NOHC Meeting Minutes

**Feb 4 -- 8, 2008**

# Monday Feb. 4, 2008:

AM: National Combined Councils Meeting:

-   Registration

-   Opening Announcements/ Posting of Colors

-   Welcome Address, *Margo Kerrigan, MPH, California Area I H S
    Director*

-   Indian Health Service -- Challenges and Changes, *Randy Grinnell,
    MPH, I H S Deputy Director of Management Operations*

-   The Impact an Opportunities for AI/AN Health Care in Medical Genetic
    Translation Research, *Michael Trujillo, MD, MPH, MS, Executive
    Director, TGen.*

-   Primary Prevention in Diabetes: A Model with Results, *David
    Marrero, PhD, Director, Diabetes Translation research Center,
    Indiana University*

PM: Breakout sessions and concurrent workshops

**[Tuesday Feb. 5, 2008:]{.underline}**

## **Dr. Tim Ricks presented the Nashville Area Dental Program Update**

**Challenges:**

Geography: 28 states

Decentralization of dental programs

Lack of funding to support dental programs

\_ Nashville Area New programs:

State Collaborations

Mobile dental van is operational

Patient education Initiative:

\_ Goal is to increase documentation of patient education.

**Project TransAm-**

-   PROJECT TRANSAM is a Civilian-Military Cooperative Action Program
    between the Indian Health Service (IHS) and the Department of
    Defense (DOD) concerning distribution of medical equipment and
    supplies obtained from closure of military bases as well as other
    sources such as the GSA Excess program, Direct Transfers from other
    Federal agencies, direct shipment and delivery from Resource Control
    Point (RCP), Discounted Medical assets from Defense Logistics Agency
    (DLA) Depots, and "Blankets for the Homeless" donation program
    sponsored by the DLA each year.

> To view the complete list of donated equipment, go to the website:
> <http://www.ihs.gov/NonMedicalPrograms/TRANSAM/index.cfm>

-   Patient Education Initiative -- the goal is to increase
    documentation of patient education -- CRS indicator. Allows
    follow-up from other health professionals.

-   Behavioral Health Initiative -- the goal is to bring dental into the
    primary care team more. Dental can boost GPRA performance for the BH
    indicators

-   Tele-Dentistry Initiative -- the goal is to provide cost-effective
    and timely consultations to providers. Benefits are: potentially
    saves CHS \$\$\$, saves patients travel time and expense, and timely
    referrals.

-   Continuing Education Program -- goal is to provide free CE to dental
    staff as local funding isn't always available. Provide CE to Area
    Dental staff via conference calls, online CE, webcasts, and Area
    Dental Meeting.

-   Dental Support Center -- provides complementary services throughout
    the Area.

**After Dr. Rick's Presentation the council started General
Discussion.**

> Results of earlier survey shows that our members, dentist in the
> field, are not familiar with the NOHC and it's goals. Also information
> is not disseminated down to clinic level.

How do we disseminate information?

-   Bring back "Dental Explorer" newsletter in electronic form.

-   Promote website by sending mass email with thee hyperlink to the
    site and instructions how to obtain passwords.

-   Information could be sent to the area representatives. Each
    representative should compile a list of his or her member dentists
    and hygienists. Area Reps will be responsible to disseminate
    information to the membership.

### Question and answers session with ADM Grim

ADM Grim is concern with the high rate of dental vacancies in the I H S.
Current vacancy rates are as follows:

Dentists 31%

Nurses 18%

Physicians 17%

-   Want to have full-time employees

-   Currently, paying locums/contract care at large expense

-   Want to have assignment incentive pay to deal with pay gap

-   Developing dental special pay to increase pay

-   Indian Health Care Improvement Act (IHCIA)

Will increase funding. IHCIA is progressing through Senate with snags

-   There are no national funds to train dental specialists due to lack
    of funds

### Guest Speaker: Randy Grinnell, MPH

### Acting Chief Director and Management Operations

-   Dental recruitment

    -   \$75K accession bonus will go in effect late February.

    -   \$36K bonus for hard to fill assignment

-   IHS Improvement ACT did not pass. President Bush opposes the Davis
    Bacon Act -- labor issue.

    -   Proposed changes in the IHS Improvement Act -- assisted living
        and wording of DHAT.

    -   2009 I H S budget will most likely stay flat

### 

### 

### 

### Guest speaker: Dr. Nancy Reifel, DDS, MPH, 

### UCLA School of Dentistry

Dr. Reifel is working with the ADA and I H S and others to develop a
curriculum for training of dental assistants as ***Community Dental
Health Coordinators (CDHC)***

-   Emerging Allied Dental Workforce Models: Considerations for Academic
    Dental Institutions

-   ADA CALL FOR LETTERS OF INTEREST: To Develop and Implement Pilot
    Community Dental Health Coordinator Training Programs.

Community Dental Health Coordinator Program:

-   Is supported by the ADA.

-   Role of CDHC:

    -   Develop and implement community-based oral health prevention and
        promotion programs

    -   Collect diagnostic data

    -   Perform a variety of clinical support treatments such as
        gingival scaling, Prevention education

    -   Collect diagnostic data,

    -   Palliative temporization on dental cavities under direct or
        indirect supervison

    -   Demonstrate knowledge and skill required for administrative
        procedures; provide individual preventive treatment services
        based on plans

    -   School based sealant program

    -   Perform palliative temporization on dental cavities in
        preparation for restorative care by a dentist. (ART by hand
        instrument only)

-   3 pilot training sites (Detroit, MI; Oklahoma, and an IHS site)

-   Candidates for CDHC are experienced dental assistant.

-   Training

    -   Experienced dental assistant

    -   Curriculum: 1 yr of didactic training and 6 months of guided
        internship.

    -   Will be training in sealants and ART (hand instruments only)

-   ADA will provide half the budget for this program

    -   Pay for clinic for backfill position

    -   Pay clinic for internship

-   Hope to train 6 students each year. 18 students over 3 yrs.

> ***[6 to 9 PM: Council reviewed and updated the NOHC
> charter.]{.underline}***

#### Wednesday Feb 6, 2008

NOHC work initiated with discussion on the following topics:

1.  OUTREACH**:**

    A.  NOHC Orientation packet for members was completed 2/08 by Lynn
        Van Pelt

    B.  NOHC Orientation packet for leadership (Chair, V. Chair &
        Secretary) to be developed by current leadership (short term
        project)

    C.  NOHC/ADA liaison position will be created by the Communication
        work group; Purpose -- communication w/ the USPHS ADA delegate
        (long term) and collaboration with the ADA on specific projects
        as needed (short term); assigned the 2008 Communications work
        plan

    D.  Establish and maintain effective methods of communication with
        NOHC membership (long term); assigned the 2008 Communications
        work plan

    E.  Establish a solely consultative relationship with the ADA
        regarding its plan to develop and implement the Community Dental
        Health Coordinator (CDHC) Training Program (long term).

    F.  NOHC representation at the annual ADO mtg.; the NOHC Chairperson
        (or his/her designee) will attend the mtg.; HQ will likely allow
        only one attendee; expense will be paid by HQ or from the NOHC
        budget (if existent).

    G.  After much discussion is was decided that the Area rep will be
        responsible for dissemination of information to his/her
        constituents. The method of information dispersement was left to
        the discretion of the Area rep. Most agreed bulk email and the
        NOHC website would be effective methods.

2.  RECRUITMENT & RETENTION (R&R):

    A.  Hygiene - contact person(s) will work with the national dental
        hygiene program & report to work group on R&R status; work group
        will compile/create educational information for service unit
        administrators regarding the need for RDH services (meet GPRA
        objectives, income potential, prevention efforts, etc.);
        (ongoing)

    B.  Dentist/DA -- contact person(s) will collaborate with the
        IHS-DOH to assist with recruitment efforts (ongoing).

    C.  Create and maintain a "Recruitment & Retention" tab under the
        NOHC "Resources" tab on the website. Purpose -- to disseminate
        R&R resource information to potential/current dental staff and
        establish links to career mentoring (ongoing).

3.  TOOLS/RESOURCES:

    A.  ART -- group decided to follow pedo's decision regarding use of
        ART in IHS facilities. It was discussed that the NOHC should to
        consider input from hygienists/DAs if we elect to draft a
        position (long term).

    B.  Website development continues (ongoing); contact -- Phil
        Driscoll; Phil will be transferring from IHS; succession plan
        for website design/maintenance at NOHC level TBD by
        Communication work group

    C.  Dental disparities position paper was tabled.

    D.  The topic of clinical based research was opened for discussion.
        The conversation was mottled with little direction. I gleaned
        from the conversation that some council members are interested
        in partnering with research groups to conduct clinical based
        research on methods/products in IHS facilities. More discussion
        will be necessary before a consensus will be reached (long
        term).

    E.  Acceptance of funding from non-IHS sources was discussed; the
        conversations again were assorted and difficult to follow; Per
        my interpretation of the conversations, at this time it is
        illegal for federal programs to accept monies directly unless
        through specific programs approved by the feds; the resources
        work group may decide to pursue support of a mechanism by which
        to accept outside funding sources without tribal involvement
        (long term).

    F.  Recurring budget -- TBD by NOHC leadership and presented to NOHC
        and RADM Halliday for review (short term/ongoing).

    G.  Post-Op Instructions -- assigned to Clinical Issues work group
        (long term); desired outcome is for clinicians to have access to
        multiple "accepted" versions of post-op instructs for use in
        their clinics; these versions will be created &/or reviewed by
        the dental specialties; Our membership expressed concern about
        this issue due to pending litigation.

4.  STANDING COMMITTEES:

    A.  Charter Review -- will occur annually at NOHC mtg. (ongoing); to
        expedite the review/revision process at future mtgs., it was
        suggested the charter be reviewed and revision recommendations
        noted by the individual council members prior to their arrival.

    B.  Oral Health Projects -- deferred to individual service units
        (long term/ongoing); NOHC may address sharing project success
        via website

    C.  HP/DP -- information regarding awards process distributed.
        Discussion limited due to the absence of Dr. Blahut. Previous
        years awards have yet to be funded.

**HP/DP Awards:**

Dr. Blahut is asking for the NOHC's opinion about the distribution of
HP/DP funds. Many tribes have pulled their share of funds from the area
and headquarters. The council debated the issue if it should support the
current policy of HP/DP fund to all I H S regardless of the program
being tribal or federal. The council voted to keep funding both programs
if the proposal is selected for funding.

For \-\-\-\-\-\-\-\-\-\-\-\-- 6

Against \-\-\-\-\-\-\-- 5

Abstain \-\-\-\-\-\-\-- 2

##### Workgroups:

The council created four work groups to deal with various issues.

-   *Communication Group*

-   *Retention and Recruitment*

-   *Clinical Issues*

-   *Resources Group*

***Communication Group:***

Members: Heshmat Mortazavi, Phil Driscol, Jennifer Borden, Joe Hosek and
Joyce Biberica

Communication Group Resources needed:

Identify the work: Communication

+--------------+-----------------+---------------+--------+-----------+
| Issue        | Resources       | Obstacles     | Ti     | Success   |
| /Responsible |                 |               | meline |           |
| party        |                 |               |        |           |
+--------------+-----------------+---------------+--------+-----------+
| Website /    | -   Talee       | -   Talee     | 4      | Up &      |
| Driscoll     |                 |               | /01/08 | running   |
|              | -   Driscoll    |               |        | per       |
|              |                 |               |        | agreed    |
|              |                 |               |        | format    |
+--------------+-----------------+---------------+--------+-----------+
| Voting &     | -   T. Ricks &  | -   Showing   | 9/09   | 3 more   |
| surveys/     |     others to   |     res       |        | surveys   |
| Biberica     |     help write  | ults/outcomes |        |           |
|              |     & review    |               |        | Return   |
|              |     surveys     | -   Accurate  |        | rate of   |
|              |                 |     e-mail    |        | 20%+      |
|              | -               |     addresses |        |           |
|              |    SurveyMonkey |               |        | Feedback |
|              |                 | -   ADO       |        | from      |
|              | -   NOHC        |               |        | con       |
|              |     Listserve   |    opposition |        | stituents |
|              |                 |               |        | useful    |
|              |                 | -   Alaska    |        | for use   |
|              |                 |     e-mail    |        | for       |
|              |                 |               |        | issues    |
|              |                 |               |        | pertinent |
|              |                 |               |        | to IHS    |
|              |                 |               |        | dental    |
|              |                 |               |        | clinical  |
|              |                 |               |        | practice  |
+--------------+-----------------+---------------+--------+-----------+
| Disseminate  | -               | -   Obtaining |       | Feedback  |
| information/ |  Representative |     e-mail    | 4/1/08 | from our  |
| All area     |     from each   |     addresses | (for   | con       |
| re           |     area to     |     &         | a      | stituents |
| presentative |     help        |               | ddress |           |
|              |     compile     |   maintaining | book)  |           |
|              |     accurate    |     address   |        |           |
|              |     e-mail      |     book      | U     |           |
|              |     address     |               | pdates |           |
|              |     book        | -   Alaska    | qua    |           |
|              |                 |     e-mail    | rterly |           |
|              | -   Headquarter |               |        |           |
|              |     newsletter  | -             |        |           |
|              |                 | Participation |        |           |
|              |                 |     by area   |        |           |
|              |                 |     reps &    |        |           |
|              |                 |               |        |           |
|              |                 |  constituents |        |           |
+--------------+-----------------+---------------+--------+-----------+
| ADA          | -   1 contact   | -   Getting & | Qua    | C         |
| Lia          |     person      |               | rterly | ontacting |
| son/Biberica |                 |  distributing | basis  | ADA PHS   |
|              |                 |     info      |        | repre     |
|              |                 |               |        | sentative |
|              |                 |               |        | &         |
|              |                 |               |        | diss      |
|              |                 |               |        | eminating |
|              |                 |               |        | in        |
|              |                 |               |        | formation |
|              |                 |               |        | quarterly |
|              |                 |               |        | to NOHC   |
|              |                 |               |        | m         |
|              |                 |               |        | embership |
+--------------+-----------------+---------------+--------+-----------+

Resource want list:

-   NOHC Listserve

-   ADO support

-   Funding for a member of the executive council to attend ADA Annual
    Conference

-   Service Unit Director Support

***Retention & recruitment Group:***

Members: Andy Wilson, Brian Talley, Rick Troyer, Ron Fuller, Lorrie
House, Travis Fisher

Objective: Create a recruitment/retention resource guide to assist,
local, area, and national programs in the recruitment and retention of
dental staff.

Objective: Create recruitment/retention tab within the NOHC website.

Resources Needed:

-   ADA Salary Survey, state labor statistics

-   Current rules and regulations regarding pay systems

-   Identify current recruitment/retention collaborative partners

-   Staffing needs assessment template

Obstacles:

-   Budget restrictions

-   Effective communication link to reach remote Tribal and IHS programs

-   Local/area administration

> Work plan:

+-------------------------+------------------+------------+------------+
| **Activities**          | **Responsible    | **Date     | **Status** |
|                         | Party**          | Due**      |            |
+-------------------------+------------------+------------+------------+
| Identify/collect market | Rick             | April 1,   |            |
| pay schedules by region |                  | 2008       |            |
| for dentists and        | Travis           |            |            |
| auxiliary staff         |                  |            |            |
+-------------------------+------------------+------------+------------+
| Identify/collect        | DePAC -- Ron,    | April 1,   |            |
| presentations materials | Andy             | 2008       |            |
| currently available.    |                  |            |            |
| (CAM, IHS DOH HQ, HSO   | IHS HQ -- Brian  |            |            |
| PAC, DEPAC)             |                  |            |            |
|                         | HSO PAC --       |            |            |
|                         | Travis           |            |            |
|                         |                  |            |            |
|                         | DA - Lorrie      |            |            |
+-------------------------+------------------+------------+------------+
| Identify communication  | DePAC -- Ron,    | Quarterly  | On-going   |
| liaison's - establish   | Andy             |            |            |
| quarterly contact with  |                  |            |            |
| recruitment & retention | IHS HQ -- Brian  |            |            |
| stakeholders            |                  |            |            |
|                         | HSO PAC --       |            |            |
|                         | Travis           |            |            |
|                         |                  |            |            |
|                         | DA - Lorrie      |            |            |
+-------------------------+------------------+------------+------------+
| Collaborate with IHS    | Rick             | Biannually | On-going   |
| DOH recruiter to        |                  |            |            |
| enhance content and     |                  |            |            |
| awareness of the MORE   |                  |            |            |
| system.                 |                  |            |            |
+-------------------------+------------------+------------+------------+
| Review recruitment &    | Committee        | Biannually | On-going   |
| retention resource      |                  |            |            |
| guide content -- make   |                  |            |            |
| corrections/updates as  |                  |            |            |
| necessary               |                  |            |            |
+-------------------------+------------------+------------+------------+
| Establish links to      | Brian            | April 1,   |            |
| career mentoring        |                  | 2008       |            |
+-------------------------+------------------+------------+------------+
| Establish Recruitment & | Andy, Brian,     | April 1,   |            |
| Retention tab under     | Travis           | 2008       |            |
| NOHC resources tab      |                  |            |            |
+-------------------------+------------------+------------+------------+

***Clinical Issues Group:***

###### Clinical Issues Group

Committee Member: Tammie Gibson -- <tgibson232@aol.com>

-   <Tammie.gibson@ihs.gov>

-   928-338-3614

**What is success fro this issue:**

ART -- we all agree that DAs & RDHs should be able to perform ART with
training. Wait for Pedo decision.

Post-op forms: This group to identify or create uniform post op
instruction forms to be used by all I H S clinics.

Clinical Alerts: as needed

Oral Health projects: as needed

**Identify resources needed:**

Copies of current post-op forms from manual and from specialists

Time to consult with specialists

Oral health projects -- CHX varnish; how to find out what projects are
in process

**Identify obstacles:**

National/system- wide approval

Specialists may not approve/participate

Where do the alerts come from?

**Time to completion?** 6 months

Report to group on: 2/6/08

OK to post on website for members? Yes.

More work needed? Yes, when?

***Resources Group:***

**Proposed Resources Needed for NOHC 2007-2008**

**Proposed Budget -- Recurring Budget:**

In the past many of the members of the Executive Committee of NOHC have
been utilizing their CME funding or personal funds to finance their
attendance at the Annual Executive Committee meeting. Miscellaneous
office expenses are often paid out of pocket of those attending the
meeting or from discretionary funding from Head Quarters. A second
face-to-face meeting of the officers of the Executive Committee will aid
in keeping the group on task to accomplish goals established at the
Annual Meeting.

  --------------------------------------------- -------------------------
  Item                                          

  Attendance of Executive Committee to one      \$51,000
  annual meeting (National Combined Councils)   
  (17 representatives @ \$3000 each)            

  Attendance of HQ representative to annual     \$3,000
  meeting of Executive Committee                

  Guest speaker at annual meeting               \$2,000

  Attendance of Executive Committee Chair to    \$3,000
  annual ADO meeting                            

  Office Expenses at annual meeting (including  \$1,000
  copies, room rental, printing, etc.)          

  Attendance of a representative of the         \$3,000
  Executive Committee to the Annual ADA Meeting 

  Mid-year meeting of Officers of Executive     \$9,000
  Committee of NOHC                             

  **Total Budget**                              **\$72,000**
  --------------------------------------------- -------------------------

**Resources Needed:**

Communications Committee:

-   Website cost of \$7,500 (if original plan does not go through)

-   List Serve

-   ADA delegate travel

-   ADO support

Recruitment and Retention Committee:

-   No request

Clinical Issues:

-   No request

Resource Group:

-   No request

### Thursday Feb 7, 2008

Many areas and service units do not fund the travel for the area
representatives, as it is required. Many of our members pay their own
way to attend this meeting or they use part of their CDE funds to be
here the council will approach HQE and ADM Halliday in order to provide
funding for this council. The following budget was presented:

12 area representatives and 5 other members travel cost \$3000 each
\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-- \$51,000

Travel to ADO meeting
\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\--
\$ 3,000

One Speaking Guest
\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\--
\$ 2,000

Office and meeting expenses (room cost, binders, copying etc)
\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\--
\$ 1,000

For complete budget see Resources Work group budget submission previous
page.

Members approved the proposed budget.

Only the communication group requested for funding (\$7500) in order to
put together a new more user friendly website. ADM Halliday Previously
suggested to keep the website in the current location on the doh.gov
site behind the firewall for more safety. Members agreed not to request
funding for an independent website. The communication group should work
with MeryBeth Kenny to further develop what has already been started.

####### Discussions with Admiral C. Halliday

Highlights of the discussion:

-   ADM is concerned with number of dental specialists leaving I H S.
    Suggesting that service units use 3^rd^ party collections and lapsed
    salaries to fund specialist position at the service unit or area
    level. Many schools provide a free place for the I H S candidates
    since they do not have to pay the stipend for that candidate.

-   OCCO is trying to streamline the CO application process to reduce
    the waiting time. Plans are to be able to apply online. Teams are
    created so that if an applicant has personnel problem he/she can
    contact the specific team member to check on the status of their
    application. Each team is designated a color. Blue team is for
    dental applicants.

-   I H S budget have been flat for three years. With the inflation,
    this basically means we have had budget reduction. It has been
    suggested to cut the new loan repayment payments and continue with
    those who are already in the system. ADA and other lobbying group
    will be working to keep the LRP budget at the current level. The
    2009 budge provides some funding for the dental modular units, EDR.

-   Iso-Hardship pay: ADM supports giving this to all dentists on those
    sites rather that those who are new to I H S. There are problems
    with the proposal. It has to go through various committees.

-   Allow officers get ASP while in training.

-   Accession Bonus: Has been raised from \$40,000 to \$60,000 and now
    is at \$75000.

-   MRB realigned back to original 3 tiers.

-   Some areas working with the Air Force or Army to train specialist at
    their facilities.

-   In regards to CDHC, ADM is in support of the Community Dental Health
    Coordinator program and ADA. He wants the NOHC to help as much as
    possible.

-   ADM. Halliday stated that more and more web based dental CDE would
    be available in the future. Mary Beth Kenny and the Clinical Support
    Center are working on this issue.

-   GPRA: very difficult issue specially with objectives being raised
    every year and resources (number of dentists) going down. Dr. Blahut
    is working on this but the OMB does not listen to arguments.

-   Adm. Halliday encourages all service units to accept dental externs
    at their facilities. He views that as a great recruiting tool. The
    program will reimburse \$2000 to each clinic that will take an
    extern. He is aware of limiting factors such as liability and
    housing.

At the end ADM Halliday suggested that the NOHC comes up with a value
for a team of dentist and assistants and how much they collect annually
in order to submit this and request for more funding for dental
programs.