Reducing Barriers and Enhancing Access to Care

Aug. 27, 2018

In the United States, many adults and children face challenges obtaining even basic dental care. While a healthy smile and a routine checkup is something many Americans take for granted, this is not the case for all.

Some 40 percent of Eastman Dental’s patients come from economically underserved backgrounds, and live in neighborhoods with high rates of crime, violence and poverty. 

Children of lower socioeconomic status suffer a disproportionate amount of dental disease, and collectively, children miss 52 million hours of school every year due to oral health pain.

In an effort to help patients, Eastman Dental partnered with the University of Rochester Medical Center’s Social Work Division in 1993 to develop a model of care with the goal of addressing the bio-psychosocial needs of the dental population.  The same year, Eastman established a pioneering Social Work program in conjunction with Strong Memorial Hospital’s program. While social work wasn’t new at that time, a dedicated social worker for dental patients was--and still is--25 years later.

“Most stand-alone nonprofit dental institutions similar to Eastman have a hard time allocating the funds to programs like social work because they don’t get reimbursed like clinical treatments do,” said Dr. Levy D.M.D., M.S., Eastman’s medical director and chief quality, compliance and safety officer for Dentistry.

For Eastman Dental, commitment to social work is a part of an integrated approach that treats not just an ailment of a patient, but the patient as a whole. “Many of our patients are dealing with a far more complex web of issues behind the scenes than a cavity,” he explained.

The program has attracted the attention of other institutions, like Columbia University, who have reached out to Dr. Levy with questions on how the Eastman Social Work program works.

Only a few dental programs actively employ a social worker, including two in New York in addition to Eastman Dental: University at Buffalo School of Dentistry and New York University College of Dentistry.

Lenora A. Colaruotolo, L.M.S.W., has been Eastman’s primary social worker for 14 years.  She’s established an extensive network of resources that help provide patients access to an array of support services.

Social Work receives referrals from a variety of sources including Eastman Dental residents and faculty, hospital clinicians, school teachers and nurses, agency personnel, and at times, the patient or parent of a patient seeking assistance.  As patient advocates, Social Work collaborates with providers and social work colleagues in hospital outpatient clinics and in-patient settings to ensure comprehensive health care for patients.  Typically it is the social worker who partners with practices and specialty clinics to coordinate pre-operative requirements, tandem surgeries, insurances, family transportation and accommodation for long-distance travel, and safe discharge. 

For example, when Tim Siebert was able to bring his wife and her 4-year-old son, Pom, home with him from Thailand to Albion, NY, he began the process of adopting Pom, who had never received dental care. Suffering from tooth pain, Pom was referred to Eastman Dental after being diagnosed with severe early childhood caries. He would need treatment in the operating room under general anesthesia, but his health insurance denied payment of the pre-service claim stating "the services are not medically necessary."  They appealed, but were denied again. 

Social Work took the lead and collaborated with the University’s medical director, legal counsel, and the NYS Attorney General's Office to help facilitate an appeal to the NYS State Insurance Department.  Lenora assisted the family with completing applications, signing forms, and gathering additional documentation from a variety of sources to support medical necessity, in addition to exploring alternative resource options.

Pom’s family finally received a letter from the NYS Insurance Department saying the insurance had approved coverage for general anesthesia and hospital costs.  Today, he is a thriving, healthy and happy little boy.

The two most common referral problems are poor adherence to treatment and inadequate resources, followed by family issues, systems issues, and barriers to care, including unreliable transportation, insufficient food, shelter, clothing and cultural or language differences. Social Work also addresses critical psychosocial issues including identifying and assessing child abuse or neglect and intimate partner violence. 

"It has been our experience over the last 25 years that addressing these issues involves much more than improving oral health literacy and removing concrete barriers," said Lenora, who recently retired. "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."

Ten years ago, Eastman’s Social Work program received 260 referrals for their services. Today, it’s estimated that 675 referrals will be made by year’s end, a huge jump that points not only to the success of the program, but also its necessity in access to care.

“My job every day is to console, educate, and facilitate advocacy efforts so that we can continue to help as many people as possible,” said Jill DelVecchio, L.M.S.W., who joined Eastman’s Social Work Department last year.

While more referrals mean more patients cared for, they are not the only ones who benefit from the Social Work program. Dental residents also gain a new perspective when they come to Eastman to complete their post-doctoral training program.

“Seeing firsthand how social work adds value to what we do helps our residents to become more well-rounded clinicians when they leave Eastman and make their mark on the dental landscape,” said Dr. Levy. “Having residents work with our social workers demonstrates that there is a lot more to dentistry than the technical treatments.”

When former Pediatric Resident Karine Nadeau, DDS (Pedo ‘11) was faced with complicated patient circumstances, she worked alongside Lenora.

“Some issues for children and families in need include language or cultural differences, and a lack of oral health knowledge,” she said. “One of the most difficult challenges we face when treating them is addressing these issues. Teamwork is vital in dentistry, and collaborating with social workers allows us to remove barriers and to be successful in treating children who otherwise would suffer from not receiving care.”

Social work also played a valuable role in educating Dr. Rob Kiser’s (Pedo ’14). “Lenora helped me observe the objective in a bad situation,” he said. “Many times in my practice this has helped me to be slower to judge others and thus able to love these kids and families more.”

By providing its residents and staff with resources and its patients with support services designed to reduce barriers, enhance adherence to treatment, and improve health outcomes, Eastman Dental demonstrates that it is not only possible, but highly valuable, to integrate social workers in the dental setting.