Unit 1: Essential Elements
Unit 1: Essential Elements

Section 1. Partnerships and Planning

Level of Service

Again, these options should arise out of your needs assessment. Comprehensive primary oral health services, emphasizing emergency care; individual and community-based preventive services; and restorative options to eliminate active decay and restore loss of function, while establishing a strong periodontal maintenance state, should be the ultimate goal. However, sometimes the community has other priorities. Get those on the table as well.

For example, if a major concern within the community is inappropriate use of the hospital ED to address oral health needs, that would be better addressed within a primary oral health setting, is it possible to partner with the existing oral health care delivery systems, both public and private, if capacity exists? See 10 Steps to an ER/Dental Referral Program. Some communities utilize a pay it forward combination of volunteerism and patient vouchers (in exchange for community service) to address this need. Others station community health workers with oral health knowledge within the ED to redirect patients to appropriate care by helping them navigate the pathways to care, including assisting with determining their eligibility and enrolling them in public insurance options.

  • Is there a need for consistent, comprehensive primary oral health care services? Is there an established FQHC or a community clinic already addressing the medical and/or behavioral health needs of the underserved in your area but that does not offer oral health services? Would this clinic be interested in pursuing the integration of an oral health program into its current scope of services? There is a federal expectation for health centers to provide integrated primary care, so this may be a win/win scenario for all involved.
  • If such a clinic exists in an adjacent county, would it be interested in opening a satellite clinic in your community to expand its capacity? A zip code query of its patient records could easily determine what percentage of its emergency or current patients come from your area. The administrative burden of establishing a satellite clinic is much less than establishing an entirely new clinic. State primary care associations (PCAs) have guidance and expertise to share with you as you ponder these questions.

PCAs are state or regional nonprofit organizations that provide training and technical assistance (T/TA) to safety-net providers. This T/TA is based on statewide and regional needs to help health centers improve programmatic, clinical, and financial performance and operations. PCAs can help health centers and look-alikes plan for the growth of health centers in their state, as well as develop strategies to recruit and retain staff.

It may be that establishing your own FQHC is what is ideally needed within your community to address not just the oral health needs but the overall health needs within the area. This not a step for the faint of heart. There are significant requirements to be met and a stepwise process to follow. Luckily, your state PCA can assist. You are not the first community to seriously consider this option.

The questions just keep coming as you consider the feasibility of an on-site dental clinic, contractual referrals with private oral health professionals in the area, or a combination of both. How will you address identified oral health needs within school-age children and/or residents in long-term care facilities? Does it make sense to utilize portable or mobile dental equipment alone or in conjunction with a fixed permanent clinic? Luckily, others have walked this maze and written down their observations as a means of providing T/TA, for example, in the 2007 Mobile-Portable Dental Manual.

As you may surmise, asking one question opens the door for many more. The rest of this manual’s chapters and the supportive references cited are a means of encouraging insightful discussions and making educated decisions. Your oral health coalition will grow along with your original dream and vision.

Resources

  • Addressing Oral Health Needs: A How to Guide. This vintage, but still relevant, guide produced by Community Catalyst, is intended to give organizations and communities ideas for addressing oral health needs by profiling the success and challenges of various programs developed to increase access and reduce the ever-growing unmet need for oral health services.
  • Framing Public Issues. Created by the Frameworks Institute, this toolkit is intended to help issues advocates learn and apply new communications thinking to frame their work for better public understanding and engagement.
  • Maximum Access with Minimum Risk: Planning for Effective Dental Growth and Expansion. This presentation of the DentaQuest Partnership for Oral Health Advancement’s Safety Net Solutions program highlights why strategic planning is important.