Conduct a Needs Assessment

A vital first step to ensuring that your program improves the oral health of older adults in your community, assessing their specific oral health needs helps you achieve the following objectives.

  • Determine whether an oral health program can meet an existing need
  • Determine whether your community is ready to launch an oral health program given the available resources
  • Uncover barriers to care
  • Reveal opportunities for partnerships
  • Identify strategic human and financial resources

A needs assessment generally includes four features: 1) an environmental scan to gather information on the oral health care landscape and health care needs among older adults in your community; 2) a market analysis on the outlook for oral health in your community and characteristics of similar oral health programs; 3) a readiness assessment of your organization’s capacity for change and how it aligns with your community’s needs; and 4) a collection of baseline data to measure progress for program evaluation.

  1. Conduct an environmental scan
  2. Conduct a market analysis
  3. Conduct a readiness assessment
  4. Collect baseline data

Conduct an Environmental Scan

“Building relationships up front [during the Needs Assessment process] was really important … In the end, we got results that were so much more meaningful to the project and to the advisory team members. Being collaborative takes time, but in the end, you get more out of the process.” – Jennifer Crittenden, MSW, Assistant Director, University of Maine Center on Aging

  • Form an advisory group to lead the environmental scan effort, providing advice and making recommendations during this systematic review of the current and anticipated factors that might affect your program, your organization, or other people who might be involved. Consider inviting key partners in your community, such as representatives from oral health associations, dental schools, the aging services network, and other health care– and social service–related entities. To ensureinterprofessional collaboration, the group should be diverse and should represent people from various health and social service professions. Early partner involvement promotes commitment later, during the program’s implementation stages. For more information, see guidance from the Association of State & Territorial Dental Directors (ASTDD) on forming an advisory group.
  • Understand the oral health landscape and emerging trends in your community through literature reviews (e.g., of research studies, academic papers, clinical studies), public records (e.g., census data) research, and direct observation. Consider population demographics (e.g., poverty level, education level, insurance status), community perceptions of oral health (including health literacy), community history, and existing policies and groups that address access to oral health services.
  • Conduct key informant interviews and focus-group sessions with people and entities involved in or affected by oral health issues (e.g., nonprofit organizations, dental schools, local governments, seniors groups, aging services network) to gain insight into your community’s observations and priorities. A discussion led by a moderator, a focus group is an effective way to elicit information about a product or topic from participants who necessarily share an interest or a characteristic. Collaborating with the right stakeholders can save you a significant amount of time and research to identify community oral health care needs. For example, a local dental school might already have collected data on older adults who need oral health care, which you can use to identify your own priorities rather than collecting the same data.
  • Conduct a survey, particularly helpful for reaching large numbers of community members, to collect information on perceived accessibility and quality of oral health care in your community and to ensure you develop your program with a person-centered approach. Consider working with specific community groups to reach survey recipients, and administer your survey in person or via U.S. mail, email, or phone.
  • Analyze your strengths, weaknesses, opportunities, and threats (SWOT analysis) based on your research findings. The fact that your organization is the only oral health care service provider within a certain geographic area might be regarded as a strength, while relying too heavily on funding from one source might be considered a weakness. Opportunities and threats often relate to factors outside your organization, such as potential new funding or plans to cut funding. For an example, see the Community Tool Box created by the University of Kansas, Section 14, on SWOT analysis.

Conduct a Market Analysis

  • Study the oral health care services available in your community, including the safety net oral health care programs and policies (e.g., Medicaid reimbursement, state regulation of health professions) affecting your community. Investigate the impact of these programs and policies, how the programs are supported financially, and whether other oral health care resources (e.g., funders, community organizations, private practices, dental schools, federally qualified health centers [FQHC] and other health centers) exist in the area.
    • Determine the availability of private and public insurance in your state and community. Medicaid funds oral health care services for adults in some states, but reimbursement levels are generally low and might not cover the oral health care services you’d like to provide. FQHCs also fund oral health care services in some areas (see the FQHC locator to find a health center).
    • Assess how other oral health care programs and dental care providers in your community charge for their services and how they acquire necessary equipment. Evaluate your target population to determine the types of insurance and forms of payment typically used for oral health care services.
    • Identify, via interviews or surveys, the challenges that other oral health care organizations or private practices face when dealing with underserved older adults in your community. This information will help you design your program to avoid these challenges.
  • Forecast your program’s expected demand on current policies (e.g., Medicaid reimbursement policies), economic forecasts, and aging trends. This information is important to ensure that your program attracts enough people to make a meaningful difference as well as to secure sufficient funding to become sustainable, in other words to continue operating over the long run.
  • Identify barriers to oral health care that exist in your community. Determine why private dentists or other community oral health care programs aren’t meeting the needs of underserved older adults or whether a shortage of oral health care service providers overall might exist.

Conduct a Readiness Assessment

  • Assess the willingness of your organization or other people who might be involved to start a new program, their understanding of the program’s potential impact, and their commitment to the program’s vision, mission, and goals. Essential to launching a program is gaining leadership buy-in.
  • Interview or survey your organization’s staff or other people who might be involved to discover the level of additional support or training they might need to start a new oral health care program. This approach also helps in assessing your organization’s culture and adaptability to change or the suitability to take on this challenge of other people who might be involved.
  • Analyze the financial readiness of your organization or other people who might be involved, which helps you identify changes necessary to support the new program (e.g., shifting staff schedules, cutting costs on current initiatives). See the Finance the Program section for assistance with determining short-term and long-term funding sources for your program.
  • Evaluate the availability of your community or organization’s structural resources or the structural resources of other people who might be involved, such as basic equipment, technology, and facility space for your program. If you’re setting up a new program, consider capital costs, such as equipment and supplies.
  • Answer the key questions in the Planning section of the Safety Net Dental Clinic Manual to gain a sense of the program’s feasibility, or the likelihood of its moving beyond development to keeping operations up and running successfully. Gathering your thoughts helps in assessing your organization’s readiness for a new program or the readiness of other people who might be involved. Have those answers prepared for leadership and staff.

Collect Baseline Data

  • Choose baseline indicators, ormetrics, that align with your organization’s goals (see the Develop a Vision, a Mission, and Goals section for more information on goal-setting). The standard against which you’ll compare information collected in the future, after program implementation, baseline information is particularly useful for judging the effects of a policy or program change. Consider gathering baseline indicators at several points over time, an approach that can increase the reliability of your results and help you identify future changes in trends. The National Oral Health Surveillance System has examples of key oral health indicators.
  • Collect data on the baseline metrics. Ideally, to paint a comprehensive picture of your community’s requirements, include a mix of qualitative data, describing oral health care needs, and quantitative data, measuring and calculating those needs. You can gather the former (primary data) via key informant interviews, focus groups, surveys, community conversations, or dental chart or record reviews and the latter (secondary data) using the Behavioral Risk Factor Surveillance System, or the CDC’s Oral Health Data website. Researchers gather primary data for a specific project or purpose, employing questions or methods tailored to the research needs. They also use secondary data, which was collected by someone else for a different, but related purpose.
  • Include in your baseline data both process metrics, or measurements of steps or services completed (e.g., number of oral health care services delivered), and outcome metrics, or measurements of whether or how health was improved (e.g., number of clients reporting reduced oral pain). See Chapter 5, Section II, of the Mobile-Portable Dental Manual for examples of process and outcome metrics.
  • Analyze and interpret the results gleaned from your data. Based on the data, determine whether trends exist that should be explored further and which metrics, if any, you most want to change. Establish priorities for your program, and determine the oral health goals you can realistically accomplish based on your analysis.
  • Develop an implementation plan, and, to raise awareness of the program, share findings from your needs assessment with your community and key stakeholders. To encourage community and stakeholder engagement with your program, tailor these presentations to include information important to each group. For more information on engaging community members and key stakeholders, see the Establish Partnerships section.
 

Program Spotlight: Maine MOTIVATE

Maine has one of the oldest populations in the country, with veterans contributing significantly to its high number of older adults. This case study describes how the Lunder-Dineen Health Education Alliance of Maine (Lunder-Dineen) conducted a needs assessment as part of its Maine’s Oral Team-Based Initiative: Vital Access to Education (MOTIVATE) program in 2013.

Maine MOTIVATE was launched with the goal of developing an evidence-based education program to train staff in long-term care facilities. As one of the first steps in 2014, Lunder-Dineen carefully selected an advisory group of oral health experts to guide the needs assessment and to determine what educational oral health content would best inform the provider staff at long-term care facilities. After sharing data and researching the oral health needs of long-term care residents, the group recommended conducting surveys and focus groups among providers (both administrative and direct care staff), residents, and caregivers at six Maine Veterans’ Homes. Results of the surveys and focus groups showed that some administrative and direct care staff lacked training on basic oral health services and that other staff faced barriers to providing care, such as busy schedules. The focus groups also revealed resident cooperation as a potential barrier to care. For example, many veterans with memory loss weren’t agreeing to receive oral health services. With these results, the program is conducting ongoing training for provider staff on basic oral health principles identified as gaps in care, holding free oral health care events at facilities where staff might otherwise be too busy to provide oral health care, and educating provider staff on best practices in delivering oral health services to residents with memory loss.

Key Resources

The resources listed below provide additional guidance and support for conducting a needs assessment.

  1. American Association for Community Dental Program’s (AACDP) Guide for Developing and Enhancing Community Oral Health Programs, Step 2: Assess Needs and Resources – The American Association for Community Dental Program designed this guide to help local public health agencies develop new community oral health programs or expand existing programs. The second step in this guide presents an overview of needs assessment, which includes organizing and conducting the assessment, analyzing data, and developing recommendations based on the findings.
  2. National Maternal and Child Oral Health Resource Center’s Safety Net Dental Clinic Manual, Chapter 1: Partnerships and Planning – This manual’s first chapter outlines the specific items communities should consider when conducting a needs assessment, including population demographics, oral health needs, accessibility of current oral health care resources, and community perceptions of the need for oral health care resources. A Phase II: In-Depth chart helps identify other important information to collect for a needs assessment.
  3. University of Kansas’ Community Tool Box, Chapter 3: Assessing Community Needs and Resources – The third chapter in this resource contains information on a variety of topics related to conducting a needs assessment, including developing a plan for assessing local needs and collecting baseline data.
  4. Association of State & Territorial Dental Directors’ Assessing Oral Health Needs: Seven Step Model – In this resource, the ASTDD describes a step-by-step model to help state and local dental programs conduct an oral health needs assessment: 1) identifying partners and forming an advisory group; 2) conducting self-assessments to determine goals and resources; 3) planning needs assessments; 4) collecting data; 5) organizing and analyzing data; 6) using data for program planning, advocacy, and education; and 7) evaluating the needs assessment.
  5. National Maternal and Child Oral Health Resource Center’s Financial Management for Safety Net Dental Clinics, Module 1: Strategic Planning – This module from the National Maternal and Child Oral Health Resource Center offer detailed information on how program staff at safety net dental clinics can develop a business plan and can make sound financial decisions during the program planning phase. Module 1.3: Developing a Business Plan presents information on conducting a market analysis.
  6. National Center for Farmworker Health’s Needs Assessment Tools – This website provides tools, webcasts, and health data for conducting a needs assessment for farmworkers’ health. Communities wishing to evaluate oral health needs of special populations can learn about specific concepts, such as focusing the needs assessment on migrant or seasonal populations and taking into account language limitations or literacy level.
  7. Centers for Disease Control and Prevention’s Needs Assessment Template (DOC) – Developed for community groups dedicated to a variety public health issues, the CDC’s Needs Assessment Template can be used by organizations to conduct telephone interviews with potential oral health stakeholders to assess the community’s needs and interest.