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

“I don’t just want whole-person care happening in the clinic, I want to see whole-person education as well.”

Research shows that up to 80 percent of a person’s overall health can be attributed to non-medical factors. These social determinants of health (SDOH)* pose intractable barriers for countless North Carolinians when accessing oral health care. Care integration has been shown to increase access and equity in oral health and benefit both patients and providers.

*Although still widely used, recently, there has been a shift in language from ‘social determinants’ to ‘social drivers’ of health. This change acknowledges that a wide range of nonmedical factors can impact a person’s overall health; however, they do not determine what a person’s health outcomes will be, but rather have the potential to drive them.

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 SDOH. Integrating dental and social work education provides students from both cohorts with invaluable experiences that 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.

UNC Chapel Hill School of Social Work & Adams School of Dentistry

Dr. Zerden created the program, Burgess-Flowers served as the clinical social work faculty member, and Yokovich contributed as the final and only macro (aka community management policy practice) social work student. Burgess-Flowers built the program and established clinical workflows in the dental settings. When Yokovich joined, she helped develop the programmatic integration, conducted research, and attended the dental school’s research day.

Currently, Burgess-Flowers is an Assistant Professor and the Director of Integrated and Applied Behavioral Sciences at High Point University and Yokovich is the Community Voice Program Coordinator at the Foundation for Health Leadership and Innovation (FHLI).

Before leaving for High Point University, Burgess-Flowers wanted to document their work and hopefully contribute to creating more opportunities for social workers to integrate into oral health care spaces. Yokovich had social work experience as well as working in both oral health spaces and wanted to help develop a model for integrating the two fields.

Burgess-Flowers and Yokovich shared their experiences and vision for integrated care in oral health settings. Join us in the conversation…

Why is this topic important to you?

“I came from a primary care setting, and I was working in integrated care with patients. I thought to myself, ‘This is whole-person care,’ but I wasn’t asking patients about their oral health.” said Burgess-Flowers. “As social workers, we talk a lot about how people need to realize that the brain is part of the body. But we’re just as guilty of leaving out the mouth.”

“I worked in a dental office as a treatment coordinator and saw the lack of resources for folks who might not be able to go to different health care offices because they don’t have the time, transportation, resources, or financial means,” said Yokovich. “If you’re going to go into integrated care, it can’t just be physical, it can’t just be behavioral outpatient, it has to be the whole-health picture.”

Can you speak about the influence of SDOH on oral health disparities and the effectiveness of addressing them through social work integration?

“Dental offices are incredibly, historically, traumatizing and can be very over-stimulating for folks with trauma histories,” said Burgess-Flowers. “One thing I’m big on is being able to explain to [oral health providers] how social determinants of health relate back to something like filling a cavity or placing a crown. That is what dentists have been historically trained [to do]. They’re procedure-based, so they really want to know how what you’re talking about or offering to assist with has an impact on what [they] do or why a patient is here.”

“The demographic of oral health providers does not match the demographics of the United States at large. There’s a very stark contrast between those providing care and those receiving care,” said Yokovich. “Something that Jamie and I tried to do while I was at the dental school was educating oral health providers to think about these systemic issues a little bit differently because they’re the ones who are then going to be taking that into practice.”

How did you see care integration help both students and patients?

“It (dental-social work integration) opened so many doors for patients to receive referrals that they might not have been able to receive before,” said Yokovich. “And being able to express concerns about different areas of their lives as well, which is super interconnected and interwoven into their whole health.”

“We’re seeing less turnover, less no-shows,” said Burgess-Flowers. “We see a lot of improvement with dental students and learners, we see their perspective on patients change. We see their burn-out rates improve. We see them feeling like they have a team of people they can lean on and work with inter-professionally and not have to take everything on themselves.”

What ideal changes do you foresee in dentistry and social work?

“I would love to see the model be standard in dental education. I want to see more social workers, and not just clinical social workers, but also your macro social workers, in dental education,” said Burgess-Flowers. “I want dentists and dental hygiene folks in social work education. I don’t just want whole-person care happening in the clinic, I want to see whole-person education as well.”

“I would love to see buy-in from every aspect of oral health care, whether that’s from the dental education perspective or private practice. And I would love to see providers start getting credentialed with Medicaid and accepting patients who they would not have traditionally accepted in their past practice,” said Yokovich. “Having that foundational educational piece is going to be really important for shaping a generation of providers that think about the care of an individual as whole.”

How do you see this research contributing to your work moving forward?

Burgess-Flowers said, “This [role] really is a beautiful blend of being able to teach dental students clinical skills, communication skills, and being trauma-informed, all the way up to self-wellness, preventing burn-out, thinking about our community, the social systems, and racism, and all of the things that come into health care and interfere with patient outcomes being what we want them to be.”

“In a perfect world,” said Yokovich, “I would love to see integrated care across the board, but I think that just starts with us being advocates now where we’re at in order to make small systemic changes happen, so this paper kind of sets a foundation for hopefully this to be replicated at different schools across the United States.”

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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