Winter 2011 Quarterly Newsletter
CONTENTS:
Director's Column
Partner Focus
Special Feature
RHAC Profile
WINTER
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DIRECTOR'S COLUMN
PRIORITIES FOR A TRANSFORMING RURAL HEALTH SYSTEM
In these times of constant change in health care, how can public sector leaders
keep up with changing priorities? Especially when it comes to rural health—with
the nuances citizens, communities and health care organizations need to
balance—policymakers can respond best when they get informed insights from
those working directly with rural health issues every day.
Mark Schoenbaum
Minnesota’s Rural Health Advisory Committee, appointed by the Governor to
advise the commissioner of health and other state agencies, takes seriously its
responsibility to assess rural needs and communicate rural priorities to decision
makers. The committee comprises 15 members: three consumers, four
legislators, a higher education member and seven members representing
various health care sectors, all from rural Minnesota. Regular readers of the
Quarterly have seen profiles of new Rural Health Advisory Committee members;
this issue interviews legislative member Representative Larry Hosch.
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The Rural Health Advisory Committee has a pretty good track record. Its past
work has influenced policy in areas such as health reform, new models of care,
rural mental health needs and small hospital stability.
Every other year the Rural Health Advisory Committee sets two-year priorities
and responds to each with a combination of research, analysis and rural
involvement to develop recommendations for the commissioner and other
policymakers. The members review current issues and challenges in rural
health, add what among them is a broad and diverse set of perspectives, and
produce a workplan for the coming two years. The committee’s recently
developed priorities are:
1. Rural Obstetric Services
2. Rural Health System Growth and Consolidation
3. Health Reform Implementation and Rural Implications
4. Dementia-Related Issues, Elder Housing And Long Term Care
5. Better Responses to Rural Mental/Behavioral Health
Emergencies
6. Medication Therapy Management and the Role of Rural
Pharmacists
7. Leadership for Rural EMS Policy and Systems Development
8. Early Successes with Community Paramedic Model.
Many of these issues may seem prevalent throughout the health system. For
each one, the Rural Health Advisory Committee has asked and answered what’s
uniquely rural. Details can be found on the Rural Health Advisory Committee
web page. The committee’s initial project in this cycle is underway; it’s
established a workgroup to develop recommendations to assure access to
obstetric services for rural Minnesota.
The Rural Health Advisory Committee, and those of us in the Office of Rural
Health and Primary Care who staff it, always welcome involvement. If you’re
interested in any of the priorities above, feel free to contact me or committee
staff Kristen Tharaldson.
With this issue, we say goodbye to our editor, Mary Ann Radigan, as she
exuberantly heads off to begin retirement. Mary Ann has edited both our
monthly and quarterly publications for seven years with creativity,
professionalism, patience and good humor. Mary Ann is the person who actually
earned the kudos I get on our publications, and we wish her the very best.
Mark Schoenbaum is director of the Office of Rural Health and Primary Care and can be
reached at [email protected] or 651-201-3859.
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PARTNER FOCUS
EXPANDING ORAL HEALTH CARE
by Leslie Nordgren, R.D.H., M.P.H., Ph.D., Research Specialist, Minnesota Office of Rural
Health and Primary Care
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In 2011, Minnesota became the first state to license a new member of the
dental team: dental therapists. Dental therapists are educated to provide basic
preventive and restorative procedures services that previously only a licensed
dentist could perform. They serve patients who have low incomes, are
uninsured and underserved, and patients in dental health professional
shortage areas. They practice in dental offices, nursing homes, schools, group
homes and other alternative settings.
Dental therapists graduate from an approved education program and pass a
board-approved licensure examination.
The state also authorized certification of an “advanced” dental therapist.
Advanced dental therapists must be licensed as a dental therapist, complete
2,000 hours of dental therapy clinical practice, graduate from an approved
advanced dental therapy education program, and pass a board-approved
certification examination. Dental Therapists
Licensed dental therapists treat patients under the supervision of a Minnesotalicensed dentist. The scope of services to be provided is defined in a written
collaborative management agreement between the dental therapist and
supervising dentist. Dental therapists may supervise up to four dental
assistants. They also dispense and administer analgesic, anti-inflammatory
and antibiotic drugs within their scope of practice and the parameters of their
collaborative management agreement.
Under general supervision, unless restricted or prohibited in their
collaborative management agreement, dental therapists may perform the
following services:
• Oral health instruction and disease prevention education, including
nutritional counseling and dietary analysis
• Preliminary charting of the oral cavity
• Radiographs
• Mechanical polishing
• Topical preventive or prophylactic agent application, including fluoride
varnishes and pit and fissure sealants
• Pulp vitality testing
• Desensitizing medication or resin application
• Athletic mouth guard fabrication
• Soft occlusal guard fabrication
• Temporary restoration placement
• Tissue conditioning and soft reline
• Atraumatic restorative therapy
• Dressing changes
• Tooth reimplantation
• Local anesthetic and nitrous oxide administration.
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Licensed dental therapists under indirect supervision may perform the
following services, unless restricted in their collaborative management
agreements:
• Emergency palliative treatment of dental pain
• Placement and removal of space maintainers
• Cavity preparation
• Restoration of primary and permanent teeth
• Placement of temporary crowns
• Preparation and placement of preformed crowns
• Pulpotomies on primary teeth
• Indirect and direct pulp capping on primary and permanent teeth
• Stabilization of reimplanted teeth
• Extractions of primary teeth
• Suture removal
• Brush biopsies
• Defective prosthetic device repair
• Permanent crown recementing.
Advanced Dental Therapists
Advanced dental therapists enter into a written collaborative management
agreement with a Minnesota-licensed dentist, which specifies the services they
may provide. These may include all services within the scope of dental therapy
practice, plus the following services under general supervision:
An oral evaluation and assessment of dental disease and the
formulation of an individual treatment plan authorized by the
collaborating dentist;
Specific nonsurgical extractions of periodontally diseased permanent
teeth
And provide, dispense and administer analgesic, anti-inflammatory and
antibiotic drugs.
Education Requirements
Minnesota law establishes the requirements for licensure and mandates that
institutions educate students to the necessary level of competency. It does not
dictate to the educational institutions what their admission requirements should
be or how to structure their programs. In Minnesota, Metropolitan State
University is educating students to be eligible for certification as an advanced
dental therapist and the University of Minnesota is educating students for
licensure as a dental therapist.
Metropolitan State University, Advanced Dental Therapy
Program
Metropolitan State University, in partnership with Normandale Community
College, was the first school in the United States to offer a Master's of Science
in Oral Health Practitioner degree. Students must be licensed dental hygienists
to be admitted to the program. Upon graduation they meet licensure
requirements for dental therapy and credentialing for advanced dental therapy
and they may continue to practice their full scope of dental hygiene. http://www-dev.health.state.mn.us/divs/orhpc/pubs/quarterly/2011/winter.html[2/28/2012 4:47:08 PM]
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The first seven students graduated from Metropolitan State University in the
summer of 2011. Early adopters of this new dental team member include
Apple Tree Dental, Children’s Dental Services and Hennepin County Medical
Center, where graduates are providing dental hygiene services and working on
the 2,000 hours of providing dental therapy services required for advanced
dental therapist certification. The second cohort of four students will graduate
in April 2013.
For information about the Oral Health Care Practitioner Program, contact
Suzanne Beatty, D.D.S. at [email protected]
University of Minnesota School of Dentistry, Dental Therapy
Program
The University of Minnesota School of Dentistry is the only dental school in the
country that educates dental therapists and the only Minnesota institution that
is accredited to teach dentistry procedures. The school offers two tracks: The
Bachelor of Science Program is for students who have completed at least one
year of prerequisite college course work and the Master of Dental Therapy
Program is for students who have already completed a baccalaureate degree.
In December 2011, the school awarded one bachelor’s degree and seven
master’s degrees in dental therapy. A ninth student will graduate in May 2012,
after an extension provided to accommodate a personal leave earlier in her
education program. One graduate is a dental therapist working for a private
practice in Montevideo, Minnesota; another is employed as a dental therapist
by Health Partners.. The University’s second class of nine students—four on
the bachelor’s degree track and five on the master’s degree track—will
graduate in December 2012. In September 2011, the School of Dentistry
admitted 10 students into its third class, and these students will graduate in
December 2013. School of Dentistry dental therapy classes have included
students from rural and urban areas in Arizona, California, Florida, Minnesota,
South Dakota and Wisconsin.
For information about the Program in Dental Therapy, contact the Division of
Dental Therapy at 612-625-4310 or [email protected].
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SPECIAL FEATURE
ON THE FASTTRAC
by Mary Ann Radigan, Communications Coordinator, Minnesota Office of Rural Health and
Primary Care
I’m in a classroom with 15 certified nursing assistant students—men and
women ranging in age from early 20s to mid 60s. Everyone is focused on the
two teachers. Yes, two teachers: One is a health care specialist and one is an
adult basic education specialist. Both are integral to a program called
FastTRAC. The teachers hone in on a puzzled look. Is it a problem with the
health care topic or with reading, math or computer literacy? Through this
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integrated curriculum—with help in the classroom and in studying and in
career planning—students are on a fast track to building a career in health
care.
Minnesota FastTRAC is a partnership of colleges, adult basic education,
workforce development and community organizations. Their unique
partnership means there is no duplication of efforts to train individuals who
want to advance—but may be underprepared academically—in fields that
communities need.
FastTRAC helps more adults enter and succeed in post-secondary education
because they are moving through a coordinated system of education and work
opportunities. Students are being trained and successfully employed at
higher-paying jobs. And they have the option of returning for more education
that builds on their previous work in the classroom and the workplace.
“It changes lives! I didn’t think I’d ever do anything other than housekeeping.
FastTRAC showed me there were other options for me,” explained one
graduate.
FastTRAC Career Pathways
FastTRAC partners select and fund local programs though a competitive
selection process. Partners include local employers, workforce development
agencies, human services and community-based organizations along with
Adult Basic Education at the Minnesota Department of Education, the
Governor’s Workforce Development Council, Greater Twin Cities United Way,
Minnesota Department of Employment and Economic Development, Minnesota
Department of Human Services, Minnesota Department of Labor and Industry,
Minnesota Office of Higher Education and Minnesota State Colleges and
Universities.
The Joyce Foundation, as part of its Shifting Gears state policy initiative to
strengthen state education and training systems in six Midwestern states for
workers with low skills, is funding FastTRAC. In 2011, the Initiative awarded
nearly $1.7 million to 17 adult career pathways projects, including 13 health
care grant awards:
Pathway to Health Care Career Success at Minnesota State Fergus
Falls trains participants to become certified medical lab technicians, offering
education in the Integrated Anatomy and Physiology classes that are the
cornerstone of many other health care program requirements. Students gain
confidence in the college process, procedures and technology requirements,
and may have an opportunity to learn with professionals at a health care
facility. Participants complete an online college orientation that includes
technology requirements, financing education, and college policies and
procedures to ensure understanding of college expectations. Pathways to Health Care Careers at Lake Superior College (Duluth)
provides access to health care careers through Certified Nursing Assistant and
Trained Medical Administration certificates. Individuals enter the workforce
directly or enroll in further training as a licensed practical nurse or registered
nurse. Online learning options and digital literacy courses are available. Health Informatics Pathway at Ridgewater College (Hutchinson)
prepares individuals to enter the Phlebotomy Technician Certificate
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program. Prior to enrolling in Medical Terminology, Pharmacology and
Computer Technology, basic reading, writing, math and computer technology
skills are provided.
Universal Health Care Worker at Minnesota West Community &
Technical College offers 10 career and technical training and certification
sessions that can be taken independently or as part of the entire credentialing
program. Participants learn skills necessary for employment as certified
nursing assistants, certified home health aides and trained medication
administration workers. They can also earn a CPR certificate or a license in
safe food handling, and receive help with computer literacy, soft skill training
and resume/job search/preparation.
South Central Health Care Career Pathway at South Central College
increases the basic skill levels of students while training them to be certified
nursing assistants and home health aides. The curriculum includes
contextualized instruction in workplace reading, writing, speaking and math
based on the needs of students. Rochester Community & Technical College Mayo C.N.A.
FastTRAC Program focuses on the Certified Nursing Assistant, Hospital
Certified Nursing Assistant, English, Medical Terminology and Introduction to
Psychology courses to train students to be certified nursing assistants.
Participants receive help with career planning and employment plan
development to ensure a smooth transition through training to employment.
Enhanced West Metro Pathway to HealthCare Careers at
Hennepin Technical College offers Introduction to Health Care, Nursing
Assistant Preparation, and/or Medical Terminology as a bridge to prepare
students who are disadvantaged to enter a health care education and career
track. Upon completion of the bridge course, students take a Nursing Assistant
college course with integrated instruction. In addition, the Nursing Assistant
course incorporates specific work culture, career exploration and career
planning within the broad field of health care, provides students with career
development skills needed in entry-level health care professions, and prepares
students to successfully use computers in future college-level courses. Pharm Tech Futures at Minneapolis Community Technical College
includes introduction to medical terminology, the language of customer service
in health care settings, contextualized reading and math, work readiness and
soft skills training, and career assessments to build core skills needed for
employment as certified pharmacy technicians. Anoka Healthcare/Nursing Pathways at Anoka Technical College and
Anoka Ramsey Community College focuses on Universal Health Care Worker
in Older Adult Services Certificate training with a special focus on low-income
households. Participants become certified nursing assistants and earn credits
toward certification in health care services for older adults.
Ramsey Medical Careers Pathway at Saint Paul College offers a
Medical Records Clerk Certificate and explores additional pathways in medical
careers. Computer keyboarding and technology is embedded throughout the
curriculum. Students also have the ability to complete a Career Assessment. Saint Paul EMS Academy at Inver Hills Community College offers a
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holistic approach to providing EMS training to youth and single parents ages
18-24 in low-income households. St. Paul Medical Careers Pathway at Saint Paul College offers the
skills required for employment as certified nursing assistants or the option of
enrolling in anatomy and physiology courses for other medical careers.
“FastTRAC gives adult learners the opportunity to benefit from integration
between adult basic education and the ‘credit-side’ of college. Students
complete the training as certified nursing assistants with credits they can apply
to other health care career pathways,” said Diane Halvorson, executive
director, South Central Workforce Council.
Information on FastTRAC is online at http://www.mnfasttrac.org/.
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RHAC MEMBER PROFILE
ORHPC TALKS WITH RURAL HEALTH ADVISORY COMMITTEE
(RHAC) MEMBER REP. LARRY HOSCH
Please explain your professional work to us.
I work in two different capacities—one as a state legislator and the other as a
social worker. I am serving my fourth term as a state representative from central Minnesota
and I am a minority whip. I serve on the Health and Human Services Reform
Committee, the Health and Human Services Finance Committee, and the
Agriculture Committee. My policy areas of interest include health care, long term
care, mental health and disability services. Outside of the legislature, I am an independent living specialist. I work with
people in Isanti, Mille Lacs, Sherburne, Stearns and Wright counties who have
cognitive, physical and mental disabilities.
And your life away from work?
My wife and I live in St. Joseph with our one-year-old and four-year-old boys
and a golden retriever. I enjoy weight lifting, running and anything outdoors
including heading up to our cabin in Outing, Minnesota. What do you think are the most important issues facing rural
health?
Our biggest issues are the changing demographics of Minnesota and access to
mental health services.
In a rural area, maintaining independence becomes increasingly difficult as we
age—from accessing transportation to finding primary and specialty care.
Preparing our communities, providers and families will be a challenge and an
opportunity for us in the coming years. http://www-dev.health.state.mn.us/divs/orhpc/pubs/quarterly/2011/winter.html[2/28/2012 4:47:08 PM]
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Access to mental health services is already challenging for rural Minnesotans
and the ability to recruit mental health professionals is becoming a near crisis.
What do you think would make the most difference for rural
health? We need to engage our cities, counties, non-governmental organizations and
providers in preparing for the graying of Minnesota. If we want to maintain an
emphasis on independence, our communities need to learn how to change and
adapt to new needs and service demands. We also need to invest in recruiting health and medical professionals and work
to provide the educational and training opportunities that will attract and retain
them.
The Rural Health Advisory Committee advises the commissioner of the
Minnesota Department of Health and other state agencies on rural issues;
provides a systematic and cohesive approach toward rural health issues; and
encourages cooperation among rural communities and providers.
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VIEW ONLINE ALL PREVIOUS ISSUES OF THE OFFICE OF RURAL HEALTH AND PRIMARY CARE PUBLICATIONS.
SAVE JUNE 25-26 for the
2012 RURAL HEALTH
CONFERENCE!
Minnesota Office of Rural Health and Primary Care
P. O. Box 64882
St. Paul, Minnesota 55164-0882
Phone 651-201-3838
Toll free in Minnesota 800-366-5424
Fax: 651-201-3830
TDD: 651-201-5797
www.health.state.mn.us/divs/orhpc
MISSION
To promote access to quality health care for rural and underserved urban Minnesotans.
From our unique position within state government, we work as partners with communities,
providers, policymakers and other organizations. Together, we develop innovative
approaches and tailor our tools and resources to the diverse populations we serve.
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