PI 1 Week 2: Determinants of Health - Vancouver College of Dental Hygiene PDF

Week 2 PI 1 Week #2 1) Determinants of Health and Cross Cultural Dental Hygiene 2) The History of Dental Hygiene Regulation in BC Required Reading: Darby & Walsh, Chapter 1, 2 & 6 Upon successful completion of the unit, the student will be able to: Describe the role of the dental hygieni...

Week 2 PI 1 Week #2 1) Determinants of Health and Cross Cultural Dental Hygiene 2) The History of Dental Hygiene Regulation in BC Required Reading: Darby & Walsh, Chapter 1, 2 & 6 Upon successful completion of the unit, the student will be able to: Describe the role of the dental hygienist in supporting the oral health care needs of the public Identify the determinants’ of health and relevance to dental hygiene care Identify how cultural beliefs can impact dental hygiene access to care Identify strategies for implementing social justice to increase access to oral health care Explain the history of dental hygiene in Canada Explain the history and structure of the CDHBC/BCCOHP and dental hygiene regulation in BC Discuss the HPA and explain self-regulation Darby and Walsh It is very important to read the chapters assigned in Darby and Walsh as they can be included in the exams and more importantly; it is the material that a lot of the National Board Exam questions are based upon.  Determinants of Health Cross-Cultural Dental Hygiene & Social Responsibility and Justice Copyright © 2010 by Saunders, an imprint of Elsevier Inc. Determinants of Health Over the last fifty years, a change has emerged in the way health researchers and practitioners understand the factors that prevent chronic disease and lead to good health. Before that, it was largely considered a matter of bio- medical cause and effect, coupled with negative life style choices. Health professionals began to see that good health and disease prevention are a lot more than that. “Ottawa Charter for Health Promotion” (1986) to achieve health for ALL by year 2000 and beyond https://www.youtube.com/watch?v=G2quVLcJVBk Health Canada Involvement In 1998, Health Canada developed a comprehensive list of factors, calling them the Determinants of Health: Income Social support Education and literacy Employment and working conditions Social environments Physical environments Personal health practices and coping skills Healthy child development, biology and genetic endowment Health services Gender Culture https://study.com/academy/lesson/poverty-cycle-definition- examples.html Correlation and Causation: Determinants of health intersect with Poverty each other; some people may face Homelessness multiple exclusions and marginalization. Unemployed Negative socio-economic conditions A new immigrant accumulate to produce negative Have no support systems health outcomes, including chronic disease. Suffering from a chronic Health disparities are often identified illness for people of low socioeconomic Denied access because of status, Aboriginal peoples, women, and those who live in geographically racism or discrimination remote areas. Correlation and Causation Where does the Dental Hygiene Profession Fit In? Where does the DH Profession Fit In?: Inclusion Inclusion - the feeling and reality of belonging has a strong influence on health and well-being. Belonging to a family, a community, a society is one of the most important things in life. It makes us feel good. It makes us healthy. Inclusion is a way of ensuring that all those who live in a society can lead full and rich lives. Where does the DH Profession Fit In: Inclusion “My” Dental Practice, “My” RDH  Roles of a Dental Hygienist Be involved in movements to alleviate disparities and develop effective care systems such as: Volunteer at dental health fairs Educate clients regarding the importance of public programs and practitioners Support research on oral health disparities Advocate for increased scope of practice regulations that would allow dental hygienists to provide more care to the underserved, in a variety of settings. Collaborate** **Part of being a professional includes collaborating among many stakeholders and advocating the need for increased access to oral-health care. Advocating at the political level There are two ways to affect governmental policy. You can choose either or both of these: Engage your elected official by writing a letter (or signing attached petition) Meet with politicians Political Advocacy Ottawa Charter of Health Promotion States that in order to improve health: Secure foundations must be maintained in the following areas. These areas are considered the basic prerequisites for health: 1. Peace 2. Shelter 3. Education 4. Food 5. Income 6. A Stable eco-system 7. Sustainable resources 8. Social justice and equality Concepts in Cross-Cultural Dental Hygiene Concepts in Cross-Cultural Dental Hygiene Basic human needs in every culture: Subsistence (survival, continuation) Safety Identity Love Freedom Maslow’s Hierarchy of Needs Cross-Cultural Dental Hygiene The effective integration of diverse cultural backgrounds of clients into the process of care Takes into account the social, political, ethnic, religious, and economic realities that shape the experiences and environments of all clients Concepts in Cross-Cultural Dental Hygiene Race Standard race classifications are limiting Many people self-identify with multiple groups Ethnicity Unique cultural and social heritage and traditions of primary racial divisions Customs, language, diet, work habits, religion Concepts in Cross-Cultural Dental Hygiene Subculture: A group of people who have developed interests or goals different from the primary culture Can be based on occupation, sexual orientation, or religion Class Activity Find a Partner who has a different Cultural Background than you. Spend Time learning about them What are some traditions ? What are some traditional Meals? Are there any rights of passage? Cultural Barriers to Oral Health Care Cultural Barriers to Oral Healthcare Stereotyping: The erroneous assumption that a person possesses certain characteristics just because he or she is a member of a particular group Ethnocentrism: The belief that one’s culture is superior to all others Leads to discrimination and ultimately loss of clients Cultural Barriers to Oral Healthcare Race and Ethnicity Hygienists must understand the local cultures they serve in order to help clients to achieve optimal health Non-Western Medical Philosophy Oral health therapy and promotion strategies must be delivered in relation to the client’s culture (see Table 6-1 in Darby & Walsh, 4th ed) Cultural Barriers to Oral Healthcare Socioeconomic Status Permeates all aspects of a person’s life (income, occupation, level of education) Poverty is a key predictor of poor oral health Cultural Barriers to Oral Healthcare High quality care is often, but not always, related to the development status of a country Developed countries: Characterized by well-developed economies and relatively high standards of living, literacy rates, life expectancy, and income Examples: Canada, United States, Australia, and Great Britain Developing countries: Characterized by undeveloped economies and lower standards of living, literacy rates, and incomes Examples: Haiti, Guatemala, and Yemen Cultural Competency Continuum Cultural Barriers to Oral Healthcare ▪Cultural destructiveness: The most negative end of the continuum. ▪It is represented by attitudes, policies, and practices that are destructive to culture, communities, and individuals. ▪The most extreme example of cultural destructiveness is actively participating in cultural genocide, which is the purposeful destruction of a culture. E.g. Rwanda  Rwanda Genocide a genocidal mass slaughter of Tutsi in Rwanda by members of the Hutu majority government. An estimated 500,000–1,000,000 Rwandans were killed during the 100- day period from April 7 to mid-July 1994, constituting as many as 70% of the Tutsi population. Cultural Barriers to Oral Healthcare ▪Cultural incapacity: individuals do not intentionally seek to be culturally destructive but lack the capacity to help diverse backgrounds ▪ Examples of this cultural awareness stage would be discriminatory hiring practices, assumptive beliefs such as all single parents are inferior parents, or all people living in certain areas are poor. ▪The systems remain extremely biased and believe in racial superiority.  Cultural Barriers to Oral Healthcare ▪Cultural blindness: At this level of the continuum, systems, agencies, or individuals provide services with the philosophy of being unbiased. ▪ This group believes that color, race, ethnicity, poverty, gender, etc. don’t matter at all or are inconsequential ▪This is a well-intended philosophy; however, the consequences of such a belief are to make services ethnocentric and therefore only useful for the most assimilated. ▪ People of diverse cultures are anticipated to meet the needs and expectations of the dominant group. Cultural Competency Continuum Cultural Precompetence: This step is on the positive end of the scale, awareness of some sensitivity but not sure what to do or “what is right.” ▪A system, agency, or individual recognizes its weaknesses in serving clients of cultural diversity and attempts to improve. ▪ Care must be taken at this level so that a false sense of accomplishment does not prevent further movement along the continuum. Cultural Competency Continuum Cultural competence: Culturally competent systems, agencies, or individuals are characterized by acceptance and respect for differences. There is ongoing self-assessment regarding culture, expansion of knowledge, and adaptation of service models to better meet the needs of specific populations. Cultural competence is also characterized by acknowledging similarities between diverse cultures. Cultural Competency Continuum Cultural proficiency: This is the most positive end of the continuum; an advanced cultural competency. All cultures are held in high self-esteem and there is high regard in adding to the knowledge base of culturally competent practices, services, research, and approaches. Cultural proficiency indicates advocating for cultural competence through all systems and improves relations between cultures throughout society. Effective Cross-Cultural Communication Cross-cultural communication is effectively communicating with someone of a different culture. Learn all that you can about the individual, family, or the community's way of life. Two important points to remember: 1. Do not expect to ever completely understand a culture that is not your own. For example, no matter how much you study the Italian culture, you will never be Italian or share the experiences of growing up in Italy or with an Italian family rich in traditions. 2. Do not fall into the stereotyping or overgeneralization trap. Do not look at people stereotypically and then never move beyond that point. The skill of cultural competency is to learn useful general information and at the same time be aware and open to variations and individual differences.  Guiding Principles: Skills that Foster Effective Cross-Cultural Communication Communicate in a language that is clear and at the client's level of understanding; send clear messages. Define any dental terminology; avoid jargon. Listen well to the client's questions and stories. Carefully observe the client's body language. Look beyond the superficial. Be patient, persistent, and most important: flexible. Recognize your own cultural biases. Emphasize common ground; do not focus on differences, instead focus on similarities. Withhold judgment; accept others’ differences. Empathize; treat each person as an individual. Do not assume understanding; ask for clarification. Always communicate in a respectful manner. Increase your knowledge and skills of cultural competence. Communicating in a Cross-Cultural Environment Dental hygienists should initiate communication with a positive attitude while establishing common ground with cross-cultural clients Topics might include children/parenting, hobbies, food and travel… Communicating in a Cross-Cultural Environment Verbal Communication Effective communication with culturally diverse people facilitates care Manner of Speaking Culturally sensitive dental hygienists modify their manner of speaking to facilitate positive interactions with culturally diverse clients Communicating in a Cross-Cultural Environment Nonverbal Communication Different cultures have distinct perspectives on gestures, zones of territory/personal space, eye contact, and physical contact Dental hygienists must be aware of what is acceptable within the cultures that they encounter in their clinical practices Dental Hygiene Process in a Cross-Cultural Environment Care of clients from different cultures or ethnic groups takes more time Approach each client as a valued, unique, individual Assess clients’ culturally related practices, attitudes, values, and beliefs as part of the process of care Dental Hygiene Process in a Cross-Cultural Environment Assessment, Diagnosis, and Care Planning It is essential to assess clients to identify culture-specific information Implementation Dental hygiene interventions must be congruent with cultural values Evaluation The client’s cultural perspective of success must be considered during this phase of care Cultural competence and Client-centeredness Both concepts began as interpersonal interaction guides for effective communication in order to maintain unconditional positive regard, effective rapport, and understanding of the client's beliefs, values, and attitudes about health and illness. Cultural Competency Education Model Self-exploration: Awareness of one's own cultural heritage and increased acceptance of different values, attitudes, and beliefs. Knowledge: To understand that one culture is not intrinsically superior to another and to recognize individual and group differences and similarities. Skill: To master appropriate and sensitive strategies and skills in communicating and interacting with persons from different cultures and to seek information about various cultures within a society. History Lesson In Dental Hygiene Week 2: History of Dental Hygiene DH is evolutionary Historically DH was regulated under the dental act and was viewed in a more occupational model. The professional and collaborative models followed with the current human needs conceptual model, adaptable to all practice settings. History of Dental Hygiene 1905 Dr. Alfred G. Fones, of Connecticut, is credited with training the first “dental hygienist” and coining the term. 1907 The Connecticut Dental Practice Act is amended to include a definition of dental hygiene. 1913 Dr. Fones opens the Fones Clinic for Dental Hygienists in Bridgeport, Conn., with 27 graduates in its first year; most worked for the local school system, reducing the caries rate for children in the public by 75 percent. 1920s The first mention of a dental hygienist in Canada, a graduate from the Forsythe Dental Infirmary in Boston, is in charge of a dental clinic in Quebec. History of dental hygiene 1923 American Dental Hygienists’ Association (ADHA) is founded 1945 The U.S. has 17 schools of dental hygiene and approximately 7000 dental hygienists in practice. 1947 The first year that dental hygiene is recognized as a health occupation in Canada (Ontario). The Board of the Royal College of Dental Surgeons of Ontario passes a resolution to recommend standardized education for dental hygienists. 1951 Dental hygiene is legally recognized as a health profession in B.C., to be regulated by the College of Dental Surgeons of B.C.; legislation is included under the Dentists Act. The first dental hygienist in Canada, Mary (Brett) Geddes, is registered by the College of Dental Surgeons in Saskatchewan. U of T begins the first two-year diploma course in Canada for dental hygienists. Alberta registers its first dental hygienist.  History of Dental Hygiene 1952 British Columbia registers its first dental hygienist, Norma Bell. The Faculty of Dentistry at U of T begins awarding a Diploma in Dental Hygiene. 1953 A class of five hygienists graduates from U of T. 1956 The Canadian Armed Forces begins training dental hygienists. 1960 Canada has 98 registered dental hygienists; B.C. has registered a total of 13 dental hygienists. 1961 University of Alberta (U of A) establishes its School of Dental Hygiene. 1963 Alumni from the School of Dental Hygiene at U of T coordinate a national effort to establish an association for dental hygienists, the Canadian Dental Hygienists Association (CDHA). 1964 BCDHA is founded. History of Dental Hygiene 1967 After two years of provisional status, the Constitution of the B.C. Dental Hygienists Association is approved. 1968 UBC begins its dental hygiene program. 1970 B.C. has registered a total of 172 dental hygienists. 1975 Quebec dental hygienists are granted self-regulation. 1978 Local anesthesia is added to dental hygienist responsibilities in B.C. 1986 UBC’s dental hygiene program is moved to Vancouver Community College.  History of Dental Hygiene 1990 The Health Professions Act (HPA) is proclaimed; the Minister of Health appoints the Health Professions Council (HPC) to review applications for designation under the HPA. Alberta achieves self-regulation. 1993 The HPC recommends that dental hygiene is designated under the HPA. Ontario dental hygienists achieve self-regulation. 1995 On March 1, dental hygiene becomes a self-regulating profession in B.C. – under CDHBC 1996 In April, the first national board exam (NDHCE) is written by 583 candidates.  History of Dental Hygiene. 1998 Saskatchewan dental hygienists become self- regulated. 1999 Residential Care Registration Bylaws for CDHBC are approved by the B.C. government. 2002 CDHA creates the Dental Hygiene Code of Ethics and Client Bill of Rights. 2004 CDHA launches the Canadian Foundation for Dental Hygiene Research and Education. 2005 Vancouver College of Dental Hygiene opens for enrollment.  History of Dental Hygiene 2008 Manitoba dental hygienists becomes self- regulated. 2009 For the first time, the CDHBC register grows to more than 3000 members, and CDHA passes the 15,000- member milestone. 2009 New Brunswick and Nova Scotia are approved for self-regulation 2010 Newfoundland and Labrador are approved for self-regulation 2022 Dental health professionals amalgamate to one college: BCC OHP Health Professions Act Passed into law in 1990 Serves as the umbrella legislation under which health professions will regulate themselves in this province. Each profession has its own regulation under the Act, setting out the governing framework specific to it, and establishing the profession’s college. Each college develops its own bylaws for approval by the government, setting out the detailed rules governing the profession Health Professions Act There are 26 regulated health professions in British Columbia, of which 25 are self-regulating professions governed by 15 regulatory colleges under the Health Profession Act One profession (emergency medical assisting) is regulated by a government-appointed licensing board under a separate statute. Health Professions and Occupations Act There are six jurisdictions in Canada that have enacted umbrella health professions legislation: 1. British Columbia: Health Professions Act, R.S.B.C. 1996, c. 183; 2. Alberta: Health Professions Act, R.S.A. 2000, c. H-7; 3. Manitoba: The Regulated Health Professions Act, S.M. 2009, c. 15 4. Ontario: Regulated Health Professions Act, S.O. 1991, c. 18; 5. Newfoundland & Labrador: Health Professions Act, S.N.L. 2010, c. H-1.02 6. Yukon Territory: Health Professions Act, S.Y. 2003, c. 24.  HPOA 1991: BCDHA submits an application to the HPC to recognize dental hygiene as a designated health profession. 1991: Accreditation surveying is transferred from the Canadian Dental Association to the Commission on Dental Accreditation of Canada (CDAC). 1993 The Health Professions Council (appointed by the Ministry of Health) recommends that dental hygiene is designated under the HPA. HPOA: definitions Certified non-registrant: is a “non-registrant to whom registrants of a college may delegate aspects of practice or who may be authorized to provide or perform aspects of practice in accordance with a bylaw of the college…and who is certified by the college in accordance with a bylaw of the college” i.e. public members of CDHBC Designated health profession: “a health profession designated for the purposes of this Act” (designated through regulation by the Lieutenant Governor in Council) Health profession: a profession in which a person exercises skill or judgment or provides a service related to (a) the preservation or improvement of the health of individuals, or (b) the treatment or care of individuals who are injured, sick, disabled or infirm. Restricted activity: is an activity designated as such through regulation, pursuant to s. 55(2)(g) of the Act. Registrant: “in respect of a designated health profession, a person who is granted registration as a member of its college”  Professional Regulation The colleges have been delegated the authority under provincial legislation to govern the practice of their members, in the public interest. Their mandate is to serve and protect the public.  Professional Regulation The primary function of the colleges is to ensure their members are qualified, competent and following clearly defined standards of practice and ethics. All colleges administer processes for responding to complaints from clients and the public and for taking action when it appears one of their members is practicing in a manner that is incompetent, unethical, illegal or impaired by alcohol, drugs or illness. HPOA Professions Dentists Chiropractors Dental hygienists Dieticians Massage therapists Midwives Audiologists/speech pathologists Chiropodists Optometrists Opticians Naturopathic medicine Medical doctors HPA Professions Physiotherapists Respiratory technologists Medical lab technologists Nurses Occupational therapy Psychology Acupuncture / Chinese medicine Denturists Dental Technology Emergency Medical Assistants Pharmacists Licensed practical nurses Podiatrists Self-Regulation On March 1, 1995 dental hygiene became a self- regulating profession in British Columbia and is regulated by the CDHBC in accordance with the Dental Hygiene Act-1991. The composition of the College board members is six elected dental hygienists; and six public representatives appointed by the Minister. They have established the Dental Hygiene Bylaws under which they governed. On November 24, 2022 the CDHBC merged with the dentists, denturists , dental assistants and dental techs to create the BCCOHP British Columbia College of Oral Health Professionals and HPOA BCCOHP is the newly amalgamated regulatory body for oral health professionals in Canada The Healthcare Professions Act has now been changed to include health care occupations – Now known as the the Healthcare Professionals and Occupations Act. The profession is no longer self regulated. Self-Regulation In addition, to bylaws, the College has established practice standards and a code of ethics. The Practice Standards serve to: Set the standard of care that is expected to be provided by all RDH’ Provide a guide for self-evaluation Are also the standard for measuring complaints against an RDH Taken together, these laws form the overall legal framework for dental hygiene practice in this province. Regulation in Dental Hygiene Dentist: a person authorized under the Dentists Act to practice dentistry Facility: licensed under the Community Care Facility Act, a hospital, or mental health facility Dental Hygienist: Dental Hygiene Act 1991-an act pertaining exclusively to the practice of dental hygiene The BCCOHP is the name of the college established under the HPA