ASHLAND COMMUNITY HEALTH CENTER INC
Grant: $113,535 - Health Resources and Services Administration - Mar. 27, 2009
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Award Description: 1. Dental Access: Dental care is the most difficult service for a frontier CHC due to a shortage of dentists in the state, particularly those who are willing to treat Medicaid and uninsured patients, and the lack of a dental school in Montana. Ashland Community Health Center (ACHC) has been unsuccessful in attracting a dentist willing to provide services in Ashland, even one day per week. Ashland could not support a full time dental practice and there is no space for one. The purpose of the project is to provide access to preventive and restorative dental care for ACHC patients and to educate patients regarding the importance of oral hygiene and regular dental check ups, ultimately reducing tooth decay and costly dental procedures. To that end, ACHC has a written contractual agreement with a dentist in Colstrip, a town 40 miles from Ashland. Transportation is provided for patients when necessary. This program enables ACHC to provide basic preventive, diagnostic and restorative dental services based upon the patient's ability to pay (sliding fee scale). More extensive procedures are beyond the funding capabilities, however, ACHC has established payment plans for costly procedures such as crowns, oral surgery, and dentures. ACHC pays up front for the procedures that are often referred to specialists. The patient, in turn, pays an affordable monthly payment, interest free, to the ACHC, enabling them to have the work done without having to wait until they have the funds when the decay makes things worse. Typically, oral surgeons, endodontists and other specialists require payment before the procedures can take place. The opportunity to have the work done with an affordable payment plan is acceptable to all patients we have worked with and they take their committment to pay regular monthly payments very seriously. To date 17 patients have joined the dental assistance program with a total of 42 dental visits. One patient returned this week to make a payment on his payment plan and to show off his 'new smile'. In addition to the agreement with the dentist in Colstrip, ACHC refers Native American patients to IHS for dental services when possible. Children up to age 19 are eligible for care through St. Vincent Healthcare Ronald McDonald mobile dental van, which comes to Miles City during summer months and is based in Billings year round. This service has been particularly useful for the Amish children who tend to have serious dental caries and are uninsured. ACHC has provided transportation for 6 children for all necessary dental work. Future visits will be for routine dental check ups. It is also part of ACHC's mission to educate the community in regard to preventive oral healthcare. Among the Amish, it is common not to seek dental care until a toothache occurs or a tooth is so decayed that it must be extracted. 2. Expansion of Mental Health Services: Colstrip is a town 40 miles northwest of Ashland. It was established as a result of coal development, but in recent years has experienced an economic declline as natural resources diminished. The result was that many residents lost, not only their jobs and homes, but also their identity, security and sense of worth. Depression manifests itself in alc+B33ohol and drug abuse. There was a need for additional mental health counseling services. ACHC provided the services of a Licensed Clinical Professional Counselor/Licensed Addiction Counselor one day per week, but this was not adequate. ARRA funds have expanded the mental health services in Colstrip to two days per week. The counselor works with groups and individuals on anger management, substance abuse and other issues. In this quarter, eleven new patients are receiving substance abuse counseling services.
Project Description: Key activities undertaken during the reporting period include: 1. Marketing of the new dental and mental health opportunities available. The clinic publishes a monthly newsletter that is mailed to 580 post office boxes in the service area. The newsletter is hand delivered to the Amish settlement north of Ashland, and sent to ACHC partners and interested parties across the state and country. The Billings Gazette, widely read byAshland residents published articles about ARRA funding, as well, naming the entities that were funded, including ACHC. Each time a newsletter is distributed, there are calls to inquire about the dental assistance program and all individuals who have called have qualified for the program and have been treated by the dentist. Other methods of marketing include information provided at the annual health fair and a Community Partners Luncheon this summer. Word of mouatieth has also been a key method of informing people about the programs. This has been found to be a primary method of getting information to the public. Posters are also displayed at the clinic and key locations around town. 2.Staff and board involvement is crucial to the success of any new program. Staff meetingsare held each week and the Board meets monthly. Providers actively identify patients with dental problems and refer them to the outreach coordinator for dental referrals. Board and community members volunteer to drive patients when transportation is needed. ACHC owns a 2008 Suburban for the purpose of transporting patients who don't have reliable vehicles or money for gas. There is also a charge account at the local gas station and patients are permitted to charge gas for medical and dental appointments. Providers also assess patients for depression or substance abuse and refer them for counseling. 4. Policies and procedures for dental and mental health referrals and transportation of patients are being completed.
Jobs Summary: 1. Dental Access: Since it is not possible to provide dental services in Ashland, patients are transported to the dentist in Colstrip. A collaborative agreement with the dentist alots approximately .1 FTEs Dental and .1 FTEs Dental Hygienist services to care for up to 6 patients per weel. Originally, ACHC planned to transport patients one morning per week to the dentist, however, this isn't possible because the dentist's schedule is booked well in advance. Ashland patients must be fitted into empty slots and can't be booked in groups. Some patients provide their own transportation and so this has not been a problem to date. Since funded, a total of 17 patients have received dental care with a total of 42 visits to the dentist. ACHC was not aware of the extensive amount of work each patient would require. Most of the patients have been without dental care for years and require multiple crowns, extractions, bridges and dentures. It has been difficult to determine how to accomodate the needs of the patient and complete the work that needs to be done without running out of funds. The dentist and project director have discussed this problem a number of times. Ultimately, the decision was made to pay for cleaning, x-rays, simple fillings, and extractions. More complex procedures, including root canals, crowns, bridges, dentures, and oral surgery are not covered. However, most of these procedures require payment in advance or substantial short term financing, which is impossible for low income patients. Therefore, ACHC pays the provider in advance and sets up a payment plan for patients. It is still a concern that funding will not be available to as many patients, but there is no use in paying to determine what is wrong and then leaving the patient with no means of getting the work done to save teeth. 2. The contracted Licensed Clinical Professional Counselor/Licensed Addiction Counselor (LCPC/LAD) now provides services in Colstrip one additional day per week (.2 FTEs). On the additional day, a total of 18 new patients have received counseling services with 41 patient encounters. The counselor is the only Licensed Addiction Counselor in the county and referrals are often made by the court system for substance abuse aftercare and court mandated anger management group therapy. (Total jobs reported: 0)
Project Status: Less Than 50% Completed
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