Issues, Strategies, and Infrastructure Development


CRITICAL PROBLEM AREA
Education
Prioritized Issues / Problems
Top three issues / problems in order of priority:
Enhance and legitimize public health education at pre-license level including need to teach about determinants of health, increased awareness of disparities in society, and public health leadership to create change; advocacy of leadership for change as part of academic culture.
Incorporate and implement cross-training and understanding with common theories and language which will facilitate better communication and cross-fertilization among health professionals leading to integration of oral health into health professionals education and curriculum (all disciplines).
Need to develop continuing education to enhance dental hygiene scope of practice including at certificate level training in public health.

Others receiving votes
Professionals in-training work more in community as part of education
Prepare lay health workers in prevention at certificate level
Access to all kinds of education at remote and rural sites
Scope of practice issues
Teach best practices related to community services
Access to continuing education (CE) for lay health workers and professionals

Critical Problem Area Education
Issue/Problem A Enhance and legitimize oral health as a component of public health education at the pre-licensure level for all health professionals* in-training.
Strategy 1 • Identify core competencies with respect to oral health for various health professions
• Provide leadership to change accreditation standards.
Short Term Actions < 2.5 years

CORE COMPETENCIES
• Advisory group to oversee core competency
• Assessment of current oral health curriculum in each health profession school
• Individual health disciplines to identify core competencies
• Organize coalition of representatives from Texas professional schools to identify commonalities and gaps
• Identify opportunities for inter-disciplinary education in oral health

LEADERSHIP
• Advisory group for accreditation process
• Develop plan for proactively changing accreditation standards of various health professions

Infrastructure Issues
1) Identify organizations or agencies that need to be involved. • Health professional schools
• Health professional accreditation organizations
• Health professional licensing boards
• Health Professional Examination Boards (e.g. Joint Commission on National Dental Examinations)t
2) Identify resource needs [people, space, equipment new funding or reallocation of funds.]

3) Identify possible means of meeting potential resource needs.
RESOURCE NEEDS
• Visionary leader/consultant
• Consensus conferences
• Awareness raising
• Funding opportunities through Centers for Disease Control and Prevention (CDC), American Dental Education Association (ADEA), Health Resources and Services Administration (HRSA), and foundations
• Project director and support staff
• Coordination of meetings with travel

MEANS OF MEETING RESOURCE NEEDS
• Tobacco funds
• Innovation grants (Texas Department of Health-TDH)
• Private foundations
• Federal/state resources
Long- Term Actions > 2.5 years
  Long-term actions not specified.
Infrastructure Issues  
1) Identify organizations or agencies that need to be involved. National professional organizations/ boards/accrediting bodies
2) Identify resource needs [people, space, equipment new funding or reallocation of funds.]

3) Identify possible means of meeting potential resource needs.
RESOURCE NEEDS
• Visionary leader/consultant
• Consensus conferences
• National leadership
• Development of model for Texas that can be replicated in other states
• Disseminate model to education institutions for health professionals in Texas

MEANS OF MEETING RESOURCE NEEDS
• Request for Proposals (RFP)
• Collaborative commitment from stakeholders
• Grants
• Legislative process

Critical Problem Area Education
Issue/Problem B Incorporate and implement cross-training and understanding of common theories and language which will facilitate better communication and cross-fertilization among health care professionals leading to integration of oral health into health professions education (all disciplines).
Strategy 2 • Institutional curriculum mapping
• Consolidate curriculum where overlap exists
• Administrative “buy-in”
• Eliminate administrative barriers such as modification of capitation formula
• Cross disciplinary clinical training “train in teams who work in teams”
• Develop and disseminate model
• Ensure that oral health is included in overall health policy, education, and funding
Short Term Actions < 2.5 years Work group indicated insufficient time to define infrastructure issues for short-term actions.
Infrastructure Issues
Long- Term Actions > 2.5 years Work group indicated insufficient time to define infrastructure issues for long-term actions.
Infrastructure Issues  

Critical Problem Area Education
Issue/Problem B Incorporate and implement cross-training and understanding of common theories and language which will facilitate better communication and cross-fertilization among health care professionals leading to integration of oral health into health professions education (all disciplines).
Strategy 2 • Institutional curriculum mapping
• Consolidate curriculum where overlap exists
• Administrative “buy-in”
• Eliminate administrative barriers such as modification of capitation formula
• Cross disciplinary clinical training “train in teams who work in teams”
• Develop and disseminate model
• Ensure that oral health is included in overall health policy, education, and funding
Short Term Actions < 2.5 years Work group indicated insufficient time to define infrastructure issues for short-term actions.
Infrastructure Issues
Long- Term Actions > 2.5 years Work group indicated insufficient time to define infrastructure issues for long-term actions.
Infrastructure Issues  

Critical Problem Area Education
Issue/Problem C Need to develop continuing education that will enhance dental hygiene scope of practice including certificate level training in public health.
Strategy 3 • Develop alliances with advocacy groups in support of issue
• Conduct and disseminate research showing need
• Identify and disseminate successful state models (e.g. Oregon)
• Learn from nurse practitioner effort
• Acquire support of Texas State Board of Dental Examiners (TSBDE)
• Non-threatening marketing utilizing focus group(s)
• Assessment of skills needed to address disparity
Short Term Actions < 2.5 years  
  1. Assess disparities and skills needed and role of oral health professional to address and disseminate to potential allies
2. Investigate successful models in other states; study lessons learned from nurse practitioner efforts
3. Identify interested parties and groups
4. Convene meeting to identify next steps; which groups to involve; target specific functions
5. Develop educators planning committee
6. Committee assesses existing courses and develops proposal including “model” for educational program, mock exam, and outcome measures
7. Seek/secure funding for start-up and pilot of program
Infrastructure Issues
1) Identify organizations or agencies that need to be involved. Advisory group/steering committee with operational funds and staff
support
2) Identify resource needs [people, space, equipment new funding or reallocation of funds.]

3) Identify possible means of meeting potential resource needs.
RESOURCES
Core project team
Funding
Data collection and analysis
RFP (contract) by state/local coalition

MEANS OF MEETING RESOURCE NEEDS
Federal/state/foundation funding resources
Long- Term Actions > 2.5 years  
  1. Present to Texas Dental Association; Determine political exchange
2. Present to Texas State Board of Dental Examiners for approval (determine if rule or statute change)
3. Present to Texas Higher Education Coordinating Board for approval, review cycle, and forwarding
4. Implement and evaluate
Infrastructure Issues  
1) Identify organizations or agencies that need to be involved. Texas Dental Association
Texas State Board of Dental Examiners
Texas Higher Education Coordinating Board
2) Identify resource needs [people, space, equipment new funding or reallocation of funds.]

3) Identify possible means of meeting potential resource needs.
RESOURCES
Meeting, travel, operational expenses

MEANS OF MEETING RESOURCE NEEDS
Identify source of long-term funding

CRITICAL PROBLEM AREA
Legislation and Public Policy
Prioritized Issues / Problems
Top three issues / problems in order of priority:
A. Low Medicaid/CHIP reimbursement impact on number of participating providers.
B. Current scope of practice - need for expanded functions and mid-level providers.
C. Recruitment to dental professions tied to minimal loan repayment programs, lack of career ladder programs and opportunity for expanded roles.

Others receiving votes
Minimal coverage for non-citizens
Enrollment barriers related to Welfare Reform information
Lack of educational efforts on prevention to adults, elderly and employers
Lack of evidence-based practice guidelines
Dental workforce not keeping pace with population growth

CRITICAL PROBLEM AREA
Community-Based Actions
Prioritized Issues / Problems
Top three issues / problems in order of priority:
A. Lack of networking system among coalitions and public/private partners.
B. Need for more community development coalitions/collaborations.
C. Lack of local public health infrastructure.

Others receiving votes
Lack of support for empowering communities for mobilizing partnerships for supporting oral health initiatives
No centralized agencies to coordinate communication and community effort
Lack of network for coalitions/advocacy groups across local, state and national levels
Lack of local "expert" leaders/advocates to represent oral health issues within coalitions
Lack of incentives to be advocates
Lack of education/knowledge base of oral health care in existing coalitions
Lack of awareness of importance of oral health issues among other health care providers
Lack of effective communication between local political action organizations and state legislators
Lack of health education/advocacy coalitions

Critical Problem Area Community-Based Action
Issue/Problem A Lack of network among coalitions and public/private partners
Strategy 1 Development of public health infrastructure
Short Term Actions < 2.5 years

• Formulate a “Call to Action”
• Develop strategic planning process with stakeholders: Mission, purpose, objectives, needs
• Identify/establish coordinating body
• Identify leaders

Infrastructure Issues
1) Identify organizations or agencies that need to be involved. • Schools of public health
• Texas Department of Health (TDH) Oral Health Program
• Dental schools/dental hygiene programs
• Texas Association of Community Health Centers (TACHC)
• Texas Association of Local Health Officials (TALHO)
• Texas Dental Association (TDA)
• Texas Dental Hygienists’ Association (TDHA)
• Southwest Society of Pediatric Dentistry
• Texas State Board of Dental Examiners (TSBDE)
2) Identify resource needs [people, space, equipment new funding or reallocation of funds.]

3) Identify possible means of meeting potential resource needs.
RESOURCE NEEDS
• Leadership
• Facility and staff
• Needs assessment resources

MEANS OF MEETING RESOURCE NEEDS
• Faculty from this and other conferences
• ASTDD report: Review of the Texas Oral Health Program
• TDH Statewideness Report
• Medicaid Program and National Heritage Insurance Corp (NHIC)
• United Way
• Statewide Health Coordinating Council
• Centers for Disease Control and Prevention (CDC)
• Maternal Child Health Bureau (MCHB) Community Integrated Service System (CISS)
Long- Term Actions > 2.5 years
• Hold regional and statewide summit meetings to focus attention on oral health issues and solutions
• Demonstrate effectiveness in changing policies
• State develops policies to meet local needs
Infrastructure Issues Work group indicated insufficient time to define infrastructure issues for these long-term actions.


Critical Problem Area Community-Based Action
Issue/Problem B Need for community development coalitions and/or collaborations
Strategy 2 Identify/activate leadership in local community (developing awareness of problem)
Short Term Actions < 2.5 years

• Develop process for technical support
• Develop community selection mechanism
• Develop process for identifying support from political action groups

Infrastructure Issues
1) Identify organizations or agencies that need to be involved. 1.Local health departments and boards of health
2. Educational institutions
3. Local dental schools
4. Dental hygiene programs
5. Schools of public health
6. Local universities
7. Representatives from local ISDs
8. Local dental/medical/nursing organizations
9. Interfaith community
10. Faith based hospitals and councils
11. Hospital organizations and health systems
12. Public health/Non-profit clinics and community health centers
13. Civic and philanthropic groups and community organizations
14. Local business/industry leaders
15. Health insurance companies
2) Identify resource needs [people, space, equipment new funding or reallocation of funds.]

3) Identify possible means of meeting potential resource needs.
RESOURCE NEEDS
Entity that will issue "Call to Action" for coalition building

MEANS OF MEETING RESOURCE NEEDS
• TDH Regional dental directors and TDH central office
• Grant process (e.g. “Community Voices”)
• Foundations
• Faith based hospitals
• Primary care organizations
• Rural Health Associations
• Oral Health America Fund
• Universities
Long- Term Actions > 2.5 years
Develop models in selected community for replications
Infrastructure Issues Work group indicated insufficient time to define infrastructure issues for the long-term actions.

Critical Problem Area Community-Based Action
Issue/Problem A Low Medicaid/CHIP reimbursement impact on number of participating providers.
Strategy 1 Build community awareness of the need for increased reimbursement.
Short Term Actions < 2.5 years

PILOT PROJECTS
• Enhanced reimbursement rates
• Focus on children birth - 6 years of age
• Focus on elderly/institutional
• Outcome based reimbursement
• Best practices, standards of practice

Develop/build public awareness of CHIP/Medicaid outreach

* Report to Legislature on Fraud Prevention
* Expand coalition: Texas Silver Haired Legislature
* Develop proposal to change resource development (taxes)

Infrastructure Issues Pilot Projects
1) Identify organizations or agencies that need to be involved. Health and Human Services Commission (HHSC), Texas Department of Health (TDH), Department of Aging, Texas Dental Association, Texas Dental Hygienists’ Association, Texas Association of Community Health Centers, CHIP Coalition,
Legislative Staff: Gray, Maxey, Moncrief, Naishtat
2) Identify resource needs [people, space, equipment new funding or reallocation of funds.]

3) Identify possible means of meeting potential resource needs.
RESOURCE NEEDS
I. Funding
• Reallocate funding to State agencies
• Grants/Foundation Support
• In kind resources - e.g., TDA
II. Leadership
• Organization/Oversight Pilot Dependent
• State/Agency/Community/Professional Associations
• State Legislative Champion
• Stakeholder buy in
III. Documentation/data collection, analysis/reporting
IV. Technical Assistance
• Geriatrics Resources and Education Centers (GRECs)
• American Academy of Pediatric Dentistry (AAPD)
• American Association of Public Health Dentistry (AAPHD)
• American Association of State and Territorial Dental Directors (ASTDD))
Infrastructure Issues Public Awareness of CHIP / Medicaid Outreach
1) Identify organizations or agencies that need to be involved.
Coalitions (e.g. CHIP Coalition)
Media
Organized Labor
Chambers of Commerce
State/local elected officials
Councils of Government
School Districts/PTA
State Health & Human Service Officials
2) Identify resource needs [people, space, equipment new funding or reallocation of funds.]

3) Identify possible means of meeting potential resource needs.
RESOURCE NEEDS
• Consultation Professional Services
Infrastructure Issues * Work group indicated insufficient time to define infrastructure issues for the short-term actions marked with an asterisk*.
Long- Term Actions > 2.5 years
• Include dental issues in Health and Human Service Commission (HHSC) agenda development
• Increase Federal match
• Leveraging local funds
• Revision of tax methodology
• Resolve FREW lawsuits
Infrastructure Issues Work group indicated insufficient time to define infrastructure issues for these long-term actions.