Appendix A

There are no right or wrong answers, just options that can assist you in investigating your personal interest in delivery of community-based care.

Basic Questions

I have an interest in public health.

  1. Very strong interest
  2. Strong interest
  3. Limited interest
  4. Very little interest

I feel a personal desire to give back by serving people in need of dental care.

  1. Very strong desire
  2. Strong desire
  3. Limited desire
  4. Very little desire

I feel a personal desire to do something different yet still use my dental hygiene skills.

  1. Very strong desire
  2. Strong desire
  3. Limited desire
  4. Very little desire

I feel a personal desire to expand my management and leadership skills.

  1. Very strong desire
  2. Strong desire
  3. Limited desire
  4. Very little desire

I know dental hygienists who are working community-based care settings.
(circle all that apply)

  1. Shadowed them on their jobs
  2. Talked with them about their jobs
  3. Know the benefits and challenges working in a community-based care setting

I have volunteered in non-traditional dental health settings.
(circle all that apply)

  1. Mission of Mercy
  2. School Dental Screening Program
  3. School presentations during Children’s Dental Health Month
  4. Tooth brushing programs in preschools
  5. Fluoride varnish programs
  6. Dental exhibit at health fairs

Types of Community-based Settings

I prefer to provide services in the following types of sites:
(circle all that apply)

  1. At an established clinic with fixed dental equipment
  2. At an established clinic with portable dental equipment
  3. Rotating to one type of site (i.e., school) with portable dental equipment
  4. Rotating to a variety of sites (school, hospital, prison) with portable dental equipment
  5. Sharing portable equipment with other hygienists in community-based care settings

I prefer to provide dental hygiene services in the following settings:
(circle all that apply)

  1. Early Childhood Programs (pregnant women, infants and toddlers)
  2. Preschool Programs (3-5 year olds)
  3. Schools (K-12)
  4. State correctional institution
  5. Local health department
  6. Indigent health care clinic
  7. Adult care home
  8. Hospital long-term care unit
  9. State institution

I prefer to provide hygiene services at a site:

  1. With a team of other dental health professionals and students
  2. With a team of health professionals
  3. With a team of other professionals such as educators
  4. With a team of office staff
  5. By myself

I am willing to travel to a site:
(circle all that apply)

  1. Greater than 25 miles but less than 50 miles from home daily
  2. Greater than 25 miles but less than 50 miles from home weekly
  3. Greater than 25 miles but less than 50 miles from home monthly
  4. Greater than 25 miles but less than 50 miles from home quarterly
  5. Unwilling to travel to a site more than 25 miles from my home

I need to provide services in an environment:

  1. Free from air with dust and other allergy producing particles
  2. Free from overly heated or extremely cold rooms
  3. Free from harsh/loud noises
  4. Free from compromising postures which create muscular/skeletal discomfort

Types of Service

I prefer providing the following clinical procedures:

  1. Fluoride applications
  2. Caries assessment using laser fluorescence (i.e., DIAGNOdent)
  3. Sealants
  4. Routine prophylaxis
  5. Scaling and root planning
  6. Sharing clinical information via tele-dentistry equipment

I prefer the following types of services:

  1. Clinical care
  2. Screening
  3. Data collection and reporting
  4. Patient education

Administration

I prefer to do record keeping:

  1. Myself using paper documents
  2. Myself using computer software and filing electronically
  3. With the assistance of an office person filing paper documents
  4. With the assistance of an office person using computer software and filing electronically

I have the following level of computer confidence and competence:

  1. Teaching myself new software programs
  2. Quick to learn new software programs from someone else
  3. Slow to learn and incorporate new software programs
  4. No interest in using the computer to document hygiene services

I prefer to…

  1. Submit patient services for billing by myself and problem solve glitches in payments
  2. Turn all billing processes over to someone else

I prefer to…

  1. Be an employee with a salary I can count on
  2. Have benefits-health and disability insurance, retirement plan
  3. Be a contractor, paid based on the services I perform

I prefer to…

  1. Join a hygiene service that is administered by others
  2. Design a hygiene service and administer it myself

Types of Patients

I am confident working with the following patient population:
(circle all that apply)

  1. Pregnant women
  2. Infants and toddlers
  3. Preschool children
  4. Elementary school children
  5. Adolescents
  6. Adults
  7. Developmentally/intellectually disabled
  8. Physically disabled
  9. Adults in assisted living or skilled care centers

Personal Career Planning

I am planning to work in dental public health:

  1. Within the next six months
  2. Within the next year
  3. Within the next 2 years
  4. Sometime in the future
  5. Maybe sometime if someone presents me with an opportunity that fits into my career and life plan
  6. After I retire from private practice

I see my involvement in dental public health as:

  1. A volunteer
  2. A substitute for an ECP hygienist
  3. Part-time
  4. Full-time
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