Oral Health Promotion: Final Exam

Identify the fundamentals of the legislative process

Legislative process steps:

Bill Drafting – Anyone can write, but a legislator must sponsor it.

Introduction – Read aloud and assigned to a committee.

Floor Action – Debate and vote.

Second Chamber – Repeat steps.

Conference Committee – Resolves differences.

Governor’s Action – Signs, vetoes, or lets it become law without a signature​

What are the advocacy roles of the dental profession in advocating for optimal oral and general health for the US population, including underserved and vulnerable populations?

- Dentists engage in policy, systems, and public health advocacy to support upstream health determinants.

- Oral Health Advocacy targets lawmakers to influence policies on access and prevention.

- Service-Learning at Tufts trains students to understand community needs, emphasizing reflection, reciprocity, and sustainable impact​

What are tools and approaches for the dental profession in advocating for optimal oral and general health for the US population, including underserved and vulnerable populations?

- PEARS Framework: Identify problems, support with evidence, propose action, anticipate counterarguments, and offer solutions.

- Ethic of Care: Promotes interdependence, sustainability, and culturally competent service.

- Justice & Autonomy: Emphasize equitable access and informed community participation​

Define the following:

Taking action to represent your own interests – speaking up for yourself

self advocacy

Define the following:

Taking action to represent one or two individuals or a small group i.e. like advocating for a patient

individual advocacy

Define the following:

Aims to inform and influence decision-makers. Used to influence those who have the formal power to make the change.

policy advocacy

Define the following:

Taking action to change policies or laws to contribute to health of people and the overall population

public health advocacy

What are the 13 components of advocacy?

1. Creating a culture of advocacy

2. Understanding the decision making process

3. Setting advocacy goals

4. Know your audience

5. Choosing allies and building coalitions

6. Developing effects messages

7. Finding and presenting data

8. Identifying modes and messengers

9. Framing messages

10. Establish a media presence

11. Meeting with decision makers

12. Mobilizing support

13. Managing an advocacy campaign

Define the following:

Influences people, especially policy makers, as they develop, review and revise laws and regulations that impact oral health

oral health advocacy

What are the 5 current issues of dentistry at the federal level?

- Funding of NIDCR

- Opioids

- Federal student loan

- Higher Education Act

- Medicare

What are state/local issues in Dentistry? (5)

- Opioids

- Medicaid dental services

- Midlevel providers (dental therapists)

- Community water fluoridation

- COVID19 responses

Define the following:

- Synchronous (live), asynchronous (store and forward), remote patient monitoring (RPM), mobile health (mHealth)

- Regulation varies between states

Teledentistry

What process of a bill is the following:

- Anyone can write a bill but a legislature needs to file and sponsor the bill

- Advocators can work with legislatures to craft bills to address concerning issues

Bill drafting

What process of a bill is the following:

- A legislator introduces a bill in the body of which he or she is a member

- After a bill has been introduced, a short description of the bill is read aloud to the chamber so that all members are aware of the bill and its subject (aka first reading).

- The presiding officer assigns the bill to a committee during the first reading of the bill

Bill introduction

t/f: in some states, bills are assigned to several committees

true

What process of a bill is the following:

Debate and vote

floor action

What process of a bill is the following:

Steps from intro to floor action are repeated

Second Chamber

What process of a bill is the following:

Formed when two chambers disagree on the final version of the bill and they work to create a compromised legislation that will pass in both chambers

Conference Committee Process

What process of a bill is the following:

They can sign/veto/allow the bill to become a law without signature

Governor's action

What process of a bill is the following:

If each chamber passes a different version of the bill, a ____________ is formed to work out the differences

-Bill cannot be sent to the governor until each chamber passes an identical version of the bill

Conference Committee

In most states, a______ can sign a bill into law, allow a bill to become law without their signature or veto the bill

governor

Define the following:

Bill returned to Legislature for possible override

Vetoed

_____________ is an abbreviation for five elements that help identify core messages of an advocacy campaign effort

PEARS

Define the following:

- Urging policymakers to adopt a specific "solution" requires that advocates first identify a problem or challenge that exists in their community, state or country

- Should answer this question: What is happening or not happening that your audience cares about?

Problem

Define the following:

- Share facts or data that demonstrate this problem exists and reveal its impact.

- Can also be helpful to build confidence in your solution

Evidence

Define the following:

- Based on whether the audience is composed of decisions-makers or influencers

- Ask decisions-makers to make the right choice

- Signing petitions, emailing, or taking other steps

Action

Define the following:

- Advocates should play devil's advocate by thinking of the skeptics in their audience

- What might they say to dispute or dismiss your messages?

- Try to anticipate and overcome their skepticism by offering responses that are grounded in the facts.

Reality Check

Define the following:

- Identifies what will change if the Action is taken

- If policymakers or people take the desired action, what impact will it have?

- How will it change things for the better?

- Advocates should consider tailoring the __________ to different audiences because they may define "the better" differently

Solution

The following are characteristics of what?

- Mid-level oral health professionals

- Scope of practice between that of hygienist and dentist

- Provide basic preventive & restorative treatment to children and adults

- Different education requirements and scope of practice depending on the state.

Dental therapist

Define the following:

Insurance for poor/low income households

Medicaid

Medicaid or medicare:

- Costs shared jointly by federal and state governments and

- There’s dental treatment for children while adults vary by state.

Medicaid

Define the following:

Insurance for people 65+ regardless of financial means, certain younger people with disabilities, and end-stage renal disease

Medicare

Medicaid or medicare:

- Cost covered by federal gov

- Mostly no dental benefits

Medicare

T/F: While Medicaid programs are required to cover dental services for children and youth under age 21, they are not required to do so for adults.

True

Which of the following adult dental services is most commonly covered by Medicaid across states?

A. Orthodontia

B. Periodontal services

C. Oral surgery

D. Dentures

C. Oral surgery (42 states cover it)

As of March 2020, how many states provide no adult dental benefits under Medicaid?

A. 0

B. 3

C. 9

D. 13

B. 3

As of March 2020, how many states cover emergency services only in adult dental benefits?

A. 0

B. 3

C. 9

D. 13

C. 9

Which of the following is a common reason states reduce or eliminate adult dental benefits under Medicaid?

A. Decline in dental service demand

B. Overuse of dental services

C. State budget shortfalls

D. Federal policy changes

C. State budget shortfalls

As of March 2020, how many states cover periodontal services and partial or full dentures in adult dental benefits?

A. 31

B. 3

C. 9

D. 40

A. 31

As of March 2020, how many states cover orthodontia in adult dental benefits?

A. 0

B. 3

C. 9

D. 32

B. 3

As of March 2020, how many states cover preventative services such as cleanings and fluoride application in adult dental benefits?

A. 0

B. 3

C. 9

D. 32

D. 32

Why is poor oral health among adults a significant public health concern?

A. It only affects cosmetic appearance.

B. It has no connection to overall health.

C. It can worsen chronic conditions and limit social and economic opportunities.

D. It primarily affects children under 12.

C. It can worsen chronic conditions and limit social and economic opportunities.

How do states most commonly alter Medicaid adult dental coverage during economic downturns?

A. Expand orthodontic services

B. Eliminate preventive care

C. Add services for all adults

D. Reduce or eliminate optional dental benefits

D. Reduce or eliminate optional dental benefits

What is one way states may expand dental benefits without changing the state Medicaid plan?

A. Partner with local dental schools for free care

B. Require all dentists to accept Medicaid

C. Use Managed Care Organizations to offer additional benefits

D. Eliminate co-pays for dental services

C. Use Managed Care Organizations to offer additional benefits

What is the primary barrier to accessing dental care in the U.S., according to the article "In Defense of Dental Therapy: An Evidence-Based Workforce Approach to Improving Access to Care"?

A. Lack of dental schools

B. Geographic distance from clinics

C. Cost and poor oral health literacy

D. Shortage of pediatric dentists

C. Cost and poor oral health literacy

Which of the following is not listed as a negative consequence of poor access to oral health care in the article "In Defense of Dental Therapy: An Evidence-Based Workforce Approach to Improving Access to Care"?

A. Increased mental health issues

B. Morbidity and mortality

C. Poor school performance

D. Systemic health complications

A. Increased mental health issues

What ethical principle does the author argue is violated by opposing dental therapy despite evidence of its effectiveness in the article "In Defense of Dental Therapy: An Evidence-Based Workforce Approach to Improving Access to Care"?

A. Autonomy

B. Confidentiality

C. Justice

D. Non-maleficence

C. Justice

What is a key reason dental therapy is considered an ethical solution to oral health disparities in the article "In Defense of Dental Therapy: An Evidence-Based Workforce Approach to Improving Access to Care"?

A. It allows dentists to delegate all procedures

B. It generates higher income for clinics

C. It replaces the need for oral health education

D. It aligns with principles of justice, beneficence, and veracity

D. It aligns with principles of justice, beneficence, and veracity

Which population has seen documented oral health improvements due to dental therapy services in the article "In Defense of Dental Therapy: An Evidence-Based Workforce Approach to Improving Access to Care"?

A. Alaska Native communities

B. Urban New York residents

C. Military families

D. Uninsured college students

A. Alaska Native communities

What does the evidence in the article "In Defense of Dental Therapy: An Evidence-Based Workforce Approach to Improving Access to Care" show about the safety and quality of dental therapists' care?

A. It’s only effective for children

B. It’s equal to that provided by dentists within their scope

C. It requires more supervision than dental hygienists

D. It varies widely depending on region

B. It's equal to that provided by dentists within their scope

What criticism of dental therapy does the article, "In Defense of Dental Therapy: An Evidence-Based Workforce Approach to Improving Access to Care," argue is unsupported by evidence?

A. Therapists work only in urban areas

B. Therapists cannot perform extractions

C. Therapists lack accreditation from CODA

D. Therapists provide unsafe care

D. Therapists provide unsafe care

Define the following:

Introducing a bill before the session starts

Pre-filling

Define the following:

The last day a member of a legislative body is permitted to introduce legislation

Bill Introduction deadlines

Define the following:

The last day a chamber may act on a bill that originated in that chamber

Crossover deadlines

Define the following:

Placing a limit on the number of bills a member of a legislative body may introduce

Bill Introduction Limits

Define the following:

Legislation that did not pass during the first year of a legislative session will be alive when the legislature reconvenes the next year

Carryover

Define the following:

Some states require a legislature to adjourn by a specific calendar date, while others place a limit on the number of days a legislative body is allowed to meet in a calendar year this is referred to as restriction on _______

"Legislative Days" Vs. "Calendar Days"

Define the following:

Where it restricts the consecutive number of years a member can be in one chamber of the legislature; it is not unusual to see a member of the legislature bounce between chambers after reaching this

consecutive term limit

Define the following:

Prohibits a member from running for an office they've held after they have served a specified number of years. Presiding officers (usually known as the President of the Senate or Speaker of the house/assembly) are the most powerful members of a legislative body

lifetime term limit

should answer the question "what is happening or not happening that your audience cares about?"

problem

t/f: Data comes from a wide variety of sources such as the CDC, national survey of children's health, the national health interview survey, medical expenditure panel survey, census data, etc.

true

Define the following:

- Strategy that puts issues in the appropriate context

- Occurs when a person or group presents an issue in a way that makes an audience more likely to support or oppose a particular position. Considers the beliefs and attitudes of the audience

framing

Which of the following should be considered in traditional media?

a.Developing a Media List: should include the names, media outlets and contact info for key reports/editors and other media

b. Designating a spokesperson for media interviews: someone should be chosen as the person who will be quoted/handle interviews

c. Creating talking points for your spokesperson: should consist of 3-4 key messages

d. Choosing the right time to reach out to news media: think carefully before deciding when or if to send an email or press release to media list

e. Building a relationship: building a relationship with reports and editors is crucial; one of the best ways is to send an email thanking a reporter for a story and suggesting a related story for a future article

f. Using letters to the editor to raise the profile of an issue: good way to raise awareness of an issue

g. All of the above

g. All of the above

What are the challenges facing adults regarding oral health, according to the MACPAC?

- Inadequate dental coverage

- Insufficient provider availability

- Individual barriers

What does MACPAC stand for?

Medicaid and CHIP Payment and Access Commission

What has the following characteristics:

- A safe, high quality, effective and ethical approach to improve the oral health workforce, increase access to dental care and achieve oral health equity

- Engage in oral health promotion programs and provide evaluative, preventative, restorative, and minor surgical dental care

Dental therapists

What are the 3 state branches and what do they consist of?

- Legislative branch consisting of a State Legislature

- Executive branch consisting of a governor

- Judicial branch consisting of a court system

What amendment?

- "Any powers not given to the federal government, but not denied to the states" belong to the state

- One of these powers reserved for the states is the right for the states to establish their own system of state government

10th Amendment

What are the DOs of Lobby for dental students?

- Dress professionally

- Introduce yourself

- Confirm appointment prior to meeting

- Introduce your organization and the highlights of the legislation you're lobbying

- Share a personal anecdote to relate why the bill is important to you

- Admit when you don't have an answer + offer to follow up

- Directly ask that the legislator co-sponsor the bill

- Say "thank you" for the opportunity

What are the DONTs of Lobby for dental students?

- Wear casual clothes

- Get discouraged if meeting with a staffer

- Arrive too early for your appointment

- Stray off topic

- Come to meeting unprepared

- Forget to reiterate the reason for your visit

- Discuss campaign contributions during the meeting

Define the following:

Students engage in activities where the emphasis is on service for the sake of the beneficiary or recipient (client, partner)

volunteerism

Define the following:

Students engage in community service activities with intentional academic and learning goals and opportunities for reflection that connect to their academic disciplines

service-learning

Define the following:

Students engage in activities to enhance their own vocational or career development

Internship

Define the following:

Students work in a discipline-based venue in place of an in-class course experience

Practicum

Define the following:

Students engage in activities to meet actual community needs as an integrated aspect of the curriculum

Community Service

Define the following:

Students engage in actively addressing mutually defined community needs as a collaboration between community partners, faculty, and students as a vehicle for achieving academic goals and course objectives

Community-Based Learning

What are the core elements of successful learning programs?

- Academic link

- Sustained community partnership development

- Orientation to community

- Guided reflection

What core element of successful learning program is the following in:

- Course based

- Structure volunteer experience

- Competency-based

Academic link

What core element of successful learning program is the following in:

- Should have an ongoing relationship with institution

- Provide contact for faculty and students

- Should be actively involved in choices of service activities and problems to be addressed in the program

Sustained community partnership development

What core element of successful learning program is the following in:

- Mission and vision of the community parter

- Description of service site

- Funding structure

- Organizational structure

- Governance

- Service to be performed

Orientation to community

What core element of successful learning program is the following in:

- Make connection between service and academic objectives

- Fosters the exploration of complex issues and personal values and goals

- Helps students examine their role in the community, relationship with people of other cultures/circumstances, and future rule in access to care for underserved

Guided reflection

Define the following:

- An ethical framework that explains that you should not commit any wrong act, even if the consequence is good

- Holds the principle that individuals know what is best for them and no one else should act in any way that compromises their agency

Autonomy

Define the following:

- Theory that is centered around the interdependence of all individuals

- Takes into account the fact that certain communities and people are more vulnerable than others

Ethic of care

Define the following:

- Movement that aims to establish equal rights and legal protection for women

- Advocated for women's rights and gender equality

Feminism

Define the following:

- Ethical framework that maintains that you should never commit any wrong act

Justice (and autonomy)

Define the following:

Principle that explains the intention to do no harm or injury to any other person

Nonmaleficence

Define the following:

- Actions that promote well-being of others

Beneficence

What are 9 best Practices for international healthcare service-learning activities?

1. Require-trip knowledge of cultural, historical, and social issues

2. Recipient community identifies its own needs

3. Define clear objectives and use established outcomes measures

4. Require at least minimum proficiency in the local language

5. Manageable group size

6. Faculty supervision during the provision of care

7. Allow limited tourism activities

8. Establish clear standards for student behavior

9. Emphasis on sustainability and continuity of program.

What theoretical framework is this?

A community is given a well without being asked whether they need one. The high-tech well breaks down and is reduced to a meeting point. Had community partners been consulted, the project’s success would have been higher – “we don’t need a well, we need farm tools” or “a well would be great, but we can’t maintain a high-tech one.”

Autonomy

What theoretical framework is this?

A UBC student is learning in a different region. Community partners have expressed that it is inappropriate for male gynecologists to practice on women. Gynecologic projects be most successful if the community partners beliefs are respected, and the staff is exclusively female.

Autonomy

What theoretical framework is this?

Instead of the UBC students flying down to Mexico to construct homes, a community partner suggests that she fly to Vancouver to deliver several lectures to the entire UBC community about poverty and homelessness in Mexico. This suggestion replaces the original intention of the project to give the opportunity to unemployed Mexicans to construct homes with the funds. It would be argued that projects which place emphasis on community partner preferences are the most successful.

Autonomy

What theoretical framework is this?

An undergraduate student decides that they would like to go to Africa over the summer because they have heard (falsely) that it increases your chance of getting into professional school. When they arrive, they find there is little that they can help with and find themselves wishing they had waiting until they developed a skill before going abroad.

Autonomy

What theoretical framework is this?

A master’s student is planning on doing research in Cambodia and contacts a community partner to ask about what training she might need. The community partner assures her that it is essential that she learns Khmer before conducting research, so she postpones her trip by a year to learn the language.

Autonomy

What theoretical framework is this?

While giving money or gift to vulnerable communities, it is important to consider if the gift will be sustainable or if it will just promote a dependency relationship

Ethic of Care

What theoretical framework is this?

- The theory that is centered around the interdependence of all individuals

- Considers the fact that certain communities and people are more vulnerable than others

Ethic of Care

What theoretical framework is this?

When designing an ISL project for Rwanda, you would have to take into account the local cultural, historical context of the genocide, and language barriers. This would be very different from designing an ISL project for Afghanistan, where you would take into account the needs and wants influenced by Islamic culture

Ethic of Care

What theoretical framework is this?

When designing a health related ISL project for India, consider the goal of having the local community achieving an equal amount of benefit as the ISL project designer.

Ethic of Care

What theoretical framework is this?

If you are going on an education related ISL project to Guatemala, it is better to go with the motivation of learning something from the local community and a sincere desire to help, rather than with the motivation of padding your resume. (In the former case, you would be more likely to learn more about the culture and consider the local context do your job more sincerely; in the latter case, you wouldn’t care as much about focusing on the details that make the experience collaborative and sincere.)

Ethic of Care

What theoretical framework is this?

On a health care project to Haiti, in a rural area with little to no infrastructure, it is best to send a volunteer who has the necessary skill to operate a project with minimum technical equipment.

Ethic of Care

What theoretical framework is this?

You may be working on a project involving sexual education for youth. This may be unacceptable to some locals and thus long-term community investment is threatened.

Ethics Pluralism