Design the Program

As you define your program’s scope, you might choose to replicate, or copy, an existing program; adapt an existing program; or design an entirely new program. Think about the tips below for designing your program.

  • Ensure that your delivery model, the approach you take to supply a product or service, is in line with your organization’s vision, mission, and goals and applies to your community’s unique circumstances. Confirm that your partners support the delivery model.
  • Determine the oral health program design that can reach your target population of older adults most effectively. Consider a mix of different services and delivery models most useful and accessible to those people. This approach can increase program flexibility and address the limitations of a single model.
  • Make certain the model fills a gap in care or will meet a currently unmet oral health need. Be realistic about what your program can and can’t offer to meet this need.
  • Consider selecting a model that addresses barriers to care, which might include income restrictions, lack of insurance, personal mobility challenges, complex medical needs, geographic location, or lack of adequate transportation.
  • Determine whether you can reasonably design your program given available financial and social resources. Consider startup costs, ongoing operational and maintenance costs, and available staff necessary for different models.
  • Consider how health care and social service providers that haven’t traditionally delivered oral health services—such as physicians, physician assistants, nurses, and social workers—can contribute to your program or can integrate oral health services into their existing models. See the Key Concept on Interprofessional Collaboration and Key Concept on Person-Centered Care for more information.

This section describes a half dozen common program models, with things to think about before deciding to adopt one of them.

  1. Dental clinic model
  2. Mobile-portable model
  3. Eligibility and enrollment model
  4. Virtual model
  5. Event-based model
  6. Outreach and education model

Dental Clinic Model

Under the dental clinic model, programs deliver oral health services to people at freestanding clinics with fixed locations (e.g., community health centers, FQHCs) or at dental clinics situated within larger medical centers. These programs generally offer a range of oral health services, which might include basic services (e.g., screenings, cleanings, X-rays), comprehensive services (e.g., fillings, oral surgery, dentures), or a combination of both. Other programs operating under the dental clinic model offer only emergency oral health services or other forms of specialized care. Listed below are a few things to think about before deciding to adopt the dental clinic model for your program.

  1. Identify participating dental care providers and determine whether they’ll work on a fulltime or part-time paid basis or whether they’ll volunteer their services at no cost. Communicate with part-time and volunteer providers to agree on a time that fits within their existing schedule.
  2. Determine whether clients will pay for services. If clients are expected to pay, decide whether to use a sliding fee scale or to require payment in full. You have the options of relying on private insurance, individual self-pay, and, in some states, Medicaid reimbursement.
  3. Investigate the potential to share resources (e.g., office staff, equipment) or to coordinate care with other medical providers, should the dental clinic be located within a larger facility or medical center.
  4. Choose a location that minimizes transportation barriers (e.g., near public transportation, centrally located), or consider helping arrange transportation. Lack of adequate transportation often poses a major barrier to older adults’ obtaining care. The brochure Choices for Mobility Independence: Transportation Options for Older Adults (PDF) can help you explore transportation assistance options.

Example

Walker Methodist Dental Clinic provides oral health care to older adults in the Minneapolis, Minnesota community as part of the larger Walker Methodist Health Center network. The dental clinic opened in 2006, and, through a major grant-funded expansion in 2015, doubled its capacity to provide oral health care and oral health education. The clinic operates four days a week, staffed by University of Minnesota School of Dentistry faculty and students, with additional support from Walker Methodist staff. In addition to providing oral health care to older adults, the program teaches geriatric oral health care continuing education courses to dental professionals. Providers participating in this program are unpaid.

Mobile-Portable Model

Under the mobile-portable model, oral health services are delivered either in a mobile dental vehicle (i.e., mobile dental unit) or at a fixed physical location where program staff bring portable dental equipment to the facility. This model focuses on providing oral health care to underserved people who lack adequate transportation or who face other barriers to care (e.g., geographic location, personal mobility). These programs tend to offer basic services, such as oral health exams and oral health education, but also can provide comprehensive services. They coordinate closely with other community partners, as well, to deliver services at locations where they’re most likely to reach older adults (e.g., community centers, senior centers, long-term care facilities, faith-based organizations), or they bring portable equipment directly into the facilities. Listed below are a few things to think about before deciding to adopt the mobile-portable model for your program.

  1. Make certain your program builds relationships with other community organizations that can assist with the logistical challenges of mobile-portable oral health care, such as determining a suitable site for van parking or finding a location for inventory storage.
  2. Recognize that staff in mobile or portable programs might have to fill multiple roles. Administrative staff, for example, might have to coordinate site visit locations and movement of equipment into a facility.
  3. Compare the difference in upfront costs and equipment durability for mobile versus portable oral health services. Self-contained mobile dental vehicles have high initial costs but might prove more durable, whereas portable equipment generally has lower upfront costs but is more at risk for “wear and tear.”
  4. Arrange access to electricity, water, and septic systems at each site you’ll visit, if you plan to deliver services directly from a mobile vehicle.
  5. Be prepared to refer people to more specialized or comprehensive care in your community that your mobile or portable program mightn’t be able to provide.

Example

Senior Mobile Dental is a nonprofit organization that brings portable dental equipment to community facilities, such as assisted living centers and nursing homes, and provides oral health services to older adults. In 2013, the program expanded its staff and services to deliver a full range of oral health services, including fillings, extractions, and dentures. The program is staffed by dentists, hygienists, a denture technician, and a full dental support team.

Eligibility and Enrollment Model

Programs operating under the eligibility and enrollment model provide care coordination (i.e., manage clients’ appointments to referred dental care providers and arrange transportation and other social services), payment counseling and financial assistance, and enrollment support to people needing oral health care. Services often are delivered as part of another model, such as a dental clinic that handles referrals to specialists and coordinates care with other general health care services delivered at the clinic. Listed below are a few things to think about before deciding to adopt the eligibility and enrollment model for your program.

  • Develop strong partnerships in communities where people can be referred for services. These partners could include participating dental practices, dental schools, and health and social service agencies. See the Establish Partnerships section for more information on developing these relationships.
  • Hire staff with experience in community outreach and case management as opposed to clinical service delivery.
  • Consider that programs under this model, without accompanying service provision under another model, don’t increase overall capacity of available services. If an insufficient number of providers or payment methods is available, these programs might be limited in their effectiveness.

Example

The Elder Dental Program is a community-based nonprofit program dedicated to helping low-income older adults in southern Massachusetts access high-quality oral health care at reduced costs. Applicants submit information about their income and savings. Once financially eligibility is determined, the program’s manager matches the applicant with a participating volunteer dentist in the community. All appointments occur in the office of the participating dentist, and people pay for services based on the Elder Dental Program sliding fee scale.

Virtual Model

The virtual model, also known as teledentistry, allows dental care providers to serve people and exchange information via technology for purposes of oral health education, diagnosis, treatment planning, or consultation. For many programs under this model, dental hygienists or dental assistants travel to a location in the community, such as a long-term care facility, to gather clinical information and to provide basic hygiene services. Dental hygienists and assistants can then transmit information to a dentist or a specialist for more involved treatment planning, and the dentist or the specialist can consult with the client using real-time video software. Listed below are a few things to think about before deciding to adopt the virtual model for your program.

  1. Research and invest in an electronic health records (or electronic dental records) system to enable communication among the care team. See the Health Information Technology section for more information.
  2. Check state and local regulations to ensure that dental hygienists and dental assistants can provide services without a dentist onsite.
  3. Consider including an allied oral health professional (e.g., dental hygienist, dental assistant) and a collaborating dentist on your team. A dental coordinator can also help offer case management and communicate with community sites and clients.

Example

The Virtual Dental Home provides oral health services in multiple locations across California. Dental hygienists and dental assistants gather diagnostic records, provide basic oral health services to people in the community, and communicate with dentists using a telehealth system to form treatment plans. Also known as e-health or m-health (mobile health), telehealth uses digital information and communication technologies (e.g., computers, mobile devices) to manage clients’ health and wellbeing. The Pacific Center for Special Care at the University of the Pacific, Arthur A. Dugoni School of Dentistry, created the Virtual Dental Home program in 2009. Now, 15 communities in California have implemented the model, and programs in Hawaii, Oregon, and Colorado are in the process of adopting and adapting the model.

Event-Based Model

Under the event-based model, programs organize and carry out dental fairs at community locations (e.g., stadiums, fairgrounds), generally by recruiting local volunteer dental staff to provide basic services to people in need. These events are usually of short duration (e.g., one day, one weekend). This model commonly focuses on delivering services to underserved people who lack adequate transportation or who’ve other geographic or mobility-related barriers to care. In addition to oral health care, these events might provide medical, vision, preventive care, and health education services. Listed below are a few things to think about before deciding to adopt the event-based model for your program.

  1. Develop an implementation plan far in advance because these event-based programs require a high level of coordination between dental care providers and other partners. Programs have found that planning and preparing for one event can take almost a year.
  1. Coordinate dental care provider locations where clients at the event can go for follow-up care. Many clients might require follow-up in the days or weeks following the event.
  2. Secure event space that’s large enough for the expected volume of clients. The event space should have areas for registration and waiting, clinic operations, and volunteer breaks. It should also have sufficient parking and be able to handle traffic flow. Possible venues include gymnasiums, civic centers, and indoor sport facilities.

Example

Since 2000, the Mission of Mercy program has operated mobile clinics in strategic locations across Virginia, providing preventive, restorative, and surgical oral health treatments to low-income people via two- or three-day events. The Virginia Health Care Foundation provides instructions and guidance on how to conduct a Mission of Mercy project.

Outreach and Education Model

Under the outreach and education model, programs provide client, caregiver, and provider education and raise awareness of recommended oral health practices in the community. These outreach efforts can be based on coursework, online tools, or media campaigns. Listed below are a few things to think about before deciding to adopt the outreach and education model for your program.

  1. Ensure that educational materials and outreach methods are culturally appropriate and accessible. For more information on cultural competence and accessibility, see the Cultural Competence section.
  2. Consider the accessibility and effectiveness of locations where you’d like to reach your target population (e.g., locations where the target population typically gathers, including, for older adults, in senior community centers).
  3. Test the messages of your educational materials with a pilot audience to evaluate the effectiveness of the delivery and its impact on the target audience. Use audience feedback to edit and improve materials.

Example

Administered by Oral Health America, Tooth Wisdom: Get Smart About Your Mouth is an educational program for older adults, health professionals, and caregivers of older adults. Oral health educational materials, including resources focusing on the importance of oral health and prevention, as well as an interactive map for website visitors to find oral health care in their area, are free and available to the public on the program’s website. In addition to educational materials, dental hygienists lead one-hour workshops in community settings where older adults naturally congregate to increase knowledge about oral health and encourage self-care.

 

Program Spotlight: Gary and Mary West Senior Dental Center

Gary and Mary West Senior Wellness Center staff and volunteers became increasingly aware that many seniors didn’t have access to affordable oral health care. A survey administered in 2014 to more than 300 older adults who used services at the Senior Wellness Center identified dental care as one of the most critical needs among this population, with high cost, lack of providers accepting state Medicaid, and lack of adequate transportation as the top barriers to care. This case study provides additional information for designing a program based on the experiences of the Gary and Mary West Senior Dental Center.

Program design for the Gary and Mary West Senior Dental Center began with the decision to co-locate with the Senior Wellness Center to capitalize on the Center’s accessible location and existing health, psychological, nutritional, social, and community supportive services. A dental center within a larger senior center allows for integration of care with other clinical and social service providers, thus connecting dental health to a person’s overall health.

The Gary and Mary West Senior Dental Center began operations on June 1, 2016. Comprehensive geriatric assessments completed by a “senior care navigator” facilitate integration of care and triage people in need (i.e., decide the order in which patients are treated based on the urgency of their need for care) to dental services, coordination with other health and social services, or both at or outside the Senior Wellness Center. Medicaid reimbursement is an important payment source for eligible people. Dental clients ineligible for Medicaid can pay through their private insurance or via a fee established by an income-based sliding fee scale.

Key Resources

The resources listed below provide additional guidance and support for designing your program.

  1. National Maternal and Child Oral Health Resource Center’s Mobile-Portable Dental Manual – This manual compares mobile and portable dental systems to help organizations design, purchase, and operate oral health care programs. It is a companion manual to the Safety Net Dental Clinic Manual, which provides more general guidance on clinic development and operations to organizations starting safety net dental clinics. Chapters on partnerships, facility design and staffing, and clinic operations are particularly relevant to selecting your program model.
  2. Rural Health Information Hub’s Oral Health Toolkit, Module 2: Rural Oral Health Program Models – Module 2 describes rural oral health models—such as the outreach and education model, the dental clinic model, and the mobile-portable model—and suggests things to think about before adopting one. Although this resource targets organizations planning to operate in rural areas, many of the considerations can be applied more generally.
  3. University of Kansas’ Community Tool Box, Chapter 19 and Toolkit 7 – This comprehensive resource features checklists and other information for communities to learn about assessment, planning, intervention, evaluation, and advocacy of community programs. Chapter 19: Choosing and Adapting Community Interventions and Toolkit 7: Developing an Intervention provide guidelines for selecting and adapting program models.
  4. Community Catalyst’s Addressing Oral Health Needs: A How to Guide – This guide describes several oral health program models and provides examples of programs that have adopted each model. Mobile units, dental clinics, referral programs, and volunteer-based programs are among the models discussed.
  5. National Maternal and Child Oral Health Resource Center’s Mobile-Portable Dental Manual: Dental Clinic Comparison Chart - This chart compares fixed clinic facilities, mobile vans, and portable equipment by listing the pros and cons of each model. Factors to consider include cost, accessibility to the target population, and ease of equipment transport.