Benefits and Challenges
Valerie A. Fatta, LMSW, University at Buffalo Clarener Moultrie, MSW, Columbia University Heather Marks, MSW, University of Washington
Facilitated Insurance Enrollment
Financial Literacy & Education
Transportation
Caregiving Resources
Health/Mental Health Referrals
Other Accommodations
By Retaining Patients We Increase Clinic Revenues
Interprofessional
Education
Dental Students Identifying and removing barriers to care for patients Improved
understanding of available resources
Communication and
behavior management
Social Work Students
Understanding the importance of Oral Health Care Assessment Advocacy Linking patients to appropriate resources
Multidisciplinary Teams
Evaluation and Assessment
Chair-side if needed Pilot Programs/Projects Research Community Outreach
Interprofessional
Practice
TMD Smoking Cessation Substance Use Nutrition Oral Hygiene HIV Screening Dental AnxietyBehavioral Needs
Research Opportunities
Educational Student perspectives Interdisciplinary education Clinical Interprofessional practice Attitudes Outcomes Dental Journals Social Work Journals
Conferences Others?
Team Approach To
Crisis Management
Child Welfare Domestic Violence Suicide Elder Abuse Prescription Drug Abuse Consent to treatmentPatient
Dental
Provider
Social
Worker
Establishing Need
To hire a social work for your clinic takes
capital (salary, supplies, etc). It would be
difficult to justify this expense without
evidence that this is a needed service which will improve your
clinic.
Surveys distributed in the clinic/waiting
rooms can help
determine the needs of your local population, and if there would be an interest in social work services.
Students can distribute the survey as part of research course work.
Finding Funding
Once need is
established, finding the funding to support this might be another
barrier.
Keep in mind your social worker or team will need office space and supplies.
Grants
University at Buffalo – Office of the Dean
University of
Washington –ABCD – Access to Baby and Child Dentistry – funding from state
Hiring Social Work Staff
Many dental educators and dental school
administrators have never had the need to hire a social worker
before. Knowing what to look for and who to hire can be challenging.
What are realistic expectations of the social worker hired?
Determine your school’s specific needs/wants
Partner with a School of Social Work if possible
Resources: NASW State’s Office of Professions United States Department of Labor, Bureau of Labor and Statistics
Education of Providers
Social workers are still new to the dental team.
Dental providers need to be educated on how to utilize social workers in the dental setting
Social workers need
education on dental terminology and oral health care.
Orientations
Courses
Clinic News Letters Meetings (Lunch and
Learns)
Brochures/Websites/ Information
Lack of Support
Emerging and small programs need
Champions who can assist in the program development and
provide support for continuation of the program
Can faculty and
administrators (both dental and social work) be identified who have passion for community access to care that are willing to take on a project
Program advisory boards
Record Keeping
How will the social work
team keep records?
Will they be separate
from the dental records?
Where will they be stored?
What assessment tools will be used?
Consent forms?
Each program/team will need to decide what is best for them
HIPAA laws
Shared information Electronic Records
Program Limitations
Case Loads? Hours? Treatment limitations? Intern limitations? Projects? How many patients do you expect
your social workers to assist at one time?
When should they be available to students/patients?
Is there any treatment limitations
determined by your school or state?
If you plan to have interns, what will their limitations be?
Will there be a limit to the amount of projects you have your social workers take on? Minimum requirement?
History of The CARES
Program
The University at Buffalo A top down initiative
Need at the School of Dental Medicine to retain patients
Students losing clinic time to no-shows and cancellations, discharges
Need at the School of Social Work for field placements
Students must complete two internships prior to graduation
Community driven mindset
Interested Faculty
Grant from Community Foundation of Buffalo
$30,000
Paid for waiting room survey, and part time social worker
One year duration
After grant competition, SDM saw continued need, adopted CARES Program as part of the Office of the Dean
Results showed the strongest need was Medical
928 patients were administered a two page survey in SDM waiting rooms. Ranked concerns:
Health problems (32%) Financial problems (25%) Medical bills (16%) Family problems (14%) End of life (12%) Living will (11%)
Transportation (11%) Housing (9%) Health care proxy (8%) Caregiving (5%)
Power of attorney (4%) Raising a grandchild (3%) Other concerns (2%)
Based on current referrals strongest need is financial
2011-2012 showed 67% of referrals for financial assistance
Waiting Room Survey
At first, the social work utilized the surveys to contact patients and set up a client base
Dental Students began to bring patients to meet with the social worker
Referrals now come only from Dental Students, faculty, staff and word of mouth
Last year, the CARES Program received 288 patient referrals
Staffing
Started with 1 part time social worker
Currently 2 full time
social workers, hiring one part time & 5
interns
Another social worker
is being hired by Oral Bio to work with TMD
Grants to expand One part time social worker One full time social worker plus 7 interns Two full time social workers plus 4 interns Two full time social workers, one part time, 5 interns
Social workers are available during clinic hours to
provide consolation and assistance to dental students
This past semester social workers have assisted
patients with domestic violence concerns (1), suicidal ideation (2), and consent to treatment concerns (2)
CARES Staff is currently teaching a section of a clinic rotation course for sophomores
CARES Interns and Staff interact with dental students on a regular basis to consult about
treatment needs and best practices for patient care
Interprofessional
Awards
American Dental Association – Geriatric Oral Health Award
American Dental Education Association – Dr. Henrie Treadwell Dental Award
Partner of the Year Award – Partners for Prevention Cancer Screening Services of Erie County
Invited Presentations
ADEA Conferences, CSWE Conferences, SUNY Upstate Medical University, University at Buffalo, Buffalo State College, Community Agencies
Grants
Community Foundation of Greater Buffalo - $33,000
Dental Trade Alliance - $25,000
Josephine Goodyear Grant - $5,000
New York State Dental Foundation - $7,000
Health Foundation of Western New York – Grant to 8th District Dental Society Shared with
CARES Program - $7,500
Publications (5 total) Social Work in Health Care
Journal of Dental Education
Gerontology and Geriatrics Education
Accomplishments
Collaboration between the schools has brought positive attention to UB
“I had a patient who had some emotional problems that I felt I was unprepared to deal with on my own and the CARES program was really helpful with this matter. They took over the situation but still let me be involved and I learned a lot from it. “
One student indicated that the school was doing much better in integrating the behavioral sciences
into the clinic, “especially with the CARES program. There are kinks in it, but it’s very necessary and
important.”
“CARES is a good idea.”
“I think it’s a nice program if it comes up in your patient family. It was nice that they came down to check every week to see if you need anything.“
“It’s one of the best things here- keeps patients here.”
“…just the fact that we have the program and I can tell the patients that we have this program to help them with any (problems) is wonderful. It’s a good program to have to refer people to. Personally, I think I didn’t really utilize it fully but it’s great to have it.”
Network of Social Work in Dentistry
Grants in progress to fund idea
TMD Program
Research Opportunities
Assistance in the Development of New Programs
Consultation Services
Other Grant Opportunities
History of Social Work
in the Center for
Pediatric Dentistry
The University of Washington pediatric dental residency program is committed to treating underserved populations including
Medicaid-insured patients with complex health challenges who may have obstacles to obtaining dental care from
more conventional practices as noted in the
Washington State’s Oral Health Workforce 2009 Final Report.
UW Pediatric Dentistry focus on underserved
Long-standing pediatric residency program
1979: Chair Dr. Pete Domoto denied funding for social worker in pediatric dentistry
2003-7: Part-time MSW student joins staff as Pedo alumni newsletter editor
MSW student researches ABCD & EPSDT = pedo patient profile
2007: “Co-existent concerns” supports need for UW social work position in pediatric dentistry
2007: Oral Health for Vulnerable Children: An Integrated
Approach
GHC grant funds pediatric dentistry social worker project
2008-Current: Access to Baby & Child Dentistry (ABCD) contract with State of Washington Medicaid program funds one social worker position
Medicaid patient enrollment assistance
Medicaid patient transportation assistance
2012: Added Social Work assistant (half time)
Funded by Floyd & Delores Jones Foundation
Funding
Pew’s recent report on the Children’s Dental Campaign showed “80 percent of dental disease in children is
concentrated in 25 percent of kids and children from poor families face disproportionately high barriers to getting care.”
The report continues that we “need to ensure that
Medicaid and the Children’s Health Insurance Program – the programs that serve low-income children – work better for kids and for providers so that insurance
coverage translates into real access to needed care.”
From the Pacific to the Palouse
Patients from 30 of 39 counties in Washington
35 of 39 counties lacked sufficient dentists for population*
*Pew Center on the States
Social work focus is overcoming barriers to care for pediatric patients
Patient population almost 80% low-income
Patients from 30 of 39 counties in Washington Major barriers to dental care for pediatric patients
Children uninsured or underinsured
Families lack transportation to appointments
Social work is integral to oral health care delivery team and contributes to the triple bottom lines of:
Patient access to care - extending oral health care to more children in the service area by overcoming barriers to care, identifying red flags and responding to the overall
situations of patients in their environment.
Improved departmental reimbursement through Medicaid enrollment and the Domoto Fund financial assistance.
Faculty and staff satisfaction from smoother interactions and better outcomes (no-shows, cultural and language barriers, mistrust of dentistry by patients and their
parent/caregivers, etc.).
History of Social Work
at Columbia
Valerie A. Fatta, LMSW University at Buffalo (716) 829-2698
