Faculty member’s research project promotes oral health for those with mental illness4 min read

Ann Arbor, Mich., Aug. 6, 2020 – University of Michigan School of Dentistry faculty member Danielle Rulli is part of an innovative project that has received additional funding to continue research on improving the oral health of people with mental health disabilities.

Rulli, a Clinical Assistant Professor in the school’s Dental Hygiene division and Director of the Graduate Dental Hygiene Program, is collaborating on a project led by Dr. Adrienne Lapidos, a Clinical Assistant Professor in the Department of Psychiatry at the U-M Medical School and a member of the U-M Depression Center and Institute for Healthcare Policy and Innovation.

The “Peer Oral Health Initiative – Developing and Testing a Brief Intervention Model” recently received a $49,250 grant from the Delta Dental Foundation that supplements an earlier $50,000 grant received from the Depression Center’s Eisenberg Collaborative Innovation Fund. The Peer Oral Health Initiative project will start in fall 2020. It builds 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 wellbeing is clearly established, but oral health remains a significant area of inequity for individuals with psychiatric disabilities, especially those who obtain services from Community Mental Health (CMH) and who are insured by Medicaid.

Individuals with psychiatric disabilities have greater oral disease risks and greater oral treatment needs than the general population. For example, the “dry mouth” side-effects of many psychotropic medications put individuals with psychiatric disabilities at risk for oral diseases, requiring special self-care and treatment approaches. Despite this heightened need, individuals with psychiatric disabilities often lack knowledge about preventive home-care behaviors, have access barriers related to social determinants of health (SDOH), 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 SDOH among psychiatric consumers is the work of CPSS. In Michigan, these frontline community health workers are individuals who have obtained treatment for a psychiatric diagnosis from the public mental health system, and who have been trained and certified by the state to serve others with similar experiences. CPSS provide outreach and support in CMH settings, and are Medicaid billable. Research evidence shows that CPSS-delivered interventions can be effective for managing physical health conditions. Drs. Lapidos and Rulli 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,” Rulli said. “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.”

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 that is designed to improve oral health knowledge, self-care behaviors, and healthcare utilization. Drs. Lapidos and Rulli 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. Drs. Lapidos and Rulli 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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The University of Michigan School of Dentistry is one of the nation’s leading dental schools engaged in oral health care education, research, patient care and community service.  General dental care clinics and specialty clinics providing advanced treatment enable the school to offer dental services and programs to patients throughout Michigan.  Classroom and clinic instruction prepare future dentists, dental specialists and dental hygienists for practice in private offices, hospitals, academia and public agencies.  Research seeks to discover and apply new knowledge that can help patients worldwide.  For more information about the School of Dentistry, visit us on the Web at: www.dent.umich.edu.  Contact: Lynn Monson, associate director of communications, at dentistry.communications@umich.edu, or (734) 615-1971.