health Dental Hygienist in a State Program iv. FQHC/Local Health Department Dental Hygienist v. RDH in Alternative Setting Contractor o Collaborative Practice Hygienist/Contractor
SC
M AN U
TE D
EP AC C
•
RI PT
•
ACCEPTED MANUSCRIPT
Figures 3a and 3b. Preliminary Results of 2013 ASTDD Listserv Query About Dental Hygienists in State Government
RI PT
Figure 3a
SC
Number of SOHP Employees
GA, NC, VA (54%)
58
26 States (46%)
M AN U
67
TE D
Figure 3b
EP
Number of Contract Employees
22
AC C
36
OR (31%) ID (17%) 10 States (51%)
12
ACCEPTED MANUSCRIPT
Figure 4. Core Competencies for Public Health Professionals. The Council on Linkages Between Academia and Public Health Practice. May 2010 revisions13
•
Policy Development/Program Planning
•
Communication
•
Cultural Competency
•
Community Dimensions of Practice
•
Public Health Science
•
Financial Planning and Management
•
Leadership and Systems Thinking
SC
Analytical/Assessment
M AN U
•
RI PT
Competency Domains
8 Domains, 74 competencies in tier 1 and in tier 2, 85 in tier 3
AC C
EP
TE D
Tiers: 1=entry level, 2=program management/supervisor, 3=senior management/executive
ACCEPTED MANUSCRIPT
Figure 5. Competency Statements for Dental Public Health (DPH). American Association of Public Health Dentistry and American Board of Dental Public Health. 1998.14
•
Program planning for Populations
RI PT
Competency Domains
Strategies for Prevention/Control of Oral Diseases and Promotion of Oral Health
•
Resources for and Management of DPH Programs
•
Ethical Standards
•
Evaluation and Monitoring of Dental Care Delivery Systems
•
Developing Oral Health Surveillance Systems
•
Communication and Collaboration
•
Public Health Policy, Legislation and Regulation
•
Scientific Literature Critique and Synthesis
•
Public Health Research
TE D
M AN U
SC
•
10 Domains with 60 competency performance indicators:
AC C
EP
No tier differentiation
ACCEPTED MANUSCRIPT
Figure 6. Competencies for State Oral Health Programs. Association of State and Territorial Dental Directors. September 2009.15
•
Plan and Evaluate Programs
•
Influence Policies and Systems Change
•
Manage People
•
Manage Programs and Resources
•
Use Public Health Science
•
Lead Strategically
SC
Build Support
M AN U
•
RI PT
Competency Domains
Guiding Principles
TE D
1. Integrating oral health and general health 2. Programming for all life stages
3. Recognizing/reducing oral health disparities
EP
4. Identifying, leveraging and using resources 5. Social responsibility to advocate for/serve underserved populations
AC C
6. Understanding and respecting other professions, their goals and roles 7. Respecting diversity/cultural competency/health literacy 8. Dedication to lifelong learning and quality improvement.
8 Guiding Principles, 7 Domains and 78 Competencies 4 tiers of examples to reflect more advanced skills
ACCEPTED MANUSCRIPT
Figure 7. AAPHD Proposed Pre-Doctoral DPH Competencies (Areas of Focus) and Curriculum Modules16 Competency Focus Areas Ethical reasoning
•
Synthesis, critique and analysis of scientific literature
•
Social and health care systems and determinants of health (individual and population)
•
Risk assessment and preventive interventions and health promotion strategies (individual and
SC
population)
Access and use population health data for health promotion, patient care and quality
M AN U
•
RI PT
•
improvement •
Communication and collaboration with stakeholders to advocate for oral and general health
•
Lifelong learning and professional growth to provide leadership in using principles of dental public health
Interdisciplinary care across the lifespan with diverse communities and cultures
TE D
•
Curriculum Modules
Principles of Dental Public Health
•
Evidence Based Dentistry
•
DPH Ethics
•
Policy and Advocacy
•
Prevention and Oral Health Promotion
•
Health Literacy and Communication
AC C
EP
•
ACCEPTED MANUSCRIPT
Legends Figure 1. 10 Essential Public Health Services to Promote Oral Health in the U.S. ASTDD Guidelines. 2013. 3
RI PT
Figure 2. Career Opportunities in Public Health. ADHA7 Figures 3a and b. Preliminary Results of 2013 ASTDD Listserv Query About Dental Hygienists in State Government
M AN U
and Public Health Practice. May 2010 revisions.13
SC
Figure 4. Core Competencies for Public Health Professionals. The Council on Linkages Between Academia
Figure 5. Competency Statements for Dental Public Health (DPH). American Association of Public Health Dentistry and American Board of Dental Public Health. 1998.14
Figure 6. Competencies for State Oral Health Programs. Association of State and Territorial Dental
TE D
Directors. September 2009.15
Figure 7. AAPHD Proposed Pre-Doctoral DPH Competencies (Areas of Focus) and Curriculum Modules16
EP
Table 1. Examples of Current and Future Public Health Activities for Dental Hygienists Using the 10
AC C
Essential PH Services to Promote Oral Health Framework
ACCEPTED MANUSCRIPT
Table 1. Examples of Current and Future Public Health Activities for Dental Hygienists in Using the 10 Essential PH Services to Promote Oral Health Framework
Policy Development 4. Participate in state/local coalitions to advocate for oral health improvements.
TE D
5. Develop a protocol and policy manual for a school-based oral health program.
Work with other disciplines to identify common risk factors for diseases and serve on response teams for infectious disease outbreaks. Work with public health educators, public health information offices and the media to create and evaluate tailored, culturally relevant materials using plain language for different groups.
M AN U
3. Conduct in-person community focus groups to field test materials.
Serve as liaison to community sites, gain consents, organize all logistics for surveys. Write reports or fact sheets reporting the findings of the studies.
RI PT
2.Conduct infection prevention and safety training and office assessment.
Future Opportunities
SC
Currently Most Apt to Do Assessment 1. Participate as screener in national, state or local surveys to collect oral status data.
EP
Assurance 6. Serve on public health councils or state dental /dental hygiene boards. 7. Serve as quality improvement staff at a community health center.
AC C
8. Design evaluation forms for conferences and workshops. 9. Conduct patient or consumer satisfaction surveys.
10. Work on a survey research project and write an abstract for presenting the findings at a research meeting.
Convene partners to write oral health policies for schools and school boards, nursing homes, town councils, Head Start, hospitals, associations and non-profit groups. Help develop state oral health plans and integrate oral health into other state education, health or Healthy People 2020 plans. Present or submit testimony on a proposed bill at a public hearing after researching the bill’s benefits and limitations. Write grants to support and evaluate community water fluoridation and school-based dental programs. Serve as faculty for a course on creating a comprehensive evaluation plan for public health programs and policies. Develop goals, objectives, activities and evaluation methods and measures for public health projects or plans. Review and summarize findings from research meetings to share with colleagues via a newsletter.
