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Avenues to Access

Hillenbrand project a road map to care

It started with a toothache, continued with a road map and where it ends remains to be seen.

As the 2011-12 Hillenbrand Fellow at the ADA, Dr. Betsy Shapiro was charged with developing a project in an area of interest to her, while also being helpful to the Association, profession or public. When it was time to select her idea, Dr. Shapiro harkened back to a phone call she had received a few years prior while in law school.

Image:  Driving her point: Dr. Betsy Shapiro presents her Avenues to Access guide to the ADA Board of Trustees at its July meeting.
Driving her point: Dr. Betsy Shapiro presents her Avenues to Access guide to the ADA Board of Trustees at its July meeting.

It was from Illinois State Rep. Robert Pritchard, whom Dr. Shapiro knew from her days as a volunteer lobbyist for the Illinois State Dental Society’s political action committee. Rep. Pritchard had a constituent in his office with a toothache, and he wasn’t leaving until somebody helped him.

“He said to me, ‘What do I do with him?’ So we got the patient taken care of and then the next question was, ‘OK, now what do we do in the bigger picture? How do I get something built here?’ And that’s kind of how it started,” said Dr. Shapiro, who hails from Waterman, Ill.

Dr. Shapiro had been in private practice as a general dentist for 15 years before attending law school, so she was well-versed in dentistry but not so familiar with the world of public health dental care. But as a dentist in a rural community of around 2,000 residents in Illinois, she was well aware of access to care issues. It was navigating the sometimes confusing acronym-laden world of public health that was the challenge.

“I kept thinking, there has to be some really simple guide to help you get started,” Dr. Shapiro said. “There are wonderful manuals on how to build a federally qualified health center, once you decide that’s what you want to do, or how to develop a community-based clinic; but getting to that point of deciding what you actually want or need to do is a little challenging. I needed help knowing the right questions to ask.”

Upon being selected as the Hillenbrand Fellow, Dr. Shapiro remembered this frustration and decided to create the guide she so wanted when she was trying to create better access to care. So she developed Avenues to Access: A Primer in Oral Health Care Delivery Methods.

In essence, it’s a road map on how to deliver oral health care to the underserved and unserved.

“This is geared toward any community group that wants to start building a safety net solution in their area,” Dr. Shapiro said.

Step by step, it provides those who are interested in bridging the gap in access to care with a guide for how to assess the need in a population, identify who is best to develop a call to action, and investigate existing resources that can help in the process. It also provides a glossary of common terms and acronyms used in the public health arena, a description of different types of clinics and facilities with information on how they are funded and a list of resources and online links for more information.

The guide and a link to Dr. Shapiro’s companion PowerPoint presentation were sent to all state dental societies, which were encouraged to pass it on to their state access to care coordinators.

“The Council on Access, Prevention and Interprofessional Relations’ very namesake states it will work to provide access to oral health care to those in need,” said Dr. David Holwager, CAPIR chair. “Dr. Shapiro’s road map paves the way by giving community groups and constituent dental societies, many with whom CAPIR has fostered great relationships, a one-stop-shop on how they can improve access in their area.”

Back in Waterman, Ill., Dr. Shapiro and Rep. Pritchard still need to do more work to build a better safety net system in their community. A few dentists in the area now accept Medicaid and a mobile unit rotates around the schools to provide some relief for children in need of care.

“These are small gains but nowhere near a solution,” Dr. Shapiro said.

Dr. Shapiro’s Hillenbrand fellowship ended Aug. 31 and she returns to the “real world,” albeit armed with more leadership and association management skills. She’s looking to find a job but is not quite sure where she will land. Dr. Shapiro acknowledges that the fellowship exposure has broadened her scope far beyond the walls of a dental clinic and deciding where to focus her job search is a bit of a challenge. But she says she’s willing to try anything.

“This experience has been amazing,” Dr. Shapiro said. “It was wonderful exposure to association management and as a member dentist it was just fascinating to see all the things the ADA provides. The access and opportunities I was given during my time here were really quite incredible.”

The Avenues to Access guide and the Power Point presentation can be found at http://www.ada.org/2574.aspx?currentTab=2#Avenues to Access.