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Dental Public Health Activities: Descriptive Summaries

Overcoming Obstacles to Oral Health: A Training Program for Caregivers of People with Disabilities and Frail Elders

Practice Number: 09002
Submitted By: Delaware Division of Public Health
Submission Date: March 2016
Last Reviewed: March 2016
Last Updated:
Best Practice Approach Example Overcoming Obstacles to Oral Health: A Training Program for Caregivers of People with Disabilities and Frail Elders

The Center for Disabilities Studies (CDS) at the University of Delaware was contracted by the Delaware Department of Health and Social Services (DHSS) Division of Public Health (DPH) to plan, coordinate, and evaluate a training for dental professionals, direct support professionals (e.g. group home managers, team leaders, etc.) and family members. This training was designed to prepare them to successfully implement an oral hygiene routine for individuals with disabilities to improve dental home care for these individuals. The training curriculum used for the program was “Overcoming Obstacles to Oral Health,” developed by the Dugoni School of Dentistry at the University of the Pacific. Two hundred ninety-one (291) individuals were trained between June 2013 and August 2014. This project was made possible with a grant from the DentaQuest Foundation.

Lessons Learned:

The process evaluation of the Overcoming Obstacles to Oral Health trainings allowed project coordinators and facilitators to determine that the four-hour trainings were too lengthy, and the locations were not convenient for the target audience.  The two-hour session was a more efficient way to deliver the training. There is some sacrifice in content and fewer opportunities for discussion, but longer sessions make it difficult for participants to find time to attend. The two-hour sessions also showed greater impact in terms of knowledge gained. 

The continuing education system for certified nursing assistants in Delaware is based on attendance, not demonstrated increase in knowledge or skills. While we observed many participants engaged and asking questions about providing care for patients that they care for, some participants focused more on obtaining credits than new skills. Our recommendation for future trainings (and perhaps the credit system in general) would be to tie earned credit to a demonstrated increase in knowledge (e.g., an 80% correct on the post-test).

The ongoing interest in the trainings--particularly among certified nursing assistants working in hospitals, residential facilities and long-term care settings–has prompted the Delaware Division of Developmental Disabilities Services and the Division of Services for Aging and Adults with Disabilities to request trainings for their staff. The cross-agency interest in this program promotes the sustainability of this training as it creates the potential for diverse funding streams to support the project. 

Another strength of the project is the relatively low cost. With an established curriculum and work books available for reprinting, training costs can be contained. Delaware tapped into the existing training network for the state health department and used their facilities and promotion mechanisms. In addition to coordinator time, costs included trainer time and travel, and purchase or reproduction of the curriculum workbook.

One activity that has evolved from this project is the development of a best practice toolkit for administrators in long-term care facilities. Many participants in the Overcoming Obstacles training reported that while the skills they learned were useful, there was not a system in place in their work places that supported routine oral hygiene for residents. This new project will assess current oral health practice in state-licensed residential facilities through a survey, develop and disseminate a best practice tool kit, and evaluate the impact of the toolkit on adoption of oral health best practices. 

Considering that each participant will return to their jobs and provide assistance with activities of daily living, routine oral health care and maintenance for persons with disabilities, the cost of this program is worthwhile and reasonable when compared to the benefits. 

Contact Person(s) for Inquiries:

Gregory B. McClure, DMD, MPH, Dental Director, Delaware Division of Public Health, Bureau of Oral Health and Dental Services, 417 Federal Street , Dover, DE 19901, Telephone: 302-744-4554, Email:

Barbara L. Antlitz, MS, Delaware Division of Public Health, Bureau of Oral Health and Dental Services

417 Federal Street , Dover, DE 19901, Telephone: 302-744-4554, Email: