Sometimes the smallest of victories can yield outsize returns. That’s what Eleni Boukas and Mackenzie Hatfield found when they came up with a way to ensure that the electric toothbrushes of their patient population (adults with developmental disabilities) were plugged in daily so they were ready for use.
Boukas, a BCBSNC Foundation Schweitzer Fellow and student at University of North Carolina School of Dentistry (UNC), believes that access to health care, including dental care, is the most pressing health-related issue of our time. Geography, cultural issues, money, language differences, and numerous other factors, she says, all too often prevent people from receiving quality health care. “Even in today’s modern
America there are still communities that are not serviced by qualified and well-trained health care professionals,” she says.
This is especially true for people with developmental disabilities. “Adults with developmental disabilities face the challenges of access to care, insurance, and available dentists willing to treat them,” she says, noting that such challenges frequently lead to delays in getting care that is urgently needed.
Allocating more money to treat people with developmental disabilities will alleviate the financial barriers to care, notes Boukas, while educating health care professionals and the general public will break down geographic, cultural, and language barriers.
Boukas and Hatfield, also a UNC dental student and BCBSNC Foundation Schweitzer Fellow, are doing their part to break down barriers to oral health care for people who are developmentally disabled through education. The community is at disproportionate risk for a host of oral health issues, says Boukas.
“Adults with developmental disabilities are at greater risk for caries, periodontal disease, malocclusion, and damaging side effects from medications,” Boukas added. “As a result of their cognitive and physical disabilities, complex medical conditions, and behavioral issues, adults with developmental disabilities often need extra help to achieve and maintain good oral health.”
Working in conjunction with Residential Services Incorporated (RSI), which provides residential and support services to developmentally disabled people in Orange County, Boukas and Hatfield are providing oral health education to adults with intellectual and developmental disabilities and their caregivers during visits to RSI group homes. “Most of the residents at RSI are patients at the dental school and this way we could work with the residents and their caregivers in both their home environment and at their dental visits,” Boukas explains.
Prior to their Fellowship project, many of the RSI residents who were independent enough to brush and floss daily were doing so incorrectly. With help from Boukas and Hatfield, they are now trained in the proper techniques. The Fellows also developed individualized oral health care plans for each resident that outline protocols for optimal health outcomes. Additionally, they gave caregivers specialized oral health training so that they may properly care for residents who are unable to brush and floss on their own and supervise those more independent residents in performing those tasks. Boukas and Hatfield have made repeat visits and three-month follow-ups at the homes to observe both residents and caregivers in action to ensure that protocols are being followed and to reinforce the adopted oral health behaviors.
Like many residential programs, RSI sees frequent staff turnover. To ensure continuity of oral health care, Boukas and Hatfield have ensured that staff will continue to receive in-person training through a new course requirement at UNC. They are also developing a webinar so staff who are hired in interim periods will receive immediate education and training.
Hatfield says the home visits are as educational for her and Boukas as they are for the RSI residents. “I’ve been surprised by how much we have actually learned,” she says. “I’ve learned that it is incredibly valuable to be in the homes with caregivers and see firsthand the struggles and challenges that they face daily. It is one thing to hear about these things and give recommendations, but it is another thing completely to actually be present and work alongside caregivers during their daily routine.”
Knowing how difficult it is to instill healthy habits in patients, Hatfield says she appreciates the little changes she sees her patients and their caregivers make on the path toward better oral health.
“For example, every time we visited a certain home they would never have the electric toothbrushes charged,” Hatfield recalls. “We found that the caregivers had forgotten to help charge the electric toothbrushes. We were able to emphasize to the caregivers the importance of the electric toothbrushes being functional for the residents. At the three-month follow-up visit we were delighted to see that all the toothbrushes were charged and ready to be used! Small victories such as this encourage us to continue our work.”
Though such victories are small, they are certainly not insignificant. Hatfield says her experience in the Schweitzer Fellowship has reminded her of the importance of using one’s skills and knowledge to positively impact others. “Being a Schweitzer Fellow means that you are fully giving yourself to the service of someone in need,” she says. “As health care providers, we have been endowed a gift and we should not allow that to go wasted; it should be used to better other people’s lives.”
Boukas and Hatfield are confident their program will last beyond their Fellowship year because they are incorporating it into the UNC curriculum. That way, says Boukas, “Dental students can have the opportunity to visit these patients in their home environment and learn firsthand the struggles and obstacles the residents and their caregivers need to overcome to maintain good oral hygiene. These home visits will allow the dental students to be able to better care for the residents at their dental appointments.”