University at Buffalo - The State University of New York

Published: January 6, 2005

By NICOLE SCHUMAN
Reporter Contributor

Taking its cue from a School of Social Work study on dental access for seniors, the CARES program in the School of Dental Medicine partners with UB social workers to provide clients with "more than just a set of teeth."

The program attempts to break down the barriers preventing older adults and those financially limited from receiving dental care by addressing patients' mental, emotional, social and financial needs, as well as their dental problems.

CARES, an acronym for counseling, advocacy, referral, education and service, began in 2001 as a result of earlier research by Deborah Waldrop, assistant professor in the School of Social Work. Waldrop conducted a needs assessment of 928 School of Dental Medicine patients with a mean age of 57. The results showed that 42 percent of the patients lived below the poverty level, said Kim Zittel-Palamara, clinical assistant professor in the dental school and CARES project director. The assessment found that the primary concerns of the patients were health (32 percent), finances (25 percent), medical bills (16 percent) and family problems (14 percent). Researchers then interviewed 157 respondents in more depth on these topics, revealing many of the barriers that prevent older adults from receiving dental care, said Zittel-Palamara, who codirects CARES with James Wysocki, clinical manager and task supervisor.

Zittel-Palamara, who holds master's and doctoral degrees in social work from UB, and Wysocki, who also earned a master's degree in social work from UB, work to provide access to dental care for those who may not be able to afford even the reduced price of the dental school clinic. Dental students and faculty refer patients to the CARES program, and some learn of the program via word of mouth.

In addition to assisting patients' dental needs, CARES helps dental students learn not only the technical aspects of oral health, but sensitivity to their patients' needs as well. Moreover, social work students benefit from the cross-concentration program by learning about advocacy and support.

"The program is made up of three components," said Zittel-Palamara. "There is the clinical, but also education and community outreach."

The program has five subprograms: social work services for dental school patients, cognitive behavioral social work for patients suffering with temporomandibular joint disorders (TJD), biobehavioral dental-student education with a focus on assisting marginalized patients, field education for social work students and community outreach to older adults attending senior centers in Western New York.

The program began with funding from the Community Foundation of Buffalo and now continues with funding from the dental school, although the group is always working to obtain grants and plan fundraisers. CARES hosted a concert last fall at the Unitarian Universalist Church in Buffalo, with all proceeds going to the CARES program.

Since its inception, CARES has reached more than 1,900 patients through the dental school, but outreach efforts go beyond the school, Zittel-Palamara notes. The group works to obtain new clients throughout all eight counties of Western New York. This can mean Zittel-Palamara traveling as far as Allegany County to present the program at nutrition sites, senior centers and at other sites in low-income areas.

"These people see the university as caring," she said. "We are reaching out, caring what the community's needs are and addressing these needs by showing what we offer."

The program also features a research component designed to help alleviate the pain and anxiety associated with dental work. Wysocki is working to create a new protocol for TJD patients. His cognitive behavioral therapy includes skills training for students focusing on patients with anxiety, depression, stress and difficulty with interpersonal relationships.

"By targeting these, you are able to effect the perception and level of jaw pain," Wysocki said. His method combines imagery, relaxation techniques, breathing exercises, rational therapy and positive coping skills to help patients deal with the stress. Coping skills also are taught to patients with mental health issues, phobias and other dental anxieties through desensitization techniques.

"We address barriers to treatment so patients can attain optimum oral health care and help with other areas besides teeth," Wysocki said.

The social work and dental students strive to manage these psychosocial issues and have intervened with 178 patients aged 60 and over. During these interventions, patients spend an average of 50 minutes with a social worker, who contacts or refers patients to an average of three community resources for assistance, whether it is financial, social or even transportation. Eight of 10 patients who received this assistance between 2001 and 2004 had received dental treatment within the past year, Zittel-Palamara said. The most common type of assistance was financial (almost 50 percent), transportation (around 33 percent), health-related (58 percent), mental health (32 percent and housing (6 percent).

CARES is a unique program among dental schools around the country, Zittel-Palamara said. While at least four other universities offer programs similar to CARES, including a program geared toward children at the Eastman Dental Center at the University of Rochester Medical Center, she said she thinks the focus of the UB program is unusual. The dental school is the only school in the country to host full-time social workers to assist older adults seeking access to dental care, provide a social worker for biobehavioral education for dental students and serve as a field school site for social work students.

"In addition to helping patients, we are educating dentists and social workers to become better at addressing the medical component of social work, such as every day, chair-side communication with patients that they may have difficulty working with otherwise," Wysocki said.

"We see people in their environment, not just in their head, as they may in the psychology realm," Zittel-Palamara said.

The dental school has been tremendously supportive of the CARES program, Zittel-Palamara added.

"We've never heard anything negative about our program," she said. "The faculty is very supportive. It's very rare when you are an outsider—a social work professor—coming into a science and dentistry program where the education is very focused on procedures. Here we are, coming in saying, 'But you also have to look at the patient's home life.' They've always been welcoming and eager to work with us," she said. "I really commend the school on how open and caring they really are to those outside of their study."