PRIORITIES FOR A TRANSFORMING RURAL HEALTH SYSTEM
In these times of constant change in health care, how can public sector leaders keep up with changing priorities? Especially when it comes to rural health—with the nuances citizens, communities and health care organizations need to balance—policymakers can respond best when they get informed insights from those working directly with rural health issues every day.
Minnesota’s Rural Health Advisory Committee, appointed by the Governor to advise the commissioner of health and other state agencies, takes seriously its responsibility to assess rural needs and communicate rural priorities to decision makers. The committee comprises 15 members: three consumers, four legislators, a higher education member and seven members representing various health care sectors, all from rural Minnesota. Regular readers of the Quarterly have seen profiles of new Rural Health Advisory Committee members; this issue interviews legislative member Representative Larry Hosch.
The Rural Health Advisory Committee has a pretty good track record. Its past work has influenced policy in areas such as health reform, new models of care, rural mental health needs and small hospital stability.
Every other year the Rural Health Advisory Committee sets two-year priorities and responds to each with a combination of research, analysis and rural involvement to develop recommendations for the commissioner and other policymakers. The members review current issues and challenges in rural health, add what among them is a broad and diverse set of perspectives, and produce a workplan for the coming two years. The committee’s recently developed priorities are:
Many of these issues may seem prevalent throughout the health system. For each one, the Rural Health Advisory Committee has asked and answered what’s uniquely rural. Details can be found on the Rural Health Advisory Committee web page. The committee’s initial project in this cycle is underway; it’s established a workgroup to develop recommendations to assure access to obstetric services for rural Minnesota.
The Rural Health Advisory Committee, and those of us in the Office of Rural Health and Primary Care who staff it, always welcome involvement. If you’re interested in any of the priorities above, feel free to contact me or committee staff Kristen Tharaldson.
With this issue, we say goodbye to our editor, Mary Ann Radigan, as she exuberantly heads off to begin retirement. Mary Ann has edited both our monthly and quarterly publications for seven years with creativity, professionalism, patience and good humor. Mary Ann is the person who actually earned the kudos I get on our publications, and we wish her the very best.
Mark Schoenbaum is director of the Office of Rural Health and Primary Care and can be reached at email@example.com or 651-201-3859.
EXPANDING ORAL HEALTH CARE
by Leslie Nordgren, R.D.H., M.P.H., Ph.D., Research Specialist, Minnesota Office of Rural Health and Primary Care
In 2011, Minnesota became the first state to license a new member of the dental team: dental therapists. Dental therapists are educated to provide basic preventive and restorative procedures services that previously only a licensed dentist could perform. They serve patients who have low incomes, are uninsured and underserved, and patients in dental health professional shortage areas. They practice in dental offices, nursing homes, schools, group homes and other alternative settings.
Dental therapists graduate from an approved education program and pass a board-approved licensure examination.
The state also authorized certification of an “advanced” dental therapist. Advanced dental therapists must be licensed as a dental therapist, complete 2,000 hours of dental therapy clinical practice, graduate from an approved advanced dental therapy education program, and pass a board-approved certification examination.
Licensed dental therapists treat patients under the supervision of a Minnesota-licensed dentist. The scope of services to be provided is defined in a written collaborative management agreement between the dental therapist and supervising dentist. Dental therapists may supervise up to four dental assistants. They also dispense and administer analgesic, anti-inflammatory and antibiotic drugs within their scope of practice and the parameters of their collaborative management agreement.
Advanced Dental Therapists
Advanced dental therapists enter into a written collaborative management agreement with a Minnesota-licensed dentist, which specifies the services they may provide. These may include all services within the scope of dental therapy practice, plus the following services under general supervision:
Minnesota law establishes the requirements for licensure and mandates that institutions educate students to the necessary level of competency. It does not dictate to the educational institutions what their admission requirements should be or how to structure their programs. In Minnesota, Metropolitan State University is educating students to be eligible for certification as an advanced dental therapist and the University of Minnesota is educating students for licensure as a dental therapist.
Metropolitan State University, Advanced Dental Therapy Program
The first seven students graduated from Metropolitan State University in the summer of 2011. Early adopters of this new dental team member include Apple Tree Dental, Children’s Dental Services and Hennepin County Medical Center, where graduates are providing dental hygiene services and working on the 2,000 hours of providing dental therapy services required for advanced dental therapist certification. The second cohort of four students will graduate in April 2013.
For information about the Oral Health Care Practitioner Program, contact Suzanne Beatty, D.D.S. at firstname.lastname@example.org
University of Minnesota School of Dentistry, Dental Therapy Program
In December 2011, the school awarded one bachelor’s degree and seven master’s degrees in dental therapy. A ninth student will graduate in May 2012, after an extension provided to accommodate a personal leave earlier in her education program. One graduate is a dental therapist working for a private practice in Montevideo, Minnesota; another is employed as a dental therapist by Health Partners.. The University’s second class of nine students—four on the bachelor’s degree track and five on the master’s degree track—will graduate in December 2012. In September 2011, the School of Dentistry admitted 10 students into its third class, and these students will graduate in December 2013. School of Dentistry dental therapy classes have included students from rural and urban areas in Arizona, California, Florida, Minnesota, South Dakota and Wisconsin.
For information about the Program in Dental Therapy, contact the Division of Dental Therapy at 612-625-4310 or email@example.com.
ON THE FASTTRAC
by Mary Ann Radigan, Communications Coordinator, Minnesota Office of Rural Health and Primary Care
I’m in a classroom with 15 certified nursing assistant students—men and women ranging in age from early 20s to mid 60s. Everyone is focused on the two teachers. Yes, two teachers: One is a health care specialist and one is an adult basic education specialist. Both are integral to a program called FastTRAC. The teachers hone in on a puzzled look. Is it a problem with the health care topic or with reading, math or computer literacy? Through this integrated curriculum—with help in the classroom and in studying and in career planning—students are on a fast track to building a career in health care.
Minnesota FastTRAC is a partnership of colleges, adult basic education, workforce development and community organizations. Their unique partnership means there is no duplication of efforts to train individuals who want to advance—but may be underprepared academically—in fields that communities need.
FastTRAC helps more adults enter and succeed in post-secondary education because they are moving through a coordinated system of education and work opportunities. Students are being trained and successfully employed at higher-paying jobs. And they have the option of returning for more education that builds on their previous work in the classroom and the workplace.
“It changes lives! I didn’t think I’d ever do anything other than housekeeping. FastTRAC showed me there were other options for me,” explained one graduate.
FastTRAC Career Pathways
FastTRAC partners select and fund local programs though a competitive selection process. Partners include local employers, workforce development agencies, human services and community-based organizations along with Adult Basic Education at the Minnesota Department of Education, the Governor’s Workforce Development Council, Greater Twin Cities United Way, Minnesota Department of Employment and Economic Development, Minnesota Department of Human Services, Minnesota Department of Labor and Industry, Minnesota Office of Higher Education and Minnesota State Colleges and Universities.
The Joyce Foundation, as part of its Shifting Gears (link no longer available) state policy initiative to strengthen state education and training systems in six Midwestern states for workers with low skills, is funding FastTRAC. In 2011, the Initiative awarded nearly $1.7 million to 17 adult career pathways projects, including 13 health care grant awards:
Pathway to Health Care Career Success at Minnesota State Fergus Falls trains participants to become certified medical lab technicians, offering education in the Integrated Anatomy and Physiology classes that are the cornerstone of many other health care program requirements. Students gain confidence in the college process, procedures and technology requirements, and may have an opportunity to learn with professionals at a health care facility. Participants complete an online college orientation that includes technology requirements, financing education, and college policies and procedures to ensure understanding of college expectations.
Pathways to Health Care Careers at Lake Superior College (Duluth) provides access to health care careers through Certified Nursing Assistant and Trained Medical Administration certificates. Individuals enter the workforce directly or enroll in further training as a licensed practical nurse or registered nurse. Online learning options and digital literacy courses are available.
Health Informatics Pathway at Ridgewater College (Hutchinson) prepares individuals to enter the Phlebotomy Technician Certificate program. Prior to enrolling in Medical Terminology, Pharmacology and Computer Technology, basic reading, writing, math and computer technology skills are provided.
Universal Health Care Worker at Minnesota West Community & Technical College offers 10 career and technical training and certification sessions that can be taken independently or as part of the entire credentialing program. Participants learn skills necessary for employment as certified nursing assistants, certified home health aides and trained medication administration workers. They can also earn a CPR certificate or a license in safe food handling, and receive help with computer literacy, soft skill training and resume/job search/preparation.
South Central Health Care Career Pathway at South Central College increases the basic skill levels of students while training them to be certified nursing assistants and home health aides. The curriculum includes contextualized instruction in workplace reading, writing, speaking and math based on the needs of students.
Rochester Community & Technical College Mayo C.N.A. FastTRAC Program focuses on the Certified Nursing Assistant, Hospital Certified Nursing Assistant, English, Medical Terminology and Introduction to Psychology courses to train students to be certified nursing assistants. Participants receive help with career planning and employment plan development to ensure a smooth transition through training to employment.
Enhanced West Metro Pathway to HealthCare Careers at Hennepin Technical College offers Introduction to Health Care, Nursing Assistant Preparation, and/or Medical Terminology as a bridge to prepare students who are disadvantaged to enter a health care education and career track. Upon completion of the bridge course, students take a Nursing Assistant college course with integrated instruction. In addition, the Nursing Assistant course incorporates specific work culture, career exploration and career planning within the broad field of health care, provides students with career development skills needed in entry-level health care professions, and prepares students to successfully use computers in future college-level courses.
Pharm Tech Futures at Minneapolis Community Technical College includes introduction to medical terminology, the language of customer service in health care settings, contextualized reading and math, work readiness and soft skills training, and career assessments to build core skills needed for employment as certified pharmacy technicians.
Anoka Healthcare/Nursing Pathways at Anoka Technical College and Anoka Ramsey Community College focuses on Universal Health Care Worker in Older Adult Services Certificate training with a special focus on low-income households. Participants become certified nursing assistants and earn credits toward certification in health care services for older adults.
Ramsey Medical Careers Pathway at Saint Paul College offers a Medical Records Clerk Certificate and explores additional pathways in medical careers. Computer keyboarding and technology is embedded throughout the curriculum. Students also have the ability to complete a Career Assessment.
Saint Paul EMS Academy at Inver Hills Community College offers a holistic approach to providing EMS training to youth and single parents ages 18-24 in low-income households.
St. Paul Medical Careers Pathway at Saint Paul College offers the skills required for employment as certified nursing assistants or the option of enrolling in anatomy and physiology courses for other medical careers.
“FastTRAC gives adult learners the opportunity to benefit from integration between adult basic education and the ‘credit-side’ of college. Students complete the training as certified nursing assistants with credits they can apply to other health care career pathways,” said Diane Halvorson, executive director, South Central Workforce Council.
Information on FastTRAC is online at http://www.mnfasttrac.org/.
ORHPC TALKS WITH RURAL HEALTH ADVISORY COMMITTEE (RHAC) MEMBER REP. LARRY HOSCH
Please explain your professional work to us.
I work in two different capacities—one as a state legislator and the other as a social worker.
I am serving my fourth term as a state representative from central Minnesota and I am a minority whip. I serve on the Health and Human Services Reform Committee, the Health and Human Services Finance Committee, and the Agriculture Committee. My policy areas of interest include health care, long term care, mental health and disability services.
Outside of the legislature, I am an independent living specialist. I work with people in Isanti, Mille Lacs, Sherburne, Stearns and Wright counties who have cognitive, physical and mental disabilities.
And your life away from work?
My wife and I live in St. Joseph with our one-year-old and four-year-old boys and a golden retriever. I enjoy weight lifting, running and anything outdoors including heading up to our cabin in Outing, Minnesota.
What do you think are the most important issues facing rural health?
Our biggest issues are the changing demographics of Minnesota and access to mental health services.
In a rural area, maintaining independence becomes increasingly difficult as we age—from accessing transportation to finding primary and specialty care. Preparing our communities, providers and families will be a challenge and an opportunity for us in the coming years.
Access to mental health services is already challenging for rural Minnesotans and the ability to recruit mental health professionals is becoming a near crisis.
What do you think would make the most difference for rural health?
View online all previous issues of the Office of Rural Health and Primary Care publications.