Oral Health Care Model in Rural Alaska Villages

Evaluation to Measure Effectiveness of Oral Health Care Model in Rural Alaska Native Villages; Communities Involved in Project Experience Nation's Highest Rate of Oral Health Disease

A model oral health program serving isolated Alaska Native communities is being evaluated for effectiveness with a goal of improving the quality of services to children and families vulnerable to some of the highest levels of measured oral health disease in the country.

Supported through a partnership of four foundations, the comprehensive evaluation will be conducted by RTI International of Research Triangle Park, North Carolina - a nonprofit research institute that provides research and technical services to governments and businesses worldwide. The two-year study offers an opportunity to determine the quality of service provided by the Alaska Native Tribal Health Consortium's Dental Health Aide Therapist Program.

"If the evaluation proves the viability of the dental health aide therapist model, the program has the potential to have the same impact on rural Alaska as the tuberculosis eradication program did in the 1940s and 1950s," said Jerry Drake, executive director of the Bethel Community Services Foundation, located in Bethel, Alaska.

Research will be guided by a National Advisory Committee and an Alaska Tribal Advisory Coordinating Committee - with members ranging from professional dentists to Alaska Native community members. The aim is to fully examine the program and its effectiveness, while assuring that cultural aspects of evaluation are done with respect, and within tribal tradition and custom.

Funding for the evaluation is being provided by the W.K. Kellogg Foundation of Battle Creek, Michigan, in partnership with the Rasmuson Foundation of Anchorage, Alaska; the Bethel Community Services Foundation Inc. of Bethel, Alaska; and the M.J. Murdock Charitable Trust of Vancouver, Washington.

"Through this research, we hope to establish a long-term process for continuous quality improvement to ensure that the best possible dental care is provided to Alaska Native patients in the state's more remote communities," said Al Yee, a Kellogg Foundation program director.

There are more than 200 Native villages in Alaska, many located in extremely remote sections of the state. Transportation is difficult and expensive, and health care services are often sparse and inconsistent. Most Alaska villages receive the services of a dentist for a week a year and often only the most urgent cases are seen.

According to the 1999 Indian Health Service Survey, the Alaska Native population has a high rate of oral disease. For example, children 2 to 5 years of age have almost five times the amount of tooth decay as do children of similar ages elsewhere in the United States. Children ages 6 to 14 have 4.5 times the amount of tooth decay and adult periodontal disease is 2.5 times higher than in the general population.

"Contributing to these unacceptable oral health statistics is the inability to recruit and retain an adequate dental health workforce in this isolated part of the country," said Yee.

"The Kellogg Foundation has a special interest in helping vulnerable children and their families succeed," said Sterling Speirn, the Kellogg Foundation's president and chief executive officer. "That's our primary organizational mission, so it's natural we would be interested in supporting programs such as this."

"Rasmuson Foundation has been unwavering in its support of improving oral health care access and outcomes in rural Alaska villages," said Diane Kaplan, Rasmuson Foundation president. "We are delighted that our partnership can have such far reaching benefits for Alaska."

Scott Wetterhall of RTI International, project director for the evaluation, said that the researchers will evaluate the implementation of the Dental Health Aide Therapist Program in communities where they work to assess its integrity to the overall program model, and identify barriers and facilitators for longer-term success.

"Among other things, we will look at patient access to care and the level of patient satisfaction from using dental therapists," Wetterhall said. "We'll also look at the quality of diagnosis and treatment, the development of community-based prevention programs and the general practice procedures used by the therapists."

In addition, he said, evaluators will examine the costs and explore the cost-effectiveness of the dental therapist program in Alaska. "Our overall approach to this evaluation will be participatory, transparent and thorough," Wetterhall said.

A final report of the results from this evaluation will be available in 2010.

About the Dental Health Aide Therapist Workforce Model

The Kellogg Foundation funds the Dental Health Aide Therapist training program through the Alaska Native Tribal Health Consortium, which is partnering with the University of Washington. Support is provided through a $2.7 million grant to the Alaska Native Tribal Health Consortium, along with additional funding of more than $1 million from the partner foundations.

The program trains mid-level oral health providers who live and work in the rural communities to provide prevention services, perform fillings, extractions and other limited dental services for children. It is based on a model program that was begun in New Zealand during the 1920s. The Alaska Native Tribal Health Consortium is currently working with the University of Washington to train approximately 24 dental health aid therapists from Alaska during a four-year period. Once trained, these therapists will work under the supervision of dentists who oversee the services in villages throughout the state.

"This model has succeeded in more than 40 countries," said Yee, "and holds great promise for improving dental access to underserved communities in Alaska."

Partners for the Evaluation

Bethel Community Services Foundation Inc. of Bethel, Alaska, is dedicated to the development, growth, continuance and enhancement of community based programs and services. In partnership with other communal institutions, foundations, restricted and unrestricted philanthropic donors, it seeks to support effective community growth and development. The Foundation was created in 1992 to manage the assets of, and contribute financial support for, the program of services offered through Bethel Community Services (BCS). BCS was founded in 1969 and introduced many human service programs to the Bethel community and the region. Visit http://bcsfoundation.org/ .

The M. J. Murdock Charitable Trust seeks to enrich the quality of life in the Pacific Northwest by providing grants and enrichment programs to non-profit organizations that seek to strengthen the region's educational, spiritual, and cultural base in creative and sustainable ways. Since its establishment on June 30, 1975, the Trust has focused most of its grantmaking efforts in the five states of the Pacific Northwest: Alaska, Idaho, Montana, Oregon, and Washington. A historical emphasis in grantmaking has been in higher education, scientific research and development, human social services, health care, and the arts. Visit http://www.murdock-trust.org .

The Rasmuson Foundation of Anchorage, Alaska, is a private foundation that works as a catalyst to promote a better life for Alaskans. Since its founding and first grant of $125 in 1955, the Rasmuson Foundation has supported Alaskan non-profit organizations in the pursuit of their goals, with particular emphasis on organizations that demonstrate strong leadership, clarity of purpose, and cautious use of resources. The vision and values established by Elmer Rasmuson continue to guide the Foundation today. The Foundation awards approximately $20 million annually to help improve the quality of life in Alaska. Visit http://www.rasmuson.org .

Established in 1930, the W.K. Kellogg Foundation of Battle Creek, Michigan, supports children, families and communities as they strengthen and create conditions that propel vulnerable children to achieve success as individuals and as contributors to the larger community and society. Grants are concentrated in the United States, Latin America and the Caribbean, and the southern African countries of Botswana, Lesotho, Malawi, Mozambique, South Africa, Swaziland and Zimbabwe. Visit http://www.wkkf.org .

RTI International is one of the world's leading research institutes, dedicated to improving the human condition by turning knowledge into practice. A staff of more than 2,600 provides research and technical services to governments and businesses worldwide in the areas of health and pharmaceuticals, education and training, surveys and statistics, advanced technology, international development, economic and social policy, energy, and the environment. RTI also employs about 1,200 term employees who support projects in more than 40 countries. Visit http://www.rti.org .

The Alaska Native Tribal Health Consortium is a non-profit health organization owned and managed by Alaska Native tribal governments and their regional health organizations. The Consortium was created in 1997 to provide statewide Native health services. To achieve its goals, ANTHC works closely with tribes, Native health organizations, the state of Alaska, and municipalities. Visit http://www.anthc.org .