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CENTER FOR PREVENTION AND HEALTH PROMOTIONOral Health ProgramKate Brown, Governor800 NE Oregon St, Ste 370Portland, Oregon 97232-2186Office: 971-673-1563Fax: 971-673-0231healthoregon.org/dppOregon Health AuthorityDental Pilot Project ProgramDental Pilot Project: #100AbstractOregon Tribes Dental Health Aide Therapist Pilot ProjectJanuary 2, 2021Applicant/Sponsor:Training Supervisor:Northwest Portland Area Indian Health Board2121 SW Broadway, Portland, Oregon 97201Christina Peters, Northwest Portland AreaIndian Health BoardMary Williard, DDSSponsor Type:Community Hospital or ClinicProject Director:Northwest Portland Area Indian Health Board is a non-profit tribal organization establishedunder the Indian Self-Determination and Education Assistance Act (P.L. 93-638) and serves allforty-three federally recognized tribes of Oregon, Washington, and Idaho. NPAIHB representsindividual tribes which have local community health clinics serving their tribal populations.There are currently 9 tribes operating clinics and/or providing direct medical and/or dentalservices in the State of Oregon.Purpose: Approved Project Period:Develops new categories of dentalhealth care personnel.Teach new oral health care roles topreviously untrained individuals6/1/2016-5/31/2022

Number of Sites:Site Locations:Training/Didactic Phase:Utilization Phase:Number of Trainees:Number of Supervisors:Number of Collaborating Dentists:Number of Sites:3Alaska Native Tribal Health ConsortiumDental Health Aide Training ProgramAnchorage, Alaska: Year OneBethel, Alaska:Year Two Confederated Tribes of Coos, LowerUmpqua & Siuslaw Indians: CTCLUSIDental Clinic Coquille Indian Tribe: Coquille IndianTribal Community Health Center(CITCHC) Native American RehabilitationAssociation (NARA)5-7293Application Chronology:Application Submitted:Application Approved for Completeness:Application Received by Technical Review Board:TRB Application Review Comments Due:TRB Board Meeting:Addendum to Application Received by Dental PilotProject Program:Addendum Received by Technical Review Board:Applicants Notified of Intent to Approve Application:Application Under 10 Day Period of Public Comment:MOA Received: Project Site CoquilleProject Approved by DirectorOregon Board of Dentistry Notified of Approval StatusOctober 6, 2015October 19, 2015October 19, 2015November 20, 2015December 10, 2015January 7, 2016January 7, 2016January 8, 2016January 11, 2016 –January 22, 2016February 5, 2016February 8, 2016February 8, 2016

Estimated Cost and Funding Source(s):Estimated Cost:Funding Source(s) Committed:Total Committed: 544,600 (First Two Years) W.K.Kellogg Foundation Pew Charitable Trusts Northwest Portland Area Indian HealthBoard Confederated Tribes of Coos, LowerUmpqua & Siuslaw Indians Coquille Indian Tribe 2,509,460Background and History of the Project:Selected Passages from the DPP #100 ApplicationNeed for the Project:Native communities are struggling under the weight of devastating oral health disparities andare searching for innovative solutions to address the unique barriers that keep oral health careout of reach for many of their members. Data presented in the Oral Health of AI/AN PreschoolChildren 2014 IHS Survey includes: Prevalence of tooth decay in AI/AN children ages 2 to 5 is nearly three times that ofwhite children in the U.S. By the age of 5, 75% of AI/AN children have a history of tooth decay. More than 40% of AI/AN children ages 3-5 have untreated tooth decay compared to14% in the general population.Description of patients:Patients at the first two pilot sites will be primarily American Indian/Alaska Natives (AI/AN) butalso includes spouses and employees of those tribes. Patients may include a limited number ofgeneral public patients. A large majority of patients are low-income and many have noinsurance at all. For most of these patients, the tribal dental clinic is the only access they haveto oral health care.Purpose of the Project:The purpose of the Tribal Dental Health Aide Therapist Project (TDHATP) is to develop a newcategory of dental personnel in Oregon and teach new oral health care roles to previouslyuntrained individuals. NPAIHB will be utilizing the very successful Alaska Dental Health AideTherapist (DHAT) program that has been providing services in Alaska for the last 11 years.The Alaska DHAT program is modeled off the international model of dental nurses that havebeen providing oral health services in nearly 100 countries around the world. Thismodernization of the dental team has put DHATs on the frontlines in Alaska, wiping out decayand improving overall oral health in previously underserved tribal communities. We believe thatthose outcomes can be replicated in Oregon with the addition of a DHAT to the dental team atour pilot sites.

Project Description:Select tribal communities in Oregon will send trainees to the DHAT program in Alaska to trainas Dental Health Aide Therapists (DHAT). While these trainees are receiving their education (2years), the tribal health directors and tribal leaders will work closely NPAIHB to create thenecessary regulatory structure, train dentists to be DHAT supervisors, and do education andoutreach to the community about the new provider.The DHAT program is an existing decade-old program in Alaska that provides an evidencebased and competency based curriculum. Skills are based on those required to be certified asa Dental Health Aide Therapist under the Alaska CHAP standards and procedures 2.30.200.One year prior to the graduation of the trainees, an experienced DHAT will come to the pilotsite to begin offering services alongside the supervising dentist. When the DHAT traineereturns to his or her tribe to complete a minimum 400-hour preceptorship with the supervisingdentist, the experienced DHAT will continue to serve the community and work as part of thedental team. After the trainee has completed the preceptorship, the experienced DHAT, thesupervising dentist, and the newly trained DHAT will work together for at least one year. Weintend in the first 3 years of the pilot project to educate a total of 5-7 DHAT trainees in up to 4pilot sites and to have experienced DHATs working in each site during the training period oftheDHAT trainees. As part of our yearly evaluation of the program, in year 3 we will evaluate theprogram with our pilot sites and make decisions at that point about whether or not we will addadditional sites and trainees.Project Objectives:Short-Term Objectives: Long-Term Objectives: Increase the efficiency of the dentalclinic and dental team;Increase the ability of tribal healthprograms to meet unmet need;Increase provider job satisfaction andpatient satisfaction.Increase the number of Nativeproviders serving Native communities;Increase patient education at thecommunity level;Increase treatment of decay anddecrease decay rates in pilotpopulations;Improve overall understanding of oralhealth in relation to overall health, and:Improve oral care behaviors in pilotcommunities.

Laws and Regulations Pertinent to theProposed Project:Current dental practice laws in Oregon do notallow our trainees to provide the oral healthservices that are within the scope of theDHAT as utilized in Alaska. The category forthis provider does not exist and there is noexisting state licensing structure in Oregon toallow for DHATs to practice outside of theDental Pilot Project as authorized by SB 738. Chapter 679o 679.010 – Definitions – DHAT categorydoesn’t exist Definition of Dentistryo 679.020 (1)- practice of dentistryo 679.025 (1) – License required to practicedentistry

Addendum to Application Received by Dental Pilot Project Program: January 7, 2016 . Addendum Received by Technical Review Board: January 7, 2016 . Applicants Notified of Intent to Approve Application: January 8, 2016 . Application Under 10 Day Period of Public Comment: January 11, 2016 - January 22, 2016 . MOA Received: Project Site Coquille