Study to Explore How to Improve Oral Health for Those With Mental Illness

Dentistry Today

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Researchers at the University of Michigan have received additional funding to continue their work investigating how to improve the oral health of people with mental health disabilities.

The Peer Oral Health Initiative—Developing and Testing a Brief Intervention Model received a $49,250 grant from the Delta Dental Foundation supplementing an earlier $50,000 grant received from the U-M Depression Center’s Eisenberg Collaborative Innovation Fund.

The project will start in the fall. It will build on a previous grant from the Michigan Health Endowment that allowed the researchers to create oral health training modules for community health workers and Certified Peer Support Specialists (CPSS).

The link between oral health and psychological well-being is clearly established, the researchers said, but oral health remains a significant area of inequity for those with psychiatric disabilities, especially those who obtain services from community mental health and who are insured by Medicaid.

Individuals with psychiatric disabilities have greater oral disease risks and greater oral treatment needs than the general populations, the researchers said. For example, the dry-mouth side effects of many psychotropic medications put them at risk for oral diseases, requiring special self-care and treatment approaches.

Despite this heightened need, the researchers said, individuals with psychiatric disabilities often lack knowledge about preventive home-care behaviors, have access barriers related to social determinants of health, have limited understanding of their own dental benefits, and often do not know how to find dentists

One area of promise in bridging gaps created by lack of oral health knowledge and social determinants of health among psychiatric consumers is the work of CPSS, the researchers said. In Michigan, these frontline community health workers have obtained treatment for a psychiatric diagnosis from the public mental health system and have been trained and certified by the state to serve others with similar experiences.

CPSS provide outreach and support in community mental health settings and are Medicaid billable. Research has shown that CPSs-delivered interventions for managing physical health conditions. The researchers will apply this evidence to an oral health context.

“Our project focuses on training community health workers, peer support specialists, and peer recovery coaches to talk to their clients with mental health disabilities about oral health and to connect them with a dental home in their community,” said researcher Danielle Rulli, a clinical assistant professor at the U-M School of Dentistry Dental Hygiene division and director of the Graduate Dental Hygiene program.

“In this project, we will develop motivational interviewing materials and other supports for these community workers and will include short videos of people sharing their oral health recovery stories,” said Rulli.

The Peer Oral Health Initiative will take place at three CPSS-run drop-in centers in Michigan, all of which serve Medicaid-insured individuals with psychiatric disabilities. The initiative has three pillars: outreach, education, and linkages.

In the outreach pillar, CPSS will roll out a public health campaign to identify and engage Medicaid-insured individuals with psychiatric disabilities who may have high oral health needs.

In the education pillar, evidence-based practices will be adapted to launch a CPSS-delivered brief intervention and referral to treatment model designed to improve oral health knowledge, self-care behaviors, and healthcare utilization. The researchers will work with McMillen Health to develop tailored health education materials for use by peers.

In the linkages pillar, CPSS will provide handoffs to local dental clinics and will follow up to ensure appointments are completed. Awareness of scope of practice is important to this initiative, the researchers said.

The researchers will not train CPSS to take on the roles more appropriate for dental professionals. Rather, they will select oral health home-care topics that can be shared with patients within the CPSS scope of practice and will carefully manualize the brief intervention to ensure fidelity and consistency of information shared.

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