Page 105 - JCTR-11-4

Journal of Clinical and
Translational Research COVID-19 impact on SBDSPs

1. Introduction Even after schools reopened, concerns about COVID-19
infection and decentralized decision-making regarding
Dental caries, especially in permanent teeth, is the most the resumption of school-based programs created further
common preventable chronic condition among 6–19-year- challenges for re-implementation. 19,20
1,2
old children and adolescents worldwide. The rates of
untreated pediatric dental caries (PDC) in the United Although we use the term de-implementation in this
States (>50%) and Oregon (49%) are relatively high. The study, many of the interruptions to SBDSP services more
prevalence of PDC among children aged 6–9 years in accurately reflect program disruption, abandonment,
certain Oregon counties has reached as high as 68%. or interruption the unplanned cessation of services due
3-5
Dental sealants, protective material applied to the occlusal to external factors such as workforce issues, funding,
surfaces of permanent molars, are clinically proven to or, in this case, the COVID-19 pandemic. 21-23 In
6,7
prevent dental caries. Community-based programs such contrast, de-implementation refers to the intentional,
as school-based dental programs and community water evidence-informed reduction or discontinuation of an
fluoridation are evidence-based interventions effective intervention. 24,25 While these concepts are theoretically
in reducing PDC. However, only 26.3% of individuals distinct, they often overlap in practice, particularly when
5,8
in Oregon receive fluoridated water from a public utility, the timeline for re-implementing services is unclear or
and overall, Oregon ranks 49 out of 50 states in providing indefinite. Importantly, the current literature does not
th
fluoridated water. 9 define a specific time threshold separating program
To address this gap, the Oregon Health Authority’s abandonment or interruption from de-implementation.
(OHA) Oral Health Unit began disseminating and Rather, the distinction lies in the nature and intent of
implementing statewide school-based dental sealant the discontinuation. Moreover, several studies use these
programs (SBDSPs) in 2006. By 2020, 20 organizations, terms interchangeably, reflecting the lack of consensus
10
24,26
including OHA, dental care organizations, federally in the field. Given the absence of consensus, we adopt
qualified health centers (FHQCs), non-profit organizations, a pragmatic definition tailored to our study’s context:
and privately owned for-profit organizations, adopted and De-implementation is defined as a total cessation of
implemented SBDSPs in 778 schools in all 36 counties. all program services due to external factors, followed
10
These programs are evidence-based, cost-effective, and by re-implementation efforts with unknown timelines.
effective in reducing dental caries among elementary and Re-implementation refers to reintroducing programs
middle school children, especially in high-risk schools in the same settings after disruption or cessation, with
(schools with 30 – 50% free or reduced lunch student adaptations to either the programs themselves or their
enrollment). 4,7,8,11-14 However, multiple factors such as implementation processes. 23
dental sealant retention, program design, funding, policies, Under normal circumstances, the implementation of
and implementation factors (e.g., school reach, workforce evidence-based interventions is influenced by a wide range
capacity, and inter/intra-organizational communications) of factors (e.g., organizational, programmatic, personnel,
may influence SBDSP’s effectiveness. 15,16 and available resources). 27-31 The current study examined
Prior to the COVID-19 pandemic, we examined crisis-related organizational factors that fall under the
that how SBDSPs were implemented and identified general conceptual frameworks of crisis management
factors influencing school reach. We outlined a multi- and implementation science. In addition, we examined
15
stage implementation process by which the programs the workforce capacity and available resources to support
reached eligible participants: (i) school recruitment, (ii) the re-implementation of programs at the school level
client recruitment, and (iii) client attendance. School following crisis-related closures.
recruitment, also known as school reach, is the first and Crisis management planning provides a structured
most critical step; without access to schools, SBDSPs face a approach to navigating and organizing crisis response
significant challenge in implementing their services. 15 while incorporating feedback mechanisms (e.g., formative

The COVID-19 pandemic, a global-scale public health evaluation) to address the implementation challenges. 27,32-37
crisis that significantly impacted health and mortality and Program planning is essential for implementation under
overwhelmed health services and resources, severely the normal conditions. 35,38-44 However, the focus shifts
17
disrupted this process. From March 2020 to March 2021, to immediate threat mitigating during a crisis, often
federal and state mitigation strategies led to school closures, overlooking adjacent public health programs. By adjacent
including in Oregon, which halted all SBDSP services programs, we mean programs, such as SBDSPs and other
18
or modified them to offer limited, contact-free services non-critical health services that might be temporarily
in compliance with COVID-19 mitigation guidelines. closed or reduced in scope to prioritize crisis management

Volume 11 Issue 4 (2025) 99 doi: 10.36922/jctr.24.00074