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Oral Health Care Integration Case Study Part 2: Social Work in Dentistry

“It’s uncomfortable to think of a social worker in your space, and it’s uncomfortable to think about asking patients the questions that we ask. So, if it feels uncomfortable, lean into it because there’s going to be something good that comes from it.”

The University of North Carolina (UNC) Chapel Hill School of Social Work and Adams School of Dentistry (ASOD) partnered to provide dental and social work students with interprofessional workforce development and learning opportunities related to social drivers of health (SDOH). Integrating dental and social work education provides students from both cohorts with valuable experiences they will carry into their future practices.

Jamie Burgess-Flowers, MSW, LCSW, Kelsey Yokovich, MSW, and Lisa de Saxe Zerden, MSW, PhD published a research paper titled “The social determinants of health, social work, and dental patients: a case study” to document the first-year implementation of this model at the dental school. If you haven’t already, read part one of this case study for more background information to join us in the conversation with Burgess-Flowers and Yokovich from the beginning.

In this blog post, Burgess-Flowers and Yokovich share insights into the value of social work integration in dental care, the need for buy-in to promote sustainable systems-level changes, and the importance of continual learning.

Case: Social Work Consultation at a Dental Clinic

Burgess-Flowers told a story about one of her first days working in a dental clinic that demonstrates how integrating dental education and social work can transform patient and provider experiences for the better. A dental student approached her seeking guidance after completing a young adult patient’s health history intake. He noticed significant decay throughout their whole mouth, “I’m really concerned because this patient in their health history interview said that they don’t do any drugs.”

Although that patient had a level of decay often seen in patients with methamphetamine substance use disorder, Burgess-Flowers consulted with the student. She encouraged him to continue asking questions rather than jumping to conclusions. As it turned out, the patient worked extended Emergency Medical Services (EMS) shifts, drank Mountain Dew for the caffeine and hydration without water, and had little to no time for personal oral hygiene.

Though a patient may be struggling with a substance use disorder, this dental student learned to challenge his assumptions and remain open to other possibilities. Social drivers of health (SDOH) come in many forms, including employment type, dietary choices, and more, as this patient experienced.

The student will carry what he learned from this firsthand work experience long after graduating from dental school. “Having [this] foundational educational piece is going to be important for shaping a generation of providers that really think about the care of an individual as whole rather than siloed,” said Yokovich.

Buy-in: Driving Sustainable Change

Social work and oral health integration remains a fairly new concept that Yokovich and Burgess-Flowers hope will expand in the future. They discussed the importance and challenges of getting buy-in from students, educators, university leaders, providers, policymakers, and anyone else involved in the care system.

Burgess-Flowers spoke about the challenge of getting buy-in from some folks in dental education who have yet to see value in integrating social work into the curriculum. “When I started at UNC, one of the faculty members who was an oral medicine specialist looked at me, and he said, ‘You need to understand that what you’re doing is incredibly valuable. You are also asking a group of folks who have been trained to use a two-millimeter point of view to look at a tiny piece of disease on the surface of a tiny tooth to back up to a two-thousand-foot view of a patient,” she said.

Yokovich, the final and only macro (aka community management policy practice) social work student to participate in the UNC School of Social Work and ASOD program, said, “There was a lot of push-back, especially when I was talking about racism and the influence that has over practice.” Building on that, Burgess-Flowers said, “Now, social work is more synonymous with social justice, and people think that we’re going to be bringing up the uncomfortable things.” She told us it takes time to overcome “people’s perceptions of what a social worker is and what we bring to the table.”

When it comes to integrating social work and dental education, Burgess-Flowers said, “Buy-in is a really slow process for me, but it’s also all about that end goal that requires a lot of patience to get there.” Her vision is that as social work becomes embedded into dental education and dental practices, the holistic approach will trickle down until new employees, faculty, and students “say, well, this is just the way we do things.”

Key Takeaways: Lean in & Keep Learning

In their closing statements, Yokovich and Burgess-Flowers encouraged anyone in health care and education to stay open to continual learning. “An overarching message is for providers and folks who are in the educational space to keep an open mind when they feel uncomfortable. Usually, good things come out of that,” said Yokovich.

“It’s uncomfortable to think of a social worker in your space, and it’s uncomfortable to think about asking patients the questions that we ask,” said Burgess-Flowers. “So, if it feels uncomfortable, lean into it because there’s going to be something good that comes from it.”

They both hope to see this interdisciplinary work continue and care integration implemented across all areas of health care.

NCOHC, a Foundation for Health Leadership & Innovation program, works to advance systems-level changes, improving the overall health and well-being of all North Carolinians by increasing access and equity in care. Sign up for our monthly newsletter to join the network and get involved!

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