Advanced Dental Therapy in Minnesota

1. Advanced Dental Therapy in Minnesota Christy Jo Fogarty, DT, RDH, BSDH, MSOHP Dental Therapist Children’s Dental Services

2. Topics • Advanced Dental Therapists (ADTs) Definition • Training and testing • Children’s Dental Services (CDS) background • Demographics of those I have served • Financial model: Cost/Benefit analysis • Finances in practice • Future of ADTs and DTs

3. DT/ADT: Definition • Dental Therapist: -Are required to complete a accredited program ending with a bachelors or masters degree and will always have indirect supervision. • Advanced Dental Therapist: -Are required to have completed a accredited program ending with a masters degree. -Currently the only program that teaches advanced dental therapy requires that students are already experienced dental hygienists, who are licensed and practicing in the profession. -After the completion of 2,000 hours of work under indirect supervision ADT’s can work under general supervision. Thus, can work in the field, much like dentists and collaborative practice hygienists. Work in a similar setting as pictured here. CDS staff providing care in schools

4. Training and Testing • ADTs study and train for 27 months at Metropolitan State University. ADT’s are trained, in their scope of practice, to the level of a dentist. • ADT must enter into a collaborative management agreement with a licensed dentist in Minnesota. • A collaborating dentist must be licensed and practicing in Minnesota. • The collaborating dentist accepts responsibility for all services authorized and performed by the advanced dental therapist pursuant to the management agreement. • The clinical testing that DT’s/ADT’s take through CRDT’s is the exact same testing DDS’s take.

5. Provided care to 28,000 patients in 2011. Provides care to children birth to age 21 and pregnant women. Provides dental care across Minnesota, in both urban and rural regions. Is primary provider of school- and Head Start-based portable care at over 200 sites across state CDS accepts all forms of public and commercial insurance, and has a zero-based sliding scale for income eligible families. CDS provides a full range of comprehensive dental care, including endodontia and hospital-based services. CDS provides specially targeted care programs to those who are blind, deaf, disabled, and autistic, and provides culturally targeted and translated care to the East African, Latino, Southeast Asian and Native American communities.

6. Demographics of those served • Since December of 2011, I have provided care to almost 900 patients. • Demographics of care: • 11% have needed emergency care • 72% of the patients travelled more than 10 miles to receive care. The greatest distance traveled by a patient served by the ADT was 500 miles. • 2% of the patients seen by the ADT required hospital based care. • 80% of patients had public insurance and 13% were uninsured. • 30% were African American, 9% were East African, 37% were Hispanic, 18% were Asian and 6% were Caucasian.

7. Results: Financial Impact Cost-Benefit Analysis based on 1 ADT providing services covered under theADT statute for 40 hours/week in a public health dental clinic.

8. Finances in practice Production Summary May 2012 (CDS began tracking ADT productivity in March. My productivity has consistently risen since that time.)

9. Future I am continuing to work to reach my 2,000 hours requirement, expected to hit in November, 2012. Once this has been met, I will go into areas identified as Dental Professional Shortage Areas to address the greatest unmet needs in Minnesota. CDS has hired one other ADT, Jamee Rosell, who is working towards the same goal. CDS is seeking potential scholarship recipients in Greater Minnesota who will work, live and serve these underserved areas as ADTs. Several other states have been working towards legislation to allow mid-level practitioners to expand the dental workforce and open access to care.

10. References http://www.pewcenteronthestates.org/report_detail.aspx?id=61628 http://www.pewcenteronthestates.org/report_detail.aspx?id=61628 http://www.normandale.mnscu.edu/academics/deans/pdfs/ADEAPresentation1.pdf https://www.revisor.mn.gov/statutes/?id=150a.105 http://www.dentalboard.state.mn.us/Portals/3/ Licensing/Dental%20Therapist/ADT-CMA%2012-4 10approved.pdf https://www.revisor.mn.gov/statutes/?id=150a.105

11. Thank you Any questions? Christy Jo Fogarty Dental Therapist Children’s Dental Services 612-867-8875 cfogarty@childrensdentalservices.org Sarah Wovcha, J.D., M.P.H Executive Director In-House Counsel Children’s Dental Services 612-636-1577 swovcha@childrensdentalservices.org