Social Work 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." Increasing Awareness among Pediatricians A five-year NY State Department of Health grant awarded in 2006 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. Evaluation of this project, Improving Utilization of Oral Health Services for Underserved Children: A Demonstration Project, showed that referrals from the pediatric clinic more than doubled following the integration of outreach services, and perhaps more important, the percentage of referred children who entered care significantly increased (11% pre-outreach vs. 35% postoutreach). Recent data reflect a continued increase in the percentage of referred children who entered care 51% during the first year, 53% the second and 51% the third. A new open access initiative, Strong Teeth, piloted in 2008, aims to expedite provision of dental exams for children (12- 36 months) referred by Pediatrics following a well-child visit. Principal Investigator and EIOH Social Worker Lenora Colaruotolo credits Health Project Counselor Elise Linke-Judge with effectively partnering with pediatric medical residents and clinic staff to increase the number of referrals to pediatric dentistry and facilitate entry into the dental care system. “In the first year, 50 children presented to Eastman Dental as a direct result of the Strong Teeth referral program, and 248 children presented in the second year,” said Colaruotolo. “Because of the program’ success and to further improve the process, we plan to include a Strong Teeth referral form in the patients’ charts for their 15-month well child check appointments.” 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.