Oral Health on Wheels: A Service Learning Project for Dental Hygiene Students

Transcription

1 Research Oral Health o Wheels: A Service Learig Project for Detal Hygiee Studets Heather Flick, RDH, MS, MPH; Sheri Barrett, EdD; Carrie Carter-Haso, RDH, MA, EdD Abstract Purpose: To provide detal hygiee studets with a service learig opportuity to work with special eeds ad culturally diverse uderserved populatios through the Oral Health o Wheels (OHOW) commuity based mobile detal hygiee cliic. Methods: A studet feedback survey was admiistered betwee the years of 2009 ad 203 to 90 studets i order to gather ad idetify sigificat satisfactio, skills acquisitio ad persoal growth iformatio after the studet s cliical experiece o the OHOW. ANOVA ad Pearso correlatio coefficiet statistical aalysis were utilized to ivestigate relatioships betwee studet resposes to key questios i the survey. Results: A aalysis of 85 studet resposes (94.44%) demostrated statistically sigificat correlatios betwee studet learig ad their uderstadig of uderserved populatios, buildig cofidece i skills, participatio as a detal team member ad uderstadig their role i total patiet care. The strog correlatios betwee these key questios related to the cliical experiece ad studets cofidece, skills itegratio ito the detal team, ad uderstadig of both total patiet care, ad the icreased uderstadig of the oral health care eeds of special populatios. All questios directly lik to the core missio of the OHOW program. Coclusio: The OHOW cliical experiece allows detal hygiee studets a uique opportuity to egage i their commuity while acquirig ecessary cliical competecies required by atioal accreditatio ad providig access to oral health care services to uderserved patiets who would otherwise go without treatmet. Keywords: access to care, alterative practice, cultural competecy, cliical educatio, detal hygiee, detal hygiee work force models This study supports the NDHRA priority area, Health Services Research: Ivestigate how alterative models of detal hygiee care delivery ca reduce health care iequities. Itroductio There have bee may well-established reports regardig the educatio of oral health care providers withi educatioal istitutios.,2 Oe most otable report i 2003 from the America Detal Educatio Associatio s (ADEA) Presidet s Commissio details the roles ad resposibilities of academic detal istitutios. 3 I that report, authors draw attetio to the sigificace educatioal istitutios have i becomig part of the moral commuity, helpig ot oly improve access to oral health care, but to be able to ifluece state ad federal policy makers, commuity leaders, idustry, ad other stakeholders to help the professio fulfill its moral duties. 3 A critical cocer i this ADEA report was meetig the oral health care eeds of our chagig demographic society icludig uderserved ad culturally diverse populatios. The Surgeo Geeral s Healthy People 2020 report oted the impact of oral health o geeral health, disparities i oral health, ad access to care withi the low icome ad uderserved. 4 For example, a higher percetage of diverse populatios have bee show to have a greater icidece of detal/oral disease. Therefore, the Surgeo Geeral outlied the substatial beefits of icludig oral health i the desig of commu- ity programmig. 3,4 It has also bee suggested that without substatial chage i detal ad detal hygiee educatio models of oral care, detistry as a professio will oly reproduce rather tha address ad chage the curret ladscape of oral health disparities. 5 The Commissio o Detal Accreditatio (CODA) stadards clearly idetify that studets graduatig from detal/detal hygiee istitutios must be competet i maagig a diverse patiet populatio ad have the iterpersoal ad commuicatio skills to fuctio successfully i multi-cultural work eviromets (Stadard 2.7), ad that they are competet i assessig the treatmet eeds of patiets with special eeds, (Stadard 2.2). 6 Therefore, if educators implemet strategies to expose studets to diverse patiet populatios, those studets may view workig with these patiets as a rewardig experiece ad be better prepared to treat them i the workforce. Legislators are turig to alterative delivery systems to address the oral health care eeds of uderserved populatios. Several midlevel provider models have bee described ad suggested such as the advaced detal hygiee practitioer (ADHP), the commuity de- 226 The Joural of Detal Hygiee Vol. 90 No. 4 August 206

2 tal health coordiator (CDHC) ad the detal health aid therapist (DHAT). 7 These models have bee proposed at a atioal level, however, idividual states are also workig o models specific to their eeds. For example, the state of Kasas has addressed access to oral health care through the eactmet of the Exteded Care Permit (ECP) Detal Hygieist ad to date has i place the ECP I, II ad III. 8 Figure : JCCC Mobile Detal Uit I order to prepare studets for workig with a diverse populatio upo graduatio, it is critical that they are exposed to ad kow how to treat those from diverse backgrouds, oral health eeds ad/or disabilities. The literature suggests the best way for studets to grasp the importace of commuity service ad to gai a sese of cultural competecy is through the implemetatio of service learig opportuities. Yoder states that itegratig service-learig ito detal curriculum will create a deeper uderstadig of the dyamics, the assets, ad the challeges of the commuity ad its relatioship to oral ad geeral health. 9 Service learig is ot simply providig services to the commuity or voluteer work. To be authetic service learig, there must be a reciprocal compoet, preparatio ad reflectio. 9,0 The services provided are i respose to a commuity eed, works with ad ehaces the studets course goals ad objectives, ad their roles as professioals ad commuity parters. 9, Yoder outlies critical compoets for the plaig, implemetatio ad evaluatio of service learig i detal curriculum which are eeded to be authetic service learig ad ot just commuity egagemet. 9 Three mai goals of service learig used i detal educatioal settigs have also bee described by Hood. 2 Improvig studet learig, promotig civic egagemet ad addressig social eeds are all crucial to a successful service learig project i additio to stregtheig the commuity at large. Other key compoets iclude reciprocatio betwee the studets ad the commuity etity beig served. Reflectio by the studet is also crucial to a successful learig experiece. 2 Elyer ad Giles discuss the importace of matchig the academic goals with the placemet of studets i the commuity settig i additio to studet reflectio as a way to deepe the trasfer of kowledge leared i the egagemet. 3 Other importat pieces oted by these authors iclude the studets relatioship with the commuity parter, the time or duratio of the experiece ad the studet s perceptio of the quality of the service learig experiece. 3 The Commissio o Detal Accreditatio (CODA) evaluates the detal istitutios ability to make sure studets are culturally competet; therefore, implemetig service learig opportuities i the detal hygiee curriculum is a effective way to esure this outcome. As a iovative approach to detal hygiee educatio ad public health, a service learig outreach cliic called, Oral Health o Wheels (OHOW) bega full operatio as a cliical rotatio for detal hygiee studets at Johso Couty Commuity College (JCCC) i August, Followig successful capital fudraisig ad college commitmet towards ogoig operatig expeses, a mobile detal hygiee vehicle was purchased to implemet this service learig program (Figure ). The mobile detal hygiee cliic is a 43 foot custom desiged truck (LifeLieMobile ) outfitted with 2 complete detal operatories, sterilizatio area, patiet itake, waitig room ad a wheel chair lift. Cliical rotatio o the OHOW allows detal hygiee studets to participate i, ad provide the full scope of detal hygiee services to culturally diverse patiets ad those with special eeds. The OHOW cotiues to be fiscally supported by the college ad is therefore maitaied as a erichig cliical experiece for the detal hygiee studets. Operatios of the OHOW are moitored by a full-time detal hygiee faculty who is the project coordiator. Additioally, commuity detists are employed to ehace iterprofessioal educatio. 2,3 Secod year detal hygiee studets sped a 3-week rotatio i the OHOW as part of their cliical istructio. A : faculty-studet ratio o the OHOW allows for exteded learig ad assistace with ew patiet experieces with special populatios served by OHOW (Table I). Vol. 90 No. 4 August 206 The Joural of Detal Hygiee 227

3 Commuity Parters (Reciprocal Compoet) The OHOW parters with 2 Johso Couty service agecies icludig Johso Couty Developmetal Supports (JCDS) ad Johso Couty Departmet of Health ad Eviromet (JCDHE). A third partership is i place with a outreach ceter, Ceter of Grace. Cliets from JCDS are diagosed with mild to severe itellectual ad developmetal disabilities. Patiets see at JCDHE are pregat mothers while Ceter of Grace cliets are predomiatly Hispaic adults. Table II describes the demographics of these commuity parters. Eligibility of cosumers are determied by the JCDS Director of Cliical Supports. Appoitmet schedulig is maitaied by ursig staff usig a re-care system prescribed by OHOW staff to beefit cliets periodotal health. Wedesday treatmet alterates betwee JCDHE ad Ceter of Grace outreach ceter. Cliets at JCDHE are iformed of the health beefits ad provisio of oral health services provided o OHOW through a iteral itake system by WIC coordiators ad urse practitioers. Cliets are the scheduled for a screeig by the biligual social workers i order to begi treatmet as most of the cliets served are Spaish speakig. Cliets at Ceter of Grace are give appoitmets o a first come first serve basis. These patiets cotiue care if they are still erolled i ESL classes at the ceter. OHOW Operatios: Faculty, Staff, Studets purpose of this service learig project was to provide detal hygiee studets a uique opportuity to gai meaigful patiet care experieces with special eeds ad culturally diverse uderserved populatios through a mobile commuity based cliic. I additio, this study evaluated studet satisfactio with their experiece o the OHOW rotatio through a studet feedback survey. Methods ad Materials Studets participated i the OHOW rotatio 3 weeks at a time, 2 times per week. Prior to participatio, studets review ad complete a series of modules o Practical Oral Care for People with Developmetal Disabilities. 5 Studets also complete a take-home exam o this iformatio thereby icreasig their ability to work with ad treat patiets with special eeds ad those from uderserved populatios. I order to evaluate studet satisfactio of the OHOW service learig project, a Studet Feedback Survey was admiistered to all studets who participated i the project over the 5 years from 2009 to 203. The survey was admiistered at the culmiatio of the secod year, prior to graduatio, givig the studets time to reflect o their service learig experiece. The survey was blid ad coset was give by participatio. A total of 90 studets completed the survey from 2009 to 203. Completio of the survey was ot required. Supervisio of the OHOW mobile cliic is coducted by a full time detal hygiee faculty from the college. A commuity pool of detists make up the staff detist positio o the OHOW. Oe detist is o the mobile uit durig each rotatio. Two detal hygiee studets rotate through the mobile detal cliic at oe time, twice per week. The same detist maitais the staff positio every Moday, servig cliets at Johso Couty Developmetal Supports (JCDS). The cosistecy of the same detist o site with the special eeds populatio stregthes the acceptability ad comfort level for the patiets. Curretly, 5 remaiig detists rotate to fill the Wedesday staff detist positio participatig from to 5 days per semester. This commuity pool of detists stregthes the relatioship with the local detist commuity ad shares the learig experieces the college offers the detal hygiee studet. I order to facilitate the cross-cultural bridge with the Spaish speakig commuity, a experieced iterpreter/traslator completes the OHOW team. As a itegral part of the OHOW mobile cliic, the iterpreter assists Spaish speakig cliets with completio of forms, ad referrals (Eglish/ Spaish), uderstadig treatmet fidigs ad eeds, oral health care istructio, schedulig ad post-treatmet follow-up. The literature is clear that detal hygiee educatio is a coducive platform to providig studets with valuable service learig experieces as a aveue for creatig commuity parterships. 2,4 Therefore, the The survey measured the degree to which OHOW icreased studet awareess of uderserved populatios, cultural diversity, cliical skills, cofidece buildig, detal team workig relatioships ad the delivery of ethical patiet care. Studets also provided ope eded feedback about curret program operatios ad the degree to which the rotatio may have iflueced their cliical detal hygiee educatio as well as future professioal edeavors. I this way, the survey assessed both quatitative ad qualitative feedback. The Feedback Survey was adapted from oe used i a study by Ashto-Brow et al, where the authors evaluated the use of public health cliics i a service-learig rotatio for detal hygiee studets. 6 That survey was origially modeled after the Health Professios Schools i Service to the Natio program take from the hadbook Methods ad Strategies for Assessig Service-Learig i the Health Professios. 7 The fial adaptatio of the survey i this study icluded a total of 25 questios. These 25 questios were broke ito 3 sectios. The first sectio icluded 0 questios pertaiig to skill developmet with a 5 poit Likert scale aswer ragig from =ot at all, to 5=very much. The secod sectio icluded questios relatig to the studets experieces o the service learig rotatio. The Likert scale i this sectio raged from =strogly disagree to 5=strogly agree. Lastly, sectio 3 icluded 4 questios for studets to provide reflectio o thigs they leared, might chage, advice for the project ad ay commets they would like to 228 The Joural of Detal Hygiee Vol. 90 No. 4 August 206

4 Table I: OHOW Service Learig Rotatio Framework OHOW Service Learig Item Studet completes modules ad exam Oral health eeds of patiets with itellectual ad developmetal disabilities Rotatio o the OHOW Service Learig Project Prevetive Services: Prophylaxis Scalig Rootplaig Polish Fluoride Educatio Radiographs Detal Exam Referral Meet with Faculty to provide reflectio: Daily Formative Feedback Summative Feedback Complete Studet Feedback Survey: Likert scale items ad Ope-eded reflectio & feedback Time Frame Week Team Members Prior to participatio i the Oral Health o Wheels Rotatio 3 Week Rotatio 2 times per week Modays ad Wedesdays After completio of Service Learig Rotatio After completio of Service Learig Rotatio Cliic III Fall Semester, 2d year of program Fall ad Sprig Semester of the 2d Year Modays JCDS Wedesdays Alterates betwee JCDHE (Pregat Mothers) ad Ceter of Grace Ed of Semester Ed of Semester All Secod Year Studets Full Time DH Faculty Both Days Moday DDS Same each week Wedesday DDS Alterates Spaish Iterpreter FT Faculty Member ad Studet meet for Reflectio Studet completes Survey Table II: Patiet Demographics of Collaborative Parterships Place of Service Demographic JCDS JCDHE Ceter of Grace Number of Patiets Served 47 Itellectual ad Developmetal Disabilities 5 Pregat Wome 5 Hispaic Adults Age Rage (Years) 2 to 67 6 to 45 6 to 60 Geder (, Percet) Ethicity (, Percet) 5 (34%) Female 96 (66%) Male 45 (99.9%) White 2 (0.0%) Other 5 (00%) Wome 45 (89%) Hispaic 6 (%) Other 40 (80%) Female (20%) Male 49 (95%) Hispaic 2 (5%) Other share with the faculty ad staff about their service learig experiece. I order to assess the studet s learig strategies while o the OHOW rotatio, studet s cofereced with the program director at the ed of each rotatio. Studets provided reflectio regardig their triumphs, progress ad opportuities for cliical skill improvemet based o their performace. Progress evaluatios were also submitted to the Secod Year Lead Cliical Coordiator(s) of Cliic III ad IV for cosideratio durig cliic course cofereces which served as additioal reflectio. Results Out of the 90 studets who respoded to the survey, 85 (94.44%) idicated satisfactio ad persoal growth after their cliical experieces o the OHOW rotatio. These resposes provided valuable feedback for ay chages i the curriculum related to itellectually ad physically disabled populatios. Studets reported sigificat satisfactio, persoal growth ad cofidece while workig with cliets with itellectual ad developmetal disabilities (p 0.05). The JCDS service site was repeatedly favored by the detal hygiee studets. Additioally, studets expressed how the OHOW rotatio exceeded their cliical expectatios ad persoal satisfactio i treatig cliets with special eeds. Vol. 90 No. 4 August 206 The Joural of Detal Hygiee 229

5 Table III: Pearso Correlatios of Studet Resposes to Key Questios Uderserved Pearso Correlatio Uderserved Leared More 0.504** Build Cofidece 0.246* Detal Team 0.437** Total PT Care 0.428** Leared More Pearso Correlatio 0.504** 0.645** 0.586** 0.545** Build Cofidece Pearso Correlatio 0.246* ** 0.426** 0.497** Detal Team Pearso Correlatio 0.437** 0.586** 0.462** 0.867** Total PT Care Pearso Correlatio 0.428** 0.545** 0.497** 0.867** 0. Pearso Correlatio=r value, Sig 2 tail=sigificace, =umber of respodets *Sigificat at the 0.05 level (2-tailed), **Sigificat at the 0.0 level (2-tailed) Table IV: Studet Resposes to Survey Questios Rage of Respose 4.2 to Uderserved Leared More Detal Team Serve Patiets Year of Studet Respose 230 The Joural of Detal Hygiee Vol. 90 No. 4 August 206

6 The survey also ascertaied the degree to which the OHOW experiece ehaced the studets detal hygiee educatio i workig with diverse, uderserved, multicultural ad special eeds populatios. Table III shows the Pearso correlatio of studets resposes to key questios asked o the survey. Studets expressed a sigificat level of satisfactio i may domais. Resposes demostrated strog correlatios betwee studet learig ad their uderstadig of uderserved populatios (r=0.504), buildig cofidece i skills (r=0.645), participatio as a detal team member (r=0.586), ad uderstadig their role i total patiet care (r=0.545) (Table III). The strog correlatios amog these key questios related to their cliical experiece ad cofidece, skills, itegratio ito the detal team, ad uderstadig of both total patiet care, ad their icreased uderstadig of the eeds of special populatios. All of these items speak to the core missio of the OHOW program. Studets also respoded favorably to the advaced challeges preseted i case treatmet. Commets cosistetly reported a favorable learig eviromet ad skill acquisitio i the mobile facility. Studets also reported sigificat satisfactio with their experiece workig as a team of professioals i order to treat the uderserved populatios o the OHOW facility. The Johso Couty Commuity College survey demostrated a high satisfactio with the ability of the OHOW rotatio to ehace the detal hygiee studets ability to provide detal hygiee care. Studet commets icluded, challegig, but a good experiece, by far my favorite rotatio site ad I wish I could have bee o the truck all the time, I leared so much. This feedback is essetial i order to cotiue to provide each studet with a authetic learig eviromet, while meetig the eeds of each service ceter. Several key questios are oted regardig the treatmet of uderserved populatios learig, workig as a team, ad servig patiets without discrimiatio. Table IV demostrates studet resposes to these key questios. It highlights studet resposes to workig with uderserved populatios, learig more skills, workig as a team ad learig the value of servig patiets with special eeds. There was a major icrease i the studet s perceived ability to lear more skills durig their rotatio o the Oral Health o Wheels service learig project. The uique operatio i the OHOW settig allows studets to treat special eeds ad uderserved populatios i a : faculty/studet ratio. Sigificat satisfactio was expressed by studets regardig the learig eviromet ad treatig patiets with itellectual (ID) ad developmetal (DD) disabilities. Ope-eded resposes o the OHOW survey idicated studets comfort level with treatig ID ad DD patiets through JCDS were quite positive. Oe piece of advice give by a studet stated I would tell ext year s studets about how great of a experiece it is workig with the populatio selected: rewardig, so just relax ad thik of the service beig provided. Discussio The faculty ad admiistratio at JCCC are committed to implemetig ad cotiuig service learig projects i the detal hygiee program. Studets positive respose to their OHOW service learig experiece, support the missio of the educatioal arm of the detal hygiee program ad the missio of OHOW. The strog correlatios idetified i this service learig evaluatio project may be i part due to the uique eviromet i which learig takes place. Studets are ecouraged ad directed by all faculty ad staff, o how to use their kowledge ad skills to deliver exceptioal patiet care while cotiuig to sharpe their professioalism. The most sigificat results were from the JCDS service site. Studets idicated treatig cliets with either itellectual/developmetal disabilities (ID/DD) exceeded their expectatios cliically ad gave them persoal satisfactio. I this settig studets work with case/ social workers, support staff, urses ad detists as well as the detal hygiee OHOW program coordiator. These results coicide with expected competecies of a graduatig detal hygieist as idicated i the CODA stadards (2-2) which address studet competecy i assessig treatmet for patiets with special eeds. 6 Additioally, havig the project coordiator who is a full time faculty o site at all times, icreases the experiece, supervisio ad skill developmet of the studet. May of these recommedatios are outlied i the Macy study which favors a more commuity based detal educatio model. 8 Studets utilized didactic lessos leared i the classroom ad applied that iformatio i the mobile cliical settig uder guided istructio. This guided istructio is thought to reduce potetial apprehesio whe treatig patiets with ID ad DD. The studets ability to lear from their experiece is a iteral process withi themselves. Differet from the osite cliic, studets do ot have schedulig burdes as this is doe by the site persoel ad project coordiator. This reduced burde may also allow studets to focus with the task preseted to them. Workig with a Spaish Iterpreter also creates seamless commuicatio with the Hispaic patiet populatio. Studets lear how to work with the iterpreter for effective traslatio. It is uderstood that a iterpreter is ot available for every o-eglish speakig ecouter post-graduatio; however, the experiece provides studets with a appreciatio of the iterpreter as a key member of the oral health care team. Additioally, this experiece may give studets the tools eeded to avigate the public health care system i their future career edeavors. 2 Other studet feedback demostrated a high satisfactio with their ability to provide detal hygiee care for special eeds populatios. Studets became more aware of ad sesitive to the umet eeds of uderserved ad diverse populatios. Oe commet i partic- Vol. 90 No. 4 August 206 The Joural of Detal Hygiee 23

7 ular highlights this reflectio, The most importat thig I leared i my rotatio was providig detal hygiee care for special eeds patiets, ad havig patiece for others havig trouble uderstadig. This outcome demostrates how the OHOW project has helped to icrease the studets sese of professioalism ad civic resposibility as a oral health care provider. 9,2 Results of this service learig project are cosistet with other research such as Wolff et al, which stated that the more experiece detal studets had with treatig persos with itellectual disabilities, the more positive their attitude cocerig this populatio. 9 I aother study by Asto-Brow et al, the authors foud that after experiece i a service-learig rotatio opportuity i the public health eviromet, detal hygiee studets expressed a improved uderstadig of ethical patiet care as well are their awareess of uderserved populatios ad cultural diversity. 6 These authors uderscore the ecessity of service learig as a way to icrease studet awareess of detal public health as a alterate career choice. 6 These suggestios have bee cited i the literature as itegral compoets for a successful service learig project. 9,2,3,8 Lautar describes the characteristics of service learig i detal hygiee educatio. 20 She suggests how providig sealats withi a rural commuity is a good example of a service learig project i the detal hygiee curriculum. This activity meets the eeds of the uderserved childre i the commuity i additio to givig studets exposure to a populatio they might ot geerally be able to treat. 20 Likewise, the OHOW project meets the oral health care eeds of uderserved disabled populatios, exposes studets to commuity service, ad coects ad egages studets to the commuity. Studets are able to reflect o their experiece ad become more culturally competet. 6 Aother study utilizig a oe-o-oe faculty metor approach foud similar outcomes after their detal hygiee studets participated i a Miles of Smiles service learig rotatio. 2 Results idicated studets were able to icrease their cliical skills, became more aware of commuity oral health eeds i child populatios, foud satisfactio i workig with these patiets, ad developed a appreciatio for alterative models for delivery of oral health care. 2 Elyer ad Giles suggest that a crucial compoet of a effective service learig project is coectig the academic goals with the placemet of studets i the commuity settig, further deepeig egagemet. 3 The outcomes of this study demostrated this suggestio by these authors. Studets perceptio of the OHOW rotatio were favorable showig high satisfactio i their feedback demostratig the experiece to be valuable both persoally, for their cliical skills, ad impactig their sesitivity to uderserved populatios. A uique hallmark of service learig i detal hygiee is how the commuity parter beefits from the service provided. 9 Patiet surveys are shared with studets as part of the studet feedback process ad reflectio, allowig the studets to see the direct impact ad appreciatio cliets express after receivig oral health care services from the OHOW project. As part of the atioal oral health care objectives, workig as a team to reduce the burde of oral disease is see as a itegral part to promote health ad quality of life for all idividuals. 4 As educatioal istitutios chage the delivery of detal educatio for future health care professioals, it is hypothesized that the chages may produce oral health professioals with a reewed dedicatio to reach out to uderserved populatios. Log term data cotiues to be collected o the OHOW project ad will be valuable i assessig the future impact of the service learig from both the studet ad commuity parter perspective. Follow-up study should iclude iformatio from graduates to assess how the project impacted their choice of employmet i public health cliics. Additioally, future plas iclude utilizig a Advaced Educatio i Geeral Detistry residet o the OHOW rotatio day per moth to collaborate with the studets ad patiets as well as reduce the burde of care i uderserved populatios. Coclusio The mai purpose of the OHOW project was to evaluate its impact o studet satisfactio ad their ability to gai valuable cliical experieces treatig uderserved populatios. The results demostrated the OHOW project was able to meet its stated purpose as studets were highly satisfied. Rotatio o the OHOW icreased studet learig ad uderstadig of uderserved populatios, built cofidece i their cliical skills, icreased their participatio as a detal team member, as well as their uderstadig of their role i total patiet care. Lastly, results from this study support the ADEA Commissio o Detal Educatio recommedatios for improvig the oral health for all Americas. The OHOW service learig project allows detal hygiee studets a uique opportuity to egage with their commuity while acquirig ecessary cliical competecies required by atioal accreditatio ad providig access to oral health care services to uderserved patiets who would otherwise go without treatmet. Heather Flick, RDH, MS, MPH, Professor, Departmet of Detal Hygiee, Johso Couty Commuity College. Project Coordiator, Oral Health o Wheels. Sheri Barrett, EdD, Director, Outcomes Assessmet, Johso Couty Commuity College. Carrie Carter- Haso, RDH, MA, EdD, Director, Departmet of Detal Hygiee, Johso Couty Commuity College. 232 The Joural of Detal Hygiee Vol. 90 No. 4 August 206

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