community ch 6-7

major areas of public health law

• police power

• disease and injury prevention

• the law of populations

police power

• Includes law enforced by governmental agencies, such as dental boards or emergency health operations

• major area of public health law

disease and injury prevention

• Includes legal activities such as prevention initiatives and occupational safety and health agency (OSHA) regulations

• major area of public health law

the law of populations

• Uses epidemiology to analyze health issues, such as the environment and community water fluoridation

• major area of public health law

within the last decade

• RDHs in many states have been given authority to provide dental hygiene without the supervision of dentists

native alaskan population

The United States Public Health Service created a dental therapist model to provide dental services to the __ __ population

Surgeon General’s “call to action” 2003

• report asked for an increase in the oral health workforce diversity, capacity, and flexibility

• Minnesota now has mid-level providers practicing within their communities.

in 2004

• ADHA recognized the need for a mid-level entry position for dental hygienists (A D H P).

• Minnesota now has mid-level providers practicing within their communities.

by individual states (legislature)

• laws that affect dental hygiene practice are enacted and enforced by

• however, federal government provides a model in which to fashion the states systems

federal government

provides a model in which to fashion the states’ systems.

legislative branch

• creates laws for each state, including laws affecting the licensing and practice of dental hygiene

• Has two legislative bodies: the House of Representatives and the Senate

  • federal government = congress

  • state government = state legislature

• only branch that can enact statues and create/change statutory laws served to promote justice

executive branch

• enforce laws, executes or carries out laws passed by the legislature and enforces laws made by state legislature

  • federal government = president

  • state government = governor

judicial branch

• interprets the laws the legislature passes; judges do not make the laws but they interpret them

• composed of courts, interprets the laws the legislature passes but it does NOT make them

• common laws

  • federal government = federal courts

  • state government = state courts

common law

• created and changed only by courts

• created through judicial decisions that in many cases other courts can change

• contains notions of common sense and precedent

statutory laws

• created and changed only by legislative branch

• describe the allowable scope of practice, necessary dental supervision requirements, requirements necessary to obtain a dental hygiene process, and suspension and revocation of licensure procedures.

• which is the legislature-enacted, written law which serves to promote justice

constitutional laws

• created and changed by people through their legislators

• Deals with the interpretation and implementation of a governments codified constitution

• The people, through their legislators, created it, and the people, also through their legislators, have the power to change it

• Takes precedence over both common and statutory laws

administrative laws

• delegated legislative power to an administrative agency

• Refers to the body of rules, regulations, orders, and decisions created by a governments administrative agencies (dental boards)

• Legislature has the authority to say whether and when administrative agencies can develop rules and regulations

laws pertaining to dental hygiene

• The rules and regulation vary by state.

• Policies enacted at the federal level pertaining to dental insurance and Medicaid may affect practice

• Statutory laws describe the allowable scope of practice, necessary dental supervision requirements, requirements necessary to obtain a dental hygiene process, and suspension and revocation of licensure procedures

state dental boards

• govern dental hygienists

  • with the exception of Iowa and new Mexico which are governed by dental hygiene committees

• Develop rules and regulations to interpret or further define the practice act

• Grant, suspend, or revoke licenses

• Are composed of dentists and dental hygienists

rules

•Develop rules and regulations to interpret or further define the practice act

•Grant, suspend, or revoke licenses

•Are composed of dentists and dental hygienists

supervision of dental hygienists

•All states have supervision requirements (all dentists must supervise dental hygienists).

•In more than 30 states have various forms of unsupervised practice.

•Eighteen states allow dental hygienists to enroll as Medicaid providers.

types of supervision of dental hygienists

• unsupervised, independent, collaborative practices

• general supervision

• indirect supervision

• direct supervision

unsupervised, independent, and collaborative practice

• Dental hygiene practice without any supervision required from a dentist. Dental referral is necessary. In many states, a dental hygienist may practice only in certain public health settings

general supervision

• Dental hygiene practice without a dentist’s “physically present” supervision. The patient must be a patient of record of a dentist in some states. Many states have additional stipulations, such as the patient must have had an exam within 30 days prior to or 30 days after dental hygiene treatment.

indirect supervision

• The dentist must be in the facility during dental hygiene treatment.

direct supervision

• The dentist must be in the treatment operatory during dental hygiene treatment.

change agents

•are individuals who cause social, cultural, or behavioral change, be it intentional or unintentional.

•They cannot be effective without the collaboration of others who are motivated by external and internal factors to pursue change.

•They are good at empowering others.

•They know what resources are available and know the position of those who oppose changes.

advocacy/ advocate

• Involves an individual or individuals with an issue and plan for remedy

• Is an individual or group of individuals with a common concern who join efforts to educate, promote, or lobby others who can assist with establishing policy, programs, or funding

• Usually closely related to the issues and work or serve with populations

• implement change in regard to how dental care is delivered, who is able to receive it, and how to ensure sustainability of a program. 

• Change in dental public health should be a primary concern and interest of dental hygienists.

change

•is an evolution from one state to another state.

•It can be abrupt or occur slowly.

•There is a need to create change in individuals that govern policy.

•Success depends on one's ability to understand others and resolve to work with them regardless of goals or interests.

• is a verb that implies action

  • modifying

  • altering

  • transforming

roles and responsibilities

•Dental hygienists are advocates for patients' health by affecting change in their behavior, change in dental office protocols, change in products used, and change in the practice of dental hygiene through the legislative and regulatory systems.

well defined goals and role of change agent

•Catalyst

•Solution giver

•Resource linker

•Process helper

the change agent in action

•Policy making

•Collaboration and partnership

•Coalition building

•Grant writing

components of planned change

• assessment

• diagnosis

• planning

• implementation

• evaluation

• documentation

assessment

• components of planned change

• Recognize when a change is needed.

• Collect data to verify the problem to be solved through change and identify the desired situation that will result from the change.

diagnosis

• components of planned change

• identify the problem that has created a need for change

planning

• components of planned change

• Plan solutions/approaches and alternatives to the problem for which change is needed. Analyze the alternative approaches in terms of advantages, disadvantages, consequences of each, resources needed, cost, and level of support. Decide on a course of action from the alternatives analyzed.

• Design a plan for change: state objectives, outline methods, develop a timetable, involve people, assign responsibilities, assign resources, and monitor stability.

implementation

• components of planned change

• Implement the plan for change.

• Monitor for unforeseen problems.

evaluation

• components of planned change

• Determine whether the desired outcome and stated objectives have been achieved as a result of the implemented change.

• if necessary, reassess the situation and modify the plan for change

• Stabilize the change by directing human and material resources to make the change permanent. Rewards and incentives should meet the human needs of the people involved.

documentation

• components of planned change

• Throughout process

• Record all data, evaluation, policies and agreements

key competencies of dental change agents

• vision

• collaboration

• communication

• negotiation

vision

• Sensitivity to changes in dental care delivery, professional perceptions, technology, and in the way in which each impacts the health of the public

• Ability to develop clearly defined, realistic goals for a project of change

• Generalized perspective of priorities

collaboration

• Ability to bring together key stakeholders and establish effective partnerships

• Networking skills to establish and maintain appropriate contacts within and outside the organization

• management skills to establish working groups and to define and delegate respective responsibilities clearly

• Is the process of working with others toward a common goal

• Occurs when two or more individuals or organizations work together on a tasks of mutual interest and benefit

communication

• Effective interpersonal skills, predominantly listening to and recognizing the concerns of others

• Ability to express enthusiasm in partnership ideas and stimulate motivation and commitment in others

• Ability to convey effectively the need for adaptation to colleagues and partners

negotiation

• Skills to influence others to commit to plans and ideas by creating a desirable and challenging vision of the future

• Tolerance of uncertainty about the causes and effects of change

• Fosters cohesiveness

• Political awareness in identifying potential hazards and balancing conflicting goals and perceptions

PAUSE

• a collaborative style for reaching an agreement

  • prepare

  • affirm relationships

  • understand interests

  • search for creative solutions

  • evaluate options objectively and reasonably

prepare - pause

• acquire facts

• identify issues and interests

• use ethical principles

• develop options

• anticipate reactions

• plan an alternative to a negotiated agreement

• select an appropriate time and place to meet

• plan opening remarks

• seek counsel

affirm relationship - pause

• courteously communicate

• acknowledge personal issues

• respect leaders authority

• seek to understand others positions

• discuss participants responses

• seek solutions that satisfy all

• confront in a gracious manner

• allow face saving

• praise valid points

• seek solutions that satisfy all

understand interests - pause

• focus on interests rather than positions

• seek to fully understand interests

• determine coinciding or conflicting points

• use caution in revealing personal interests

search for creative solutions -pause

• invent solutions based on need

• expand the topic with additional interests

standard components of a grant proposal

• cover letter

• needs statement or statement of problems

• project description

• evaluation plan

• budget request and budget justification

• applicant qualifications

• future funding or sustainability plan

• appendices

cover letter

• component of grant proposal

• Includes the project title, name of the agency submitting the grant proposal, agency address, name of the prospective funder, beginning and ending project dates, and total amount of funds requested.

• Title page and abstract, which briefly describes the major points of the proposal.

needs statement or statement of problems

• component of grant proposal

• Documents present the problem to be addressed with text, statistics, graphs, and/or charts.

• It should also describe the causes of the problem creating the need and identify approaches or solutions that have already been attempted.

project description

• component of grant proposal

• Contains three main parts:

  • goal(s) and objective(s)

  • methods to address the identified problem or need

  • time line for completing each component.

evaluation plan

• component of grant proposal

• Shows how the organization will measure the success of the project and outcome objectives; should include details about how information will be collected, analyzed, and shared with the funder

budget request and budget justification

• component of grant proposal

• Should contain details regarding salaried individuals, direct and indirect costs of supplies and equipment, administrative costs, and any matching donations of money or supplies.

applicant qualifications

• component of grant proposal

• Should convince grant reviewers of the validity of the requesting organization’s project

future funding or sustainability plan

• component of grant proposal

• Shows a continued effort to ensure the program’s security and longevity

appendices

• component of grant proposal

• Provides supplemental materials that do not belong in the body of the proposal but are important data that should be shared with the funder.

barriers to creating a coalition

• turf issues

• negative history

• domination by “professionals” or some other elite

• poor links to the community

• minimal organization capacity

• funding

• failure to provide and create leadership within the coalition

• failure to show benefits of perceived or actual-costs of working together

turf issues

• Organizations are often very sensitive about sharing their work, their target populations, and especially their funding.

• Part of creating a coalition may be to convince a number of organizations that working together will in fact both benefit all of them and better address their common issues

negative history

• Organizations, individuals, or the community as a whole may have had experiences in the past that have convinced them that working with certain others is simply not possible.

• A new coalition may have to contend with this history before it can actually start the work it needs to do.

domination by “professionals” or some other elite

• All too often in their rush to solve problems or to "help the disadvantaged," agency people with advanced degrees, local politicians, business leaders, and others neglect to involve the people most affected by the issue at hand and other affected community members.

• Creating a participatory atmosphere and reining in those who believe they have all the answers are almost always required when starting a coalition.

poor links to the community

A first step may have to be the development of hitherto nonexistent relationships among agencies and the community at large

minimal organizational capacity

It might be necessary to find a coordinator or one or more individuals or organizations to seek a way to share the burden with the new group if it is to develop beyond a first meeting

coalition funding

• The difficulty of finding funding is an obvious obstacle. Less obvious are the dangers of available funding that pushes the coalition in the wrong direction or requires it to act too quickly to address the issue effectively.

• New coalitions should be alert to funding possibilities from all quarters and be vigilant about the kind of funding they apply for and accept.

failure to provide and create leadership within coalition

•Coalitions demand a very special kind of collaborative leadership. It may be necessary to bring in an outside facilitator and/or to train someone in collaborative leadership to salvage the situation.

failure to show benefits of perceived or actual-costs of working together

The task may be to find ways to increase benefits and decrease costs for individuals and organizations if the coalition is to survive

policies

• Written descriptions of rules, regulations, and stipulations to govern individual actions and procedures

• have been predominantly set by government, including those that affect dental care and dental public health.

ethics

guiding principles for individuals or groups based on what is right and what is wrong

types of government policy

• national health policy

• state health policy

• local health policy

national health policy

• health policies for a particular nation that are in the best interest of the public as a whole

•Research and record the status of health in a particular nation

•Determines guidelines and sets goals to affect change in the nation's health

Manager of policies and funds

state health policy

• is responsible for carrying out federal policy.

•It develops protocol for implementation.

•Each state has a designated dental director or representative that manages oral health programs.

•When needed, policies at a state level are changed to implement programs effectively.

local health policy

• Local health policy is developed by local health departments or city or county governments.

• These partnerships create a breeding ground for change agents.

• Local policy establishment and enactment are supported by:

  • Professional associations

  • Local businesses

  • Private foundations

  • Educational institutions

lobbying for policy change

•The attempt to influence or sway others towards a desired position or action

•"Art of the sell"

• formally seeks to influence legislators to enact desired legislation and informally to persuade others

•Most valued assets are their established relationships.

•A tool to provide advice on strategies, tactics, and procedures to maximize your effectiveness

•Provides access to those whom the change agent wants to influence

strength in numbers

• partnerships

• collaborations

• teams

collaboration

• the process of working together toward a common goal

• occurs when two or more organizations or individuals work on a task of mutual interest and benefit.

•Strengthened through networking

• is vital.

partnership

•The state or condition of associating or participating with others regularly regarding a joint interest

•An intense form of collaboration

•An agreement between entities

•Becoming important with new health care needs, trends, and issues

•Demonstrate the fortification of relationships involved in the process of change

•Legal documents or contracts are used in formal partherships which outlines each memeber’s responsibilities

formal partnership documents

•Memorandum of understanding (M O U)

•Affiliation agreement

•Partnership agreement

coalition building

•Cornerstones of creating successful change within a community

•Partnerships that function on a larger scale

•Come in a variety of forms: permanent, temporary, single, or multi-issue

•Increases the potential for success in creating policy change, increasing public knowledge, creating a network, and developing of innovative solutions to complex problems

grant writing

•A grant is a sum of money given to an agency or individual to address a problem or need in the community

One must request or apply for this funding

change

•Dental hygienists can contribute to the _ process to advocate for increased Medicaid coverage, community water fluoridation, and state funding of oral prevention programs.

• in dental care can be accomplished by individuals, collaborations, partnerships, and coalitions.

goals of coalitions

•Influencing or developing public policy

•Changing people's behavior

•Building a health community

administrative

1. State agencies such as dental boards fall within which

type of law?

a. Common

b. Statutory

c. Constitutional

d. Administrative

legislative

Which branch of government makes laws for the

state?

a. Legislative

b. Executive

c. Administrative

d. Judicial

state law

Laws that explain what services dental hygienists can

provide are found in

a. Medicaid rules

b. State law

c. Federal law

d. Health care regulations

both statements are true

Judges do not make laws, but they interpret them.

a. The first statement is true, but the second statement

is false.

b. The first statement is false, but the second statement

is true.

c. Both statements are true.

d. Both statements are false.

both statements are false

Because federal laws regulate dental hygiene practice, federal senators are involved with state regulation.

a. The first statement is true, but the second statement

is false.

b. The first statement is false, but the second statement

is true.

c. Both statements are true.

d. Both statements are false

change agent

Which of the following is an individual or group who causes a social, cultural, or behavioral change, be it intentional or unintentional?

a. Mentor

b. Change agent

c. Lobbying

d. Grants writer

by determining the type of dental treatment rendered

. Which of the following is not a way in which social

advocates initiate change in dental public health?

a. By delivering dental care

b. By helping to sustain dental public health programs

c. By determining the type of dental treatment rendered

d. By determining who receives dental care

influencing individuals who govern policy

. What is necessary to create change?

a. Influencing individuals who govern policy

b. Increasing an organization’s financial status

c. Redesigning the public health facility

d. All of the above

all of the above

What are the roles identified for the dental hygiene

change agent?

a. Catalyst

b. Solution giver

c. Resource linker

d. All of the above

modification

Making basic changes without losing the essential

components is termed?

a. Modification

b. Competency

c. Application

d. Networking

coalition

• is an alliance of distinct organizationS or people to take joint action

• Represents an array of interests and brings together organizations and individuals to build a power base that works to accomplish change in response to mutual concern       

stakeholder

• Individuals in organization who have a particular vested interest in a specific topic, issue, or initiative

• Usually compose coalitions                           

grantsmanship

• Is the art of obtaining grants for funding projects

• Technical skill

policy

• a written description of rules, regulations, and stipulations to govern individual action

• Can be as formal as laws or rules with accountability and consequences or as loosely structured as guides or advisory opinions with no binding legality