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Professor bonds social work with dentistry

  • Practice

Margarita Artavia, professor of practicum education at the USC Suzanne Dworak-Peck School of Social Work, has four primary tenets for life in which she strongly believes and have never failed her: respect, openness, curiosity and individual accountability. Since 2016, Artavia has held a joint appointment with the Herman Ostrow School of Dentistry at USC. With vision, love of the task, and her tenets as the foundation, she developed an interdisciplinary educational opportunity that bonds social work and dentistry together.

The Associated Social Work Educational Internship Program began at the Dr. Roseann Mulligan Special Patients Clinic (SPC) where Artavia created a program providing Master of Social Work (MSW) students with clinical experience collaborating with dental faculty and students to improve service for patients. Social work interns are now also at the USC Pediatric Dental Clinic (PDC), located at the Los Angeles General Medical Center, which serves children and families who come in through resource care, formerly known as foster care, and the USC Dental Clinic at Union Rescue Mission (USC-URM) which sits in the heart of Skid Row in downtown Los Angeles.

“The work at each clinic looks different because the population, culture and how each clinic functions is different,” Artavia said.

Artavia co-facilitates teaching modules for the behavioral dentistry course at Ostrow, and is an active facilitator for the USC Interprofessional Education Program (IPE). She works in tandem with Daniel Jacob, clinical assistant professor in dental public health and pediatric dentistry at Ostrow, who is also a licensed clinical social worker with 23 years of experience. Jacob serves as the practicum instructor for the MSW interns, providing weekly, individual supervision of the students placed at SPC and USC-URM, while Artavia oversees the interns at PDC and provides overall group supervision.

The internships all begin the same way — with a vigorous, three-to-four-day orientation which includes training on tools, resources, the electronic health web database and HIPAA compliance. All the skills they will need to be effective in their roles on site at the clinics.

“The social workers learn from the dentists, residents and students by translating and observing in the rooms,” Artavia explained. “And the dental faculty and students are learning about the engagement process from the social work interns.”

Jacob adds that the dental students are not stepping outside of the scope of their practice, but rather gaining certain skillsets that are extremely helpful to them with regard to patient engagement, clinical interviewing, compassion, empathy and relationship building.

“There are other influences going on in our patients’ lives, and that’s where social work comes into play,” Jacob said. “We identify barriers and needs, and provide support to our patients as they are referred to us and try to address those particular needs.”

The mouth does not exist by itself

Nearly a decade ago, Roseann Mulligan, DDS, associate dean of dental public health and community outreach at Ostrow, began to accumulate a set of available resources in order to better serve her patients. At SPC she was working with adults experiencing developmental, physical, medical, behavioral or psychological issues. While addressing their oral health needs, her patients often talked about other problems they were facing.

“I always wanted to do more for them,” Mulligan said.

She harkened back to her training in gerontology, in which interdisciplinary care was stressed to provide a holistic approach, and decided that this kind of additional instruction is what dental students needed at Ostrow.

Enter Artavia.

“You have to have vision in order for it to make sense,” Mulligan said. “Whether it's the dental students, the social work students or faculty, Margarita could see the potential right away.”

Artavia began by learning the philosophy behind the dental practice, which was important to fully understand before she implemented change.

“How can you change something until you understand it?” Artavia said. “I am a strong believer in entering systems and relationships from a position of cultural humility. You’ve got to go in and see and hear first.”

Mulligan describes Artavia as the lynchpin of the internship program’s success.

“She built a program from the social work point of view,” Mulligan said. “It's not just the uniqueness of the experience. The MSW students learn what we like to teach in dentistry, which is the importance of oral health in so many aspects of a person’s life, whether it's systemic health, psychological acceptance, self-esteem or one’s presentation to others.”

Likewise, dental students learn how valuable the practice of social work can be to helping their patients who have unmet needs that restrict them taking care of their overall health and well-being. The MSW internship program provides them with an understanding of community resources that are available to assist their patients in achieving better quality of life.

A successful partnership on many levels

Throughout their nine-month practicum placement at Ostrow, social work interns apply what they learn in the classroom into real-world practice. They address the barriers to care that dental patients may be experiencing. First and foremost, why past patients are not regularly going to the dentist. Is it due to lack of transportation, housing, clothing, food or something else? The patients or their caregivers are often very anxious, so MSW interns provide psychoeducation interventions — serving as liaisons between the dental team and their patients with translation services, resource coordination and referrals, and assessments for child abuse, intimate partner violence and suicidality.

Julia Visner, a second-year MSW student, was an intern in the program at PDC.

“I was able to support children and their families who were very nervous about going to the dentist and were missing treatments,” Visner said. “The dental students and staff were amazing in teaching me about dental terminology and explaining the treatments the children needed so that I knew how best to work with the families.”

The other side of the collaboration is the work Artavia and Jacob focus on with fourth-year Doctor of Dental Science (DDS) students and dental faculty. They present on social determinants of health risk factors, including mental health disorders, medical conditions and co-morbidities, in an effort to help them understand what might be impacting a patient’s inability to come to an appointment or follow through on compliance. At the SPC, for example, there is a large population of patients living with HIV and AIDS. Jacob explains that a significant part of the education and mentorship for dental students working with this population is centered around the need for compassionate empathy within their patient management system.

Daniel Kohanghadosh, a fourth-year dental student, worked at both PDC and SPC during his training.

“Being part of this interdisciplinary collaboration will undeniably have a profound impact on my dental career,” Kohanghadosh said. “The opportunity to work alongside social workers has allowed me to witness the transformative power of their interventions firsthand. They not only enhance the quality of dental care provided, but also highlight the significance of addressing the emotional and psychological well-being of patients. The experience broadened my perspective of interdisciplinary practice and reinforced the importance of a holistic approach to health care.”

At USC-URM, Mulligan says the no-show rate is almost nonexistent, and she attributes this to the social work and dentistry collaboration.

“This is a real-time collaborative,” Mulligan said. “I think that's quite different. In the moment, when there's a patient and there's an issue, each one of them contributes and they very much work together as a team.”

For Jacob, working with Artavia is a great example of social worker as teacher and mentor — leading with humility, respect and a true investment in supporting both the program model she constructed from a social work capacity and the dental partners.

“I did not know in the beginning how much I was going to love this beautiful collaboration that we have,” Artavia said. “It was challenging at the start, but I believe we're in a comfortable place now with room to continue to grow and develop. And I look forward, so much, to more collaboration throughout the years.”

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