Tackling a Pediatric Dental Dilemma An interprofessional team aims to improve the oral health of Minnesota children with special health care needs. In the Limelight
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In the Limelight  |   July 01, 2017
Tackling a Pediatric Dental Dilemma
Author Notes
  • Carol Polovoy is managing editor of The ASHA Leader. cpolovoy@asha.org
    Carol Polovoy is managing editor of The ASHA Leader. cpolovoy@asha.org×
  • Support for this project was provided by the Robert Wood Johnson Foundation. The views expressed here do not necessarily reflect the views of the Foundation.
    Support for this project was provided by the Robert Wood Johnson Foundation. The views expressed here do not necessarily reflect the views of the Foundation.×
Article Information
Healthcare Settings / In the Limelight
In the Limelight   |   July 01, 2017
Tackling a Pediatric Dental Dilemma
The ASHA Leader, July 2017, Vol. 22, 28-29. doi:10.1044/leader.LML.22072017.28
The ASHA Leader, July 2017, Vol. 22, 28-29. doi:10.1044/leader.LML.22072017.28
Name: Mark DeRuiter, PhD, MBA, CCC-A/SLP
Position: Director of Graduate Studies and Clinical Education, Department of Speech-Language-Hearing Sciences, University of Minnesota
Hometown: Eagan, Minnesota
Mark DeRuiter didn’t hesitate when a University of Minnesota colleague asked him to join a unique project: improve the oral health care of children with special health care needs, especially those from low socioeconomic families, in Minnesota.
The project is part of the Robert Wood Johnson Foundation’s Clinical Scholars National Leadership program, an initiative to improve access to health care and foster a culture of health in the United States. Teams of health care professionals propose a real-world project to address a “wicked problem” that affects health in their own communities.
Pediatric dentist Jeff Karp is leading the University of Minnesota project team, which also includes pediatrician and health services researcher Peter Scal. DeRuiter, the dually certified director of graduate studies and clinical education in speech-language-hearing at the University of Minnesota, jumped at the chance to join the project because it “struck a chord for me and was something I could really stand behind from personal and professional experience.”
The professional experience dates back to DeRuiter’s clinical fellowship, when he did oral exams on children in several Head Start facilities. “One of the things that would always stand out to me was the condition of their teeth,” he says. “We could address the problem within the network and web of services that was Head Start. But the number of kids who had really significant dental issues as very little people was fascinating—you could tell there just wasn’t a lot of oral health care going on.”

Many families struggle with the health care system. “They want to do all the right things, but because of payers, referrals they may need, or other time challenges, they can’t … this is really hard.”

The personal experience is related to DeRuiter’s son, now 21, who was born with cleft lip and palate. “We had great care in Minnesota for his clefts,” DeRuiter says, including 11 different surgeries and procedures. “But it was really complicated and really hard. You have to know the health care system very well and advocate for yourself and your child within that system. And when you get a denial for a consult or procedure, you don’t give up. You figure out another way.”
But many families struggle with the system, he explains. “They want to do all the right things, but because of payers, referrals they may need, or other time challenges, they can’t. If you’re working full time and can’t take or make a phone call at work, this is really hard.”
The ‘wicked’ problem
In Minnesota, there are fewer than 80 licensed pediatric dentists, with 12 more in training, DeRuiter explains, but probably about 179,000 children with special health care needs. Many dentists refer children with developmental and medical issues to the University of Minnesota’s pediatric dental clinic—the only one in the state—because they feel ill-equipped to work with those children. They may be unsure, for example, how to deal with the anxieties of a child with autism or how to communicate with a child who is deaf.
DeRuiter’s team wants to help dentists treat these kids in their own communities. The three-year Clinical Scholars project, which began in September 2016, plans two tracks to reach that goal. The first is providing specific teleconference training to dentists on working with children with special needs. Those who participate in the teleconference education could, over time, set up their own networks and resources to assist each other. “We hope to have providers all over the state, including rural areas, connecting with us and connecting with one another.”
The second track is teaching families about the importance of oral health and how to advocate within and navigate the health care system. The project proposes to use community health workers to connect and work with families.
Community health care workers are frontline public health workers who have a close understanding of the community that they serve. They coordinate and advocate for health care in a given community—recent immigrants, for example, or people who speak a language other than English. In Minnesota, DeRuiter explains, community health workers can bill under the state’s medical assistance program.

“I always tell my students, when you find yourself feeling like you know all of the content in an area, you are in a very dangerous place.”

Already a leader
It may seem incongruous that DeRuiter is part of a “leadership” program. He holds a PhD and an MBA, and his academic, professional and volunteer résumé includes department directorships, state advisory committees, and numerous positions at ASHA, the Council of Academic Programs in Communication Sciences and Disorders, and the Council for Clinical Certification.
But DeRuiter disagrees. “I always tell my students, when you find yourself feeling like you know all of the content in an area, you are in a very dangerous place,” he says. “Because no one knows everything. And leadership’s the same way. You can learn a great deal just by engaging in something new.”
The leadership facet of the program—which DeRuiter describes as “amazing”—includes two weeklong retreats a year, teleconferences about leadership and leadership-related topics, and online modules on specific areas within leadership.
“The program has an enormous wealth of resources and knowledge that I can push forward in many different ways in my career,” he says. “For instance, I just did a module on emergency communications: What do we do when something goes really wrong out there? How do you plan for that, and how do you communicate when you have to deliver very, very stressful news? There’s a formula to do it, and to do it well. Those are the kinds of things that you can just keep learning.”
As the project evolves, the methods and implementation strategies may change, but the goal is firm: making it easier and faster for children with special health care needs to get the oral care they need, delivered close to home in a coordinated, interdisciplinary, culturally competent and family-centered way.
Although DeRuiter is leaving the University of Minnesota in mid-July to join the University of Arizona’s Speech, Language, and Hearing Sciences Department as associate department head for clinical education, he will remain on the project.
“We don’t want families of children with a cleft or Down syndrome or autism or any other physical, developmental, intellectual, sensory, behavioral, emotional or other disability to have to take a day off of work and figure out how to travel 150 miles to get to the University of Minnesota for dental care,” DeRuiter said. “The wonderful outcome we had with my son, who’s now a junior in college, should be available to every family in Minnesota.”
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July 2017
Volume 22, Issue 7