Evidence-level

Effective (About evidence-level criteria)

Description

Northern Dental Access Center is a nonprofit community dental clinic that serves low-income residents in rural northwest Minnesota. This 26-county region, including counties in North Dakota, has the highest birth rates in the state along with high rates of infant mortality and births to teenage mothers, highest rates of overall poverty and children in poverty, and lowest median household income and highest rates of public assistance payments per capita. About 20%-30% of the region's population is Native American, a group that often faces greater levels of poverty, unemployment, and chronic disease.

Northern Dental has partnered with Community Resource Connections, Beltrami Area Service Collaborative, and Evergreen Youth & Family Services to provide dental care, mental health screenings and referrals, and insurance counseling to patients in order to help reduce barriers to care. As a result, Northern Dental has been able to connect patients and clients with services beyond their dental needs.

This program received support from a 2012-2015 Federal Office of Rural Health Policy (FORHP) Rural Health Care Services Outreach grant to identify and address barriers to care, including mental health issues. The focus of this expansion was to build on the already existing patient advocacy and support services that the organization provides. This project added an expanded safety net beneath the most vulnerable patients and augments dental care with integrated patient support and outreach.

Services offered

• Patient advocacy and care coordination through seven certified community health workers (CHWs)
• Patient transportation assistance
• Information about and referrals to local health and human services
• Referrals to mental health and primary care providers for intervention/treatment
• Insurance navigation and enrollment

Results

• 1,480 people received insurance navigation or enrollment assistance.
• Over 1,200 urgent care/walk-in encounters were provided.
• Over 2,000 referrals to partner agencies were made to assist patients in accessing support services.
• Patients accessing the transportation assistance program were 37% more likely to complete treatment.
• 30% of patients access one or more support services, 20% of whom were referred to a support service by clinical staff.

In addition to opening a new clinic in rural Norman County, Northern Dental also saw the following results:

• 40% reduction since 2012 in patients reporting using the emergency department for dental emergencies
• More than 40% reduction since 2013 in external referrals for specialty care involving long-distance travel
• 98% of patients reporting the following in an exit survey:
  • The quality of their dental care is good/excellent.
  • The facility has a welcoming environment.
  • They are likely to return for their next appointment.

For more information about Northern Dental Access Center and its wraparound services:

Larson, J.E., Leider, J.P., & Knudson, A. (2019). A Practice Report from the Northern Dental Access Center: Offering Wraparound Services at a Community Dental Access Clinic to Improve Treatment Outcomes among Rural Populations in Poverty. Journal of Public Health Management and Practice, 25(5), E22-E29. Article Abstract

Challenges

• Collaborative partners facing funding and other resource challenges
• Patients' resistance to co-location of care
• No current model for incorporating CHWs into a clinic setting
• Challenges in meeting revenue expectations

Replication

• Create a data tracking system to measure impact
• Conduct weekly, monthly, quarterly, and annual reports to track progress
• Conduct patient surveys at the start and end of treatments
• Make data-driven decisions
• Remain transparent

Contact Information

Jeanne Edevold Larson, Executive Director
Northern Dental Access Center
218.444.9646
Jeanne.larson@northerndentalaccess.org