It’s well documented that oral health is connected to the whole body. So, it makes sense for CHWs and health promoters to understand why oral health is important and what to look out for when visiting clients. Many agencies recognize the need to include oral health in CHW training.
Some states, such as Oregon and Minnesota, require CHWs to take training in oral health.
To help your program meet any requirements or support initiatives—and improve oral and overall health outcomes in clients and patients—we did a deep dive into each state to see what they offer in terms of oral health training, requirements, and resources for CHWs.
Do you know of anything we left out? Let us know, and we’ll add it to this list.
Oral Health CHW Training Initiatives by State
The Alaska Community Health Aide Program (CHAP)/Dental Health Aide Program (DHAP) complements Alaska’s tribal health care system to ensure access to primary health services in remote frontier communities serving Alaska Natives.
Arizona has a state Oral Health Action Plan that includes a strategy to “engage other health professionals (physician assistants, nurse practitioners, community health workers (CHWs), to help consumers navigate the healthcare system.”
The Arkansas Department of Health includes a STAR.Health initiative that use CHWs to promote health in maternal-child health, oral health, and chronic disease management.
The California Oral Health Plan includes a strategy to “Provide technical assistance and training to support the inclusion of oral health goals in promotora/community health worker (CHW) programs and home visitation programs.”
Colorado doesn’t specifically recommend oral health training by CHWs but it does expand the role of dental hygienists to include some traditional CHW skills, “Colorado allows licensed independent dental hygienists to provide preventive care and refer for restorative treatment.” The state does include standards and requirements for health navigators—sometimes called oral health patient navigators–on “Recognizing and reporting abnormal signs and symptoms of common conditions including mental and oral health.”
Connecticut is showing some signs of requiring oral health training for CHWs by integrating oral health with medical health.
Delaware is committed to training CHWs in oral health by training with a presentation called “An Inside Look into the Connection Between Oral Health and Overall Wellness,” from the Division of Public Health at Delaware Health and Social Services. It also has an “Oral Health 101” presentation. “We also encourage the Smiles for Life educational resources,” says Gabrielle Hilliard, the public health treatment program administrator at the Delaware Department of Health and Social Services’ Division of Public Health.
The Florida Senate issued language addressing “critical shortages of providers” in oral health care, among others, and is encouraging CHWs to plug that gap. The Florida Oral Health Alliance works with the Florida Community Health Worker Coalition to work toward its oral health plan.
Georgia was one of 13 states working on state guidelines for instituting best practices for oral health access.
Hawaii was one of 13 states working on state guidelines for instituting best practices for oral health access.
Illinois was one of 13 states working on state guidelines for instituting best practices for oral health access. Its action plan includes, “Increase oral health services (diagnostic, preventive, and restorative) to Medicaid and SCHIP children, birth through 13, by 14 percent.” It received a HRSA grant to build up an oral health workforce.
The CHW Workgroup includes an initiative for “diagnosis-related patient education towards self-managing physical, mental, or oral health in conjunction with a health care team.”
Iowa was one of 13 states working on state guidelines for instituting best practices for oral health access.
Kansas does not yet have established CHW requirements but does have many areas of specialty, including oral health as well as diabetes, asthma, and others, according to Oral Health Kansas. Kathy Hunt, Dental Program Director, says “Next steps are to offer supplemental specialty courses (on-line and face to face) after graduation that will best match job placement,” including CHWs who will work in oral health.
We were unable to find details on CHWs and oral health in Kentucky.
We were unable to find details on CHWs and oral health in Louisiana.
We were unable to find details on CHWs and oral health in Maine.
“Maryland had just begun its process to accredit CHW Certification Training Programs and has not yet issued any accreditations,” says Kimberly Hiner, deputy director of the Office of Population Health Improvement at the Maryland Department of Health.
“Maryland’s CHW certification process is built on our CHW core competencies. While oral health is not explicitly listed as a core competency, training programs may have it incorporated into their comprehensive curricula. We should have more information within the next six to twelve months.”
Oral health is offered as a special health topic to be potentially taken for the CHW requirement course, and/or offered as a potential course for the CHW Certification Renewal.
Michigan was one of 13 states working on state guidelines for instituting best practices for oral health access.
Minnesota initiated an expansion of its oral health workforce because more than half of its counties are considered Dental Health Professional Shortage Areas. Minnesota’s 2013-2018 Oral Health Plan details strategies to expand the oral health workforce to reduce these disparities, including using CHWs.
Some CHWs in Mississippi have completed oral health training, according to Tameka Walls, director of the Mississippi Delta Health Collaborative at the Mississippi State Department of Health.
CHWs in Missouri do not currently receive training regarding oral health, but “we are considering options to encourage this training,” says Karen Dent, Director of the Oral Health Network of Missouri at the Missouri Primary Care Association.
Montana encourages training in oral health for CHWs but has no posted requirements.
The state Health Worker training program does not offer training in oral health, but the state has used CHWs in the past and has placed some individuals in the training program.
CHWs who are not certified or who have the first level of certification in Nevada, need the basic state-approved course. “There’s 20 additional hours of required ‘general training,’ which is not prescribed and CHWs can certainly submit trainings that were on oral health,” says Kayla Valy, project manager for the Nevada Community Health Worker Association. “Oral health trainings are likely to be approved for the ‘general’ category but not specifically called out anywhere.”
The Nevada Certification Board has information for people who would like details on the requirements and process of becoming a certified CHW.
New Hampshire encourages training in oral health for CHWs but has no posted requirements. The Oral Health Program at the New Hampshire Department of Health and Human Services has some information about oral health initiatives.
New Jersey has no posted requirements and did not respond to our survey, but the Children’s Oral Health page at the State of New Jersey Department of Health lists some educational resources.
New Mexico was one of 13 states working on state guidelines for instituting best practices for oral health access.
“Will test a model that uses family-level, peer-counseled, and technology-assisted behavioral risk reduction strategies, aims to divert children with early- and advanced-stage early childhood caries (ECC) from high-cost surgical dental rehabilitation (DR) to low-cost non-surgical disease management (NSDM). Together, parents and community health workers (CHWs) will use MySmileBuddy (MSB), a mobile tablet-based health technology, to plan, implement, and monitor positive oral health behaviors, including dietary control and use of fluorides, which arrest ECC’s progression.”
Oral health for CHWs as part of Maternal and Infant Community Health Collaborative.
North Carolina supports community dental health coordinators. “CDHCs are dental assistants or dental hygienists with the combined skills of a community health worker, dental auxiliary, and care coordinator who are recruited from the vulnerable community they will serve,” according to a newsletter from the NC Department of Health and Human Services.
North Dakota is working on a Community Health Dental Coordinator program supported by the state Dental Association, the ADA, and other partners. “There are a few in North Dakota who have taken the training, and are working in the state (though community health workers/Community health dental coordinators do not yet provide care that can be reimbursed – this is a conversation that is being had with state Medicaid),” says Shawnda Schroeder, the oral health expert at the University of North Dakota School of Medicine and Health Sciences’ Center for Rural Health. “The state has just begun to have conversations around dental community health workers and there is consensus among oral health providers and stakeholders that this model could work in North Dakota.”
Oregon’s Traditional Health Worker (THW) program requires applicants to complete between 1.5 and 3 hours oral health training.
The state pledged to “develop programs that promote and support oral health careers” to meet a gap in promoting oral health education in its Pennsylvania Oral Health Plan 2017-2020 (PDF). This includes “comprehensive plan to improve the number of oral health professionals graduating and remaining in Pennsylvania.”
Rhode Island has requirements for becoming a certified CHW, and while CHWs aren’t required to complete oral health training, they are required to include a “portfolio”: a collection of personal and professional activities and achievements in categories that can include oral health. The state’s Oral Health Program is a “mini-residency” that increases career opportunities for oral health professionals and access to the marginalized communities.
Oral health is a specialty track that the South Carolina Community Health Worker Association would like to provide to CHWs. It is an area that trainers in the state are looking to include in the future.
“Delta Dental of South Dakota, which covers over thirty‐thousand isolated, low‐income, and underserved Medicaid beneficiaries and other American Indians on reservations throughout South Dakota, received an award to improve oral health and health care for American Indian mothers, their young children, and American Indian people with diabetes.”
The Tennessee Department of Health made October 2019 Child Health Month and published a toolkit full of resources for health workers (available here as a cached resource).
Certified CHWs in Texas should be trained in oral health principles as part of the core competency Knowledge Base on Specific Health Issues. It includes the objective, “Find information on specific health topics and issues across all ages [lifespan focus], including healthy lifestyles, maternal and child health, heart disease & stroke, diabetes, cancer, oral health and behavioral health.”
The Utah Department of Health’s Office of Health Disparities publishes many resources for community-focused workers and program coordinators, including “Seal Your Smile: A Step Toward Combatting Oral Health Disparities in Utah,” “Cross-Cultural Education and Training: Oral Health Education Institutions in Utah,” and “Addressing Oral Health Disparities in Urban Settings: A Strategic Approach to Advance Access to Oral Health Care.”
Vermont offers a few initiatives focused on improving oral health (PDF), especially in rural areas. A major achievement is “Access to oral health care was a top priority identified in our current CHNA. In response a multi-agency Rural Oral Health Access initiative was launched to provide oral health screening and dental hygiene services to children in elementary schools throughout our HSA and to link these children to a dental home.”
Virginia’s action plan includes increasing utilization of dental services. Virginia Health Catalyst has resources surrounding its initiatives for CHWs.
The Washington State Department of Health has many resources and trainings for community health workers focused on oral and dental health. The Community Health Worker Training project includes a course available to Washington participants on oral health, available in English and Spanish.
The Wisconsin Oral Health Coalition released “Roadmap to Improving Oral Health 2020-2025” to reduce the prevalence of oral disease and reduce disparities in oral health status among populations but doesn’t contain specific information about CHWs.