528 From Complaining to Constructive: Turning Frustration Into Advocacy

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2:02because it's one thing for us to speak out as one individual, or, you know, that's fine if I'm talking to my specific legislator. To be like, hey, this is an issue and things have been coming across. But to explain that to the rest of the legislature, it's much different when you can talk on behalf of all hygienists or, you know, everyone in your association and not just myself, ways to get involved and to help with that are just, you know, being involved. And, you know, remember or not, reach out, find out when your day at the capital is. Attend, like, know that it doesn't have to be this scary thing, that there'll be stuff provided for you and education on how to do that, and how to just talk with your own personal legislators and stuff about what's going on and why it's important, why it not only affects your job, but the kind of care that's going to be available in your community. A tale of two hygienists. Welcome back to a tale of two hygienists.

3:04I'm Jessica Atkinson here with my illustrious, Lee Curley-Haird co-host. David Torres. And we are so excited for today's episode. We have the one, the only Daniel Evans. And listeners, Daniel Evans is a registered Denoha Janis with over 25 years in experience, a strong focus on advocacy and access to care. She serves as a legislative chair for the Utah Denoha Janis Association, where she helped pass direct access to legislation and secure Medicaid reimbursement for hygiene services. Daniel also works nationally in oral health advocacy, while continuing to practice clinically and run a mobile hygiene practice. Welcome to the episode, Daniel. Thank you for having me. I'm so excited to be here with you both. Daniel is the OG of mobile practice in the state of Utah. And I was impressed to have her on to tell you our listeners

4:07how you can go from wanting change to creating change to impacting change for more than just yourself. Danielle, why are you the OG? What, like, I mean, I titled you that, so I know why you're the OG. I know, I know you know, yeah. For me, I think it just started. I was working private practice, doing my thing, working full-time as a regular clinical dental hygienist for quite a while. And so it was, I think I was like eight years into 15 years at the same practice when one of my favorite patients started aging out. So I had this couple that used to come see me, Ron and Kathy. And they were just fantastic. You know, they were an older, retired couple, just totally put together. He was a prominent architect up in Salt Lake City when he was working and they were just come in

5:10and they were just a joy to be around. You know, those people that took great pride and care and their, you know, overall health and their oral health. So when I first started seeing Ron, he had, like, fairly recognizable Parkinson's disease. You know, like, sometimes you can see just a little tremor shake in his hand, things like that. And he had still just this beautiful home care and a macula smile, this beautiful cosmetic smile. He had, you know, that tight knife edge pink, stipple gingerbread that we like to corn mouth. Yes, unicorn mouth for sure. And so it was like, they would come in. It would just be like, we were just visiting and catching up, you know, just like, like a friendship, you know, like, like we do as hygienists and build these relationships with their patients and, you know, they'd sit and tell me about their trips. They had planned with their grandsons and things like that. And of course, I, you know, removed the biofilm and stuff like that.

6:11But really it was just more chit chatting and visiting and then really like healthcare felt like because they just did such a great job. And then over the course of, you know, the eight years that I had been seeing him, his disease just started to progress and Kathy ended up having to move him into an assisted living facility. His, his Parkinson's was just getting too much for her to handle at home. And with that, his, you know, his medications increased. Is there a stomian increased? All while his dexterity was decreasing. And what used to be just these totally healthy visits turned into him coming in with just teeth that were just bombed out time and time again, you know, the dentist would come and do, you know, three, four surface fillings turned into crowns, turned into patching class five areas, you know, and so he was coming in with more frequency. But it was just still like no, no match for it.

7:13And the last time that he came in, I was walking a patient out and I could see outside the windows that Kathy was struggling to get him out of the car and into a wheelchair to bring him in. And so I thought, okay, I gotta go back and wipe down my room and get my notes done so I can hurry and come back and get him. And by the time I came up to get him, Kathy had left there, Ronan hadn't acted as she, she felt many, she had to take him back to the facility to get cleaned up. And it just absolutely broke my heart to see him like that and to see them like that and to have to go through that. And I just thought this is absurd that I can't go to him to help him maintain not only his oral health but his dignity. Yeah. And at the time, you know, like we could, we could go into public health settings at the time in Utah that we had to have a dentist come and do an exam first

8:16and then the dentist had to come and do an exam every six months in order for us to do that. And I don't, I don't think we work with heartless dentists or anything here, but it's just not financially feasible for dentists to leave their practice. Or even physically feasible. Yeah, I think, yeah, I think if it was all of my patients end up in this, it's a living home. So I can go to one and I can have some designated time to this place, but when it is a situation where you are running your own practice, seeing patients eight to five and are going to five, six, seven, 10 different places twice a year in order for your dental hygienist to continue preventive care is unrealistic. Absolutely. Yep. And that's exactly what was going on. And I just thought, you know, something's got to change like this, there's got to be a better way

9:16and there's got to be something else that can be done. And so you have the skill, you have the flexibility, you have the desire to make a difference. Every time you tell a story down, I get the chills every single time. And I think about a hygienist that are listening and thinking about their patient population that we get attached to. And maybe they have somebody in their mind that they're like, oh, I remember, just if I could go and see so and so in where they are at and do place-based care, what a difference that would make. Yeah. Yeah. For sure. And you couldn't do it. You couldn't have it, right? I couldn't and I was really frustrated because I lived down in Southern Utah, which is about four hours away from our state capital where all the changes and stuff are made so you changed the situation where we could do it. And so I was just like, what's my association doing for me?

10:19Like, all those identities are up north. Like, why aren't they there doing something and trying to make a difference with this? And then it just really hit me that I couldn't expect them to do something that I wasn't willing to do myself. And that's how I inadvertently became legislative to share with the Utah Association. So, and I just haven't stopped, you know, when things kept leading to another and it's been a great ride, stepping up and getting involved more. So Danielle, what challenges do you see clinicians facing today that maybe policymakers often don't understand? I don't think they understand the issues we come up with. I think we're dealing with this a lot here in our state

11:20and states across the country with this idea of that we need supervision from our employers from dentists and not just like supervision should be about the supervision of patient care, like total patient care, not the supervision of another licensed professional. And so I think that is something we face as you look at like wanting to go out and do your job somewhere else. Like, how am I safe and effective within this little box here within these four walls, but nowhere else? And so I think that's one issue. I think we get caught up inadvertently and you know, just the way dental practices are set up. They're not really set up to implement other change. And there's a lot of stuff going on now, a lot of new things that help with prevention and minimally invasive care and things that we could be doing, but our offices aren't set up to allow for us to implement stuff. And I think it leaves a lot of hygienist feeling frustrated

12:21and like they're not as impactful as they could be for patient care. And I think it's hard to get that message across the legislators that it's not like we're trying to break away from dentists and fragment ourselves, but we still very much want to collaborate, but we want to be able to make those clinical decisions and provide and offer all the services that we're capable of doing for patients instead of it being like, you know, you have an hour if you're lucky and you got to fit everything into that versus having that capacity to provide so much more. Well, you mentioned that hygienist often tends to feel frustrated and wanting to do more than what they can do. What do you think they have time to do? Yeah, what do you think they should start? What should they do? How can we kind of like stop venting and actually make something happen for that change? For me, I felt like it's being involved

13:21with our professional association has made all the difference for me for making changes, because it's one thing for us to speak out as one individual or, you know, that's fine. If I'm talking to my specific legislator to be like, hey, this is an issue and things I'm coming across, but to explain that to the rest of the legislature, it's much different when you can talk on behalf of all hygienists or, you know, everyone in your association and not just myself. And so that was just really impactful for getting involved. I think it was the first year I attended a national, like the national ADHD meeting was the first year that it hit me that like ADHD isn't this far off place of all these people that are supposed to be doing all this stuff for me because I paid my dues, but that I am ADHD and you are ADHD and because you're part of that association, there's policies and resolutions that are there that stand behind you.

14:23So like it allowed me to use my voice and speak out knowing like, hey, I'm on the right side of this because I have this whole association that believes this and backs this too. And so being able to use your voice in a more impactful way and I found when I started doing that, it allowed others to use their voice too. So our first day at the Capitol that I put on because I was like, hey, something's got a change for Ron and Cassie here, you know, I was like eight other hygienists sitting around a table trying to figure it out. Like I had no idea what I was doing, but I just had to join out and building on it and networking with other people, done this in other states because it wasn't brand new. This wasn't, you know, breaking ground here. It was the first time being done in Utah, but there were other states that allowed for that. So, but it was seeing that other people had done it and you can use that momentum and insight change. Danielle, I have had the opportunity to sit at your feet

15:26and to learn the ropes of legislation. You talk about your understanding of the importance of being a member of your association. Can you speak to how legislators see associations, how legislators see white papers, how legislators see when you're on this, at this level of conversation, why those things matter? I think those things matter because it shows that it's not just a one person problem, you know, that there's other people out there that this is affecting more than just me and having those resources just helps because it provides like evidence-based information for them, so it's not just me speaking and saying this, but there's actual stuff there that's backing that, that's letting them see a broader picture of what's going on and an idea of the issue a little bit more

16:29than you can explain in just a few minutes that you have their attention. And it holds weight. It holds weight. It does. Association platforms hold weight. I give, absolutely. If an association feels one way, that holds weight on the legislative level, which is something I really didn't understand until I was nose deep in this and going, oh, those kinds of things are speaking louder than, I thought they did. Yeah, it's bringing a larger number of people to the table when you can speak on behalf of an association. I think being able to kind of have like that sense of like a kind of ability, like, wait a minute, I don't know what I don't know. And oftentimes we have these stories where we have these patients that we wish we can do more, right? But it's not until you network, it's not until you ask other hygienists that are out there and they're creating and navigating this change where you feel inspired.

17:31And so like, I am extremely honored to get to, you know, ask you all these questions because obviously there's some listeners out there that they wish that they can do so much more on a day-to-day basis. And oftentimes we kind of have to go through a heart ache or break when we realize that our patients are showing those symptoms. And we're only as tied to our practice and our chair. And so I wanna encourage listeners and advocate for themselves for their patients to, you know, obviously outreach and get to know the process because we all can make change starting from our chairs, of course, but day-to-day change is where legislation can become impactful. It's just that one person to have that moment of realization. And so, you know, tell me about these Medicaid reimbursements. And why is this so, so important?

18:33And I believe that obviously like being able to kind of have more of that resource is what gets us to kind of do more for our services. Yeah, I think so. So we ended up passing that direct access in 2015. So in the state of Utah patients have direct access to the services that we provide. And that was great and wonderful. But when you start doing that, you need to be able to sustain your programs. And so that's what we found out was like, oh, we need to be able to be reimburse. We can't just volunteer our way through this. So that was a crucial next step was to being able to become a Medicaid provider. And again, like I said, I didn't know at the time. I didn't know what I was doing. I was learning every year. So we passed direct access and I thought, well, great, let's contact some insurance companies now and see if they'll, you know, enroll us as providers. And I thought, oh, I've heard like Delta Dennell and California reimburse his hygienist.

19:34I'm just going to call them up. So I did. And with her, like, oh, that's cute. But you need to be recognized in your state first, like through your state as a Medicaid provider. And then that's when you can start. You're like, it was cute. I was watching out looking. I mean, like, that's from just saying, I think a lot of people feel like, well, I don't know how to do that. And I just want people to know, I didn't either, you know, but you just got to be afraid to not fail and to ask them questions and figure it out. So that's where we started as a state going and reaching out to our state, Medicaid department and coming to an aggrance on, hey, these are things that we are qualified to do. These are the services we're providing. Will you provide reimbursement for them? So we can sustain these programs and keep going. Because if you can't get paid, you're not going to be able to continue to run a program and stop on grant funding alone. And the sheer will of heart that. Yeah, so do you remember that moment

20:36where you officially got the, yes, like, okay, like the funding has been approved and how did that feel? I mean, it just felt great. I felt like we were finally being recognized. There have been so many times that we had gone up to the capital and would sit in committee meetings and talked with the legislators about advocating and why we needed this stuff and it had always come down to like, well, what do the dentists think? What do the dentists think? And it finally got to a point where we were showing up enough and talking about the right things that they stopped asking those questions all the way and trusted what we were seeing as well and recognizing that. And so there was so many wins that came without of them hearing our voice and hearing our needs that it was just amazing because I just thought it's gonna just open up all of these avenues where people that haven't had access

21:37that maybe they have a Medicaid benefit but still lack the ability to transportation wise or cognition wise or any of these other things to get into a traditional setting where a Medicaid dentist was. So it was awesome. Where it really caught on from me is to see it grow and see how look Danielle is doing it. Danielle has created a business doing it. She is sustained doing it and you can do it too. And I would like to see this type of thing just penetrate the heart of every listener and go, I can do this too. I can do it once a month. I can do it depending on your state. Let me just preface that. Well, you not ever, let me rewind. Let me really, it's gotta, you've gotta make sure that it's legal in your state. And if it's not, you can make a change. One of my favorite stories that was shared earlier

22:38on the podcast was Shelley saying, I got started with my mobile practice because Danielle referred a patient to me, a retired dental hygienist and that we want to be able to provide good, quality, comprehensive care to these patients that really deserve it, whether or not they're able to come into a work in mortar office or not. The ripple effect you have created, that has to feel amazing. And you know, for listeners who doubt themselves that if they can either make a change or anything like that, just listen to these stories. I mean, my gun is being able to be responsible or be the reason why others are doing the same and are reaching with their programs to be able to provide patient care, their lives that are being changed and their smiles has to be amazing. Do I have goosebumps? I think I have goosebumps, this is a tie.

23:38Okay. Talking with Danielle is goosebumps inducing for sure. And her work has not stopped. She is still our state legislative chair. And as everybody is feeling in the country that there are lots of changes on the horizon and it's never ending. So right now across the country, we're all looking at potential of assistance scaling and on a number of different things and depending on your state. Well, you're simultaneously trying to be able to do more. There's a feeling that there's lots of feelings in the air. And Danielle, I'd like you to share a little more about what is currently on your ripple effect trajectory. Sure. So we've had these great wins in Utah. And I have to say there's been my absolute honor to lead this committee and to help with this charge.

24:41But it's also come with surrounding myself with other amazing people. So when we did past direct access in Utah immediately after that, our state president at the time started a public health access committee. And so when we were able to open ourselves up to these public health settings, this committee went in and set up a model of what this looks like of. What does it look like to do school-based program? What does it look like to provide care in an assisted living facility or long-term care facility? All of the things that were listed in public health and provided a model. So then anybody could come and plug themselves into it and help expand and make this grow. And so I wanted to start with that. And as we've then progressed to Medicaid reimbursement and officially defining what teledendistry was five years after the fact that we were doing it. And having that in there, there's been setbacks

25:44along the way too. And last year was one of those. We've had some regressive language that got put in, but it's that push and shove and that give and take of where you're getting something and something maybe inadvertently lost. So we're still plugging along. So this year we are in one of those still plugging along years that we are looking to increase what public health settings are. We would like to see hospitals and medical settings listed as a place that we can go and practice without requiring a dentist examination first. We need to reinstate what palliative care is for a dental hygienist back into our practice act in our state and a few other things. All while trying to work within our dental association, our legislator that's running a bill for us this year brings them to the table when they bring us to the table. And we've tried to have those collaborative conversations.

26:45So with that, we're looking at the possibility that lots of other states are looking at a dental assistant scaling language in our state and trying to navigate what that looks like. That hey, we still need to get this, but we don't want to give our scope away in the meantime as well. So we're looking at how to address that just like all of these other states are and just bringing up the issues that are important around it. That one, it's looked at as this hygiene shortage of making sure we are including that shortage from the data that Health Policy Institute did shows it's a retention issue, not necessarily just a shortage issue. And so pointing out out that there are short hygienists, but there's not a shortage of us. Yes, yes. So, but pointing out that it's hygienist failure

27:46is a shortage of places with good workplace culture. You know, that they want places where they can practice at the top of their scope, things like that would help of professional satisfaction that comes through having that autonomy and just different things like that. And we're just trying to point out that if we need to increase provider types, then, you know, if there is a true shortage or rural areas need more providers that we should be looking at dental therapy, you know, and adding a mid-level provider that has an evidence-based education and has been a proven model to improve access to care and looking at maintaining and increasing those standards of care with a mid-level provider, not below-level providers. And giving providers that are already educated, capable and have the capacity, the autonomy, to work in settings without needing all of this unnecessary supervision.

28:48Yes. Yes. And how can we help? I mean, what role do conversations like this on a podcast or social media and the office-level play in making that change? Because I can think of a, you know, if a frustrated hygienist is listening to this ring now, you know, what do you want them to hear about this? I mean, office culture, our scope, you know, what are some of the things that's... Yeah. Well, I think a lot of that comes, I'm like, there's hard things out there. Like, there's a lot of practices that are, you know, that struggle financially, when you look at low reimbursement rates from insurance and things like that, that if those were increased and, you know, practices were raining more money, I think that could solve, you know, some of these issues, you know, hygienists would, perhaps have the opportunity to get benefits offered or, you know, have good equipment or not have their appointment time shortened and things like that. But also opening up that professional autonomy

29:51where you're allowed to make those clinical decisions, I think, does a lot for culture and your ability to feel good about the care you're providing for your patients. So I think ways to get involved and to help with that are just, you know, being involved and, you know, member or not, like, reach out and find out when your day at the capital is, attend. Like, no, it doesn't have to be this scary thing. There'll be stuff provided for you and education and how to do that and how to just talk with your own personal legislators and stuff about what's going on and why it's important and why it not only affects your job, but the kind of care that's going to be available in your community for people and the kind of care that people deserve. Like, they deserve to have high standards of care. And, and I think that's a big thing, continuing just to educate, you know, not just our colleagues on these issues that are going on, but the public, your family members, your neighbors,

30:51they can be a great resource in advocating for wanting quality care as well. I so vote those are just a few things of getting out there and getting involved. So I'm like, it doesn't mean you have to, you know, member or not, you're going to be invited to your day at the capital, you're going to be invited to get messaging on how you can speak up and the appropriate times to do it to help ensure that we're keeping a standard of care for, you know, the citizens across the country. Absolutely. Kind of reminds me of that quote. What does that quote says? Be the change you want the world to be, right? Like, it's like the, it's a Gandhi quote. Be the change you want to see in the world. Yeah, I think it was Gandhi. Anybody, anyone, Gandhi? Yes, it is. I, I, I, I, I knew Daniel would know because she has been the change that she wanted to see. And if you have been listening to this podcast today, feeling that frustration, feeling that,

31:52ugh, that, that gut feel that you want something to change, you want things to look different. Know that it starts with you. And here is an example of Danielle, who started calling, started acting, started getting involved and has made a change that has had ripples that she can't even see. And I am so grateful that I know you and I'm so grateful that I could be part of that ripple effect. And thank you so much for coming and inspiring yet another hygienist who's been listening that's going to go and call her legislator, write a letter, put her name on a Google doc, his name, think his hair there, everyone. No, no, no, no, no respect for her persons here. That's a dental hygienist and start, start. Applicating. Thank you, Danielle. Well, thank you for having me.

32:53It was our pleasure. You're welcome anytime. That's a wrap on today's episode of a tale of two hygienist podcasts. If this conversation made you feel seen, inspired, or even just a little fired up, share it with a fellow hygienist or fellow dental professional, share it with your neighbors, your friends, share it with everyone. That is how this community grows. Make sure you subscribe, even to review and connect with us on social media so that we can keep on going with this conversation. Remember, you career your voice and your story matter here. We're David and Jessica. And until next time, keep learning, keep laughing and keep showing up for yourself and for each other. This has been a production of Endeavour Business Media, a division of Endeavour B to B.