State of Oregon : Oregon.gov Home Page : State of Oregon ......2017 in Bethel. At the end of his training we anticipate he will receive an Associate’s Degree from Ilisagvik College

Dental Pilot Project Program Quarterly Progress Report

October 3, 2016

Project Name & ID Number: “Oregon Tribes Dental Health Aide Therapist Pilot Project” Dental Pilot Project #100

Date Span of Reporting Period: July 1, 2016 – October 3, 2016

Primary Contact Name and Title: Pamela Johnson, Project Manager

Submission Date: October 13, 2013

1. Accomplishments/Highlights.

We have recruited excellent students.

We have engaged in a thorough and challenging process of creating anevaluation plan that meets both the requirements of the OHA Pilot Project, andthe needs of the participating tribes to define what measures of success will bemost beneficial as they transform their oral health delivery systems.

This pilot has been the catalyst for deep discussions about the current physicalfacilities, clinic best practices and community programs at each Tribe. Whether ornot they are meeting the existing needs of the community, who is currently leftout of services and why, and how best to provide care with the addition of a newprovider to the dental team

2. Lessons Learned/Challenges.

We have had to revisit the plans for the experienced DHAT to work at the clinic ayear in advance of the DHAT trainee arriving. It is very hard to convincesomeone to move a few thousand miles away for a temporary job. We areexploring incentives, including how we could create a more permanent position(as best we can within the constraints of our pilot project) for this provider.

We know that decision-making processes with tribal governments are deliberate

CENTER FOR PREVENTION AND HEALTH PROMOTION Oral Health Program

Kate Brown, Governor

800 NE Oregon St, Ste 370 Portland, Oregon 97232-2186

Office: 971-673-1563 Cell: 509-413-9318 Fax: 971-673-0231

healthoregon.org/dpp

and methodical. We did not fully anticipate how that would impact our timelines. We have had the opportunity to engage tribal leaders at CTCLUSI and CIT on the expansion of their dental programs in very comprehensive ways. We believe that the decisions made are definitely better for it, it has just taken a lot longer than we originally anticipated.

3. Timeline. Timeline Update. See attached revised timeline

4. Data. Baseline Data: NPAIHB requested an extension on the submission of a baseline data report due to the delay in the finalization of the Evaluation and Monitoring Plan.

a. Revised Due Date: November, 15, 2016 b. Approved by Oregon Health Authority

5. Training/Didactic. The Alaska Dental Health Aide Therapist (DHAT) Educational Program is a 2-year program that provides students with the educational experiences necessary to become oral health providers. DHAT students attend classes in Anchorage during their first year of education. The students relocate to Bethel, Alaska for their second year of education. (Alaska Native Tribal Health Consortium http://anthc.org/dental-health-aide/) The “Oregon Tribes Dental Health Aide Therapist Pilot Project,” Dental Pilot Project #100, presently has 3 trainees in the Alaska DHAT Educational Program.

1. Trainees a. Naomi Petri: Naomi is an enrolled member of the Confederated Tribes of Coos,

Lower Umpqua, and Siuslaw Indians. She was the valedictorian of her high school class (Class of 2015). We learned from the Tribal Education Counselor that Naomi was interested in the dental professions so we asked her if she would be willing to consider the Alaska DHAT training program. She was interested so she completed the ANTHC admission process which included submission of her transcripts, an application process through the University of Washington Dentex Program (as detailed in our original pilot application), and an in person interview. She was accepted into the ANTHC DHAT training program and has successfully completed her first year of didactic training. She received a certificate from the University of Washington DENTEX program. She is currently in Bethel, AK completing her clinical year of training. She is also a candidate for an Associates Degree from Ilisagvik College due to the change in affiliation from the UW Dentex program to Ilisagvik College. Naomi will graduate from the program in June of 2016 and will begin her preceptorship in late summer of 2016 with the Confederated Tribes of Coos, Lower Umpqua, and Siuslaw Indians Dental program under the direct supervision of Dr. Sarah Rodgers, DDS. Once she has completed her minimum 400 hour

http://anthc.org/dental-health-aide/

preceptorship (the exact length of the preceptorship is determined by the supervising dentist but may not be less than 400 hours), she will enter into a collaborative practice agreement (or standing orders) with Dr. Rodgers and begin to provide services under the general supervision of Dr. Rodgers.

b. Marissa Gardner: Marissa is an enrolled member of the Confederated Tribes of Coos, Lower Umpqua, and Siuslaw Indians. She was identified by the Tribal Education Counselor she completed the ANTHC application process which included transcripts, a recommendation, an essay and a personal interview in Anchorage with the ANTHC DHAT training instructors. She was also interested in a career in dentistry and was considering a hygiene program. Marissa is in the first year of the training program in Anchorage. We anticipate that she will complete this first year and begin her second year of training in July of 2017 in Bethel. At the end of her training we anticipate she will receive an Associate’s Degree from Ilisagvik College.

c. Jason Mecum is an enrolled member of the Coquille Indian Tribe. He was an Emergency Medical Technician (EMT) when he learned about the participation of the Coquille Indian Tribe in the Oregon Oral Health Pilot Project. He was very interested in training to be a DHAT and completed the ANTHC application process which included transcripts, a recommendation, an essay and a personal interview in Anchorage with the ANTHC DHAT training instructors. Jason is in the first year of the training program in Anchorage. We anticipate that he will complete this first year and begin his second year of training in July of 2017 in Bethel. At the end of his training we anticipate he will receive an Associate’s Degree from Ilisagvik College. Jason is committed to contributing to the health of American Indian/Alaskan Native people in southwestern Oregon. Additionally he is enthusiastic about giving back to the Coquille Indian Tribe by being at the fore front of developing an Oral Health Program for the current and future generations. Jason is an avid health advocate and he enjoys running, fishing, camping and hunting and he looking forward to returning to his ancestral home.

d. Alexandria Jones is an enrolled member of the Coquille Indian Tribe. Prior to entering the DHAT training program in Anchorage, she was an EFDA in Medford, Oregon at Willamette Dental. She was very interested in training to be a DHAT. The dentist she worked with at Willamette was also very excited for her to join the training program and has been a strong mentor for her before and during her training. She completed the ANTHC application process which included transcripts, a recommendation, an essay and a personal interview in Anchorage with the ANTHC DHAT training instructors. She was accepted by the ANTHC DHAT Training program Alexandria is in the first year of the training program in Anchorage. We anticipate that she will complete this first year and begin her second year of training in July of 2017 in Bethel. At the end of her training we anticipate she will receive an Associate’s Degree from Ilisagvik College.

Alexandria spent her youth on the Coquille Indian Tribe reservation in Coos Bay Oregon. She came of age with firsthand knowledge of the challenges to obtaining culturally sensitive, consistent oral health care in her community. Her experience has contributed to Alexandria’s strong sense of commitment to improving access to dental providers, herself, whom are sensitive to the barriers facing tribal people and building a program for her people. Alexandria is also excited to return to her ancestral homelands and give back, in the spirit of Potlach, to her people.

6. Employment/Utilization. At this time all of the trainees are in the didactic/training phase of the project. There are no trainees currently providing services in the State of Oregon.

7. Patient Safety. Trainee Competency. At this time all of the trainees are in the didactic/training phase of the project. There are no trainees currently providing services in the State of Oregon. All trainees are under the direct supervision of their supervising dental instructors.

8. Complaints. At this time all of the trainees are in the didactic/training phase of the project. There are no trainees currently providing services in the State of Oregon. There have been no reported complaints.

9. Adverse Events. At this time all of the trainees are in the didactic/training phase of the project. There are no trainees currently providing services in the State of Oregon. There have been no reported adverse events.

10. Evaluation & Monitoring.

Evaluation & Monitoring Plan: a. NPAIHB Requested an extension on the submission of the final evaluation and

monitoring plan due to circumstances out of our control: i. Feedback from the OHA evaluation team and internal staff was not

delivered until August 11th. The feedback contained significant requests for revision which we then had to take back to the Tribes to discuss if and what changes would be made to the evaluation plan.

ii. Every tribal government has its own process for passing resolutions (similar to state and local governments). The process for Coquille is quite extensive and begins with a legal review and then is scheduled into the

council’s calendar along with all the other business the council has before it. We could not present the final evaluation to the Coquille Indian Tribal Council for resolution to approve the evaluation plan until we received the comments back from OHA and incorporated any changes into the final plan. The Tribal Council is tentatively planning to consider the final draft Evaluation Plan on October 22, 2016.

iii. We have turned requested documents into the Portland Area Institutional Review Board (IRB), however, the process is still not complete in part because of the requirement for tribal resolutions to be passed and submitted to the IRB.

1. Revised Due Date: November, 15, 2016 2. Approved by Oregon Health Authority

b. Concerns raised in the evaluation plan review included how best to measure safety and quality of procedures completed by DHAT. We have addressed those concerns and are confident our revisions meet OHA Pilot Project requirements. Attached is the revised Evaluation Plan for your consideration as we are awaiting approval by Coquille. We will turn in a draft monthly monitoring report template on or before November 15.

11. Financial Status Update. There have been no changes in the financial status of the Dental Pilot Project.

12. Miscellaneous. Program Updates • Candidates for the DHAT Education Program have been selected from each tribe and are all meeting expectations in the program. • Evaluation Plan is under review of IRB and Coquille Indian Tribe and has been revised to reflect concerns raised by OHA. • Dr. Rodgers has completed the first of her DHAT supervision training that included a two day training in Anchorage and Sitka. Prior to the arrival of her first DHAT, she will receive training in Bethel where she will be able to work alongside all the 2nd year DHAT trainees and directly observe their work and learn from the experienced dentist instructors in Bethel how to best guide her DHATs through their preceptorship. • We are still in the process of recruiting an experienced DHAT to provide services in advance of the return of the DHAT trainees. • The ANTHC DHAT Education Program is now affiliated with Ilisagvik, as was reported in our application addendum. Attached is the MOA. Much will be gained by this transfer. Ilisagvik is an accredited college, accredited by the same regional accrediting body, Northwest Commission on Colleges and Universities, as the University of Washington. Students now have access to academic advising, student financial aid and scholarship support and tutoring. Full recognition as a degree granting program means wider participation of the program staff in college committees and activities that will enrich their understanding of post-secondary education. The degree granting status also affords us the opportunity to apply for CODA accreditation, an option that would not be available if the training program had remained with MEDEX as merely a certificate program.

The ANTHC DHAT training program is deep into the process of self-study required for application for CODA Accreditation. This has been a great opportunity for them to take a deep and thorough look at their program, map out how the current curriculum and program compares to the CODA Educational Standards for Dental Therapy, and put in place processes to address any areas that need improvements or modification. We are confident that the ANTHC DHAT training program will meet accreditation requirements. CODA will not begin conferring accreditation until the later part of 2017 at the earliest. Sites Confederated Tribes of Coos, Lower Umpqua, and Siuslaw Indians (CTCLUSI) Dental Cinic located in Coos Bay, Oregon. CTCLUSI currently has a clinic with three chairs, one full time dentist, one part time dentist, one hygienist and two dental assistants. They are in the early stages of a clinic expansion that will grow the clinic from 3 chairs to 5 chairs to accommodate the new DHAT providers. As stated above, Dr. Rodgers, the chief dentist who will be responsible for supervising the two DHAT students from CTCLUSI once they return, has begun her supervising dentist training.

Coquille Indian Tribe located in Coos Bay, Oregon. Coquille currently operates a medical facility with plans to expand to offer oral health services. This work is expected to happen over the next two years while the DHAT students are in training. During that time, the physical space will be constructed (or rented) and the dental program will be built. Coquille will employ a dentist to supervise the two DHAT students from Coquille.

13. Next Steps.

Evaluation & Monitoring Plan Due November 15, 2016

Baseline Data Due November 15, 2016

Next Quarterly Progress Report Due on January 3, 2017

NPAIHB Project Timeline FS2

1

Pilot Site

Year

Timeframe

Activity

Responsible Staff

Completed/Update (Oct 2016)

Confederated Tribes of Coos, Lower Umpqua and Siuslaw Indians = 1

2015

April---June

Recruit DHAT trainee

HHS Director, Continuing Ed counsellor

Completed Two trainees, Naomi Petri (Class of 2017) and Marissa Gardner (Class of 2018) (CTCLUSI)

1

2015

July

DHAT Trainee begins training in AK

Trainee, AK Teaching staff

Completed

1

2015

Oct---Dec

Hire DHAT Coordinator

Tribal Health Director (THD)

Completed September 2016

Coquille Indian Tribe = 2

2015

Oct---Dec


HHS Director, Tribal Health Director (THD)

Completed May 2016

2015

Oct---Dec

Identify researchers to implement monitoring and evaluation plan

(PD) Project Specialist (PS)

Completed – Mekinak signed contract April 2016

1

2015

Oct---Dec

Build Communications Plan/Execute

Coordinator (DC), Other pilot site

Completed – NPAIHB works closely with DHAT coordinator and communications team onsite to amend and execute existing communication plan

1&2

2016

Jan---Jun

Collect Baseline Data (Report baseline data in June)

Researcher, Dental team

Delayed to Oct-Nov 2016

1&2

2016

Jan---Apr

Recruit DHAT trainee from local community,


Completed Two Trainees Jason Mecum and Alexandria Jones (both Class of 2018) (Coquille)

1

2016

Jan---Apr

Start recruiting process for experienced DHAT


Ongoing, Candidates identified, interviews completed, in negotiation

1&2 2016 May Trainees begins prerequisites for DHAT training program in AK (in OR) Trainee Completed


2

1

2016

June

Train supervising dentist, Hygienist and dental support staff

AK Teaching staff, DHAT, Supervising Dentist (SD), Hygienist (Hyg), Dental Support Staff (DSS)

Ongoing, first level of dental team training completed May 2016 (Dentist + Hygienist) Next level of supervising dentist training to be completed Nov 2016 Dental support staff (scheduling) training timing TBD (dependent on hiring of experienced DHAT or arrival of first trainee DHAT)

1 2016 Jun---Jul Experienced DHAT arrives and begins community education campaign DHAT TBD – likely early 2017 1&2

2016

July

DHAT Trainees begins training in AK

AK Teaching Staff, Trainee

Completed

1 2016 Jul---Aug Experienced DHAT begins providing services DHAT TBD – Likely early 2017 3 2016 September Learning tour to Alaska for potential 3rd site THD, Dentist,

NPAIHB Staff Completed

3

2016

Aug---Dec


HHS Director, THD, THR

Third site TBD – likely early 2017

2

2016

Oct---Dec


PS, DC, Other pilot site staff

Completed – NPAIHB works closely with DHAT coordinator and communications team onsite to amend and execute existing communication plan

All Pilot Sites

2016

Oct---Dec

Annual Assessment (Report to OHA in December)

Researcher, PD, DC, Other Pilot Site Staff, Dental team

Delayed – first report of baseline data due November 2016

1 2017 Jan---Dec Experienced DHAT providing services with dental team DHAT

All Pilot Sites

2017

Jan---Apr

Updated – Funding agreement between tribe and IHS amended to allow for reimbursement of services provided by DHAT to be eligible for reimbursement. Work with OHA on mechanism for DHAT Medicaid reimbursement – answer question – private insurance billing?

PD, PA, THD, other pilot site staff + OHA Tribal liaison and staff


3

2 & 3 (TBD)

2017

Jan---Apr

Recruit DHAT trainee from local community


Site 2 - Complete

2

2017

Jan---Apr

Start recruiting process for AK DHAT


Delayed – Site 2 construction through 2017

All Pilot Sites 2017 May Updated – continue work with OHA on DHAT billing PD + OHA 2 & 3 2017 May Trainees begins prerequisites for DHAT training program in AK (in OR) Trainee

2

2017

June


AK Teaching staff, DHAT, SD, Hyg, DSS


2

2017

June---July

Experienced DHAT arrives at pilot site 2 and begins community education campaign

DHAT


2&3

2017

July



2 2017 July---Aug Experienced DHAT begins providing services DHAT Delayed – Site 2 construction through 2017

4

2017

Aug---Dec



1

2017

Sept

DHAT trainee returns to begin preceptorship with supervising dentist

DHAT, Supervising Dentist

3

2017

Oct---Dec


PS, DC, Other pilot site staff

NPAIHB

2017

Oct---Dec

Apply for continued funding from existing funders

PD, PS, Project Analyst (PA), DC

All Pilot Sites

2017

Oct---Dec



NPAIHB

2018

Jan---Mar

Pilot Project Assesment --- Where are the projects, where are we on the plan, do we need to make any changes, future planning for years 2---5

PD, PS, PA, DC, Pilot Site Staff

1 & 2 2018 Jan---Dec Experienced DHAT providing services with dental team DHAT NPAIHB 2018 Jan---Dec Begin work to create a DHAT Training program in Oregon PD, PA, PS, DC

3

2018

Jan---Apr

Updated – Funding agreement between tribe and IHS amended to allow for reimbursement of services provided by DHAT to be eligible for reimbursement.

PD, PA, THD, other pilot site staff,


4

3 & 4 (TBD)

2018

Jan---Apr



3

2018

Jan---Apr

Start recruiting process for AK DHAT to come to


3 2018 May Updated – continue work with OHA on DHAT billing if necessary Pilot site staff 3&4 2018 May Trainees begins prerequisites for DHAT training program in AK (in OR) Trainee

3

2018



3 2018 June---July Experienced DHAT arrives and begins community education campaign DHAT 3&4

2018

July



3 2018 July---Aug Experienced DHAT begins providing services DHAT

5

2018 Aug---Dec



1 & 2

2018

Sept

DHAT trainees return to begin preceptorship with supervising dentist


4

2018

Oct---Dec


PS, PA, DC, Other pilot site staff

All Pilot Sites

2018

Oct---Dec



1 2019 January Contract with Experienced DHAT expires 2 & 3 2019 Jan---Dec Experienced DHAT providing services with dental team DHAT

4

2019

Jan---Apr


PD, PA, THD, other pilot site staff

4&5 (TBD)

2019

Jan---Apr



4

2019

Jan---Apr

Start recruiting process for AK DHAT (UPDATED - likely to use existing DHAT already in Oregon)


NPAIHB 2019 Jan---Dec Continue work to create a DHAT training program in Oregon PD, PA, PS, DC


5

4 2019 May Updated – continue work with OHA on DHAT billing if necessary Pilot site staff 4&5 2019 May Trainees begins prerequisites for DHAT training program in AK (in OR) Trainee

4

2019

June



NPAIHB

2019

June

Pilot Project Assesment --- Will we continue to add pilot sites after 2020, Where are the projects, where are we on the plan, do we need to make any changes, future planning for years 2---5

4 2019 June---July Experienced DHAT arrives and begins community education campaign DHAT 4&5

2019

July



4 2019 July---Aug Experienced DHAT begins providing services DHAT 2&3

2019

Sept--- DHAT



4

2019

Oct---Dec


PS, PA, DC, Other pilot site staff

All Pilot Sites

2019

Oct---Dec



2 2020 January Contract with Experienced DHAT expires 3&4 2020 Jan---Dec Experienced DHAT providing services with dental team DHAT NPAIHB

2020

Jan---Jun

Next 5 years of Pilot Project Planning, Pilot Project Assessment --- Where are the projects, where are we on the plan, do we need to make any changes, future planning for years 5 and beyond

PD, PS, PA, DC, Pilot Site Staff

5

2020

Jan---Apr


PD, PA, THD, other pilot site staff

5

Jan---Apr



5

2020

Jan---Apr

Start recruiting process for AK DHAT (UPDATED - likely to use existing DHAT already in Oregon)


5 2020 May Updated – continue work with OHA on DHAT billing if necessary Pilot site staff 5 May Trainees begins prerequisites for DHAT training program in AK (in OR) Trainee


6

5

2020

June



5 2020 June---July Experienced DHAT arrives and begins community education campaign DHAT

5

2020 July



5 2020 July---Aug Experienced DHAT begins providing services DHAT 3&4

2020

Sept--- DHAT



All Pilot Sites

2020

Oct---Dec



Documents

State of Oregon : Oregon.gov Home Page : State of Oregon ......2017 in Bethel. At the end of his training we anticipate he will receive an Associate’s Degree from Ilisagvik College