Brevard County Volunteer Dental Clinic - Dentists' Care

State: FL Type: Model Practice Year: 2004

The Brevard County Volunteer Dental Clinic serves low-income adult clients from diverse populations who require urgent dental care. The program was an outcome of a community-wide effort to stem the tide of uninsured or underinsured adults using local emergency departments for treatment of oral health problems. Statistics showed need for evaluation, treatment and referrals for dental health. Calculations by the program coordinator and the scheduling staff estimate that this program currently meets 50 percent of the need for indigent adult dental care within the county. From March 2002 to March 2003 team efforts resulted in 465 clients receiving services valued at $158,303 during 44 four-hour sessions by 22 volunteer dentists. The goal of this program is to provide timely intervention and oral health service delivery to the stated population in order to reduce impact on local emergency departments and elevate the oral health care of Brevard’s low-income citizens. This program has significantly reduced the number of individuals seeking dental care through local emergency departments, thereby decreasing costs to area hospitals and local taxpayers while greatly improving the health of many of the targeted population. CHD and volunteer staff have continually re-evaluated the program and made changes that have improved delivery of service. Key to the development of this program has been support and financial backing from the Board of County Commissioners, the County Dental Society, and the CHD. An existing working relationship between the coordinator and the dental society proved particularly beneficial. Another key to success is recruiting and using volunteer dentists, dental hygienists and support staff. This program can be replicated in large or small, rural or suburban, public or private health centers throughout the United States.
The dental program addresses oral health care for the adult indigent population of Brevard County. The need was determined in 1994, when local hospitals began to see a significant rise in the number of uninsured, underinsured, low-income adults who were using their emergency departments for treatment of oral health care needs. Often these clients came to the emergency department because of swelling, pain, and exacerbation of dental diagnoses. The hospitals, local dental society, and Brevard County Health Department reviewed the statistical trends and determined there was limited availability and access to dental health care for this population. The response was to form the Brevard County Volunteer Dental Program, also called “Dentists Care.” The original program design was to use volunteer dental providers and CHD dental operatories for clients who met financial eligibility guidelines and were uninsured. The number of clinics that could be scheduled and clients who could be seen was limited by the limited availability of volunteer dentists and volunteer support staff. At the outset, marketing was by word of mouth, and word spread quickly throughout the county. Between October 1995 and September 1997, over 1300 clients received dental services from approximately 90 volunteer dentists. Although the program was making significant strides in providing dental services to this underserved population, it was evident that program needed to be refined and restructured. One of the earliest problems encountered was a severe disproportion in the number of providers versus the number of clients with need. Also, clients who were unable to receive immediate appointments often experienced relief of symptoms by the time their appointment date arrived and failed to show for their examination. In 2002, the program was restructured to decrease or eliminate wait times for scheduling of services. Currently, the appointment center schedules clients on the first and fifteenth of the month. Clients who have completed prior eligibility determination are instructed to call in on one of these two dates, beginning at 9:00 a.m. The clients are scheduled until all appointments for the month are filled. With seven to eight clinics a month occurring in north, central or south Brevard and 10 to 12 clients being seen during each clinic session, approximately 96 clients are seen by the volunteer dentists each month. During February and March of this year, every client who called in was given an appointment. “Failure to show” rates have dropped significantly, and clients have expressed great satisfaction with the program.
Agency Community RolesThe relationship of the community partners has remained strong the program. The CHD as the lead agency, is in charge of facilities use, appointment scheduling, and employment of the program coordinator, and remains committed to this community need. The link to the Brevard County Dental Society is strong; the coordinator attends monthly dental society meetings in order to keep in touch with dentists and to make new new contacts within the dental community. The Brevard County Board of County Commissioners continues to assist the program financially. The director of the County Health Department continues to interact with each of the partners to ensure program structure, support, and continuity.  Costs and ExpendituresFunding for the program is provided by the Brevard County Board of County Commissioners ($25,000 annually) and the Brevard County Dental Society ($10,000 annually). In-kind donations from the CHD include facilities, supplies, equipment, and supervisory/administrative costs.  ImplementationThe program developed when the community partners recognized the need, developed programmatic goals, and hired a Volunteer Dental Clinic Coordinator to recruit and maintain volunteer practitioners as well as establish guidelines for clinic scheduling and client intervention. The CHD provided dental operatories at the three Brevard County Health Department clinical sites located in north, central, and south Brevard County. Volunteer dentists often brought their own dental hygienists or support staff. As dental equipment was available at each of the CHD sites, limited specialty equipment or supplies were requisitioned, and several dentists chose to bring their own tools from their private offices. Start-up time was minimal. As the facilities were available, the most time-costly factors involved program administration and provider negotiation. The dentists who provide services complete volunteer packets for the Department of Health, State of Florida and are therefore covered under Sovereign Immunity. Commitment by these providers/stakeholders had been sufficient to perpetuate the practice. Many of the volunteers, having served once, find the effort so positive that they are more than willing to repeat the process. Service providers may volunteer as often as monthly or only once or twice a year. Client demand exceeds totality of available resources; however, the program stakeholders’ commitments exceed monthly stated goals. Each year of the program has seen a greater number of volunteer dentists and a greater number of monthly clinics offered. In 2002, there were three to four clinics per month; in 2003, five to six; and from January to March 2004, seven to nine. Future plans include expanding the clinics to ten to twelve every month, provided that the number of volunteering practitioners continues to increase.
The Volunteer Dental Clinic has more than met the programmatic goals. Program evaluation is not only statistically analyzed, but is evaluated by the number of satisfied clients who have completed care through the program and who no longer burden the emergency departments with exacerbated symptoms due to lack of needed oral health care. Challenges to this program include limited logistical resources and volunteer practitioners. While the program continues to meet the needs of many of this population, there is still a true disproportion between number of providers of low-cost/no-cost dental care and the number of low income, uninsured or under-insured clients with needs. To increase the volunteerism within the dental community, the coordinator not only attends meetings as previously mentioned, she also visits the dentists in their offices, attends seminars and dental conventions where she markets this program. The Volunteer Dental Program is continually evaluated through monthly statistical reports to the director of the CHD, the commissioners and the dental society reflecting number of providers, number of clients, number of services and estimated value of services provided. Client satisfaction surveys are reviewed for client comment and satisfaction. The results of these reports and satisfaction surveys indicates a growing number of clients served, an increased participation by private sector dentists, a decrease in the number of clients who would have sought care through local emergency departments. As there are no other programs within the county meeting this populace’s needs, the CHD is certain that these changes can only be attributed to the staff of the Volunteer Dental Program. This practice surely has met its goals and is more than worth the resources invested. Unintended consequences of this program include referral to other health specialties. Once dental health has been re-established, clients are able to evaluate other health care needs or concerns. This program has been able to direct many of the clients to other health care providers who have increased the client’s overall health. There are many success stories associated with this program. The coordinator, volunteer staff, associated partners and all involved are to be saluted for their contributions to the clientele of this program.
Lessons LearnedIt takes time to develop a working relationship with the volunteer dental staff and try to convince them to “try” a day in the clinic and work alongside the CHD to meet the community’s needs. Working with the clients can also present physical and mental challenges to volunteers, as the clients may not have the social skills, emotional stability or “client etiquette” to which the staff is accustomed. However, there has been a very positive response by both the staff and clients served. There are challenges in coordinating appointments and scheduling between facilities, staff and clients. This program’s schedule has had to change the program grows and needs change. Key Elements ReplicationAgencies wishing to replicate this program should first determine their community’s needs and any disparities in services currently offered within the community. Once the need has been established, it is necessary to form partnerships to ensure the program can be sustained. Rapport must be established with local dentists and dental associations, both to recruit volunteers and to deflect any possible conflict of interest between the private and public health sector.