ADA Task Force on workforce models.

On Friday, April 15, ADAA was invited to address the American Dental Association's Workforce Models Task Force in Chicago at ADA headquarters. Appearing on behalf of ADAA was President-Elect Debra L. Von Alman. Reprinted here in their entirety are her remarks to the Task Force. ADAA expresses its appreciation for the opportunity to address this body.

"All personnel who participate in the provision of oral health care must have appropriate education, training and meet any additional criteria needed to assure competence.

The dental profession has the responsibility to provide guidance to all agencies, organizations and governmental bodies--such as state dental boards and legislatures--that have an interest in or responsibility and authority for, decisions on utilization, education and supervision of allied dental personnel.

In this context the primary responsibility is to assure decisions on allied dental personnel utilization will not adversely affect the health and well-being of the public, or cause increased risk to the patient. In meeting those responsibilities dentists must also identify those functions or procedures that require the knowledge and skill of the dentist and therefore must be preformed only by a licensed dentist.

Constituent dental societies should advocate the functions that may be appropriately delegated to allied dental personnel based on the best interest of the patient, the education, training, and credentialing of the allied dental personnel, considerations of the cost-effectiveness and efficiency in delivery patterns and valid research demonstrating the feasibility and practicality of utilizing allied dental personnel in such roles in actual practice settings.

Provisions for the delegation of intraoral expanded functions to allied dental personnel that are included in state dental practice acts and regulations should specify education and training requirements, level of supervision by the dentist, assurance of quality and controls to assure protection for the public.

Formal education and training are essential for preparing allied dental personnel to perform the intraoral expanded functions that are permitted."

These statements are direct quotes from the American Dental Association's Comprehensive Policy Statement on Allied Dental Personnel.

The American Dental Assistants Association believes that our goal here is to work toward enhancing the field of dental assisting and the utilization of Dental Assistants in the dental team. Resulting in increased availability for the delivery of oral health care to underserved areas.

A "broad picture look" shows:

1. Fifty states and the District of Columbia each with its own very different practice acts.

2. An absence of mandatory education and/or a National Standard of Care in regards to dental assistants

3. A shortage of dental assistants.

To reach our goals we must consider:

1. Creating uniform educational requirements.

2. Establishing nationally recognized standard levels of competency, educational qualifications and in our ever-changing field, continuing education requirements.

3. We need to create a nationally respected, education-based profession. Well-trained, educated, and utilized dental assistants remain in the dental field.

Keeping in mind that the motto of the ADAA is Education, Efficiency, Loyalty, and Service, the average ADAA member has been an assistant for 21 years and has been with their employer for 12 years.

Our Vision of the Future Dental Workforce Models

In order for any model to work the ADAA feels that the model needs National Acceptance.

We must have uniform levels of patient care based on established educational guidelines.

For any workforce model to be feasible, dentists must be knowledgeable in the utilization of educated dental assistants and the delegation of duties to qualified personnel.

The ADAA envisions a minimum of four specific categories of tasks that would be assigned to the professional dental assistant. These task groups have not been assigned an official title, as of yet, so I will refer to them as A, B, C, and D.

A. This assistant would perform tasks that require no experience, or formal education, and very little training. This assistant needs only to be provided with a short instruction sheet to read or one-time verbal instructions.

B. This level of moderately complex tasks would require fewer than two years of full time or up to four years of part time dental assisting experience or up to 12 months of formal (ADA accredited and ADAA approved) education or training in order to perform this level of tasks.

C. Moderately complex tasks would require two plus years of full-time or up to four years of part-time work experience or at least 12 months of formal (ADA accredited and ADAA approved) dental assisting education.

D. Complex tasks would require specific advanced education in addition to or beyond the levels required for previously identified tasks.

The American Dental Assistants Association feels strongly that mandatory education is necessary to achieve the top three levels of this assisting task grouping. This education must take place in an ADA accredited institution. There needs to be test measuring and demonstration of competency.

There are currently 284 ADA accredited dental assisting programs, with eight more sites preparing for accreditation visits this year. Some of these programs utilize, and we advocate, distance learning.

We also foresee the use of ADA/ADAA packaged courses that can be used to obtain and or maintain each of these levels of assisting.

We look for a committee created from members of the American Dental Association, the American Dental Education Association and the American Dental Assistants Association set to monitor these programs and courses.

In the year 2000 an Alliance between the American Dental Assistants Association and the Dental Assisting National Board was established. Their Mission Statement reads: To come together to advance the dental assisting profession and to enhance the delivery of oral health care by presenting a united and strengthened voice that reflects all careers within dental assisting.

Between 2001 and 2005 this Alliance surveyed 2,500 Certified Dental Assistants, ADA Accredited Dental Assisting Program Directors and 5.000 Dentists in regards to a "task list" of 70 core competencies. In this blind study, each individual was asked to rank these tasks according to a predetermined set of criteria, thus placing them in the A, B, C, D levels for dental assistants. Tasks ranged from receiving and preparing the patient for treatment, to place, cure and finish composite resin restorations. The ADAA/DANB alliance will be presenting a white paper of this Core Competencies Research in fall 2005.

How will this model address access to care questions and the needs of the underserved?

Utilization of a highly educated and trained dental assistant will free the dentist for dentistry.

As duties are assigned to the dental assistant a greater number of patients will be served and at the same time the level of care will not be diminished. When a greater number of patients are served within the same amount of time productivity of the office is increased. As the production increases there is a greater opportunity for the practitioner to provide care to those underserved populations in his or her area. It also allows time for the dentist to bring teams of professionals into otherwise underserved areas in order to provide needed dental care.

Access to dental care and the needs of the underserved can also be addressed:

* There are immediate opportunities that are not currently being utilized. Many of the existing dental assisting and hygiene program clinics are used only during set hours of the day or even during set months of the year. These facilities could be used to provide dental treatment to underserved populations during evenings, weekends and vacation or summer hours.

* Because most often there are multiple operatories available, the dental teams could use these facilities to see greater numbers of patients with needs for preventive care such as coronal polishing, fluoride treatments, and patient education, and restorative needs such as placing, carving, and finishing restorations. These tasks being assigned to auxiliaries.

* Students working under the supervision of dentists and experienced auxiliaries could gain needed experience prior to entering the workforce.

* Educational facilities often have access to interpreters and other adjunct services that are not available in traditional dental office settings.

Even if existing program facilities are not used, this type of outreach program into communities will increase awareness of dentistry and increase the numbers of potential dental, hygiene and dental assisting students who bring with them bilingual skills as well as varied cultural backgrounds.

For the ADAA vision to become a reality the following changes to the existing models need to be instituted:

* A national standard must be obtained for dental practice acts.

* Competency levels need to be set for expanded functions.

* Mandatory education at an ADA Accredited institution is needed in order to obtain designation.

* We will need testing, measuring, and demonstration of competency.

* Comfort with distance learning, on-line learning, home study courses and other models of education will be essential.

The American Dental Assistants Association needs to be involved with the establishment and continued improvement of educational programs as well as the expanded functions themselves.

Debra L. Von Alman, CDA, RDA, has long been active with the American Dental Assistants Association on the local, state and national level and is currently national President-Elect. She is a graduate of Hibbing Technical College Dental Assisting Program and has been an assistant for over 20 years working both clinically and administratively. Currently she is employed with The Dental Specialists, in the suburban Minneapolis/St. Paul area.