ADHA Access December 2012 : Page 18

CODA and Dental Hygiene’s Changing World By Josh Snyder missioner, despite the fact that these groups have far fewer t doesn’t take a career specialist or fortuneteller to state accredited programs than dental hygiene. the obvious – the profession of dental hygiene is growing, “We believe that this data demonstrates that dental and will continue to do so. It seems that not a day goes by hygiene is not fairly represented at the commission, which without a new program opening its doors, promising students makes decisions about the educational requirements of our a high-quality education in a booming career field. Over the profession,” Steinbach said. past 25 years, the number of programs has increased by 70 While equal representation is still in the works, many have percent, and in 2012 has reached to nearly 350 programs. 1 asked what, exactly, will increased representation on CODA Though there is substantial growth in the profession, it do to benefit dental hygienists? The main concern is ensuring has not immediately equated to an increase in clinical jobs. there is proper oversight in the accreditation process. Accord-Dental hygiene is changing in new, exciting and unsuspected ing to Steinbach, the U.S. Department of Education’s Pro-ways. Which is why now, more than ever, the voices of dental cedures and Criteria for Recognition of Accrediting Agencies hygienists must be heard, to help shape the profession into states that each accreditation program must have policies one that will rise up to the challenges of access to care and and procedures to ensure the organization makes objective growing elderly populations. decisions based on reliable information, and that accred-The goal of the Commission on Dental Accreditation, ited programs have a procedural due process that does not better known as CODA, is “to accredit dental and dental-exhibit partiality or behavior that leads to potential impro-related education programs conducted at the post-secondary prieties that impugn the integrity of the accrediting process. level.” 2 Created in 1975 with the intent to develop plans and With an increase in CODA representation, dental hygienists strategies to meet these goals, CODA frequently gathers to can ensure this level of integrity is being upheld. “serve the public by establishing, maintaining and applying “ADHA has long been concerned that the integrity of the standards that ensure the quality and continuous improve-CODA decision-making and policy-making activities have ment of dental and dental-related educa-tion and reflect the evolving practice of n Common Misconceptions dentistry.” 2 Representation on CODA has been a As with any issue, there are often large amounts of misinformation that can priority of the American Dental Hygien-take an already complex topic and make it nearly impossible to decipher. ists’ Association (ADHA) for the reasons And CODA and the process of dental accreditation is no exception. Below are outlined above. The number of dental just a few of those misconceptions, and the realities behind them. hygiene education programs is on the rise. The profession is changing in ways Myth 1: Accreditation could limit the growth of new dental hygiene pro-no one could have predicted. To ensure grams. proper representation, ADHA formally re-quested an increase in ADHA-appointed Fact: Denying a new program that meets all of the quality standards for dental hygienists to serve on the com-accreditation could be considered “restraint of trade,” which could possibly mission. The request was made in the incur legal risks for the accrediting body. form of an appeal letter, sent directly to CODA in May 2012. Myth 2: Accreditation is typically a revenue-producing activity for sponsor-Pam Steinbach, ADHA director of ing organizations. education, said the increase in repre-Fact: Specialized accreditation requires subsidization in many fields, but this sentation is necessary, given the current is usually not advertised to interested stakeholders. Competing accredita-make-up of the commission. tion programs are at even more of a financial risk due to the inevitable price “We believe that the current repre -competition. sentation of the accredited dental hy-giene programs by one ADHA appointed Myth 3: Review of information submitted requiring feasibility studies for commissioner does not adequately repre-new programs allows the accreditation body to “second guess” the research/ sent a fair and balanced representation market data collected in these studies. of the 335 accredited dental hygiene programs,” Steinbach said. Fact: Accrediting bodies may require feasibility studies from applicants These numbers, as Steinbach pointed with new programs demonstrating some evidence of need for accreditation out, stand in stark contrast when com-eligibility purposes, but these requirements do not usually result in an effort pared to the rest of the commission. by accreditation staff/assessors to “second guess” or challenge the results of There are 444 accredited advanced these studies unless there is some evidence of gross negligence on the part dental specialty programs, which are of the organization conducting such studies. represented by a total of nine commis-sioners, one appointed by each of the Myth 4: If a new accreditation agency is created for dental hygiene pro-postdoctoral specialty programs. The grams, CODA would stop offering accreditation services to all dental hygiene dental profession is represented by 12 programs. dentists. These CODA commissioners Fact: Given the size of the dental hygiene market, and its expansion, this were each appointed by ADA, ADEA and would be highly unlikely. AADB, with each group selecting four appointees. All other allied programs are also represented by one appointed com-I 18 DEC 2012 access

Special Feature

Josh Snyder

CODA and Dental Hygiene’s Changing World<br /> <br /> It doesn’t take a career specialist or fortuneteller to state the obvious – the profession of dental hygiene is growing, and will continue to do so. It seems that not a day goes by without a new program opening its doors, promising students a high-quality education in a booming career field. Over the past 25 years, the number of programs has increased by 70 percent, and in 2012 has reached to nearly 350 programs.1<br /> <br /> Though there is substantial growth in the profession, it has not immediately equated to an increase in clinical jobs.Dental hygiene is changing in new, exciting and unsuspected ways. Which is why now, more than ever, the voices of dental hygienists must be heard, to help shape the profession into one that will rise up to the challenges of access to care and growing elderly populations.<br /> <br /> The goal of the Commission on Dental Accreditation, better known as CODA, is “to accredit dental and dental related education programs conducted at the post-secondary level.”2 Created in 1975 with the intent to develop plans and strategies to meet these goals, CODA frequently gathers to “serve the public by establishing, maintaining and applying standards that ensure the quality and continuous improvement of dental and dental-related education and reflect the evolving practice of dentistry.”2<br /> <br /> Representation on CODA has been a priority of the American Dental Hygienists’ Association (ADHA) for the reasons outlined above. The number of dental hygiene education programs is on the rise. The profession is changing in ways no one could have predicted. To ensure proper representation, ADHA formally requested an increase in ADHA-appointed dental hygienists to serve on the commission.The request was made in the form of an appeal letter, sent directly to CODA in May 2012.<br /> <br /> Pam Steinbach, ADHA director of education, said the increase in representation is necessary, given the current make-up of the commission.<br /> <br /> “We believe that the current representation of the accredited dental hygiene programs by one ADHA appointed commissioner does not adequately represent a fair and balanced representation of the 335 accredited dental hygiene programs,” Steinbach said.<br /> <br /> These numbers, as Steinbach pointed out, stand in stark contrast when compared to the rest of the commission. There are 444 accredited advanced dental specialty programs, which are represented by a total of nine commissioners, one appointed by each of the postdoctoral specialty programs. The dental profession is represented by 12 dentists. These CODA commissioners were each appointed by ADA, ADEA and AADB, with each group selecting four appointees. All other allied programs are also represented by one appointed commissioner Despite the fact that these groups have far fewer accredited programs than dental hygiene.<br /> <br /> “We believe that this data demonstrates that dental hygiene is not fairly represented at the commission, which makes decisions about the educational requirements of our profession,” Steinbach said.<br /> <br /> While equal representation is still in the works, many have asked what, exactly, will increased representation on CODA do to benefit dental hygienists? The main concern is ensuring there is proper oversight in the accreditation process. According to Steinbach, the U.S. Department of Education’s Procedures and Criteria for Recognition of Accrediting Agencies states that each accreditation program must have policies and procedures to ensure the organization makes objective decisions based on reliable information, and that accredited programs have a procedural due process that does not exhibit partiality or behavior that leads to potential improprieties that impugn the integrity of the accrediting process. With an increase in CODA representation, dental hygienists can ensure this level of integrity is being upheld.<br /> <br /> “ADHA has long been concerned that the integrity of the CODA decision-making and policy-making activities have Been compromised by overt activities of affiliated dental organizations,” Steinbach said. “In fact, ADHA submitted formal requests to CODA in 1984 and again in 2007, requesting an increase in representation, with both of those requests being denied.<br /> <br /> “With the proliferation of dental hygiene education programs and programs preparing alternative workforce providers, we are strongly recommending an increase in dental hygiene representation to CODA in an effort to ensure fair representation of the dental hygiene educational programs and to improve the integrity of the accreditation decision-making processes.”<br /> <br /> ADHA’s formal request, to add dental hygiene representation to CODA in terms of appointed commissioners, was referred to CODA’s Quality Assurance and Strategic Planning (QASP) Committee. The recommendation, originally made by ADHA-appointed Commissioner Kathi Shepherd, RDH, MS, at the August 2012 CODA meeting, was amended to include all allied representation on the CODA Board of Commissioners. As a result, the QASP Committee will look at CODA board representation of dental hygiene, dental assisting and dental lab tech based on the number of programs accredited in each discipline. At the August meeting, there was little discussion among commissioners, and it was unanimously voted to refer for review.The QASP Committee is scheduled to report back at the February 2013 CODA meeting and bring their recommendation to the full commission.<br /> <br /> While the commission reviews ADHA’s request, there are other plans in motion that will have an impact on the future of dental hygiene education and accreditation. Recently, ADHA requested an accreditation feasibility study. The results were recently reported to the ADHA Board of Trustees by the association’s accreditation consultant, Michael Hamm. The board accepted the report at the recent fall meeting, and classified it as confidential because it contains important data and information for future consideration.<br /> <br /> Steinbach added that ADHA is continuing its advocacy efforts as well, going beyond the request for more representation.<br /> <br /> “ADHA’s educational advocacy initiatives include our regular review of the standards; recommendations to CODA, such as needed changes in the standards; and attendance as observers at CODA board meetings and at CODA’s dental hygiene review committee meetings.”<br /> <br /> Lastly, she added that, if dental hygienists wish to see change in CODA representation, a great way to do that is to get involved.<br /> <br /> “Dental hygienists can stay involved by maintaining their awareness of regulatory and legislative issues impacting the profession.” <br /> <br /> So what does the immediate future look like? Will dental hygienists see increased representation on CODA? What are some of the hurdles that will need to be overcome to succeed?<br /> <br /> “ADHA remains hopeful that our request for increased dental hygiene representation on the CODA governing body will be approved by the QASP and that CODA will then forward a resolution to the 2013 ADA House of Delegates,” Steinbach said. “If our request is denied, then the ADHA board will re-consider the recommendations as outlined in the Accreditation Feasibility Study Report.”<br /> <br /> The educational challenges that face the profession, according to Steinbach, are similar in nature to changes already being seen in the profession.<br /> <br /> “Historically, the dental hygiene education curriculum was predicated on the delivery of oral health care through the private practice dental delivery system. Currently, significant segments of the U.S. population do not receive any oral health care through this traditional system.<br /> <br /> “With the many national calls for changing the oral health care delivery system and education of oral health professionals, it is important to revise the dental hygiene educational curriculum to prepare future dental hygienists to deliver quality oral health care to all segments of the U.S. population and to be responsive to an evolving health care delivery system.” <br /> <br /> Other factors potentially affecting the profession are an increasing elderly population that is also becoming more culturally diverse. This results in more complex treatment for patients, which requires dental Hygienists to have a broad-based education. Along with this comes the trend for health practitioners to be more aware of prevention, and educating patients on proper, healthy habits that can prevent disease later in life. Dental hygiene is no exception, and this aspect must receive more attention within the dental hygiene education system.<br /> <br /> But perhaps the biggest challenge is to bring consistency and integrity to the high volume of dental hygiene programs opening across the country. According to Steinbach, entry-level dental hygiene programs are currently offered in a variety of settings, such as schools of allied health, dental schools, community or junior colleges and technical colleges and universities. Programs in educational settings that limit their length struggle to incorporate new content and techniques to enhance oral health care. As a result, curricula are overcrowded.<br /> <br /> And with an increased membership on CODA, dental hygienists can begin to move the profession forward to its next logical point – setting the entry point into the profession at the advanced degree level. According to Steinbach, this change is the next step the profession must take to adapt to the new workforce challenges that lie ahead.<br /> <br /> “The failure to standardize entry level at the baccalaureate level has slowed the pace of development of advanced dental hygiene programs and the continued development of the dental hygiene body of knowledge. Given that some other professions and allied health professions have already moved beyond the baccalaureate degree as the entry to practice, dental hygiene must plan for the required curriculum changes and move toward a baccalaureate degree as the entry to practice in the future.”<br /> <br /> References<br /> <br /> 1. Dental Hygiene Education: Curricula, Program, Enrollment and Graduate Information. American Dental Hygienists’ Association, Apr. 2012. Available at: www.adha.org/downloads/edu/dh_ed_fact_sheet.pdf. Accessed Nov. 7,2012. <br /> <br /> 2 Commission on Dental Accreditation (CODA). American Dental Association Available at: www.ada.org/117.aspx. Accessed Nov. 6, 2012.<br /> <br /> Josh Snyder is ADHA staff editor - Journal of Dental Hygiene.<br /> <br /> Common Misconceptions<br /> <br /> As with any issue, there are often large amounts of misinformation that can take an already complex topic and make it nearly impossible to decipher.And CODA and the process of dental accreditation is no exception. Below are just a few of those misconceptions, and the realities behind them.<br /> <br /> Myth 1: Accreditation could limit the growth of new dental hygiene programs.<br /> <br /> Fact: Denying a new program that meets all of the quality standards for accreditation could be considered “restraint of trade,” which could possibly incur legal risks for the accrediting body.<br /> <br /> Myth 2: Accreditation is typically a revenue-producing activity for sponsoring organizations.<br /> <br /> Fact: Specialized accreditation requires subsidization in many fields, but this is usually not advertised to interested stakeholders. Competing accreditation programs are at even more of a financial risk due to the inevitable price competition.<br /> <br /> Myth 3: Review of information submitted requiring feasibility studies for new programs allows the accreditation body to “second guess” the research/ market data collected in these studies.<br /> <br /> Fact: Accrediting bodies may require feasibility studies from applicants with new programs demonstrating some evidence of need for accreditation eligibility purposes, but these requirements do not usually result in an effort by accreditation staff/assessors to “second guess” or challenge the results of these studies unless there is some evidence of gross negligence on the part of the organization conducting such studies.<br /> <br /> Myth 4: If a new accreditation agency is created for dental hygiene programs, CODA would stop offering accreditation services to all dental hygiene programs.<br /> <br /> Fact: Given the size of the dental hygiene market, and its expansion, this would be highly unlikely.

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