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Port Gamble S'Klallam Health Department - Kingston, WA
Program Description
  
 
Preceptorship Recipient:
2007



Site Contact:
Dorie Salem-Soule, RDH
dorie@hootcreek.com

Preceptor:
Rama Oskouian, DMD
rama@woodenvillesmiles.com
The Port Gamble S'Klallam Health Department (PGSHD) is located on the Port Gamble S'Klallam Reservation in Kingston, at the north end of Kitsap County. The area is rural. The Reservation borders Port Gamble Bay, which provides access to fishing and clamming Bremerton, the largest city in proximity, is a one-hour drive from the Reservation. Seattle is two hours away by ferry.

The target population for this project is American Indians and Alaska Natives in Kitsap County. In 2005, the PGSHD provided care for more than 3010 individuals. Over the last five years, the number of patients served has grown steadily at an average rate of 13% per year. 80% of the PGSHD's service population is Native American. Approximately five percent of all patients are ages 0-3. Thirty six percent of patients are 19 years old and younger. Only 25% have private insurance or other third party coverage. More than 30% of the PGSHD's current service population is below 100% of the federal poverty guidelines, and 61% are between 100% and 200% of the poverty guidelines.

The PGSHD's service population faces numerous barriers to accessing health care, including: lack of health insurance, lack of care providers in the region who accept underinsured patients, lack of experience accessing services, low level of education, lack of experience using preventive care, lack of reliable transportation, and lack of culturally appropriate service delivery.

The Port Gamble S'Klallam Clinic contracts with a local Pediatric dentist, 1 day a month, to handle the Tribal children within the practice. The more complex Pediatric cases are referred to our contractors' office. There is only one other Pediatric dentist within the county that will accept DSHS clients, that is the majority of our case load.
Preceptor
  
Rama Oskouian, DMD, is a graduate of the University of Pennsylvania's School of Dental Medicine where she graduated in 2000. Enjoying her time on the east coast, she completed a fellowship in pediatric dentistry at the prestigious Children's Hospital of Philadelphia. Following her fellowship, she completed two years of residency training in pediatric dentistry at Cincinnati Children's Hospital Medical Center. In 2003 she enrolled in a two year fellowship in pediatric dentistry at the University of Washington. In between training new dentists on how to be pediatric dentists, she earned a Master of Public Health degree with a specialty in Maternal Child Health in the fall of 2005 and earned a certificate in the Teaching Scholars program.

She has also been actively involved in training Pediatricians, Pediatric and Family medicine residents and medical students about pediatric oral health. Dr Oskouian has given multiple presentations at national, regional and local meetings and local hospitals. She is passionate about helping children access dental services, and training primary care providers in helping provide preventive services. Dr Oskouian also has extensive experience in the use of fluoride varnish and in the education of dental and non-dental personnel in doing oral health assessments and recognizing early signs of dental decay through the ABCD program in Washington State.

Dr Rama is also thrilled to be the Washington State Dental Director for the Special Olympics, where she screens athletes and educates them and their families about oral health. She also practices part-time at the Tulalip Indian Health Clinic. Dr Rama serves on the AAP's Oral Health Initiative Steering Committee and is also active with the AAP training of medical professionals in oral health and helping reduce the caries risk
in population.
  
Training Day    
The training day began with an introduction of attendees including Dr Scott Lindquist (Director, Kitsap County Health Department), Carol Bruce RDH (Kitsap County Health Department), and many PGSHD employees and local community health clinicians. Dr Oskouian presented a PowerPoint entitled "How to properly do oral health risk assessment on children."  Following the presentation, Dr Oskouian demonstrated children's exam techniques, allowing some attendees to participate in the volunteer exams and fluoride varnish applications.    
Next Steps    
Our next steps will include strengthening the lines of communication between the PGSHD, the tribal Pediatrician, RN's, Physicians Assistants, ECEAP (daycare), tribal foster care, CHR/WIC, community/tribal members, and the tribal Dental clinics Dentists and Hygienist. We will be working with the PGSHD to expand their use of fluoride varnish treatment and health assessments within the Health clinic environment (ie, Well Baby Check program), especially to those not participating in the ECAEP programs. The Dental Clinic will continue to provide fluoride varnish applications and risk assessments to our ECAEP/Headstart students
(0-3yrs.) at least twice a year. Additionally the dental department
will coordinate further training on children's oral hygiene and
risk assessment.		    
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