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A 'village approach'

Dentist develops CE course on treating special needs patients

Springfield, Va.—Mentoring and determination were the keys to success for an ADA member who developed a continuing education program with a hands-on clinic designed to help dentists treat more patients with special health needs.

Dr. Harvey Levy (right) cheers up a young patient and his mother during the hands-on clinic March 27
All done: Dr. Harvey Levy (right) cheers up a young patient and his mother during the hands-on clinic March 27. At the clinic, 70 patients received oral health care from dentists who are seeking to treat more patients with special needs in their practices.

The program had been in the works since 2007 when Dr. Keith Beasley completed the ADA Institute for Diversity in Leadership. The two-part course, Treating Patients with Special Needs, was held in February and March of this year. Session two featured a hands-on clinic for 70 patients with special needs.

"I always had lessons learned from my failures and successes," said Dr. Beasley. "My mentors explained that you might think you're the only one who cares about something but when you ask for volunteers, you find people who don't want to do the planning and logistics but will contribute in some way to get it accomplished. That's just what happened."

The ADA Institute for Diversity in Leadership is designed to enhance the leadership skills of dentists who belong to racial, ethnic and/or gender backgrounds that have been traditionally underrepresented in leadership roles. To complete the program, members must conduct a project that addresses a civic or professional issue of personal importance. For Dr. Beasley, that issue was access to care for patients with special health needs.

For large U.S. counties, those in his area—greater-Washington, D.C.—are among the country's most affluent and well-educated. "But when it comes to the treatment of special needs patients, we are no different than the poorest county in the country," said Dr. Beasley.

"We in the dental community are not doing enough to treat these patients. Families and caregivers have a terrible time finding dentists to treat people with special needs, and I wanted to find out why," said Dr. Beasley. "What are the barriers to providing care? Do dentists and their staff members need more training? Would a continuing education program help?"

His early attempts to create a CE program were met with mixed results but he remained focused, said Dr. Terry Dickinson, Virginia Dental Association executive director and one of Dr. Beasley's mentors.

"I really admire people who don't give up," said Dr. Dickinson. "It's an important message to everyone: you launch something new and you have to be ready for pushback from a number of different areas. He just consistently regrouped and off he would go again."

ADA leaders, dentists in the public and private sector, and faculty from Northwestern University's Kellogg School of Management serve as mentors for Institute class members as they pursue their leadership projects. Connecting with organizations in his community, Dr. Beasley met Cheryl Johnson from The Arc of Northern Virginia, a service organization for people with disabilities, who as part of her graduate studies designed a medical model in which physicians and dentists provide care to patients with special needs.

As Dr. Beasley sought data on why more dentists are not treating special needs patients, Dr. Dickinson put him in touch with Dr. Tegwyn Brickhouse, chair of the department of pediatric dentistry at the Virginia Commonwealth University School of Dentistry, who had conducted a survey on that topic in 2006.

Dr. Beasley prepares to treat a patient at the clinic in Springfield, Va., in March
Vital CE: Dr. Beasley prepares to treat a patient at the clinic in Springfield, Va., in March. Many patients with special needs are manageable in a clinical health setting, he said, and practitioners should receive training to feel more comfortable providing that care.
Of Virginia dentists responding to Dr. Brickhouse's survey, 58 percent said they do not routinely treat special needs patients; 67 percent felt that dental school did not adequately prepare them to treat patients with special needs; and 71 percent said their dental schools did not include courses on treating patients with special needs.

In addition to their concerns over a lack of training and experience, Dr. Brickhouse's data identified a number of other factors that precluded dentists from treating special needs patients, including: lack of staff training; need for special office accommodations; disruption of normal office routines; concerns over financial compensation; perceived need for hospital access; amount of time needed to complete a procedure; and problems with Medicaid reimbursement.

"That really told us what we needed to do with this course," said Dr. Beasley. "Give dentists and their staff members some tools and techniques that would help them treat these patients, and help them feel more comfortable doing it."

In 2008, Dr. Dickinson learned of a grant from the Virginia Board for People with Disabilities to provide funds for health care providers who treat patients with disabilities.

It was the state funding—which Dr. Beasley sought and received in 2009—that led to the two-part course conducted this year. "The funding enabled us to say, 'This is what we could do if money was not a problem,'" said Dr. Beasley.

The didactic portion of the course took place Feb. 19 and featured speakers Dr. Beasley, Dr. Harvey Levy, Dr. James Schroeder, Dr. Janet Southerland, Dr. William P. Piscitelli and Ms. Johnson. Included among the topics were defining patients with special needs; evaluation, examination and treatment options; private practice care; and hands-on techniques and equipment.

"We limited attendance to 30 people," said Dr. Beasley. "I felt that if 12 signed up it would be successful. Thirty people were signed up—20 dentists and 10 dental team members. We even had a few folks from out of state."

Session two on March 27 brought session one attendees back for a hands-on clinic with more than 70 intellectually challenged and special needs patients, their families and caregivers at the Northern Virginia Community College's dental hygiene clinic. Session one speakers were on hand for assistance and the VDA Mission of Mercy program donated equipment. The Arc of Northern Virginia advertised the clinic and provided support.

"The hands-on portion of the course gave practitioners the opportunity to actually see the patients that they might be treating, and get an idea of who they could manage and who is maybe outside their comfort zone," said Dr. Southerland, chair of the department of hospital dentistry at the University of North Carolina at Chapel Hill.

"There are so many patients that fall into this category—patients who are mentally and developmentally handicapped, those who live in group homes or other types of facilities," said Dr. Southerland. "They are a challenging patient population but there are smaller cohorts in this group that are manageable in a clinical setting for routine dental care."

"This has to be repeated," said Dr. Levy, a Frederick, Md., dentist who has lectured and written extensively on the topic of special needs patients. Dr. Beasley took a course that Dr. Levy taught several years ago and sought his expertise when he began his leadership project.

"The experience that this program gave to everyone involved was incredible," said Dr. Levy. "The patients got access to quality care that they so badly needed, student hygienists got valuable experience they can't get in a textbook and dentists got hands-on experience treating this patient population. Everybody won."

Dr. Beasley agreed. "The patients loved it. Here was an opportunity for patients and caregivers to bring sons and daughters and loved ones to this location for treatment. It was a village approach and it worked."

"Special needs patients, especially adults, are among the most underserved of all population groups," said Dr. Dickinson. "They present more challenges for practitioners that maybe have no training in that particular segment of society. Dentists come out of dental school and if they get any training treating this population, it's very little. People came to this program and got so excited and said, 'I can do this.'"

The grant cycle from the state of Virginia has ended, but "I don't want to lose the momentum," said Dr. Beasley. "We are trying to get corporate sponsors for another event in the fall." A message he leaves with participants is something he calls the "Take One" call to action.

"In the end I challenge each doctor to take just one patient into their practice," he said. "It's a start."

A Department of Veterans Affairs dentist since 2009, Dr. Beasley now practices with the Southeast Louisiana Veterans Health Care System in New Orleans. He retired from the U.S. Navy Dental Corps in 2006. He describes his experience in the Institute for Diversity in Leadership as "one of the best things I've done in life as far as organized dentistry." He credits the success of his program to ADA staff and Kellogg faculty for their guidance and support. "I cannot tell you how many doors were opened when I told people I was a student in the ADA Institute for Diversity in Leadership," he said. "It was a phenomenal opportunity."

For more information about the ADA Institute for Diversity in Leadership, visit www.ada.org/2872.aspx.