Email this pageSocial Work at Eastman Institute for Oral Health
Contact Social Work Services Lenora A. Colaruotolo, LMSW |
Dear Eastman Institute for Oral Health Colleagues: |
Eastman Dental Demonstrates Social Work's Critical Role
While social work has historically played an important role in medical health care, dentistry has for the most part, not included a social work model of care as part of its operation.
Except a few, like Eastman Dental, whose social workers for the last 15 years have been quietly making significant contributions to patient care, resident/faculty education and program development.
Eastman Dental's partnership with social work started slow, but quick results led to an increasing larger role as described in the June 2009 issue of Journal of Dental Education. This model demonstrates through measurable results how a viable social work program can play a critical role in resolving some longstanding problems in oral health care.
Patients are most frequently referred to social work for poor adherence to treatment and inadequate resources, followed by family issues, systems issues, and barriers to care, such as unreliable transportation, insufficient food, shelter or clothing, and cultural or language differences.
"It has been our experience over the last 15 years that addressing these issues involves much more than improving oral health literacy and providing bus fare," said Lenora A. Colaruotolo, L.M.S.W., EIOH Social Worker. "There is a complex web of issues that conspire against preventive health practices. Individuals and families made vulnerable by poverty, loss and illness need significant and ongoing support to follow through on recommendations for themselves and their children."
Eastman Dental social workers use a biopsychosocial-oriented model to address and ultimately help close the gaps in patient care and resident education in an academic dental environment. The Pediatric Dentistry Division received a three-year Health Resources and Services Administration pediatric residency expansion grant to fund a program designed by the social worker to enhance residents' sensitivity to the stressors and social contexts of families living in poverty.
"We wanted to place residents in our patients' shoes, by exposing them to environments and situations that they would not ordinarily encounter," explained Colaruotolo. "As a result, their perceptions of poverty and how people live, or 'should' live were explored throughout the year as a way to uncover and discuss biases that impact the delivery of care."
Residents visited shelters for battered women and homeless youth, a juvenile detention center, foster care clinics, the Department of Social Services, accompanied social workers and paraprofessionals on home visits, used the public transportation system to navigate the city, and attended ad hoc meetings within the community.
Social work's contributions in the dental setting include resident/faculty education on critical psychosocial issues such as child maltreatment and intimate partner violence, and development and implementation for grant-funded projects to address oral health disparities.
The article explores many other ways that social work has helped enhance the education, clinical care, research, emergent care, and shows how partnering with a wide variety of community agencies helps improve education and diminish disease.
"Fifteen years and more than 2,000 referrals later, it is clear there is a place for social workers in dentistry," said Cyril Meyerowitz, director of Eastman Institute for Oral Health. "What began as a modest, part time position in 1993 has evolved into a multifaceted, full-time role, extending its reach by adding oral health project counselors on grant funded projects and social work undergraduate and graduate students in dental clinics."
Eastman Social Work Updates
Grant Projects
Dental Home for the Children Project
The Dental Home for Children Project, funded by HRSA's Maternal Child Health Bureau and one of the Healthy Tomorrows Partnership for Children Projects, focuses on children who tend to received sporadic and urgent dental care only, resulting in ongoing disease, incomplete treatment, intermittent pain, and premature loss of dentition. This project operates from the premise that poor oral health is more often than not a consequence of psychosocial factors that need intervention. The project utilizes a trained Health Project Counselor, Kimberly Flint to assess and address barriers to care, improve oral health literacy, and enhance utilization by providing case management services, transportation as needed, and additional reminders about upcoming appointments. Project evaluation shows a trend for an increase in kept appointments over time and a decrease in failed appointments, cancelled appointments, and emergency appointments, which strongly supports the conclusion that enrollment in a program like the Dental Home for Children project will encourage more appropriate patterns of care among higher risk patients.
Improving Utilization of Oral Health Services for Underserved Children
A five-year NY State Department of Health grant awarded in 2006, Improving Utilization of Oral Health Services for Underserved Children: A Demonstration Project, is a collaboration linking the pediatric dental clinic at Eastman Dental and the ambulatory pediatric primary care clinic at Golisano Children's Hospital. The goals are twofold: to improve communication between the pediatric primary care and pediatric dental care systems and further integrate oral health in urban pediatric primary care settings, thus increasing treatment for the number for low income children up to age 6 who have moderate to extensive dental disease. Thanks to this project, a Health Project Counselor, Elise Linke-Judge has effectively partnered with pediatric medical residents and clinic staff to increase the number of referrals to pediatric dentistry and facilitate entry into the dental care system.
Sponsor A Smile
To date, thanks to generous contributions of many staff, faculty and residents, social work has been able to provide pediatric oral sedation medication not covered by insurance plans, offset parking garage fees and purchase durable age-appropriate play equipment for the pediatric dentistry waiting room, as well as five subscriptions to children's magazines. The next purchase, when enough funds are available, is to finance additional enhancements to the pediatric waiting area including books, bookshelves and children's tables and chairs.
Cleft Camp Benefits Both Patients and Clinicians
It's common knowledge that recreational events, such as camp are beneficial to patients with craniofacial anomalies. But what about the clinician? Eastman Dental's social worker, a member of the Center for Craniofacial Anomalies at Golisano Children's Hospital at Strong, participates in an annual craniofacial camp, a social-recreational event. This topic was presented at the recent American Cleft Palate-Craniofacial Association conference highlighting how these events enable clinicians to learn more about our patients' daily needs and abilities to cope with their craniofacial disorders as well as how to establish improved communication through interactions outside the clinical setting.
Social Work and Pediatric Dentistry
A Conversation with Dr. Alvin Amante
Alvin Amante, an Eastman Dental Pediatric Dentistry Resident, frequently works closely with Social Work. Dr. Amante received a call from the after-hours answering service late one evening about a young child who was reportedly punched in the mouth by an adult and needed medical attention. However, when Dr. Amante called the family, he spoke with a male adult who would not disclose his relationship with the child. He did not know the child's date of birth or pediatrician. He went on to say that the child was okay. That didn't sit right with Dr. Amante, who persisted in calling the family, in an attempt to speak with the child's mother, and to encourage them to bring the child in for treatment. After repeated calls from Dr. Amante, the family informed him that they had taken care of the problem and had brought the child to the emergency room.
Why did you keep calling back the family who originally called in?
My reaction to the situation was a gut response. As a pediatric dentist, I am a mandatory reporter who is obligated by law to report any suspicion of child abuse or child neglect. Aside from this responsibility, I could not help but feel concern for a child who might have been harmed, whether physically or emotionally. As a new father myself, I know how vulnerable children are and how they depend and rely on their parents for care. If an adult harms a child, I feel it is our responsibility as a community to step in to protect the child. With regard to this case, when I was not able to secure reliable information from the person I spoke with about how the child sustained an injury to her mouth, I contacted the on-call Social Worker at Strong Hospital for guidance. Through social work's involvement, I was informed the child had not been treated at any area hospital emergency department, as claimed by the individual; they recommended I contact the police authorities, which I did. Social work subsequently filed a report with Child Protective Services. Although, I will never know the outcome of this case, I am hopeful for the safety and well being of this child.
Why is the social work component important in dentistry?
Through the years, I have been fortunate to work with social workers during my volunteer activities in Seattle and my residency program here at Eastman Dental. As a volunteer dental provider for homeless kids in a day shelter, I worked with tireless social workers who made sure that patients were seen and treated at our mobile van. The social workers remained available to support us with problematic patients struggling with emotional or drug problems. Here at Eastman Dental, I consider myself fortunate to be able to work with Lenora, Kim and the rest of the team. It is reassuring to have a social work presence to provide education and guidance to residents with regard to the myriad and diverse issues of our dental population. They emphasize that we do not just treat teeth but that we are part of a vast network and safety net that supports children and families in need.
Why do you want to be a pediatric dentist?
After completing my Eastman Dental AEGD residency in 2000, I relocated to Seattle and became part of a group practice. As I began to see more children in the practice, I found that I enjoyed treating them and was challenged by kids presenting with dental phobias or severe dental needs. Through my volunteer work with Medical Teams International, I also became aware of social inequities and oral health disparities faced by children living in homeless shelters in Seattle or in the shanties of Oaxaca, Mexico.
How did you become interested in dentistry?
I graduated from the University of the Philippines in 1993. I was the youngest of 8 children and most of my brothers and sisters had already chosen different professions. There was no dentist in the family, so that's what I chose. There was no turning back after making that decision, and I have no regrets.
Describe your experience with Eastman Dental.
I started the AEGD residency here in 1998 and returned ten years later, in July 2008 for my Pediatric Dentistry training. I must say while working here at Eastman Dental, I have thoroughly enjoyed meeting people from all walks of life and different corners of the world. I know the General Dentistry training I received at Eastman Dental served me well, and I am confident that at the completion of my Pediatric Dentistry training, I will be well positioned for professional practice.
