Oral Health WorkforceThe ADHA Perspective: Evolution & Revolution

Ann Battrell, MSDH ADHA Executive Director

August 2012

I. The Dental Hygiene LandscapeII. Advanced Dental Hygiene

Practitioner (ADHP) 2004III. ADHA’s Role in the Development,

Evolution and Advocacy of New Oral Health Providers

IV. Workforce Update

Framework

Background:The Dental Hygiene Landscape

• The workforce– Currently 150,000+ dental hygienists in the U.S.– One of the top 10 fastest growing health care professions

• 38% growth projected between 2010-2020

• The educational infrastructure– 334 entry level dental hygiene programs– 58 degree completion programs– 20 Masters programs

• States expanding role for Dental Hygienists– 35 states allow hygienists to initiate care in community

settings– 15 states directly reimburse hygienists

Dental Hygiene Direct Access Expanding

• Dental hygienist initiate patient care without the presence of a dentist in settings outside of the private office

• Many forms – collaborative practice, public health supervision, limited access permit, etc.

• Utilizes the existing dental hygiene workforce to increase access

Resource: ADHA’s Chart on Direct Access States:http://www.adha.org/governmental_affairs/downloads/direct_access.pdf

2004

ADHA Policies on Workforce

The American Dental Hygienists’ Association advocates the creation of an advanced dental hygiene practitioner who provides diagnostic, preventive, restorative and therapeutic services directly to the public.Advanced Dental Hygiene Practitioner 4-04

2008Minnesota & Dental Therapists

Minnesota Legislation:– Passed in 2008/2009 – ADHA and MNDHA

supported legislation– Created two new models:

• Dental Therapist (DT)• Advanced Dental Therapist (ADT)

– ADT Masters program at Metropolitan State University is dental hygiene-based• Curriculum based, in part, on the ADHP Competencies• Graduates are dually licensed to provide dental

hygiene and dental therapy services• First class graduated in June 2011 and are

currently employed

2009ADHA WORKFORCE POLICIES

BEGIN TO BROADEN & INCLUDE COLLABORATION

The ADHA supports oral health care workforce models/providers that culminate in:

–Graduation from an accredited institution

–Professional Licensure–Direct access to patient care

ADHA Access to Care Policy 2009 4S-09

COLLABORATION & COALITIONS

The American Dental Hygienists’ Association affirms its support for optimal oral health for all people and is committed to collaborative partnerships and coalitions that improve access to oral health services.

Access to Care 7S-09/27-74

2010ADHA Defines Midlevel Oral

Health Practitioner

Mid-level Oral Health Practitioner:A licensed dental hygienist who has graduated from an accredited dental hygiene program and who provides primary oral health care directly to patients to promote and restore oral health through assessment, diagnosis, treatment, evaluation and referral services. The Mid-level Oral Health Practitioner has met the educational requirements to provide services within an expanded scope of care, and practices under regulations set forth by the appropriate licensing agency.

Dental Hygiene Practice 2010 2-10

The American Dental Hygienists’ Association supports programs that inform stakeholders of the scope of dental hygiene practice and its contribution to health in collaboration with health care delivery providers

Access to Care 16-10/38-82

ADHA’s Approach to New Providers • Policies afford ADHA flexibility in considering new

provider models (not just the ADHP)

• Consider on a state-by-state basis

• Work in partnership with state dental hygiene associations and numerous stakeholders

• Focus on developing providers who are appropriately educated, licensed & deliver safe and quality oral healthcare directly to the public

• Commitment to advocate in support of dental hygiene-based models

Why Dental Hygiene-based?

• The workforce is educated, licensed, prepared and available

• The educational infrastructure is in place• Dental hygienists currently work in alternative

settings to increase access• Patients will benefit from a practitioner who

can provide both preventive and restorative services

Workforce Update…..

Anticipated Workforce Legislation in 2013

ID

AZ

UT

MT

WY

NM

CO

AL

FL

SC

TN

KY

INOH

NC

SD

KS

NE

MN

WI

IA

IL

MO

AR

MS

ND

OR

CA NV

WA

AK

PA

ME

VA

NY

CT

WV

DE

MD

NJ

VTNH

MA

RI

LA

GA

MI

HI

OK

TX

D.C.

Workforce legislationanticipated in 2013

No workforce legislationexpected

Kellogg’s Dental Therapist Initiative

• Washington State, Kansas & Vermont– Advocating dental hygiene-based models – Dental hygiene educators are active collaborators in

effort– State dental hygiene associations actively engaged

in advocacy in support of models

• Ohio & New Mexico– Ongoing discussion about dental hygiene link in

legislative efforts– State dental hygiene association and dental hygiene

educators actively engaged

Other Legislative Proposals• Connecticut

– Advanced Dental Hygiene Practitioner legislation

• Maine– Coalition led effort to establish a dental-hygiene based

model– State dental hygiene association actively engaged in

advocacy effort• New Hampshire

– Coalition led initiative to pilot test a new provider– State dental hygiene association is an active participant

in coalition

Pilot Programs• Oregon

– The Oregon Health Authority may approve pilots that teach new skills to existing dental providers and develop new providers

• California – Legislation pending to authorize pilots using dental

assistants and dental hygienists with advanced training to provide restorative services under varying levels of supervision

• Michigan– University of Detroit Mercy is developing a restorative

function dental hygienist pilot program

ADHA Moving Forward…• ADHA Accreditation Study Completed

– To study existing and potential options for the accreditation of programs that educate oral health providers

– ADHA Board of Trustees will consider the report in September

• Potential Consideration of Defining Dental Hygiene Advanced Practice

The Momentum in Support of New Providers

• Affordable Care Act Grants to Pilot Test Alternative Dental Health Care Providers

• Continued interest from policymakers, foundations, stakeholders, the public and the media

• Continual data demonstrating safety and effectiveness of non-dentist providers

• ADHA and our state associations remain committed partners in developing solutions to increasing access

American Dental Hygienists’ Association444 N. Michigan Ave., Suite 3400

Chicago, IL 60611312-440-8900

www.adha.org

ADHA ResourcesDental Hygiene Education:

http://www.adha.org/careerinfo/index.html

Practice Issues:http://www.adha.org/governmental_affairs/practice_issues.htm

ADHA Policies http://www.adha.org/aboutadha/index.html