The fifth season of the STAR² Center Talks Workforce Success podcast highlights Primary Care Organizations (PCAs), Community Health Centers (CHCs), and National Training and Technical Assistant Partners (NTTAPs) who successfully used, disseminated, and/or implemented practices, strategies, tools, and more gathered from the STAR² Center’s training opportunities, technical assistance, or original resources. In this episode, Michelle Fernández Gabilondo speaks with Candace Owen, education director at the National Network for Oral Health Access (NNOHA), about changes impacting the oral health workforce as the effects of the pandemic continue to unfold in health centers. Candace and Michelle revisit NNOHA and STAR² Center collaborative trainings and discuss how the STAR² Center’s Comprehensive Workforce Plan template can be used to engage leadership in developing dental staff at health centers.

Transcript by Rev.com

Michelle Fernández Gabilondo: Welcome everyone. My name is Michelle Fernández Gabilondo. I am the Associate Director of Workforce Development at the Association of Clinicians for the Underserved. And today, we are in season five of our podcast for The STAR² Center Talks Workforce Success. We are super excited today we have Candace Owen from the National Network of Oral Health Access. Candace is the Education Director and also registered dental hygienist. We are very honored, as I said, to have Candace here today. So welcome, Candace. We’ll go ahead and get started with the first question. Just jump right in. Could you introduce yourself and tell us a little bit more about your professional journey, your role, NNOHA as an organization, really anything you would like to share?

Candace Owen: Thanks for having me. As you mentioned, I am Candace Owen. I am the Education Director for the National Network for Oral Health Access or we call ourselves NNOHA. And NNOHA is a HRSA National Training and Technical Assistance partner in Oral health. And we also are a membership organization that provides support and training resources for dental professionals that work in federally qualified health centers or other safety net settings.

Before I started with NNOHA I actually was faculty at the University of New Mexico Department of Dental Medicine. They have a dental residency program and a dental hygiene school there. And I taught interprofessional education and also focused on underserved populations like patients with developmental disabilities. I have all of my degrees from the University of New Mexico, my dental hygiene degree, my Master’s in public health and my Master’s in dental hygiene. And then in 2017 I moved over to NNOHA which is based in Denver, Colorado. And with NNOHA I oversee all of our educational and training resources and I serve as a subject matter expert for various topics for dental team members and community health centers to help them increase access to oral healthcare, but also in optimizing the dental workforce and enhancing oral health equity.

Michelle Fernández Gabilondo: Wonderful. Thank you so much for giving us that background of who you are and about NNOHA. As I said, really excited to have you here because actually, we get to collaborate a lot with NNOHA as you know, with our learning collaboratives and a lot of different things. So we’ll talk a little bit about that today. And it was also nice to get to know a little bit more of your background because I didn’t know a lot of stuff, even with all the work that we’ve done together. So actually, jumping in to that as well, could you share with our listeners today just some of those collaborative efforts that NNOHA has undertaken with us here at the STAR² Center?

Candace Owen: Sure. I mean, I think we’ve been partnering for quite a while, probably since 2017. First, I think it started as some partnerships with just some various presentations on the oral health workforce and leaning on each other for different areas of expertise. And then in 2020 with COVID, discovered some increased conversations in community health centers about shortages of the dental workforce and some of those rapid changes that happened. And so we started increasing our conversations a little bit about how can we help health centers better improve their recruitment and retention for dental team members. And so it became a natural partnership to engage more personally with community health centers through a learning collaborative. And so those learning collaboratives that we do are little communities of health centers that are able to engage on a similar topic over the course of a few months.

So we started the Oral Health Workforce Learning Collaborative, and since then we’ve worked with over 20 health centers every year, the STAR² Center’s recruitment and retention framework. So during the learning collaborative we go through and every session is a different piece of your recruitment and retention, I guess, handbook. And they’re able to build a robust oral health workforce recruitment and retention plan. We are currently in our third year, we just had a session yesterday, but we covered topics like culture in the workplace, how to advertise positions, the role of social media in hiring, interview strategies, salaries, benefits, and we also are able to bring in health centers across the country to share their stories, including those that previously participated in some learning collaboratives with us.

Michelle Fernández Gabilondo: I find our learning collaboratives just really great. The participants are excellent, but also just highlighting how fundamentally important dental health and the oral health staff are to health centers. So, that’s something that’s really exciting because when we talk about workforce, really it’s everybody in the health centers, so we want to make sure that dental staff get that same focus. So, that’s why it’s always great to be able to collaborate with you. Going off of that, really through our collaborations, we’ve had the chance to work with dental staff from health centers nationwide. As you mentioned, I didn’t even realize there was so many health centers, but could you share with the audience and our listeners some of the pressing challenges you are seeing or hearing about in relation to the oral health workforce?

Candace Owen: Yeah, I think that with COVID there’s been a real impact, particularly with auxiliary staff, like dental assistants. And so that’s probably the biggest challenge that we’re experiencing right now is a shortage of dental assistants. And actually the shortage of dental assistants and community health centers was happening before COVID, but it was definitely exacerbated by the pandemic. And what we’re really seeing I think is the challenge of competing salaries not only with other types of dental settings like private practice clinics, but also other areas of workforce like customer service jobs and whatnot that are just able to pay more or maybe have more enhanced benefits and a little bit less stress with direct patient care. And so dental assistants is definitely an area that we’re seeing continued challenges, being able to recruit and retain them. And so I think the learning collaborative that we were just talking about has been really helpful to share some strategies on being more transparent upon hiring and ways to enhance your recruitment strategies, but also thinking about down the road, what are some other things that can be implemented to help improve your recruitment and retention?

And one of those things that we’ve been seeing is in-house dental assistant training programs within community health centers creating their own type of programs. They recruit folks to join their training program and then they’re able to retain them for just a little while longer. But if anything, it also helps enhance the community’s access to dental care, even if they end up leaving, we’re improving the community’s resources. So that’s been great.

The other challenge I think, which I believe everyone is experiencing in some way is burnout. And so the shortages of the dental workforce and staff having that increased PPE, the protective equipment that folks are having to really take extra time, wearing it all the time, other COVID implications. Catching up from COVID, dental was really impacted in that a lot of their services had to shut down during COVID, so they had to either pause care for preventive dental care or they had to close down clinics because of the nature of the aerosols generated during dental procedures. And so in turn now, a lot of clinics are seeing an influx of patients that weren’t being seen for over a year. And so their capacity is just really difficult right now.

Michelle Fernández Gabilondo: Absolutely, we know how much burnout is a huge problem, but really that effect of now suddenly having that influx of patients coming back, that is such a good point. And as you know from our learning collaboratives, what we hear from the different health centers is just people are overwhelmed by the need that there is and just not enough people in the workforce. And the same as you said with dental assistants. Absolutely. I don’t think that there is a time where we don’t hear about the dire need for dental assistants, but how complicated it really is when it comes to compensation. And that’s something that has been so wonderful getting to collaborate with NNOHA on this because we’re able to bring that workforce perspective and then really highlight just how important the oral health workforce is.

So for this next question, and I think in some way you’ve already answered some of it, but how have you been able to leverage the STAR² Center resources to aid in your work? What I’m really thinking probably more than anything is our health center comprehensive workforce template, which is, as you said, that framework that we use throughout the learning collaborative. And then as you’ve used these tools, have you received any feedback from the health centers about the ways that they’ve been able to use or implement those workforce resources?

Candace Owen: Yeah. I mean, as you mentioned, that recruitment retention plan that they’re able to walk away with during the learning collaborative. And, as I mentioned, we’ve had over 20 health centers each year since 2020 participate with us. So that’s about 60 health centers that we’ve worked with directly has been able to leave the learning collaborative, having at least the large pieces completed for an oral health workforce recruitment and retention plan, which maybe may not have been formalized specific for dental within the health center before their participation.

But the STAR² Center also has just so many great resources to use and that are applicable to really any type of team member in the community health center. So it’s great to have a partner who’s an expert in the space because then we don’t have to reinvent the wheel. Particularly some of the feedback that we’ve heard is with the turnover calculator that you all have, it’s a helpful tool just to be able to justify our salary increases and things like that as opposed to losing that team member and having to go through the whole recruitment process and all of that again, which there’s cost associated with that that’s not often seen or calculated. So having something to really monetize that and put a number to it I think has been helpful.

Comments from our collaborative work, we’ve seen that… Some of the comments that we hear a lot is that we’ve been able to create a space for community health centers to connect and share ideas specifically around workforce. And so it allowed folks to get, I guess, a peace of mind because they’re able to learn that everyone is experiencing similar hardships and limitations when it comes to the workforce, but also we’ve heard that they’ve been able to learn about both of our organizations, NNOHA and the STAR² Center, and learn about the things that we have to offer.

Michelle Fernández Gabilondo: Absolutely. And that is, I think, one of the biggest highlights of being able to work together because we’re both bringing our expertise to be able to help the health centers, and then obviously the feedback we get from them is so valuable and important. And I do agree with you with the turnover tool. I know that’s something I’m pretty sure we talk about maybe in most of the sessions that we have because we often get the question, how do we talk to leadership about investing in workforce? And there’s so many different ways to go about that, but we also find that oftentimes when people talk about this is what it’s costing us versus investing, it really gets leadership’s focus and they understand, okay, we’re losing a lot more versus what we could be gaining with that investment.

Thank you for giving us the opportunity to collaborate. And then this is going to be a bit of a big question, so just taking it away a little bit from the conversation necessarily around our collaborations, but really tapping into NNOHA’s very specific expertise. What I want to know is how do you see the oral health workforce evolving in health centers? And again, I know it’s a big question, so feel free to answer as you feel it’s appropriate, but I think just having your expertise in this would be really wonderful for our listeners.

Candace Owen: I think that maybe the biggest thing that we’re going to see over the next few years, which we’re seeing a little bit now, is the emergence of new dental team members in the workforce and maybe development or enhancement of some existing team members. We have seen, obviously, dental therapists come into the picture. There’s also community dental health coordinators. And that’s all to help bridge the gap in care, but then also to help increase access and improve care coordination. Community health workers have been in healthcare for quite a long time, but now we’re seeing a lot of clinics start utilizing them specifically for dental and having a community health worker for the dental clinic. And so I think those type of new positions coming into the health center space and being used and leveraged a little bit more.

But then we also have existing dental team members that have opportunities to enhance their position, just state by state. There are some states that have expanded function or expanded duty dental assistants. They’re called FTAs or ADAs, and it just expands their scope of practice. They’re able to do a couple more things, some states allow them to place sealants or things like that and using them to a different capacity.

Some states have also implemented different types of dental hygienists. And so while there are states like Colorado that have a really expansive scope of practice for the dental hygienists already, some states have really limited scopes for hygienists, but they’re introducing a new type of provider called a public health dental hygiene practitioner. And it expands their scope and it might, based on the state, be expanding their scope to the equivalent of a regular hygienist in a different state, but it’s still a step forward in being able to increase access to care. Then allowing these team members to work to a larger scope, I think it’s going to help improve access, but also improve satisfaction for these team members.

Michelle Fernández Gabilondo: I think satisfaction is such a key part of it because obviously, it then plays into what we talked about before, stuff like burnout and ensuring a resilient workforce and all of those things. But that’s so interesting. I didn’t know those things that were going on in the oral health workforce. And as always, what I find so interesting is how innovative health centers really are in modifying different roles to ensure that the services are available to the populations that they serve, and how fundamentally important dental is to overall healthcare, which I think we definitely need more focus on. That’s one thing that I think is so wonderful about NNOHA because that really is your area of expertise and the focus that you’re bringing out there. So I just wanted to say thank you for that.

And then as we end today’s interview, I know we went through different topics of how we work together, how we collaborate, the resources that have been used from the STAR² Center, but also talking about the oral health workforce in general. But I really want to give you the space and time to talk about any resources, upcoming training opportunities, other training or technical assistance that NNOHA may have that you really would like to share with the listeners today.

Candace Owen: Sure. And thank you for that. We have some really exciting things coming up that I think will help workforce in particular. So, we’re excited to announce first Dental hygiene and dental assistant webinar series that is starting in May. Our first one is actually on May 10th, but we have a series of three webinars specifically targeted towards those team members. And so we have one on infection prevention and control, wellness, and then utilizing these type of team members for integration. And we also, as I mentioned, are developing some different white papers or users guide that are intended to help the community health centers implement or possibly try some new things to help improve their recruitment and retention. First being a dental assistant in-house training program users guide. And so that should be coming out in the next month. And that user’s guide is going to share some findings that we had from interviewing community health centers across the country that have sustained in-house dental assistant training programs, talking about some lessons learned and some implementation strategies.

And we have an old paper that is an academic partnerships white paper. And what it is, it talks about the different type of partnerships that community health centers can have with academic or training programs. We’re updating that this year. Again should be out in the next month or so. And talking about why it’s valuable to have an academic partnerships with a dental residency program or a dental hygiene program, dental assistant program, because we see oftentimes that folks that rotate through a community health center during their education are more likely to consider the community health center as a workplace. And also we see a lot of those folks that rotated through a community health center in their education also lead into more leadership positions because they have that aligned mission and that understanding of the health center from early on. And so that resource I think will be really great to talk about different partnerships that a health center can pursue and how to do that.

And then finally, I’ll just put in a plug for our NNOHA annual conference. It’s November 5th through the 8th and Denver, Colorado, which is where NNOHA is located. So we’re excited to have people come to our home state. All that information that I mentioned is available on our website, nnoha.org.

Michelle Fernández Gabilondo: Perfect. Thank you. I actually was about to ask if you could tell everyone what your website is so they can know to go there. We want to make sure that you have access to the different resources that Candace talked about because they really are absolutely excellent and just an amazing NTTAP to be able to work with. And the materials they put out there are just of the highest caliber. We’ll make sure to link everything so that all of you have access to NNOHA’s resources.

Well, Candace, again, just thank you so much for being here today. I’m really excited for our continued partnerships and working together in the future because again, the dental health staff are such a fundamental part of our workforce, so we really just want to highlight that. Thank you for the work that you’ve done alongside the STAR² Center. And thank you everyone today for listening again. Today we were talking with Candace Owen, Education Director at the National Network for Oral Health Access, also known as NNOHA. Again, I am Michelle Fernández Gabilondo, and this is The STAR² Center Talks Workforce Success.