5.5.1 Recruitment and Retention Recruitment may become more of an issue in the future, although the DHAT training program operated in Anchorage and Bethel continues to attract qualified candidates. Identifying motivated and qualified candidates has been challenging for some of the dental directors, particularly as they attempt to place therapists in some of the smaller villages. In designing the program, the organizers wanted to emulate the success of the Community Health Aide Program, in which each health aide serves in his or her village. This appears to be the most effective approach, although it can limit the pool of candidates, especially in some of the more remote sites. If the therapist is from the village, placement can be somewhat easier, particularly given the chronic housing shortage in rural Alaska. If the therapist is not from the village, there needs to be a level of trust and acceptance that can take considerable time and effort to develop. The effectiveness of the DHAT program ultimately depended on the tribal organizationâ€™s ability to commit sufficient support for the therapist, including providing onsite housing and supervising dentists who support the workforce concept and other necessary personnel, such as chairside assistants, to enable the therapist to function. Identifying capable persons to be trained and serve as assistants is not limited to therapists; that is a system-wide problem, but one that may be exacerbated by the smaller pool of candidates in rural villages. The dental directors working for the organizations differ in their length of service at a particular institution, which may range from less than 1 year to over 25 years. They may differ in their familiarity with the DHAT concept and willingness to enable the therapist to operate within his or her scope of practice rather than be used as an assistant for a licensed dentist. Retention (after their 4-year payback period) may be more successful when the therapist has family ties to the community where he or she is living. Two of the therapists, however, chose to leave their assigned villages because they wanted to have better educational opportunities for their children. This is not a problem that is specific to the DHAT program, but it is one that needs to be addressed openly when attempting to build a sustainable, village-based program. The difficulty of serving as a therapist, with some sort of mix of itinerant care and week-long trips away from their families, must also be acknowledged as a factor that may influence retention.
5.5.2 Matching of Resources to Service Needs The dental directors who were interviewed for this study spend significant time trying to juggle service needs with available resources. Travel schedules for dental teams to visit remote sites are drawn up months in advance and must take into account village size, the oral health needs of the community, the availability of providers, and weather and other logistical factors.