The East Carolina University (ECU) School of Dental Medicine has received a $3.1 million grant from the Health Resources and Services Administration (HRSA) to enhance resident training in the care of patients with special needs in eastern North Carolina and across the state.
One of the largest in the school’s history, the five-year grant will focus on improving dental care for pediatric and elderly patients as well as those with mobility issues and other complex health problems and those with mental, emotional, and behavioral challenges.
“This grant highlights our mission and strong community partnerships,” said Dr. Greg Chadwick, dean of the School of Dental Medicine. “It positions our residents and future dentists to work in rural communities and learn to engage and respond to patients’ complex health challenges.”
The project, “ECU Leadership Training in Special Needs Population Oral Health Care,” will address three goals: assessing and treating the needs of vulnerable populations, expanding pediatric dentistry training to a rural location, and developing tools and training for population health management.
“This project is intended to take dentists who have basic knowledge and skills in treating special populations and expand on these so that they are able to be leaders in the care of these patients,” said Dr. Michael Webb, principal investigator and chair of the school’s Department of Pediatric Dentistry and Orthodontics and Dentofacial Orthopedics.
The team will work to address three significant gaps in the current oral healthcare workforce, the school said, including the lack of readiness in treating adults and children with special healthcare needs.
According to the American Dental Education Association’s 2018 national Survey of Graduating Seniors, students expressed less confidence in their skills related to providing care for patients with physical, mental, and developmental disabilities.
“This grant will allow the School of Dental Medicine to expand the scope of training for dental providers at all levels so that they are better prepared not only in the technical aspects of oral healthcare but also in working with community partners to provide total healthcare,” said Webb.
“We are hoping to foster leadership skills in our residents so that they can extend this work beyond the time spent in the residency throughout their professional careers,” said Webb.
The project will include academic input in pediatrics, nursing, pediatric dentistry, general dentistry, and dental public health. Pediatric dentistry training will be expanded to a rural site in Herford County.
Residents from the existing Advanced Education in General Dentistry (AEGD) program will be offered a second year of training that emphasizes oral healthcare delivery for vulnerable populations.
According to data from the 2016 National Residential Information Systems Project, about 60% of people with intellectual and/or developmental disabilities are covered by Medicaid.
Most dentists don’t participate in Medicaid because reimbursement is low, making it difficult for these patients to get access to dental care, with little opportunity for prevention or early intervention, the school said. Dental disease is then more advanced, and dental treatment needs are more complex, the school added.
Once the planning year is complete, the project will provide enhanced training to three residents per year. Trainees will be recruited from the existing programs that include 21 AEGD residents and six pediatric dentistry residents.
The second gap in oral healthcare the grant will help address is the shortage of dentists in rural and underserved areas of the state.
“Rural communities in North Carolina have a need for dentists, especially pediatric dentists,” Webb said, “who are part of a medical-dental healthcare team that can address social determinants of health. Underserved populations including patients with special needs and those in rural communities have multiple barriers to care that need to be addressed.
Those factors, the conditions in which people are born, grow, live, work, and age, and can include socioeconomic status, education, neighborhood and physical environment, employment, social support networks, as well as access to healthcare, take interprofessional teams to address.
“If you spend a little time here, things start to make sense,” said Dr. Mark Moss, co-project director and associate professor in the dental school’s Department of Foundational Sciences.
“There are a lot of people in North Carolina who want to make their communities better places to live. There are a lot of young dentists who want to be part of a better future. We feel like we have the perfect opportunity to make ECU a pillar in this endeavor,” said Moss.
The project will be based at Ross Hall with some components at the school’s community service learning center in Ahoskie and other sites around the state. It will include members of the AEGD program, the special care dentistry program, and the school’s dental public health program, as well as the College of Allied Health Sciences.
Members of the Eastern Area Health Education Center, the ECU Brody School of Medicine, and the Department of Dental Hygiene at Catawba Valley Community College have been enlisted as well. The program’s diverse team reflects the interprofessional approach of the grant itself, the school said, in the spirit of collaborating to provide more complete care to patients.
“This type of collaboration is what makes the Health Sciences Campus at ECU so unique,” said Dr. Molly Jacobs, health economist and assistant professor in health services and information management of the College of Allied Health Sciences.
“While these issues are important to us all, these large endeavors are only possible when individuals with diverse abilities and expertise are able to collaborate. This type of project is important to everyone at ECU. We all want to better serve our community and provide better training for everyone moving forward,” Jacobs said.
The third component of the grant will work to help new dental professionals evolve along with the changing healthcare delivery system, the school said. The gap for vulnerable populations is due to gaps in Medicaid reimbursement and Medicare funding, where no dental benefits exist, and a shift toward an aging population, the school said.
“ECU is supporting the dental workforce transition in an emerging healthcare system,” said Webb.
“It will no longer be acceptable to simply provide late-stage repair. A proactive approach will be necessary, especially as the demographics of the population shifts with more baby boomers moving into an age category that is characterized by many more complex medical conditions,” Webb said.
The grant will allow the team to meet these factors head-on by integrating medical, dental, and societal factors that impact healthcare and producing professionals who can navigate the new system, the school said.
“Medically complex patients are increasingly being seen in dental offices,” said Webb.
“As medical science advances more and more, patients are needing dental care that have conditions they may not have even survived a few years ago. Integration of care is essential so that there is communication among the healthcare providers to provide the patient the best treatment possible,” Webb said.
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