At The Rutgers School of Dental Medicine (Rutgers) three extramural dental clinics began implementing the medical home model, with integrated trauma-informed care, in 2018 to expand oral health care services for people with HIV, and improve outcomes on the HIV care continuum. After instituting the model, the dental clinics saw increases in referrals from partner organizations and in the numbers of new clients.
Galloway, Northfield, and Somerdale, NJ
Many people with HIV do not receive adequate oral health care due to chronic illness, inability to pay for care, shortage of dentists trained and willing to treat individuals with HIV, dental anxiety, transportation barriers, and discrimination by providers.
Rutgers conducts extensive outreach with partner organizations in the area, including with community-based organizations and HIV primary care providers, to encourage oral health care referrals. Rutgers outreach staff engage clients through face-to-face visits at these partner agency sites. In addition, they reduce barriers to oral health care access (e.g., by offering transportation services) and facilitate appointment scheduling.
The Recall Recovery Program aims to retain clients in oral health and HIV care. Rutgers staff access electronic health record (EHR) reports to determine the last date of service and the treatment provided. Staff then call the clients, screen for barriers, and schedule follow up appointments. The Recall Recovery Program also educates clients and works to alleviate fear of the dentist.
Rutgers completes needs assessments with clients to understand issues related to primary and HIV medical care and refers them back to a medical provider if necessary. Rutgers also educates medical providers on the importance of sending lab work and medication lists when clients are referred for oral health care.
Rutgers took part in the Ryan White HIV/AIDS Program (RWHAP) Part B-supported New Jersey HIV Trauma-Informed Care Project, which aims to eliminate environmental triggers, de-escalate situations, ensure safety, and sustain a trauma-informed culture of care. The program consisted of trainings, and facility and organizational culture assessments. Through this initiative, task forces were created in all three Rutgers dental clinics to incorporate trauma-informed care in program activities. Literature pertaining to trauma was provided in English and Spanish for clients, informational signs were posted in English and Spanish, and “all genders” restroom signs were installed.
Nutrition counseling and tobacco prevention/cessation has become a part of the six-month checkup process.
In the two years since implementation began in 2018, Rutgers has increased the numbers of referrals from partner organizations and RWHAP clients receiving oral health services.
EHR data, CAREWare, and spreadsheets to track service use.
Number of clients seen, number of visits per client, and number of service units.
Disaggregated by client demographic characteristics with a focus on gender, race, and ethnicity.
From 2018 to 2020:
Source: Communication with the Best Practices Compilation team. 2020–2021.
"We can access reports that show us exactly when [clients] were in last, what treatment they had [not yet received]. I'll call them up, talk to them, ask them how they're doing and why they have been away, and we get them back into the program. If there's any problems with transportation, we help them out with transportation."
- Involvement of all staff. All staff members in the clinics were involved in the implementation of the strategy. They include the assistant dean, dentists, dental hygienists, dental assistants, administrative coordinators, office managers, and administrative staff.
- Staff training. Staff members received over 40 hours of trauma-informed care training, including “Take-5” mini sessions. The goal of these trainings was to provide agency staff with the knowledge, skills, and tools to maintain a service delivery environment and interpersonal protocols that are safe, inclusive, welcoming, accepting, and in tune with the client population.
- Referral partnerships. Through an “inter-professional care model,” Rutgers communicated with surrounding agencies, including community-based organizations, HIV primary care clinics, other schools of dental medicine, and other health care professionals to remove silos and generate referrals.
- While there are no ongoing costs to the intervention, sustainability involved building organizational capacity through agency-wide trainings, dedicating appropriate resources to the strategy’s essential activities, developing related policies and procedures, employing continuous quality improvement programs, and strategic leadership.
- A lack of communication across different disciplines in the healthcare continuum places an unnecessary burden on people with HIV. Therefore,
reducing silos across partners has been a main goal of the initiative.
- This intervention strategy encouraged the agency to look at patients more holistically, addressing their basic dental, medical, and psychosocial needs.
- Monitoring and evaluating the intervention strategy was critical to ensure effectiveness. For example, when Rutgers identified that the
dental clinics werenot receiving lab values, staff conducted targeted outreach to collaborating HIV providers, resulting in better access to requested documentation.