Module 10: Taking the First Steps — Building Organizational Capacity for Oral Health Care

November 2013

IHIP

Session Length: 45 minutes

Materials Needed

Computer and compatible LCD projector to play the PowerPoint presentation
Whiteboard, large paper and easel, or other means of taking notes
Colorful markers.

POWERPOINT PRESENTATION

SLIDES 1–3: Refresher — Overview of Pros, Cons, and Important Considerations for the Six Organizational Models

Briefly review the pros and cons of the 6 organizational models that were first discussed in module 3.

Overview of the Six SPNS Organizational Models Studied

Model	Grantee	Pros	Cons/Caveats
Increasing services at their existing clinics	Harbor Health	Most expedient model	Does not necessarily enable clinic to expand oral health care access to new geographic areas or populations
Building satellite clinics	AIDS Care Group AIDS Resource Center Wisconsin Special Health Resources for Texas Community Health Center, Inc Tenderloin Health Center	Reduces travel time for some patients, often reducing a huge barrier to care Enables greater patient enrollment Improves likelihood of program sustainability	Can be costly Can take a lot of time to establish, including navigation of regulations and completion of construction
Collaborating with clinics in dental hygiene schools or community colleges	HIV Alliance*	High-quality oral health care for PLWHA in a mixed clinic setting Improved training in care of PLWHA and reduced perception of HIV stigma on part of students Enhanced clinical space and equipment Faculty supervision and training	Requires careful coordination and flexibility Ensure that expectations for participating organizations in partnership are clearly and formally spelled out and agreed upon prior to beginning collaboration
Fee-for-service dental reimbursement with contracted providers	AIDS Resource Center Wisconsin	Reduced travel time for patients More cost-effective than establishing a formal satellite clinic	Important to ensure that dentists recruited are culturally and clinically competent to serve PLWHA Funding options for fee-for-service varies by State and may be more or less attractive to providers as a result
Leasing space at existing private offices/clinics	Center for Comprehensive Care	Increased access to care for patients Less resource-intensive than building a satellite clinic Provision of care in private clinics that are non-HIV-affiliated may reduce risk of stigma for patients	Leased office locations may not qualify as Medicaid-certified providers, limiting ability to bill for dental services in some States Important to ensure that patient caseload is manageable so that patients can be seen at regular intervals for follow-up care to improve retention and clinical outcomes
Purchasing mobile dental units	Sandhills Medical Center University of Miami Louisiana State University Montefiore Medical Center	Enables provision of care to patients isolated by geography or with challenges traveling to dental services Ability to serve a high volume of patients	Expensive to purchase Expensive and time-intensive to maintain both the dental equipment and the unit itself* Cannot be used anywhere—need open, flat area; proper parking permits; access to electricity to operate van and equipment; etc. Requires research into unique State regulations, infection control procedures, town and county parking ordinances, medical record access and storage, and scheduling and staffing Requires referral of clients to other nonmobile clinics for many dental services, including most x-rays Patient confidentiality may be a concern when using electronic medical records through wireless system Difficult to navigate roads with sensitive dental equipment on board because measures used to hold equipment stable were often insufficient

*While HIV Alliance was the only grantee to use relationship with dental program as their program model, several other grantees established formal or informal relationships with dental professional schools.

**Mobile dental units used by grantees ranged from $144,000 for a one-chair unit to $330,000 for two-chair unit.

***All grantees who employed a mobile dental unit experienced frequent mechanical, electrical, and vacuum system problems.

SLIDE 4: Finding Solutions to Common Barriers to Organizational Growth

Which of the model(s) of care would be the best fit for our organization and the populations we serve?
What will be the biggest barriers to care in implementing this/ these model(s) of care in our organization from:
– A systematic/regulatory standpoint?
– A financial standpoint?
– A human resources/staffing standpoint?
– A patient standpoint?
What strategies or resources are needed to overcome these barriers?
Do existing staff roles and responsibilities need to be redefined? How?

GROUP ACTIVITY

Divide the class into 2 or 3 groups and provide each group with a large sheet of paper, markers, and an easel or tape to affix the paper to the wall.
For 20 minutes, have each group address the questions listed in the PowerPoint slide, assigning one person in each group to take notes.
Once the groups have finished taking notes, go through each question with the class, giving one person from each group the chance to share their group’s response to each question.
At the end of the discussion, have the group vote on the top 3 to 5 initiatives or issues that the organization should undertake. Identify the key action items needed to occur to address these initiatives/issues and assign individuals to lead research into and implementation of the initiatives.
Designate someone to schedule a followup meeting within the next 1 to 2 months to touch base on progress toward the stated initiatives.

SPNS Affiliation

Innovations in Oral Health Care Initiative

Main contents page for curriculum

Implementing Oral Health Care into HIV Primary Care Settings Curriculum