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Oral Health Training Initiatives in Every State

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

Alaska

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

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.”

Arkansas

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.

California

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

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

Connecticut is showing some signs of requiring oral health training for CHWs by integrating oral health with medical health.

Delaware

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.

Florida

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

Georgia was one of 13 states working on state guidelines for instituting best practices for oral health access.

Hawaii

Hawaii was one of 13 states working on state guidelines for instituting best practices for oral health access.

Idaho

The Idaho Oral Health Network carves out space for CHWs to help with oral health. Idaho also was one of 13 states working on state guidelines for instituting best practices for oral health access.

Illinois

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.

Indiana

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

Iowa was one of 13 states working on state guidelines for instituting best practices for oral health access.

Kansas

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.

Kentucky

We were unable to find details on CHWs and oral health in Kentucky.

Louisiana

We were unable to find details on CHWs and oral health in Louisiana.

Maine

We were unable to find details on CHWs and oral health in Maine.

Maryland

“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.”

Massachusetts

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

Michigan was one of 13 states working on state guidelines for instituting best practices for oral health access.

Minnesota

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.

Mississippi

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.

Missouri

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

Montana encourages training in oral health for CHWs but has no posted requirements.

Nebraska

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.

Nevada

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

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

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

New Mexico was one of 13 states working on state guidelines for instituting best practices for oral health access.

New York

“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

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

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

Oregon’s Traditional Health Worker (THW) program requires applicants to complete between 1.5 and 3 hours oral health training.

Pennsylvania

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

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.

South Carolina

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.

South Dakota

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.”

Tennessee

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).

Texas

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.”

Utah

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

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

Virginia’s action plan includes increasing utilization of dental services. Virginia Health Catalyst has resources surrounding its initiatives for CHWs.

Washington

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.

Wisconsin

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.

No information was available for Alabama, Delaware, Ohio, Oklahoma, West Virginia, or Wyoming.

What’s New for Diabetes and Prediabetes

CHWTraining launched its Diabetes and Prediabetes more than six years ago, and it remains our top requested course. It’s not hard to understand why, as diabetes continues to grow in the U.S. and trigger a host of other chronic diseases.

Adults in the U.S. need diabetes support, especially now when the coronavirus brings new threats to communities and people who already have the disease. Without the proper education about diabetes, patient populations will only decline if trends continue on the path they’re on.

CHWs, Diabetes and Prediabetes

Community health workers, community care coordinators, health promoters and others are more important than ever in helping people understand their diabetes or prediabetes diagnoses and control it.

CHWs can advise on what diabetes is, how to interpret blood sugar levels, share healthy eating ideas and recipes, and give ideas for physical activity. They can also connect clients to professionals who can provide more support beyond a physical, such as dental workers and dietitians. They can also help vulnerable and minority communities who have statistically worse health outcomes from diabetes.

That’s why we created Diabetes and Prediabetes (and the Spanish language Diabetes y prediabetes) included it as part of our chronic illness learning track. As part of our latest updates to the course, we took a careful look at how things have changed with diabetes.

[Related: Add Chronic Illness training to any Learning Track]

Diabetes is on the Rise

The number of people with diabetes in the US is up. In the United States, an estimated 34.2 million people of all ages have diabetes. That number continues to rise. In 2018, about 1.5 million adults in the United States were newly diagnosed with diabetes, according to the CDC’s National Diabetes Statistics Report 2020.

[Source: CDC]

Diabetes is the seventh leading cause of death in the United States.

African Americans, Hispanic/Latino Americans, and Native Americans are at a higher risk for both type 2 diabetes and gestational diabetes. These health disparities gain an alarming momentum when you see that more African-American and Hispanic people are testing positive for COVID-19 and are being hospitalized at higher rates than whites.

Diabetes and COVID-19

Scientists and officials have revealed that most cases of the disease are mild. Most serious cases are in patients with underlying health conditions, such as hypertension, obesity, and diabetes.

This is a serious consideration in the US, because the CDC reports that 60 percent of U.S. adults have a chronic condition. More people in the ICU for COVID-19 had diabetes than any other condition.

Diabetes makes outcomes worse by weakening the immune system, especially if the infected person’s diabetes is not well managed.  This means that their bodies have to work even harder to fight off the infection.

Stress can cause another problem with immune defense systems and blood sugar levels. It can cause both to grow out of control. This can make diabetes even worse. The American Diabetes Association has more information on How COVID-19 Impacts People with Diabetes.

This is an opportunity for community-focused health workers to step in and help. By helping patients understand how to interpret their blood sugar readings and helping them eat nutritiously, they can both help them manage diabetes and boost their overall immune system.

Diabetes and Oral Health

The relationship between oral health and diabetes is more pronounced than many people realize. Good dental hygiene is associated with a lower diabetes risk, according to a study. On the other hand, people with a dental disease, such as periodontal (gum) disease, are at a higher risk of developing it. One surprising statistic says “In individuals missing 15 or more teeth, this risk increases to 21%.”

CHWs can help by educating clients and caregivers on good oral health habits, including frequent brushing, daily flossing, and avoiding sugary snacks. Many people are not seeing dental workers because of cancellations and coronavirus risks, which means they need to be extra vigilant with their oral hygiene to avoid the need of seeing a professional.

More information on oral health and its relationship with other chronic disease is in the course Oral Health Disparities.

Diabetes is bad for people in the U.S. more than ever before. Community health workers are more important than ever when it comes to avoiding and managing diabetes and prediabetes.

If you’re not including training about diabetes in your CHW workforce, start now. If you’re interested in building a diabetes education program for your team with these or other courses, contact us to learn how to add certified training to your program. Our team will be in touch ASAP to schedule a time to chat.

Image by Myriam Zilles from Pixabay

CHWTraining Releases New Course for Under-served Communities: “Oral Health Disparities”

Online training offers guidance for community health workers, case managers, and others to bridge gaps in oral-health awareness and access

Woburn, Mass., Feb. 14, 2020 – CHWTraining, a trusted provider of educational support and structure that enables organizations to build healthier communities from Talance, Inc., has added the new online course “Oral Health Disparities.” The 2- to 3-hour self-guided training is designed for people who need to show clients and caregivers how to improve oral health while navigating social determinates of health.

Oral Health Disparities,” available in English and Spanish, is ideal for clinical and non-clinical staff, including community health workers, promotoras de salud, case managers, patient navigators, support staff, and more.

Many people in the United States fail to understand the profound relationship between oral health and overall well-being. The mouth can show signs of nutritional gaps or general infection. Poor oral health reduces quality of life and is related to chronic systemic conditions, including stroke, heart and lung disease, and diabetes.

But significant disparities remain in oral care across different populations, where oral-health literacy can be negatively affected by factors ranging from race and ethnicity to socioeconomic status, geography, culture, language, gender, and age.

According to the Centers for Disease Control, non-Hispanic blacks, and Mexican Americans between 35 and 44 years of age experience untreated tooth decay nearly twice as much as white non-Hispanics. Latino children have higher rates of tooth decay, rampant decay, and treatment need compared to non-Latino white children. Many people living in less-affluent urban and rural areas either can’t afford dental insurance or face other barriers—including language, culture, or a lack of available information and resources—to finding and receiving oral care. Poor dental health in under-served communities can correlate to chronic conditions ranging from heart disease to diabetes to brain degeneration and more.

However, oral disease is preventable with the proper training. Oral Health Disparities helps employers, health systems, agencies, and health departments invest in training that promotes prevention and coordinates care among at-risk patients.

The course provides oral-health training and support for healthcare workers on various oral-health aspects, including teaching clients the basics of good oral care and dietary choices, learning to recognize oral signs of health or substance-use issues, and helping to bridge gaps and barriers to quality care.

About CHWTraining

CHWTraining provides online training-technology tools to organizations that want to create workers who transform health in America’s communities. It’s perfect for training new employees who need core competencies or standardizing training for existing staff—on their own time. The assessment-based certificates confirm that participants can demonstrate their knowledge.

About Talance

At Talance, we believe we all have a civic responsibility to help build healthy communities. Since 2000, we’ve collaborated with educators, advocates, health practitioners, governments, and employers to drive positive, lasting change in the environments where people actually live and work. Talance delivers online community-health education that is trusted by clients across the nation, who rely on our expertise to help develop custom curricula or tap into our original course library that is developed by a professional team of industry leaders.

Interested in educating your team in oral-health disparities? Contact us to learn how at www.chwtraining.org/contact.

CHWs Can Improve Oral Health Disparities

People who work with people’s teeth understand what kind of view that provides to the whole body. They see first hand how the mouth can reflect problems around the body and how problems with the mouth can affect the rest of the body. Poor dental health can correlate to chronic conditions ranging from heart disease to diabetes to brain degeneration—and more.

Almost all Americans understand this first-hand. Over 90% have at least one tooth that’s been treated for decay or needs to be. About a quarter of U.S. adults between 20 and 64 need a filling. Cavities are the most common chronic childhood infectious disease. Periodontal disease is also tragically undertreated in the States and affects about half of us. The problem there is that people with gum disease are 2 to 3 times more likely to have cardiovascular problems.

Oral Health Disparities

Access to health care and proper education helps address this gap, but there are stark disparities in the oral health of men, women, and children. These oral health disparities can have serious consequences, which we explore in depth in the CHWTraining course Oral Health Disparities.

Learn more about how CHWTraining Subscriptions can help increase CHW/promotora satisfaction, retention, and improve oral health outcomes

Some of the statistics from our course are unsettling.

“Blacks, non-Hispanics, and Mexican Americans aged 35–44 years experience untreated tooth decay nearly twice as much as white, non-Hispanics,” according to the CDC. Latino children have higher rates of tooth decay, rampant decay, and treatment need, compared to non-Latino white children.

Image: Pew Charitable Trusts

Education is widely lacking. I, for one, have never once in my life been told that women have unique oral health concerns, despite regular checkups and experience with recurring canker sores and inflamed gums. Are most pregnant women told they are far more likely to have gum disease or loose teeth or that morning sickness is a problem for teeth? I’m guessing not.

The trouble is that too few of the people in charge see it that way. Starting from the top with health policy all the way down to children who haven’t learned to brush regularly, too many people are tuned out to the connection between oral and overall health.

Many people can’t afford dental insurance or expensive electronic toothbrushes or a house where the water is fluoridated, especially in underserved rural and urban areas. Still, there isn’t much care coordination and patient navigation to support people.

Fortunately, this trend is reversable because relatively simple prevention goes a long way with oral and overall health.

CHWs Can Reverse Oral Health Disparities

Communities and health systems need to step up oral health by providing better access to dentists and education. Community health workers (CHWs), promotores de salud, and other lay educators are in a perfect position to help.

States and health systems should work to include oral health education as a part of CHW training. They can help people navigate such barriers as poverty, language, geography, and even transportation. And they can do it where people live, not necessarily in a clinical setting. This is a relatively low-cost way to engage families but can have a tremendous impact a person’s health, from childhood through the rest of their life.

Interested in educating your team in oral health disparities? Contact us to learn how.