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staff still serves as the foundation for the process by which many residents receive their dental care. With the Civil Rights Movement of the 1960s, the notion that persons who are served by a particular government program should also play a role in that program’s administration gained momentum. Although many lauded the expertise, compassion, and dedication of individual health care professionals who were providing services as employees of the Indian Health Service, critics viewed the agency as rigid, hierarchical, and insufficiently responsive to the idea that program recipients should be empowered to manage their own health care. President Nixon in 1970 stated that “the goal of any new national policy toward the Indian people…[should be]…to strengthen the Indian’s sense of autonomy without threatening his sense of community” (Kunitz, 1996). With the passage of the Indian Self-Determination and Education Assistance Act (PL 93-638) in 1975 and the passage the next year of the Indian Health Care Improvement Act (PL 94-437), the option to transfer responsibility for dental and health care to Tribes and tribal organizations became law. During the next 25 years, tribal health organizations, in assuming responsibility for provision of dental services, continued to use the IHS workforce model of using staff dentists—either IHS officers or contract workers—and itinerant dentists to provide oral health services in Alaska. Under this model, some smaller villages may have only a single 1week visit by a dentist every 12 months. Currently, there are 13 tribal health organizations that operate their own dental programs in Alaska. 2.2

Alaska Native Oral Health Status in 1999 The Indian Health Service undertook an Oral Health Survey of American Indian and

Alaska Natives who had been treated and served in dental service units that were directly or indirectly supported by the IHS. The survey included 12,881 patients and documented the degree of dental disease across multiple ages groups, underscoring the significant unmet need of these populations, regardless of what measure oral health was examined. 2.3

Development of the DHAT Concept

In 1999, Mark Gorman, then Vice President of Community Health Services for the Southeast Alaska Regional Health Consortium (SEARHC) met with Tom Bornstein, SEARHC’s Dental Director to discuss the issue of “extending care to an incredibly needy population.” 1 Noting that “a good idea has many parents,” he asked the dental director to think about ways to do things differently, given that there were “continual complaints that access to care was


Interview with Mark Gorman, May 13, 2009.